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Research Critiques and PICOT Statement Final Draft

Research Critiques and PICOT Statement Final Draft

Sample Answer 

Research Critiques and PICOT Statement Final Draft

Background

The spread of nosocomial infections (sometimes called hospital-acquired infections) is one of the major clinical issues in healthcare practice. In particular, several researchers have attempted to examine better ways of reducing the spread of methicillin-resistant staphylococcus aureus (MRSA), which is a unique form of S. aureus characterized by resistance to multiple antibacterial drugs. The application of contact precautionary measures in hospitals when dealing with individuals infected with MRSA is viewed by most health experts and facilities as a standard preventive practice, including the CDC. Thus, McKinnell et al.’s (2017) study objective was to investigate hospital policy change from contact isolation to chlorhexidine bathing for MRSA infection control. The research question that the research specifically aims to address is “whether or not the discontinuation/termination of use of contact safety measures for MRSA after the commencement of worldwide chlorhexidine bathing as a standard does affect the rate of MRSA infections in hospitals?” The researchers believe the findings of this investigation are more likely to impact positively the way healthcare practitioners address the spread of MRSA from patient to patient during hospitalization.

Whereas other studies have negatively criticized the use of contact isolation in an acute care setting to minimize the transfer of hospital-acquired pathogens (especially MRSA) from one patient to another, its use is still considered standard practice worldwide, including the CDC. Unlike in acute care settings, the problem is that very little is known about the efficiency and success of contact isolation in reducing MRSA transmissions in long-term care settings. Unlike McKinnell et al., Morgan et al.’s (2017) research explores whether or not contact isolation safety measures or precautions can reduce MRSA acquisition by patients admitted in long-term care institutions/facilities. Therefore, the research specifically aims to address the question, “Does contact isolation precautions reduce MRSA acquisition in long-term care facilities?” According to the experts, the outcomes of this study have critical implications for the healthcare practice. Specifically, it might inform whether contact isolation is effective in preventing MRSA transmission in long-term care settings, such as restorative, rehabilitative, and nursing homes.

Schmidt et al.’s (2020) research’s intention is to address the spread of multidrug-resistant pathogenic microorganisms because of frequent hospitalization – a phenomenon that is increasingly becoming common among kids with life-limiting pre-existing conditions. Besides increased hospital stays, the incidences of drug resistance among children are also on the rise because of immunosuppression, the use of more specialized equipment (such as a central nervous catheter), and numerous antibiotic therapies. Standard hygiene protocols require the isolation of children that get infected with multidrug-resistant microorganisms. However, the isolation of these patients in pediatric care settings negatively impacts the participation of kids and healthcare workers in the exercise. Therefore, the objective or aim of this research was to investigate the opinions and attitudes of nurses towards PALLINI, which is a hygiene model for individuals infected with MR pathogens. The research question being addressed is, “what is the viewpoint of nurses regarding multidrug-resistant pathogens in the healthcare system?” In general, by identifying the reception and perception of nurses towards PALLINI, stakeholders can identify and implement the best hygiene concept that can help reduce the stigmatization associated with the isolation of children diagnosed with multi-drug resistance.

On the other hand, Albrecht et al.’s (2017) study’s intent is to understand the impact of glove and gowns on the prevention of MRSA in healthcare nursing homes. The aim/objective is to determine the present application and viewpoints associated with gown and glove use in these nursing home care settings. The research question that researchers sought to address was, “what value do the residents, administrators, and staff assign to gloves and gowns for MRSA acquisition control?” The outcomes of this research will play a significant part in informing a strategy that nurses and other healthcare workers might employ to minimize the transmission of MRSA in nursing homes and other long-term care facilities.

How the Articles Support the Practice Issue Selected

The PICOT question being addressed is “in patients with MRSA infections (P), how do contact isolation precautions (I) compared to hand hygiene(C) affect the prevention of healthcare-associated infections (O) during a one-month hospital stay (T).” In simple terms, the study aims to compare how contact isolation compares to hand/body hygiene in preventing the spread of hospital-acquired illnesses, especially MRSA, a strain of bacterial pathogens that have developed resistance to various antibacterial drugs.

Therefore, all the articles support the problem of MRSA transmission in hospitals differently. For example, McKinnell et al.’s (2017) research will provide answers as to whether or not the discontinuation of contact precautions for MRSA after the introduction of universal chlorhexidine bathing does affect the rate of MRSA infections in hospitals. The study seeks to evaluate the difference in efficiencies between contact isolation and chlorhexidine bathing. On the other hand, Morgan et al. (2017) try to assess whether or not the discontinuation/termination of the use of contact safety measures for MRSA after the commencement of worldwide chlorhexidine bathing as a standard does affect the rate of MRSA infections in hospitals.

