Critical Appraisal Essay

Activity 1: ….2
Personal Knowing: ….2
Empirical Knowing: …2
Ethical Knowing: …3
Aesthetic Knowing: ..3
Activity 2: ………4
Activity 3: …….5
Activity 4: …….5
Appendix 1 ….5
Activity 5: ……6
Introduction: ..6
Literature Review: 7
Methodology: …8
Conclusion: …..11
Activity 6: ….11
References: …13

Activity 1:

Barbara presented the model for the patterns of nursing knowledge which are used till now and are opt by the nurses of different programs and specialization. The four patterns of nursing knowledge are the following:

Personal Knowing:

Personal knowledge is what the person knows and understands because of their personal experience and personal life. Every person has its knowledge that comes to them through observation, reflection, and self-actualization (Barrett and Carper, 2017). When people make decisions, it is highly connected with their knowledge and they tend to decide by thinking about what they have learned and seen in the past. In my nursing, at the start, I saw how the people were quite impatient when it comes to the emergency ward due to which they want to be treated and looked upon as the priority. In case it doesn’t happen so they start to lose their patience. Through my knowledge, I knew that people do not stop being impatient especially in the emergency ward unless they are satisfied. So I made sure to communicate with all the patients and their families to make them relax and to overall make the environment of the emergency room less complicated (Oliveria, et al, 2017).

Empirical Knowing:

Empirical knowing is what the person knows from the researches he has done or read or the objective facts which he read. People are exposed to the theories and the general ideas and laws which are present in the evidence-based practices. It is known as the science of learning because of scientific facts. In my adult nursing, all the use of knowledge is based on empirical knowledge (Alba, 2018). If the condition of the patient starts to deteriorate in the absence of the doctor then the nurse has to make the decision. In my case, I have been handling the cases almost daily which are based and treated on my empirical knowledge.

Ethical Knowing:

The ethical sense is developed inside the person on its own without any external force. The person has its perception of the things that what is right and what is wrong (Bender and Elias, 2017). Many people do have different contradictory perceptions too and the reason is that they are self-made. In the case of the nurses, the main personal ethic that the nurses have to follow is to protect and respect human life. There is a common code of ethics for nurses through which all the nurses understand what is wrong and what is right. In my case, the ethical knowledge that is used inside the healthcare department is about how the information about the patients should be kept confidential (Janssens, et al, 2016).

Aesthetic Knowing:

Aesthetic nursing or knowledge is known as art. It is the combination of all the knowledge and working together. It is also described as an “aha” moment when the nurse realized something due to the combination of all the knowledge processed to them. In my case, nurses usually get this moment when they are trying to decide in the absence of any healthcare practitioner (Dobrowolska, et al, 2016).

Activity 2:



Activity 3:

PICO is the research strategy that helps in identifying the question for the research paper. In PICO, “P” stands for the Problem, patient, or the overall population. In this, we only talk about these major aspects. “I” stands for intervention or the indicator, this focuses on what the problem is indicating or anything related to it. “C” stands for the comparison that is how the problem and the indication are compared together and what would be the outcome of it. “O” stands for the Outcome of the interest, this focuses on how much the outcome of the research would get famous. The reason for this is to evaluate if the research is worth to be done or if it is just useless to do whole research when there is no audience to read it (Eldawlatly, et al, 2018). The research question from the PICO strategy can be made that “Does cleanliness among the healthcare workers reduce the hospital-acquired infections” In this our P is the hospital-acquired infection, I is the cleanliness as it is the intervention, C is for the no cleanliness that what happens if there would be no cleanliness, O is for the reduced infection that is the outcome would be that there would be no infection at all if there would be enough cleanliness in the hospital (Scells, et al, 2017).

Activity 4:

Appendix 1

Author, Date of publication Study title and journal name vol. page number Main issues identified in the literature review/background Design


Main findings Implications for practice Limitations
Gunter Kampf, PD Dr. med., Harald Loffler, Prof. Dr., and Petra Gastmeier, Prof. Dr. med.

2009, October

Hand Hygienec for the prevention of Nosocomial infections.




That cleanliness is important for the health care staff as they play a huge role in the nosocomial infections. Examining the literature from the WHO recommendations on hand hygiene That hand hygiene That in future, there would be complete focus on the washing of the hands or hands hygiene by the staff members. The limitation was that the study was only focused on the hand hygiene and not in cleanliness overall. So in case people do wash hands or remain unhygienic with dirty clothes then there would be no use of clean hands.


