Research Critiques and PICOT Statement Final Draft .

PLEASE, ASSIGN THE SAME WRITER AS WAS IN ORDER#202888 Prepare this assignment as a 1,500-1,750 word paper using the guidelines below. PICOT Statement The final PICOT statement 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 Statement Final Draft . Research Critiques In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions.

ORDER A PLAGIARISM-FREE PAPER HERE

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement. Refer to \”Research Critique Guidelines.\” 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 statement, 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. Prepare this assignment according to the APA guidelines. An abstract is not required. PICOT Statement: For hospitalized adult Intensive care Unit (ICU) and Emergency Department (ED) patients (P), does use of the Central Venous Catheter (CVC) Insertion Bundle (I) compared with Insertions without use of the CVC Insertion Bundle (C) reduce the rate of central line-associated blood stream infections (O ) within 180 days of process improvement implementation (T)?

PICOT Statement

“For hospitalized adult Intensive care Unit (ICU) and Emergency Department (ED) patients (P), does use of the Central Venous Catheter (CVC) Insertion Bundle (I) compared with Insertions without use of the CVC Insertion Bundle (C) reduce the rate of central line-associated bloodstream infections (O ) within 180 days of process improvement implementation (T)?”

Research Critiques

Qualitative Study

Background of study

LeMaster et al. (2014) presented the results of a study that was conducted with the intention of identifying the specific barriers and enablers to the adoption of a central line bundle in the emergency department. This is based on the awareness that despite being preventable, central line-associated bloodstream infection (CLABSI) are still common in the emergency department where they cause avertable mortality and morbidity. CLABSI is identified as the leading cause of preventable mortality and morbidity in the emergency department reported in 0.16% of the cases that pass through the emergency department. The study identifies central line bundles as the combined use of safety teams, checklist implementation, chlorhexidine, washing hands, and barrier precautions to address CLABSI. The article further concedes that although medical organizations have reduced CLABSI incidences in their facilities through structured approaches, their efforts have achieved less desirable outcomes in the emergency department. This has been blamed on operational barriers that hinder the implementation of central line bundles in the emergency department. Some of the operational barriers include high patient volumes in the emergency department and high acuity, associated use of checklists, need for workflow redesign, and engaged medical personnel. The study was justified that to decrease CLABSI in the emergency department, there was a need to identify the specific barriers and enablers linked with central line bundle use in the emergency department as some of the factors that must be considered for central line bundles to be successfully implemented in the emergency department (LeMaster et al., 2014). In this respect, the study sought to improve central line bundles implementation in the emergency department to decrease CLABSI incidence.

Method of study

To identify the specific barriers and enablers linked with central line bundle use in the emergency department, the study applied a qualitative research approach. The approach included elements of grounded theory that recruited medical personnel employed in six emergency departments that applied central line bundles. The study recruited participants in two phases. The first phase comprised of 49 participants who include physicians, nurses, and administrators who were subjected to semi-structured interviews. The second phase entailed conducting three focus group discussion sessions that had between six and eight participants. The interviews and focus group discussions collected the participants’ opinions about their experiences using central line bundles in the emergency department. The transcripts from the interviews and focus group discussions were then subjected to thematic analysis that identified topic commonalities based on the information trends (LeMaster et al., 2014).

The qualitative approach applied in the study is considered appropriate. That is because it is based on grounded theory, an approach that examines new phenomena from an unknown position to a known position while creating a base for future research. By applying this approach, the study is able to use individual perceptions and experiences to generate theory that would guide future research activities. From this perspective, it is clear that the research is able to explore new themes as they emerge, something that would not have been possible if other research methods had been applied. Besides that, the use of semi-structured questions implies that the interaction with the participants did not rely on fixed set of questions. Instead, the questions could be considered as loose guidelines that allow for new themes to be explored in detail even as they emerged. Also, the approach ensured that the collected primary data could be linked to the secondary data collected from reviewing relevant past publications. Through applying a qualitative approach, the primary and secondary information were turned complementary so that the study easily transitioned from an unknown position towards a known position even as it developed new theories. The secondary information from the literature review already showed that applying central line bundles reduced CLABSI, although this was not true for the emergency department. Through identifying the enablers and barriers to central line bundles use in the emergency department, the study is able to present new theory on how best to reduce CLABSI in the emergency department using central line bundles.