Schmidt et al.’s (2020) research examined how the PALLINI tool might help nurses attend to young patients colonized with MRSA by alleviating the negative perceptions that often impact the delivery of care. On the other hand, Albrecht et al.’s (2017) explored the current perceptions and uses of gowns and gloves in preventing the spread of MRSA in nursing homes. The precautionary measures highlighted in this research are part of the contact isolation protocols in the healthcare plan stipulated in the PICOT question. In the PICOT question, the comparison is between the contact isolation group and the hand hygiene group –how they relate in terms of reducing the spread of hospital-acquired infections such as MRSA. Schmidt et al.’s (2020) study participants represent the intervention group (contact isolation), while Albrecht et al.’s (2017) research participants represent the control group (hand hygiene). Based on the PICOT question, the objective is to investigate how ‘contact isolation,’ as a precautionary measure, compares to hand hygiene in lowering the spread of hospital-acquired illnesses, especially methicillin-resistant Staphylococcus aureus during a hospital stay.  

Method of Study

McKinnell et al. (2017) applied a comparative experimental study design to compare the impacts of chlorhexidine bathing and contact isolation. The researchers identified a total of 453 ICU patients in TMMC (Torrance Memorial Medical Center) in Torrance, California. Surveillance of MRSA was done upon admission and release of patients, with MRSA acquisition being defined by the presence of clinical cultures after about 72 hours. All the patients were monitored for MRSA, based on the present guidelines of the National Healthcare Safety Network. Similarly, Morgan et al. (2017) applied a comparative study approach to examine whether contact isolation reduced MRSA acquisition in long-term care centers compared to standard precautions. The investigators conducted retrospective effectiveness research (using concurrent and pre-post controls). They utilized data retrieved from the VA care database, which was collected exactly two years following a legislative recommendation by the federal government for the introduction of more aggressive use of contact precautionary measures in healthcare facilities.

The comparative study design model (experimental) used in both articles has its fair share of advantages and setbacks. One benefit of using the comparative method in research is that it allows researchers to falsify or verify whether there is a significant relationship between two or more phenomena. This is very important in experimental research because researchers can make deductive decisions from their findings. For example, in this case, McKinnell et al. (2017) are able to compare contact isolation and chlorhexidine bathing. Their results will likely inform the nursing practice by recommending the most effective method among the two. However, one of the drawbacks of comparative study models is that it is impossible or impractical to compare phenomena when data is insufficient.

Schmidt et al. (2020) used a semi-structured interview methodology to collect their qualitative data. In particular, they mixed a structured qualitative content analytical approach and guideline-oriented interviews (open and topic-based data collection). The researchers purposefully sampled nurses working in a pediatric palliative care department, with eligibility being that they should have been working for at least three months at the palliative care unit. Participants were first required to recount their understanding and experiences working with the PALLINI concept before open-ended questions were used to inquire about their exact interactions with the model. On the other hand, Albrecht et al. (2017) used the focus group methodology – including five with the residents, one with administrators, and three with staff members – to collect information about the present perceptions and application of gown and gloves in nursing home care. All the focus groups were identified from three nursing homes in Maryland.

There are certain advantages and disadvantages associated with the techniques applied above. For example, the benefit of Schmidt et al.’s (2020) semi-structured interview methodology is that it offers flexibility to the respondents and, thus, the interviewer can collect better responses compared to things like questionnaires. There is also the advantage of the interviewer being able to read and record the mood and feelings of the respondents. But, conducting interviews is time-consuming and requires a lot of financial investment. Besides, interviews are sometimes prone to bias, with respondents sometimes likely to answer questions based on the interviewer’s age, class, race, reaction, as well as physical appearance. On the other hand, the benefit of Albrecht et al.’s (2017) focus group approach is that it is less time-consuming and cheaper because large groups of participants are interviewed at once compared to interviews that require interviewing each participant separately. Similar to the interview technique, focus groups also face the challenge of moderator bias – who might inadvertently or intentionally introduce personal preferences and biases into discussions.

Results of Study

McKinnell et al. (2017) found no significant evidence that suggests that discontinuing the contact isolation procedure with chlorhexidine bathing increased rates of MRSA infections. In addition, the researchers reported that chlorhexidine resulted in fewer contact precaution days (about 58 percent) compared to contact isolation, meaning that it is a more effective approach in stopping MRSA transmission. There was, though, no statistical evidence to show a significant difference between time schedules. Therefore, the researchers recommend applying chlorhexidine bathing instead of contact isolation precautions because it is equally effective in infection control and reduces cost.

On the other hand, Morgan et al. (2017) found that proactive surveillance and contact precautions did not affect the rate of MRSA acquisition in the long-term care setting. For the 74 long-term healthcare institutions surveyed (and a total of 75,414 patients admitted across Virginia, the general incidence of nosocomial infection acquisition was about 2.6 percent per 1000 patient days. Therefore, the researchers recommend that interventions should focus on high-risk patients and activities in acute settings to reduce MRSA acquisitions rather than long-term care facilities.