Activity 5:

Knowledge, Attitude and Performance of Nurses toward Hand Hygiene in Hospitals 


This is considered to be an important topic in the field of nursing because nurses play a huge role in the healthcare departments. Most of the time they have to take over the whole hospital and all the patients whenever there is no doctor to visit (Sharif, et al, 2016). The study is about how hygiene especially hand hygiene is important for the nurses when they are treating the patients. This is the topic that needs to be more understood by the nurses and the patients (Bennett, et al, 2015). When the patient’s condition deteriorates, it is always analyzed that it is due to their condition but no focus is given on the hand hygiene of the nurses who are always present with the patients. All the hospitals do care about the hygiene and cleanliness of the patients but the focus rarely gets to the hand hygiene of nurses (Elaziz, et al, 2015). All the hospitals and the healthcare departments are exposed to the Nosocomial infections but the research shows that these infections can be easily reduced if the nurses would follow proper hand hygiene. Among all the other prevention methods of the infections hand hygiene is considered as the most common and easiest method to follow (Ghezeljeh, et al, 2015).

Literature Review:

Nurses have the complete exposure towards all the patients, they communicate, touch, give them food, inject them with medicines, and do a lot for them. According to the World Health Organization, 1,400,000 patients suffer or get infected from the nosocomial infections which they get exposed to in the hospitals (Castle, et al, 2016). Even in the developed countries, the percentage of nosocomial infections is 40%, this shows that the condition of the underdeveloped and the developing countries would be far worse (Hosseinialhashemi, et al, 2015). Nosocomial infections make the patient stay in the hospital for far longer because their healing process is slowed down due to these infections. This increases their cause for the treatment too which wasn’t their fault but the staff’s fault that they get these infections. Nurses play a major part in taking care of the patients and they are also responsible to make sure that their patients get better as soon as possible (Sakihama, et al, 2020). But the studies show that nurses are more in contact with the patients as compared to other practitioners. This is the reason why they also play a huge part in infecting the patients with infections and they don’t pay much attention to their hand hygiene (Park, et al, 2014). Most nurses do not have much knowledge about their hand hygiene and they said that they prefer to spend time taking care of the patients rather than spending their time washing hands all the time. Many nurses prefer to wear gloves and dispose of them instead of keeping their hands clean, in this way they end up wearing the same gloves throughout the day or with different patients. The study which was conducted by (Asadollahi, et al, 2015) shows that the nurses have knowledge about different areas and they treat the patent as effectively as they can but 68% of the nurses do not have enough knowledge about the hand hygiene and they do not find it very important. All the studies show the attitude of the nurses and it showed that most of them need to have more knowledge about it and the nurses who do know about it do not find it important enough to follow. In Asia, as compared to other countries, the rate of poor knowledge about hand hygiene is high. Among the patients, nosocomial infections are mostly the reason behind the mortality rate and the disability rate that rises among all the patients (Sarani, et al, 2015). The patients who are more exposed to nosocomial infections are the ones who are present in the ICU, CCU, NICU, acute surgeries, and the patients of the orthopedics. The reason that these patients are more exposed is that their condition is already quite delicate and any minor thing can make a reaction to their existing condition. As for the gloves, gloves are considered to be effective and a safety measure for cleanliness but the nurses do not find it important to change their gloves all the time. They mostly wear gloves to keep their hands clean and far from the infections when they should wear them to make sure that they aren’t sending in any infections to the patient from their hands or gloves (Shinde, et al, 2014).


There were a total of 240 nurses on the specific healthcare department and among which the research was done on 200 of them. The criteria to select the nurse for the study was to make sure that the nurse has at least three months of experience of working in that particular institute. An accessible sampling technique was used, the questionnaire was made that was research-based. There were two sections of the questionnaire; the first was related to the demographic information about the nurse for example their age, gender, sector, and their background (White, et al, 2015). In the second section, there were again three sub-sections. In the first subsection, some questions were related to the knowledge that how much the nurse does know about hand hygiene. There were 10 items in those sections and the participants have to answer either in yes or no. Then the second subsection was related to evaluating the attitude of the nurses towards hand hygiene. There were 10 questions in that part too which were comprised of the scale from 1 to 5. Where 1 referred to the strongly disagree and 5 refers to the strongly agree. Then the third subsection was related to the performance of the nurses, there were again 10 questions and the answers were written in the form of the scale, where 5 represents always, 4 represents mostly, 3 represents half of the cases, 2 represents some cases and 1 represents never.

