NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research

NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below. PICOT Question Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor. The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study). Research Critiques In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions. The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question. Refer to “Research Critiques and PICOT Guidelines – Final DraftQuestions under each heading should be addressed as a narrative in the structure of a formal paper. Proposed Evidence-Based Practice Change Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes. quantitative_research_critique.docx research_critique.docx quakitative_chg_1.pdf qualitative_chg_2.pdf chlorhexidinebathing_quantative_2.pdf ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Running Head: QUANTITATIVE RESEARCH CRITIQUE Quantitative Research Critique Grand Canyon University NRS-433V-0502 Introduction to Nursing Research March 29, 2020 1 QUANTITATIVE RESEARCH CRITIQUE 2 Introduction Hospital-acquired infections (also known as nosocomial infections) are infections that are acquired in the hospital, which means that the patient didn’t have the infection before admission. There is potential reason to acquire hospital infections, such as a proper sterilization because most of these infections are coming from contaminated surfaces. The nosocomial infections may increase hospital stays, and lead morbidity and mortality; therefore, it is crucial to minimize and prevent the occurrence of hospital-acquired infections (HAIs). Chlorhexidine is a germicidal agent, which health care professionals use in the hospitals and may be useful in reducing nosocomial infections will be discussed in this paper by analyzing two quantitative research articles. Quantitative Studies Two quantitative research articles with the following titles will be used to answer the PICOT question: • “Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability” • “The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis” Background Both research articles have similar backgrounds. The research articles evaluate the use of CHG wipes on patients with central lines to reduce HAIs. The objective may be very close to the QUANTITATIVE RESEARCH CRITIQUE 3 purpose; the objective of the two research articles is protecting patients from bloodstream nosocomial infection using clorhexidine agent. Bloodstream nosocomial infections are one of the most serious infections as they are directly flowing in the bloodstream and can cause death; therefore, the reduction of HAIs is a goal for all hospitals. However, nurses hold a high responsibility for this problem, as they should be accountable for proper use of sterilization agents. The PICOT question is as follows: In patients with central lines does the use of CHG wipes [daily] vs. standard baths decrease central-line associated bloodstream infections (CLABSI’s) over 3 months, where: • P (population): Infection in patients with central lines. • I (intervention): Use of CHG wipes in patients with central lines. • C (comparison): No use of CHG wipes in patients with central lines. • (outcome): Decreased infections rates • T(Time frame): 3 months How the Two Research Articles Support the Issue of Nosocomial Bloodstream Infection? The two articles will be used to answer the PICOT question by analyzing both articles in order to conclude the best reasonable answer for the PICOT question. The research articles’ population, intervention group, comparison group, outcomes, and the time frame will be the key to find the answer. The comparison between the parameters in the research articles and in the PICOT question will make a turning point in answering the PICOT question. In the PICOT question, the intervention groups are patients with central lines who had used chlorhexidine wipes. On the other hand, the comparison group are patients with central lines who had not used chlorhexidine QUANTITATIVE RESEARCH CRITIQUE 4 wipes. NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS The research article “Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability”, written by Montecalvo et al., (2019) is the three-phase study, with the intervention group of medical intensive care unit, the respiratory care unit, and the medical-surgical intensive care units patients who had used chlorhexidine bathing to reduce HAIs and the comparison group of medical intensive care unit, the respiratory care unit of a tertiary care hospital, and the medical-surgical intensive care units patients prior the usage of chlorhexidine bathing. On the other hand, the research article “The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis” by Musuuza et al., (2019), where the intervention group are patients who had chlorhexidine bathing intervention, and the comparison group are patients who didn’t take chlorhexidine bathing intervention. Method of Study Each research followed a different method of study, the article titled “Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability” used multiple hospital study with