Healthcare professionals in acute care hospital settings at the frontline of patient care affect many aspects of the patient's hospital stay, including infection prevention. The wearing of artificial nails by healthcare professionals in direct patient care is against best practice, although it is often seen. Therefore, the following PICOT question arises: In direct patient care providers who fail to adhere to policy (e.g., artificial nail use per hand hygiene policy) (P), how does a multimodal approach (I) compared to a single approach (education) (C) affect compliance with policy (0) within six months (T)? A systematic review was conducted using CINAHL, PubMed, and Cochrane databases to review interventions that increase compliance in clinical practice and hand hygiene. Education, conducting audit and feedback (A & F), and providing reinforcements were necessary to increase clinical practice change compliance. Implementing the interventions gleaned from the evidence, the compliance rate with the desired practice changes progressively improved from baseline audits from a 26% increase in Sept 2020 to 34% in Nov 2020. A consistent plan of the 3-prong intervention approach of education, A & F, and reminders was executed to increase compliance. The project provided an evidence-based method for increasing compliance which can be used in multiple challenges facing the organization.

Date of publication

Spring 3-19-2021

Document Type

DNP Scholarly Project



Persistent identifier


Committee members

Faculty Mentor: Cheryl D. Parker, PhD, RN-BC, CNE; Committee Member: Lauri D. Joh, PhD, RN, CNS; Industry Mentor: Shelley Brown-Cleere, MSN, RN; DNP Program Director: Sandra Petersen, DNP, APRN; Executive Director School of Nursing: Jennifer Chilton, PhD., RN; Dean, College of Nursing and Health Sciences: Barbara Haas, PhD., RN


Doctor of Nursing Practice