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Practice Problem: The rate of nosocomial infections amongst dialysis patients is a rapidly growing population. Solution: Will frequent handwashing in chronic hemodialysis patients and direct patient care staff assist in the prevention of nosocomial infections?    

Null Hypothesis: There was no change in the number of nosocomial infections between frequent handwashing in chronic hemodialysis patients and direct patient care staff. 

Alternate Hypothesis: Increased handwashing in dialysis patients and direct patient care staff will assist in the prevention of nosocomial infection. 

Independent variable: Dialysis patient and direct patient care staff. 

Dependent variable: Increased frequency of handwashing 

Prediction: The rate of nosocomial infections amongst dialysis patients is a rapidly growing population. not requiring hemodialysis (Agata., Mount., & Schaffner, 2000). To identify the risk factors for acquiring a nosocomial infection among hemodialysis patients, a matched case-control study must be conducted (Agata., Mount., & Schaffner, 2000).  The Plan, Do, Study, Act (PDSA) model can be applied to assist with frequent handwashing. The objective of the cycle will be stated explicitly.  Preliminary work must be completed to assist with recruitment and establishment in practice setting, which will involve stakeholder engagement (McQuillan et al., 2016). The details will be clearly defined detailing the proposed change and its implementation as part of the planning process (McQuillan et al., 2016). The measurement of success will assist standardizing the intervention and data collection components of the PDSA cycle, which will ultimately improve the quality of the change intervention process (McQuillan et al., 2016). The prediction concludes that frequent handwashing in the dialysis patient and direct patient care staff will decrease hospital admission for nosocomial infection by 1% annually. 


Agata, E., Mount, D., & Schaffner, T. (2000). Hospital-acquired infections among chronic 

            hemodialysis patients. National Library of Medicine. 35(6): 1083-8. 


McQuillan, R., Silver, S., Harel, Z., Weizman, A., Thomas, A., Bell, C., Chertow, G., Chan, 

            C., & Nesrallah, G. (2016). How to measure and interpret quality improvement data.

 Clinical Journal of the American Society of Nephrology. 11(5) 908-914. 





        Does increased nurse to patient ratios contribute to missed nursing care?

Null Hypothesis and Alternate Hypothesis

The nursing care of patients is the same with high nurse to patient ratios as it is with lower nurse to patient ratios.

        Patient’s care by nursing is missed when nurse to patient ratio is increased.

Independent Variable and Dependent Variable

         The independent variable is the patient.

         The dependent variables are missed care and changing ratios.

Prediction for Expected relationship

         Nursing care is affected by increased ratios as patient care takes time and is reduced when nurses are understaffed ( Bragadóttir, Kalisch, & Tryggvadóttir, 

2017) . Increasing admissions, staff call-outs, pandemics with increased illness all affect the care given to patients (North et al. 2013). The working attitude of  nursing unit’s

management team will also reflect how well the outcome of an increased ratio (SEVERINSSON, 2012). Acuity of the patients also impact nursing care. 

Bragadóttir, H., Kalisch, B. J., & Tryggvadóttir, G. B. (2017). Correlates and predictors of missed nursing care in hospitals. Journal of Clinical Nursing (John Wiley &

          Sons, Inc.)26(11–12), 1524–1534.

NORTH, N., LEUNG, W., ASHTON, T., RASMUSSEN, E., HUGHES, F., & FINLAYSON, M. (2013). Nurse turnover in New Zealand: costs and relationships with

          staffing practises and patient outcomes. Journal of Nursing Management (John Wiley & Sons, Inc.)21(3), 419–428. https://doi-

SEVERINSSON, E. (2012). Research supervision: supervisory style, research-related tasks, importance and quality – part 1. Journal of Nursing Management (John

          Wiley & Sons, Inc.)20(2), 215–223.



Evaluate the usability challenges that you faced during implementation, as well as the factors that caused these challenges

            The implementation of health information technologies may face a number of usability challenges. Human factors may play a role in the usability challenges that are experienced in the process. Human factors such as performance, capabilities as well as limitations and utilization of the healthcare systems may affect the adoption of health information systems. The human factors also predispose health organizations in the implementation process to errors such as technical, judgmental, and monitoring errors (Ratwani et al., 2019). Additional factors such as ergonomics may also affect the usability of health information technologies. Ergonomics include the ability of the health information system to address organizational needs by enhancing system workflow. Therefore, there is a need to consider design factors such as interoperability and easy of operations in the system development process. 