The nurses were given 10 minutes each to complete the questionnaire within that time and then hand back the questionnaire after 10 minutes. The questionnaires were before had been tested for the reliability and they turn out to be alpha reliable. The data was analyzed through the Chi-square which turned out to be significant. There were many ethical considerations, the letter was taken from the nurses and they were free to leave the part of the research whenever they feel like without any reason. Also, all the nurses were made sure that their names, and any personal details which they filled in the first section; all the demographic details wouldn’t be used nor would be told to any person. The letter of consent was in written form and all the nurses give that written consent so that in case of any problem the researches would have proved that the participants filled the form through consent and not by force. All the 200 forms were filled and returned at the right time, none of the participants retreat at any moment. The findings showed that the age of the nurses ranges from 20 to 57, which makes the mean age of all the nurses to be 32. Among 200 members, 173 participants were male, among which 161 had a degree in BScN and 155 of them were married. The working experience of the nurses was between 5 to 10 years. Among these nurses, 58 which is 29% of the total participants belonged from the ICU, CCU, and dialysis departments. The findings showed that 74.5% of the nurses had good knowledge about hand hygiene. In the questionnaire, 98% of the nurses responded with correct in the sections where they were asked that if they should wash their hands at the arrival or departure. They also answered correctly when they were asked if they should remove their rings, watches, bracelet, or any accessory from their hands before going for the surgery. As for the wrong answers, this showed that the participants answered wrong when they were asked that hand hygiene isn’t necessary once they are done with the official activities. 27.5% answered wrong when they were asked that using the antiseptics is considered to be very necessary before wearing the gloves and after taking it off. 23% of the participants answered wrong when they were asked that the hot water shouldn’t be used for the staff members when they are washing hands because of the risks of the dermal irritation. Then in the second subsection which was about the attitude towards hand hygiene. The nurses responded correctly and incorrectly in this section too. They responded correctly when they were asked that they have to be a role model in front of their patients about hand hygiene and its importance, 96% of the respondents responded correctly. The negative attitude was shown in the questions when they were asked if it is important for me to complete the tasks and care for the patients rather than washing the hands and caring for hand hygiene when there is too much workload, 45% of the respondents responded wrong in this situation. The results of this section showed that 87.5% of the nurses have good knowledge about hand hygiene and their performance was good. In the last section, the answers showed that 93.5% of the nurses prefer to wash hands when they get back from the toilet. As for the main observed option, 25% of them answered that they wash hands before they enter into the isolation room. For the half of cases option, 13.5% of the nurses wash their hands before they go for any kind of invasive measures. In some cases, 10.5% of the nurses responded that they wash their hands after they get in contact with the patient’s skin. As for the never, 7.5% of them responded that they wash the hands before treating any care-giving wound.


The results showed that the nurses do have knowledge about hand hygiene but the knowledge is specific and in some areas, there is a need to add in more knowledge about hand hygiene in some areas. In the areas where the nurses need to have more knowledge so there can be training sessions held for them or the courses through which they can hold the grip of those areas too in which they are weak. All the nurses were positive about hand hygiene so it showed that once they get the information about the areas they are weak in, so they will start adopting those areas too. This study was based on only one hospital but to get more accurate information, the same study can be done by multiple hospitals and the sampling size can also increase from 200. Also, this shows that there can be a difference in the behavior and attitude of the nurses towards hand hygiene when it comes to different cultures. The results showed the positive side of hand hygiene and how the nurses had prior knowledge about it, but it also highlights some points which the nurses should know but they were confused about it or many of them do not have enough knowledge about it so they selected the wrong option.

Activity 6:

This module helps in understanding the studies which are done by other people. I understood the point that how the researches are based on the gap which needs to be studied and needs to be highlighted. Once the gap is analyzed then the second major thing is to understand the sample and also make a plan that how the sample would be used to answer the research question. In the above research study, it was observed that the researches could have also used other methods for the study; they could have used the observed method, where they would see and observe that how many times nurses do wash their hands and how serious they do take the hand hygiene. As they are nurses it shows that they do know all the things that how much they follow the knowledge and the precautions would have been analyzed if the methodology would have been from the questionnaire to the observation method.


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