three-phase study design; pre-intervention, intervention (chlorhexidine bathing), and post-intervention (Montecalvo et al., 2012). On the other hand, the article “The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis”, used a meta-analysis method, with 26 pieces of research included in the meta-analysis filtered in strict criteria from 788 records identified (Musuuza et al., (2019). The difference between the two methods is that the 3-phase study design is tolerating and interacting with current patients that are a relatively small sample, while meta-analysis is analyzing hundreds or thousands of cases from past researches. The 3-phase study is reflecting QUANTITATIVE RESEARCH CRITIQUE 5 an accurate comparison because the comparison is applied to the same patients. However, this study has a limitation which is the lack of patients’ specific data, and this method is costly too. On the other hand, the meta-analysis method is having a great amount of accuracy because a vast number of cases are being analyzed, but it may not reflect the present because it is based on previous studies. Results of Study Both studies had studied the impact of using the chlorhexidine agent with patients to reduce nosocomial bloodstream infections. The results of both studies are promising and may have positive implications on the nursing practice. The study, which used a 3-phase study design concluded: “chlorhexidine bathing seems to be a useful adjunctive measure for reducing central venous catheter-associated bloodstream infection” (Montecalvo et al., 2012). The study which used meta-analysis research had stated that chlorhexidine had significantly reduced the incidence of bloodstream infections in both intensive care unit and non-intensive care unit patients, also CHG bathing is an effective, relatively low-cost intervention (Musuuza et al., 2019). The results of two studies may guide us to very useful implications in the nursing practice. NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research Such as taking chlorhexidine as a subject to research in order to use it in real practice. Also, being more aware of infections coming from the hospital that can threaten the patient’s lives. In the end, applying the usage of chlorhexidine as a mandatory protective practice in hospitals. Outcomes Comparison The anticipated outcomes of the PICOT question may be presented as: QUANTITATIVE RESEARCH CRITIQUE • 6 In patients with central lines, the use of CHG wipes [daily] vs. standard baths decreases central line-associated bloodstream infections (CLABSI’s) over 3 months. When making a comparison between the anticipated outcome of the PICOT question and the outcomes of both research studies, similarity can be noticed. Both research studies suggested that the usage of chlorhexidine is beneficial in reducing infections in patients within hospitals. The central lines catheters are connected to the bloodstream, so patients with central lines need a higher amount of care to avoid contamination. Our understanding of the two research articles that chlorhexidine is an effective agent used to reduce acquired infections, leads us to conclude that the answer of PICOT question is simply “yes” as presented in the statement above. References QUANTITATIVE RESEARCH CRITIQUE 7 Montecalvo, M. A., McKenna, D., Yarrish, R., Mack, L., Maguire, G., Haas, J., … Wormser, G. P. (2012). Chlorhexidine Bathing to Reduce Central Venous Catheter-associated Bloodstream Infection: Impact and Sustainability. The American Journal of Medicine, 125(5), 505–511. DOI:10.1016/j.amjmed.2011.10.032 Musuuza, J. S., Guru, P. K., O’Horo, J. C., Bongiorno, C. M., Korobkin, M. A., Gangnon, R. E., & Safdar, N. (2019). The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC Infectious Diseases, 19(1). DOI:10.1186/s12879-019-4002-7 Running Head: RESEARCH CRITIQUE Article Critique Grand Canyon University NRS-433V-0502 Introduction to Nursing Research March 22, 2020 1 2 RESEARCH CRITIQUE Introduction Healthcare-associated infections (HAIs) is one of the leading causes of complications across the continuum of care causing high rates of mortality and morbidity, thus posing a threat to patient care at the global level. The main HAIs include central line-associated bloodstream infections (CLABSI) and methicillin-resistant staphylococcus aureus (MRSA). These infections cause a high level of global burden due to the increase in health care cost. However, with the application of relevant knowledge and use of appropriate technology, most of these infections are preventable. By that token, and based on my PICOT question: Will use of CHG wipes decrease infection rates in patients with central lines? I will analyze two qualitative studies to advance the knowledge base on the prevention of these infections as posed by different scholars, scientists and researchers. Background of Study The article “Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veterans Hospital by examining nurses’ perspectives and experiences” written by Musuuza et al.,(2017) is one of the works set to expound on this field. As the title of the article