Results of study

The study results were presented in terms of the themes that had been identified in the study. Firstly, it identified barriers to central line bundle adoption in the emergency department to include difficulty in infection surveillance and tracking compliance, ambiguity in roles, high acuity and volume in the emergency department, culture, space, staffing, and time constraints. Secondly, it identified the enablers for central line bundle adoption in the emergency department to include champions, infection and compliance surveillance data, empowerment of observers, clear personnel responsibilities and engagement, and workflow redesign. These results are important to emergency department personnel and administrators since it shows them the specific enablers that should be leveraged and barriers that should be addressed to effectively reduce CLABSI incidence to the desired levels in the emergency department. These results can be used as evidence to show that central line bundles can effectively be used in the emergency department to achieve results similar to those reported when bundles are used in other departments (LeMaster et al., 2014).

Ethical considerations

The study does not indicate whether there were any ethical considerations when the study was conducted. In fact, there is no mention about whether or not the participants provided informed consent to indicate their readiness to participate in the study. Despite the absence of tangible evidence to show that there were ethical considerations in the study, there is no evidence to show that ethics were not considered in the study. Firstly, the study recruited medical professionals whose participation was voluntary. This shows that although they did not provide informed consent, they could withdraw from the study whenever they felt like doing so to imply that a consent form was unnecessary. Secondly, the study proceeded after approval was received from the institutional review board. The approval from the board implies that the researchers had provided ample evidence to show that the participants would be protected from harm and their rights would be protected during the entire course of the study. Finally, the identity of the participants was protected since they were not identified in the article (LeMaster et al., 2014) Research Critiques and PICOT Statement Final Draft .

Conclusion

The article presents the results of a study to evaluate how central line bundles can best be applied in the emergency department to reduce CLABSI incidence. It concedes that although central line bundles have been effectively applied in other departments with positive results regarding CLABSI incidence control, the same cannot be said for the emergency department where their results have been limited. Applying a qualitative research approach that recruited participants from the emergency department, the article noted that there were barriers and enablers to the bundles adoption. The barriers include difficulty in infection surveillance and tracking compliance, ambiguity in roles, high acuity and volume in the emergency department, culture, space, staffing, and time constraints. The enablers include champions, infection and compliance surveillance data, empowerment of observers, clear personnel responsibilities and engagement, and workflow redesign. Based on the results, the recommendation is made that the barriers should be addressed and enablers leveraged to improve the results of central line bundle adoption in the emergency department Research Critiques and PICOT Statement Final Draft .

Quantitative Study

Background of study

Atilla et al. (2016) present the outcomes of a quantitative study carried out to determine the importance of care bundles with regards to reducing the incidence of central line-associated bloodstream infection (CLABSI) in the ICU. The study is conducted under the premise that care bundles are important for preventing CLABSI and CVC management in the ICU. This is based on the awareness that CVC use in the ICU is extensive, although it possess some unique mechanical and infectious risks that could have fatal consequences for the patients. Besides that, the study acknowledges that different approaches have been applied to address the risks to include education programs, surveillance studies, and feedback. It concedes that although these approaches have had limited benefits in reducing the CLABSI-associated risks linked with using CVC, care bundles offer an alternative approach for managing the risks that could complement the other approaches and improve outcomes. The underlying intention is to establish the value of care bundles in reducing the incidence of CLABSI in the ICU. In this respect, Atilla et al. (2016) explore the position that care bundles can play in the management of CVC within the ICU Research Critiques and PICOT Statement Final Draft .

