Research Critiques And PICOT Question Guidelines Discussion

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 And PICOT Question Guidelines Discussion.

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Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four 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.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change Research Critiques And PICOT Question Guidelines Discussion.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

The use of catheters on critically ill patients is common practice today as it reduces the need for frequent movements to and from the lavatory. While the catheter has a multitude of advantages especially in helping alleviate the health of patients, their use sometimes leads to urinary tract infections commonly referred to as catheter associated urinary tract infection (CAUTI). This health acquired infection is a nursing practice problem that has triggered a handful of researches aimed at finding a solution. The purpose of this paper is to form a PICOT question aimed at addressed the identified nursing practice problem. In critically ill patients at risk of catheter-associated urinary tract infections (CAUTI) in an acute care setting (P), does applying a nurse-driven bladder bundle (I) reduce the occurrence of CAUTI (O) compared to patients given the usual care (C) within a timeframe of 3 months (T)Research Critiques And PICOT Question Guidelines Discussion.

Background of Studies

Ravi and Joshi (2018) conducted a qualitative study seeking to determine the effectiveness of CAUTI care bundles on at-risk patients. The two researchers determined that success of care bundle would be if its individual elements had positive outcomes on patients. A second qualitative study by Mody et al. (2017) examined the extensive application of the care bundle intervention. The focus of the study was on 48 different states across the United States. A quantitative study conducted by Davies et al. (2018) aimed at determining the effectiveness of the bundled approach to reducing catheter-associated UTIs. Their research was motivated by the need to find a solution to the problem and also by the fact that since 2015, fines are imposed on providers when their patients acquire health-related illnesses such as CAUTI. Research by Witwer et al. (2019) focused on CAUTI best practices for neurovascular/cardiovascular/intensive care unit patients. The researchers proposed that healthcare providers need to conduct frequent audits on the use of catheters and the application of bundle methods. Based on audits conducted between 1st March and October 3oth 2018, Witwer et al. (2019) made the preliminary conclusion that when the bundle methods are appropriately done, the incidences of CAUTI reduce marginally Research Critiques And PICOT Question Guidelines Discussion.

How These Articles Support the Nursing Practice Problem

Broadly, the studies conducted offer support for nursing practice based on the fact that they have suggested approaches that can be used to help alleviate the identified problem CAUTI. The researchers acknowledge that CAUTI is a prevalent health care acquired illness and interventions are required (Witwer et al., 2019). The focus of the fours studies is the bundle intervention which addresses key issues of timely extraction of the catheter, standardization of use, cleanliness and maintenance of the devices placement minimizations (Ravi & Joshi, 2018). Research studies analyzed point out the importance of effectively applying the suggested bundle intervention otherwise they will fail to address the identified nursing problem of CAUTI. Since the use of catheters is mostly on critically ill patients, the suggested methods go a long way in improving their plight in terms of health outcomes. Davies et al. (2018) have emphasized that the incorporation of the bundle approach helps both the patients and health care institution – reputation in the latter’s case. The suggestions offered in these four articles compare closely with the picot question on two bases. One, the picot intervention suggested is the use of nurse-driven bundle of care similar to the studies and the fact that the use of this method could help improve the health prospects of the at-risk critically ill patients Research Critiques And PICOT Question Guidelines Discussion.

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Method of Studies

The method of study used by Davies et al. (2018) is retrospective review to evaluate trauma patents. With the bundle intervention appropriately used the urinary catheterization process and culturing practices leading to reduction in type one errors. The benefit of a retrospective study is watching and interviewing patients and burses was not necessary. This made it less time consuming. The limitation of this method is that it is hard to quantify the statistical figures and results. Witwer et al. (2019) on the other hand engaged with a Joint Commission to trace the incidence of CAUTI for each of weekly patients’ audits done three times per week. The selected patients were the ones that had catheters left in their bladder. The joint commission also involved the patients being observed by listening to their views in terms of the impacts that the catheters were having on the, and also the ways that nurses were handling them and these were compared with the standards set. The Poisson regression model used in this study has the benefit of being reliable in finding solutions of the standard issues identified. The drawback of this method is that the data fails to match the Poisson distribution in settings where a significant number of patients are not hospitalized. The Ravi and Joshi (2018) study method was observational. In their study, they focused on the outcomes of interventions met after eight months and then engaged in a 21-month intervention. The two separate outcomes were then compared. The researchers focused on a single health facility that had 410 beds and served an average of 5,000 patients annually. The benefit of using observational study is that the researcher is able to see firsthand how the catheters are handled by the nursing team. The drawback of this method is that it is difficulot to control the variables being studied because the researcher takes a hands-off approach to see how things work. Lastly, an inductive method was used for the Mody et al. (2017) study. Ideally, patients were organized in different focus groups and studied separately and results later used for comparisons Research Critiques And PICOT Question Guidelines Discussion.