Determine whether these challenges were a result of the implementation or design & Formulate strategies for overcoming these usability challenges

            One of the strategies that I would use to address the above usability challenges is testing the health information system on a regular basis prior to its implementation. The health organization and stakeholders involved in the system development should ensure that rigorous testing of the system be performed to identify and correct any problems. The testing also provides insights into the integrity of the system and its ability to deliver the anticipated organizational goals and outcomes. The other strategy that I would adopt is promoting the development of the desired competencies among the staffs, as a way of addressing the human factors that may affect the process. One of the ways that can be used to promote competencies among the staffs is providing them with training and continuous educational opportunities on the use of the health information system. Training ensures that the staffs adopt the required knowledge and skills needed for the use of the system. Continuous educational opportunities such as coaching and mentorship and provision of regular feedback are also important in addressing the usability challenges (Hirschtritt & Hirschtritt, 2019). Therefore, the consideration of the above strategies will ensure the successful implementation of the health information systems in the organization. 


Hirschtritt, M. E., & Hirschtritt, D. B. (2019). Improving Usability of Health Information Technology. JAMA, 322(4), 364–365.

Ratwani, R. M., Reider, J., & Singh, H. (2019). A Decade of Health Information Technology Usability Challenges and the Path Forward. JAMA, 321(8), 743–744.



Usability and Clinical Application Design Challenge Case Study 1

 In the example given an organization has chosen to utilize an existing electronic system within its network for a small medical center. Included in this decision was an expedited timeframe of six months for installation and implementation. Unfortunately, organizations’ health information technology (HIT) systems are not a one size fits all. Selection and implementation of an clinical information system (CIS) should involve usability principles to mitigate failure and produce an  effective and efficient system (Ball et al., 2010).  The medical center had several challenges including: inappropriate order sets, poorly timed equipment arrival, inefficient cross-over of laboratory results between units, and computer training retention from extended time-lag from training to go-live. The following paragraph identifies the challenges in a hastily implemented CIS system impacting end-user satisfaction and patient safety resulting in an extended usability issues after go-live.

Evaluation and Strategies

 The implementation challenges described in the case study were a trickledown effect from a  system design flaw. Gruber et al. (2009) noted in their systematic review of factors influencing outcomes of CIS implementation that the highest levels of success and failures were in CIS implementation. Successes included training and education, go-live support, and recognized uniqueness of clinical area. Misaligned systems lead to a negative impact on nurses ability to care for patients (Staggers & Elias, 2018). Strategies to mitigate the implementation impacts at this facility would be to utilize usability principles. 

  1. With an early focus on the end-user. 
  • Send nursing end-users, providers, and IT staff to shadow the system at the other facility
    • Needs analysis
    • Workflow analysis
    • Evaluate efficiency for the small medical center
    • Determine educational time needed
  1. Iterative design process
  • Keep staff nurses and providers involved during design build and testing
  1. Systematic product evaluations 
  • Plan in the project scope for computer terminal delays and system testing
  • Train nurses as super users to assist with go-live and additional staff to assist with patient care

Involving end users in the design process will assist in developing a robust HIT system to increase efficiencies, and ensure patient safety to mitigate workarounds, equipment failure, poorly integrated systems, and inefficient training.  


Ball, M. J., Douglas, J. V., Walker, P. H., DuLong, D., Gugerty, B., Hannah, K. J., Kiel, J., Newbold, S. K., Sensmeier, J. E., Skiba, D. J., & Troseth, M. R. (Eds.). (2010). Nursing Informatics: Where Technology and Caring Meet (4th ed. 2011 edition). Springer.

Gruber, D., Cummings, G. G., Leblanc, L., & Smith, D. L. (2009). Factors Influencing Outcomes of Clinical Information Systems Implementation: A Systematic Review. CIN: Computers, Informatics, Nursing, 27(3), 151–163.

Staggers, N., & Elias, B. (2018). The Imperative of Solving Nurses’ Usability Problems With Health Information Technology | Ovid. JONA: The Journal of Nursing Administration, 48(4), 191–196.

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