Schmidt et al. (2020) identified four different classes of nurses’ opinions and attitudes towards PALLINI, including participation, quality of care, effort, and safety. The results showed that the nurses were ambivalent about PALLINI in all four categories. Specifically, ambivalence or uncertainty stemmed from noncompliance by the family members versus guaranteeing infection control. Also, indecision arose from the impaired relationship existing between nurses and parents of the children vs. delivering better healthcare to the youngsters as well as extra work for children with MRSA pathogens vs. the absence of sufficient resources. In spite of the ambivalence, nurses highlighted the essence of organizing routine activities for the patients they are required to take care of, allowing them to experience the highest level of social participation as possible.

Lastly, Albrecht et al. (2017) indicated employing gloves and gowns principally as self-protective gear against getting in touch with bodily fluids from patients as opposed to preventing the transmission of MRSA. In addition, the researchers described glove use as a more acceptable and common practice among staff members than gown use. Both administrators and staff members expressed a readiness to use gloves and gowns for care activities classified as high-risk. Finally, the researchers identified a knowledge gap about MRSA infection and transmission among residents and direct staff employees.

Ethical Considerations

The two important considerations that researchers must observe when conducting research is the aspect of informed consent as well as getting approval from a review board. In accordance with these rules, Schmidt et al. (2020) obtained written consent from all participants after thoroughly explaining to each member of the method and purpose of the research. The researchers also made sure that participation was voluntary. On the other hand, Albrecht et al. (2017) sought the consent of each participant verbally. The researchers also made sure that their study received approval from the University of Maryland’s Institutional Review Board.

Because the two studies dealt with human subjects and patient information, the researchers followed several ethical considerations, including seeking informed consent of the participants before recruitment, seeking the permission of Institutional Review Boards before commissioning the study events, and ensuring that all participants understood the procedures, risks, and benefits of the studies.

Outcomes Comparison

The PICOT question being addressed is “in patients with MRSA infections (P), how do contact isolation precautions (I) compared to hand hygiene(C) affect the prevention of healthcare-associated infections (O) during a one-month hospital stay (T).” Thus, based on the PICOT question, contact isolation is expected to be the most effective method of preventing the spread of MRSA compared to hand hygiene.

The results of the four studies compare differently to the PICOT question’s anticipated outcomes, with others supporting its hypothesis and others rejecting it. For example, McKinnell et al.’s (2017) study contradicted the PICOT question’s anticipated results by demonstrating that the application of chlorhexidine bathing was more effective than contact isolation in controlling MRSA infections as well as reducing the resultant costs. Similarly, Morgan et al.’s (2017) research found that proactive surveillance and contact precautions did not affect the rate of MRSA acquisition in the long-term care setting, meaning that hand hygiene is the more effective option. However, Schmidt et al.’s (2020) study supported the PICOT question’s anticipated outcomes by proving that contact isolation can lower the spread of MRSA. The nurse participants highlighted the essence of organizing routine activities for the patients they are required to take care of, allowing them to experience the highest level of social participation possible. Similarly, Albrecht et al. (2017) showed that employing gloves and gowns principally as self-protective gear against getting in touch with bodily fluids from patients was a more effective means of preventing the transmission of MRSA.

References

Albrecht, J. S., Croft, L., Morgan, D. J., & Roghmann, M. (2017). Perceptions of gown and glove to prevent methicillin-resistant Staphylococcus aureus transmission in nursing homes. JAMDA, 18, 158-161.

McKinnell, J. A., Eells, S. J., Clark, E., Rand, D. D., Kiet, G. T., Macias-Gil, R., … & Miller, L. G. (2017). Discontinuation of contact precautions with the introduction of universal daily chlorhexidine bathing. Epidemiology & Infection145(12), 2575-2581. DOI: 10.1017/S0950268817001121

Morgan, D. J., Zhan, M., Goto, M., Franciscus, C., Alexander, B., Vaughan-Sarrazin, M., & Pineles, L. (2019). The Effectiveness of Contact Precautions on Methicillin-Resistant Staphylococcus aureus in Long-term Care Across the United States. Clinical Infectious Diseases, XX(XX):1–8. DOI: 10.1093/cid/ciz1045

Schmidt, P., Hartenstein-Pinter, A., Wager, J., Hasan, C., & Zernikow, B. (2020). Addressing multidrug-resistant pathogens in pediatric palliative care patients – the nurses’ point of view. Palliative Medicine, 34(3), 249-357.

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Question 


Research Critiques and PICOT Statement Final Draft

Prepare this assignment as a 1,500-1,750 word paper using the instructor’s feedback from the previous course assignments and the guidelines below.

Research Critiques and PICOT Statement Final Draft

Research Critiques and PICOT Statement Final Draft

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 Draft.” Questions 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 explanations and use that information to propose evidence-based practice changes.

General Requirements

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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. Refer to the LopesWrite Technical Support articles for assistance.

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