Results of Studies

In the Ravi and Joshi (2018) study, it was determined that the prevalence of CAUTIs dropped significantly when the preventative procedures were combined into a single plan. Mody et al. (2017) found a decline in CAUTI by 54% within a year of intervention. In addition, 75% of the facilities that adopted the bundle approach had over 40% decline in CAUTI. Davies et al. (2018) found that the urine culturing technique led to a reduction in the need for catheter insertion and, on overall, a decline of CAUTI by 37%. The Witwer et al. (2019) study found that there is a strong association between adhering to the entire bundle care as recommended and CAUTI rates. Adherence led to a decline in CAUTI rate. In the overall, the application of the suggested measures by the four studies would help hospitals manage CAUTI rate Research Critiques And PICOT Question Guidelines Discussion.

Ethical Considerations

The researchers of the four different studies were guided by ethical standards and codes of practice. Key among these are impartiality, transparency and accountability, beneficence and honesty. Participants were issued with written informed consent to make them aware of the scope of the research and what its intended use of the findings were. Beneficence concept were applied by ensuring the participants directly benefited in one way or the other and were also protected from hazards in the course of the research.

Outcomes Comparison

Guided by the analyzed research studies addressing the issue of CAUTI, the expected outcomes of the current study are that the proposed intervention using the bundles method will yield positive outcomes. This is in the sense that CAUTI rates will decline when nurses in healthcare facilities apply the proposed measures. What’s more, adoption by hospitals across the country will lead to improved health outcomes especially in regard to healthcare acquired illnesses. The current research question and the four from the qualitative and quantitative research studies will likely have similar outcomes because they are generally related questions researched using different methods of study Research Critiques And PICOT Question Guidelines Discussion.

Proposed Evidence-Based Practice Change

Nursing practice is evidence based and when faced with challenges such as a problem that needs being resolved, organizing it using the PICOT mnemonic helps address individual components relevant to ensuring all key issues are addressed. The picot question developed at the start of this essay outlined the individual problem, CAUTI, the proposed intervention which is the use of bundled care, expected outcomes which in this case was improved health outcomes for critically ill patients using catheters and timeline within which the results were expected is three months. Drawing from the findings of this research, an evidence based practice that could help address the identified nursing practice problem is adoption of the bundled care by nurses.

Conclusion

In a few words, the catheter associated urinary tract infection (CAUTI) can be reduced if the evidence based practice of bundled care is applied. Four research articles analyzed highlight the importance of applying the individual components of bundled intervention to help reduce the healthcare acquired infection of CAUTI. The challenge for healthcare providers and in particular nurses is to develop standards of practice while using catheters on patents. Based on the findings of the analyzed articles, if catheters are handled more professionally in terms of timely extraction, maintenance of consistent standards and maintaining cleanliness while using them, the incidences of CAUTI would reduce materially Research Critiques And PICOT Question Guidelines Discussion.

References

Davies, P. E., Daley, M. J., Hecht, J., Hobbs, A., Burger, C., Watkins, L., Murray, T., Shea, K., Ali, S., Brown, L. H., Coopwood, T. B., & Brown, C. V. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control, 46(7), 758-763. https://doi.org/10.1016/j.ajic.2017.11.032

Mody, L., Greene, M. T., Meddings, J., Krein, S. L., McNamara, S. E., Trautner, B. W., Ratz, D., Stone, N. D., Min, L., Schweon, S. J., Rolle, A. J., Olmsted, R. N., Burwen, D. R., Battles, J., Edson, B., & Saint, S. (2017). A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Internal Medicine, 177(8),Research Critiques And PICOT Question Guidelines Discussion 1154. https://doi.org/10.1001/jamainternmed.2017.1689

Ravi, P., & Joshi, M. (2018). Role of “Bladder care bundle” and “Infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society, 20(2), 116. https://doi.org/10.4103/jmms.jmms_8_18

Witwer, M., Dobbins, G., Uher, C., & McFarren, M.D. (2019). Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit. American Journal of Infection Control, 47(6), S30. Doi:https://doi.org/10.1016/j.ajic.2019.04.062.