outlines, the research is based on the use of chlorhexidine in the prevention and reduction of the HAIs in the ICU.NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research The main aim of this article is to designate the practice of daily CHG bathing while also identifying the obstacles and the facilitators enhancing its adoption. Being the primary caretakers of the patients, nurses’ knowledge on the prevention techniques of the HAIs is critical; it is in that light that the article focuses on examining the nurses’ perspectives and experiences while using the CHG bathing. Through the use of qualitative content analysis, the report analyses the gathered data from the semi-structured interviews conducted on nurse managers, registered nurses and health care, technicians. Through 3 RESEARCH CRITIQUE results inferences, the bathing processes, as well as the barriers and facilitators of the application of CHG wipes that relates to my PICOT question. On the other hand, the article “Using a Systems Engineering Initiative for Patients Safety to Evaluate a Hospital Wide Daily Chlorhexidine Bathing Observation” by Caya et al., focuses on the use of SPEIs method to evaluate the implementation of the CHG bathing in the inpatient units. Through the use of observation and patient survey, the gathering of data on compliance is enhanced, therefore establishing the bathing protocol. Support for the PICOT Question Through the data gathered in the article by Musuuza et al. (2017), which includes the nurses and patients’ perspectives and assessment of CHG, the effectiveness of the CHG in the prevention of the HIAs can be outlined. This article will, therefore, be used to help determine the knowledge base for the nurses, health care technicians and the patients on the application of CHG in bathing for the prevention of HIAs. On the other hand, the data gathered by Caya et al. (2015), on the evaluation of the daily CHG bathing in hospitals will be used to ensure that appropriate education on compliance is given to nurses and the relevant health care technicians to ensure that the right protocols are used in the application of the CHG to maximize the effectiveness. In other words, this article will provide the necessary measures that need to be followed for the CHG wipes to work accordingly to decrease the rates of infections. The intervention in the first article focuses on the sustainability of CHG bathing; similarly, the intervention on the second article looks into the evaluation of the CHG bathing; this compares to the ‘use of CHG bathing as well as wipes in patients at the central line as they provide a more in-depth and broader approach on the usage of the Chlorhexidine gluconate (CHG) in patients, providing a 4 RESEARCH CRITIQUE base for effective utilization and long term usage of the mechanism. On the other hand, the comparisons create the implications of lack of the usage of the CHG on patients. Method of Study The method of data collection and analysis used determines the reliability and the validity of the data gathered; therefore, it’s imperative to use an appropriate method for a study (Giusti et al., 2020). On that note, Musuuza et al. (2017) use the semi-structured interviews for data collection and qualitative context analysis for the coding and analysis of data. Furthermore, Dedoose software is used for the management and coding of data besides of two authors to ensure trustworthiness and integrity is observed. On the other hand, Caya et al. use direct observation and survey for the collection of data and IBM SPSS statistic for statistical analysis. NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research These methods of data collections differ as the semi-structured interviews are open, allowing the interviewee to provide information beyond the ones asked. Conversely, the survey method rigid, limiting the interviews answer to the ones provided. Also, while the former is applied for qualitative analysis, the survey method is effective for the collection of quantifiable data. The primary advantage of semi-structured interviews is that it provides more in-depth information while allowing the interviewer to learn the reasons behind the question as two-way communication is effective. However, this method is time-consuming. On the contrast, the survey method is cost-effective, consuming less time while also covering a large number of respondents. However, the close-ended question limits the validity of the answers provided. Results of Study The key findings of the article by Jackson et al. includes the bathing steps as described by the participants. In this case, the first step is the resolution to give a bath, which is influenced by 5 RESEARCH CRITIQUE different factors including prioritization, patients, nurse, length of the patient stay and the shift. The ability to provide a bath follow which is mainly influenced by the patient, the workload of the nurses, the environment and the availability of equipment and technology. Next in line is receiving aid to do a bath, which is mainly dependent on the staffs and the patient factors. The delegation of