Method of study

Atilla et al. (2016) apply a quantitative methodology that uses a case study approach to collect primary data. In this case, 114 patients using CVC were recruited from a medical (22-bed capacity) and surgical ICU (13-bed capacity). These participants were enrolled into the study between July 2013 and June 2014 and included those who had CLABSI is presented in active surveillance data. The study entailed applying a care bundle that comprised of optimal hand hygiene, 21% aqueous povidone-iodine or chlorhexidine (2%) (minus alcohol) for skin antisepsis before drying the skin, using a barrier precaution (such as drapes, mask, gown, and sterile gloves), choosing optimal insertion sites, removing the catheter promptly, and evaluating the need for CVC daily. Failing to observe any aspect of the care bundle was considered non-compliance. Catheter placement occurred using the femoral, jugular and subclavian routes. Application of the care bundle was supervised by an Infection Control Committee nursing member during the daytime and the clinical nurse during the night who also evaluated for complications and infection. The bundles were supported by regular education programs for the ICU medical personnel. Data from the study was then collected over three periods designated as the prior period, intervention period and post-intervention period. The CLABSI rate was computed as follows: ((CLABSI incidences/ central line days)*100). The CVC duration was computed as: (central line days/ patient days). Once the quantitative data was collected, statistical analysis was conducted using SPSS software version 18 with focus on mean, standard deviation, median, and frequency. Normally distributed data was evaluated using Shapiro-Wilk test while Mann-Whitney U test was used to evaluate non-normally distributed data with chi-square used to compare frequencies. P-value less than 0.05 was considered significant. The data focus was on evaluating CLABSI rates (Atilla et al., 2016).

The methodology applied in Atilla et al. (2016) can be considered appropriate. That is because it allowed the research to collect the required data from a large number of participants and subject it to the right statistical analysis that highlighted the important aspects of the collected information. It allowed the study to apply the care bundle while determining its effects in terms of CLABSI incidence. Also, mentioning the data analysis software used and its version improves research replication efforts. Besides offering the required data, the comprehensive methodology facilitates efforts to replicate the study. Still, there are concerns about researcher bias, particularly when it is considered that there is no mention about whether or not an independent third party was involved in conducting independent verification of the methodology.

Results of study

The data analysis for Atilla et al. (2016) was conducted for 114 patients with CVC of which 60 of them were male while the remaining 54 were female. The mean age of the participants was 67 years with a standard deviation of 21.3 years. The study determined that for the patients with CLABSI, catheterization occurred for longer period and CVC was more frequently applied using femoral access. In addition, applying the care bundle reduced CLABSI incidence. In the medical ICU, CLABSI rate was reported as 6.2 for every 1,000 catheter days for the prior period, reducing to 3.88 for every 1,000 catheter days for the intervention period, and 1.05 for every 1,000 catheter days for the post-intervention period. In the surgical ICU, CLABSI rate was reported as 8.27 for every 1,000 catheter days for the prior period, reducing to 4.6 for every 1,000 catheter days for the intervention period, and 3.73 for every 1,000 catheter days for the post-intervention period. Overall, the results make it clear that the care bundle is effectively reduced CLABSI incidence in the ICU. These results are valuable for CVC management in the ICU since they present an effective strategy for reducing CLABSI rates. The study concludes with the recommendation that effective care bundles for CVC management should include options choice of catheter insertion site, using barrier precaution, and removing the catheter when it is no longer needed (Atilla et al., 2016).

Ethical considerations

Research approval for the study presented in Atilla et al. (2016) was sought from an Institutional Review Board (IRB) before the research could proceed. Still, there is no evidence to show that informed consent was sought from the human participants before they were included in the study. The methodology section indicates that primary data for the study was collected from active surveillance data after seeking approval and receiving written consent from the Council of Planning of Training and Coordination for the medical facility. The implication is that researchers presented evidence that they would conduct the study in an ethical manner while protecting the participants since any indication that the human participants would be harmed would have resulted in the council not providing approval for the study to proceed. In essence, the approval indicates that the council had determined that the human subjects would be protected from either intentional or unintentional harm (Atilla et al., 2016) Research Critiques and PICOT Statement Final Draft .

Conclusion

Atilla et al. (2016) evaluate the value of care bundles being applied in the ICU with regards to reducing CLABSI incidence for patients using CVC. Applying a quantitative methodology, the study recruited 114 participants who were then subjected to the care bundle. The results of the study noted reduced CLABSI incidence when the bundle was used resulting in the recommendation that effective care bundles for CVC management should include options choice of catheter insertion site, using barrier precaution, and removing the catheter when it is no longer needed Research Critiques and PICOT Statement Final Draft .