Qualitative Research Critique and Ethical Considerations

Critically ill patients who are catheterized have an increased risk of developing catheter-associated urinary tract infections (CAUTI), which can have a detrimental effect on their overall health. CAUTIs are among the most prevalent kinds of hospital-acquired infections (HAIs) that may result in morbidity and mortality globally. CAUTIs are responsible for forty percent of all HAIs (Soundaram et al., 2020). These infections can make patients and staff members uncomfortable at care facilities, and they might have negative effects on patients. The use of a care bundle is something that should be considered for CAUTI management in order to prevent unfavorable effects. This paper seeks to provide a summary of two peer-reviewed qualitative studies that address the following PICOT question: In critically ill patients at risk of catheter-associated urinary tract infections (CAUTI) in an acute care setting (P), does applying a nurse-driven bladder bundle (I) reduce the occurrence of CAUTI (O) compared to patients given the usual care (C) within a timeframe of 3 months (T)? Research Critiques And PICOT Question Guidelines Discussion

Background of the Studies

Ravi and Joshi (2018) conducted an investigation of the effectiveness of CAUTI care bundles and infection control nurses in lowering the number of cases of CAUTI. The researchers suggested that the care bundle may be helpful if all its components had a favorable influence on the patient. As a result, the adoption of the care bundle ought to strengthen comprehensive features in the care of patients. The care bundle technique is an approach that combines measures that have been established and suggested for the decrease of urinary tract infections (UTIs) (Ravi & Joshi, 2018). This healthcare practice can be implemented in health facilities with the goal of attaining a significant decrease in the occurrence of CAUTIs. The question that was investigated in this study was whether or not the use of a CAUTI Care Bundle and an infection control nurse (ICN) is beneficial in lowering the rate of CAUTI.

The second study that was conducted by Mody et al. (2017) examines the implementation of nationwide bundle care to reduce catheter-associated urinary tract infections in inpatient divisions in hospitals located in 48 different states throughout the United States (Mody et al., 2017)Research Critiques And PICOT Question Guidelines Discussion. The purpose of this research was to investigate the impact that implementing CAUTI bundle care had on the number of CAUTI cases that occurred in hospitals. The question that was investigated is whether implementing the national bundle care may lessen the incidence of CAUTIs or not.

Support for the Nursing Practice Problem

These articles provide an analysis of bundle intervention as a means to prevent and manage CAUTIs. As such, it supports the nursing practice issue of CAUTI in critically ill patients. The use of bundled therapeutic interventions for CAUTIs has the potential to be an efficient technique that may assist in enhancing patients’ chances of experiencing favorable results. The bundled care approach can consist of prompt extraction of catheters, device standardization, catheter general upkeep, and minimization of placements where possible (Ravi & Joshi, 2018). Such crucial measures are potentially useful for enhancing preventative efforts for critically ill patients. It is conceivable that the bundled care will be weighted more toward making sure the favorable outcomes are achieved while minimizing the hazards. It has the potential to be a valuable intervention that may assist acute care patients to experience less of the negative effects of CAUTIs. According to Mody et al. (2017)’s findings, the bundle intervention has the potential to successfully lower CAUTI rates. It is possible to utilize it to decrease the number of times a catheter is used, which will have a beneficial effect on the patients Research Critiques And PICOT Question Guidelines Discussion.

Method of Studies

Ravi and Joshi (2018) designed their research as an observational study. They focused on the results that were met after eight months of intervention, accompanied by 21 months of intervention. The distinctions were carefully noted down during the process of seeing and recording the results. The research was carried out at a health care facility that had 410 beds and saw 5,000 inpatients on a yearly basis. The interventional investigation would be useful in gaining a better grasp of the distinction perceived.

In the study that Mody et al. (2017) conducted, an inductive method was used. Focus groups were used to gather the data, and then the data from every group was gathered, compiled into smaller components, and classified in order to synthesize the findings. Interviews were conducted with the focus groups, and the data from those interviews was obtained. In order to get to a point when there was no more information to learn, this data was examined group by group and evaluated for themes. There was a total of thirteen nurses of varying ages participating in the focus group. When generating thematic components as part of the qualitative research process, the possible constraint of subjectivity in interpretation is a focus group’s possible limitation.