the bath, which is done mostly to the HCT follows as guided by various conditions. In summation is the decision on the type of soap to be used, which is dependent on the policies, knowledge and the nurse. Furthermore, the outcome of the bathing process varied from completed baths, interrupted and those not done. Moreover, most participants did not know the application of CHG in the prevention and reduction of HIAs as they viewed it as regular soap, thus just another part of the process. On the other hand, based on observation, 28 CHG baths from 17 adults inpatients units done by both the RN and NAs with an overall of 105 nursing surveys and 86 patients survey. Based on these researches, it’s evident that while most nurses are aware of HIAs, many of them are not conversant on how CHG can be used to reduce and prevent them. Also, for the ones aware, compliance following still have a long way to go. As a result, these findings can help in the bridging of this gap through the offering of relevant information. Ethical Considerations In research, there are ethical considerations that are made among them is informed consent and respect for confidentiality and anonymity (Miracle, 2016). Based on both of these articles, the principle of anonymity is followed as neither the hospitals, nurses or patients names are disclosed. Also, the informed consent in the article by Musuuza, et al. is followed as all the participants took part in the research voluntarily. However, there is no mention of informed consent in the Caya et al. article. 6 RESEARCH CRITIQUE References Caya, T., Musuuza, J., Yanke, E., Schmitz, M., Anderson, B., Carayon, P., & Safdar, N. (2015). Using a systems engineering initiative for patient safety to evaluate a hospital-wide daily chlorhexidine bathing intervention, 30(4), 337. Giusti, K. E., Capone, W. M., & Perkins, L. (2020). U.S. Patent No. 10,559,048. Washington, DC: U.S. Patent and Trademark Office. https://patents.google.com/patent/US10559048B2/en Miracle, V. A. (2016). The Belmont Report: The triple crown of research ethics. Dimensions of Critical Care Nursing, 35(4), 223-228. Musuuza, J. S., Roberts, T. J., Carayon, P., & Safdar, N. (2017). Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences. BMC infectious diseases, 17(1), 75. Preventing Healthcare-associated Infections | HAI | CDC. (2019). Retrieved 22 March 2020, from NRS 433V GCU Influence of Chlorhexidine Bathing on Central Venous Catheter Research https://www.cdc.gov/hai/prevent/prevention.html Musuuza et al. BMC Infectious Diseases (2017) 17:75 DOI 10.1186/s12879-017-2180-8 RESEARCH ARTICLE Open Access Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran’s Hospital by examining nurses’ perspectives and experiences Jackson S. Musuuza1,4, Tonya J. Roberts1,2, Pascale Carayon3,5 and Nasia Safdar1,3,4* Abstract Background: Daily bathing with chlorhexidine gluconate (CHG) of intensive care unit (ICU) patients has been shown to reduce healthcare-associated infections and colonization by multidrug resistant organisms. The objective of this project was to describe the process of daily CHG bathing and identify the barriers and facilitators that can influence its successful adoption and sustainability in an ICU of a Veterans Administration Hospital. Methods: We conducted 26 semi-structured interviews with a convenience sample of 4 nurse managers (NMs), 13 registered nurses (RNs) and 9 health care technicians (HCTs) working in the ICU. We used qualitative content analysis to code and analyze the data. Dedoose software was used to facilitate data management and coding. Trustworthiness and scientific integrity of the data were ensured by having two authors corroborate the coding process, conducting member checks and keeping an audit trail of all the decisions made. Results: Duration of the interviews was 15 to 39 min (average = 26 min). Five steps of bathing were identified: 1) decision to give a bath; 2) ability to give a bath; 3) decision about which soap to use; 4) delegation of a bath; and 5) getting assistance to do a bath. The bathing process resulted in one of the following three outcomes: 1) complete bath; 2) interrupted bath; and 3) bath not done. The outcome was influenced by a combination of barriers and facilitators at each step. Most barriers were related to perceived workload, patient factors, and scheduling. Facilitators were mainly organizational factors such as the policy of daily CHG bathing, the consistent supply of CHG soap, and support such as reminders to conduct CHG baths by nurse managers. Conclusions: Patient bathing in ICUs is a complex process that can be hindered and interrupted by numerous factors. The decision to use CHG soap for bathing was only one of 5 steps of bathing and was largely influenced by scheduling/ workload and patient factors such as clinical stability, hypersensitivity to CHG, patient refusal, presence of IV lines and general hygiene. Interventions that address the organizational, provider, and patient barriers to bathing could im … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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