Results

Ravi and Joshi (2018) discovered that the prevalence of CAUTIs dropped significantly when the preventative procedures were combined into a single plan. In the context of healthcare, the employment of bundles proved to be a beneficial strategy for promoting favorable results. Researchers concluded that a control strategy was necessary in order to bring down the number of HAIs. The research also showed that monitoring of CAUTI patients does not contribute significantly to the lowering of occurrences of the infections. To improve the likelihood of favorable results, preventative measures are necessary Research Critiques And PICOT Question Guidelines Discussion.

In their results, Mody et al. (2017) showed a decrease in the incidence of catheter associated UTIs by 54% over the span of one year. They observed that the majority of the facilities are capable of achieving such decreases since 75.0 percent of the facilities showed a decrease of 40% or more after implementing the bladder bundle. The results of this research provide new knowledge that may be used to successfully support a decrease in the number of healthcare-associated illnesses in a wide variety of healthcare institutions located in a variety of geographic locations. These findings illustrate the necessity of conducting active monitoring for multidrug-resistant pathogens and device-associated infections with simple feedback. The authors also came to the conclusion that an interactive educational approach needs to be incorporated into the bundle of care and should place an emphasis on both general infection control and equipment maintenance, as well as preventative barrier procedures during high-risk events.

Ethical Considerations

When carrying out these studies, there were a number of ethical factors taken into account. Beneficence, respect, fairness, sincerity, and integrity are all principles that were upheld by the researchers. Prior to conducting any of these studies, the researchers in each of them got the subjects’ informed consent. They acted in accordance with the concept of beneficence by guaranteeing that the subjects benefitted from the study and were protected from any potential risks. A respectful relationship was maintained with the subjects by keeping them apprised of the information and data that was being gathered and the purposes for which it would be put to use in the investigation. The subjects’ right to privacy and the integrity of the interactions were both safeguarded through the application of justice within the context of the research.

Conclusion

In a nutshell, catheter-associated urinary tract infections can lead to implications among critically ill patients and cause adverse health outcomes. As such, maintaining compliance with the bundle intervention is an essential component that has the potential to contribute to improved results. In order to guarantee beneficial outcomes in acute care settings, it is essential that the daily procedures associated with bundled care be carried out as intended. Research Critiques And PICOT Question Guidelines Discussion

References

Mody, L., Greene, M. T., Meddings, J., Krein, S. L., McNamara, S. E., Trautner, B. W., Ratz, D., Stone, N. D., Min, L., Schweon, S. J., Rolle, A. J., Olmsted, R. N., Burwen, D. R., Battles, J., Edson, B., & Saint, S. (2017). A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA Internal Medicine, 177(8), 1154. https://doi.org/10.1001/jamainternmed.2017.1689

Soundaram, G. V., Sundaramurthy, R., Jeyashree, K., Ganesan, V., Arunagiri, R., & Charles, J. (2020). Impact of care bundle implementation on incidence of catheter-associated urinary tract infection: a comparative study in the intensive care units of a tertiary care teaching hospital in south India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(7), 544. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482344/

Research Critiques and PICOT Question Guidelines –

Final Draft

Qualitative and Quantitative Studies

Introduction

Introduce your nursing practice problem and discuss the purpose of your paper.
State your updated PICOT question incorporating any feedback that you received from your instructor. Research Critiques And PICOT Question Guidelines Discussion

Background of Studies

Summary of studies including problem, significance to nursing, purpose, objective, and research questions.

How Do These Four Articles Support the Nursing Practice Problem You Chose?

Discuss how the four articles will be used to answer your PICOT question.
Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

Method of Studies:

State the methods of the four articles you are comparing and describe how they are different.
State one benefit and one limitation of each method you have identified.

Results of Studies:

Summarize the key findings of each of the studies into a comprehensive summary.
What are the implications of the four studies you chose in nursing practice? Research Critiques And PICOT Question Guidelines Discussion

Ethical Considerations

Discuss two ethical considerations in conducting research.
Describe how the researchers in the four articles you choose took these ethical considerations into account while performing their research.

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Outcomes Comparison

What are the anticipated outcomes for your PICOT question?
How do the outcomes of the four articles you chose compare to your anticipated outcomes?

Proposed Evidence-Based Practice Change

What is the link between the PICOT question, the research articles, and the nursing practice problem you identified?
Based on this information, propose an evidence-based practice change for your identified setting.

Conclusion

Your conclusion should summarize the main points in the essay, including a varied restatement of the thesis Research Critiques And PICOT Question Guidelines Discussion