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Health Care Associated Infections Research Paper

Health Care Associated Infections Research Paper

Health Care Associated Infections Research Paper

Health Care Associated Infections Research Paper

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the “Research Critique Guidelines – Part 1” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses. Health Care Associated Infections Research Paper

Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.


Prepare this assignment according to the 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. NRS 433 GCU Health Care Associated Infections Research Paper


Health Care Associated Infections Research Paper. Research Critique Guidelines – Part I Use this document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the studies in your responses. Qualitative Studies Background of Study 1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question. How do these two articles support the nurse practice issue you chose? 1. Discuss how these two articles will be used to answer your PICOT question. 2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question. Method of Study: 1. State the methods of the two articles you are comparing and describe how they are different. 2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method. Results of Study 1. Summarize the key findings of each study in one or two comprehensive paragraphs. 2. What are the implications of the two studies in nursing practice? Ethical Considerations 1. Discuss two ethical consideration in conducting research. 2. Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research. © 2019. Grand Canyon University. All Rights Reserved. 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).NRS 433 GCU Health Care Associated Infections Research Paper
Health Care Associated Infections Research Paper. 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 improve adherence to a daily CHG bathing protocol. Background Healthcare-associated infections (HAIs) lead to increased morbidity, mortality and medical costs [1–3]. In the United States alone, about 722,000 people get an HAI every year and 75,000 people with HAIs die [2]. * Correspondence: ns2@medicine.wisc.edu 1 William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI, USA 3 Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA Full list of author information is available at the end of the article Zimlichman et al., considering only the five major HAIs, estimated that HAIs cost the United States healthcare system $9.8 billion annually [1]. Daily bathing with chlorhexidine gluconate (CHG) for intensive care unit (ICU) patients has been shown to reduce healthcare-associated bloodstream infections (BSIs) [4–11] and colonization by multidrug resistant organisms (MDROs) [5, 6, 10]. A lot of evidence about interventions to reduce HAIs has been generated in recent years. However, there is still a substantial gap between evidence and practice in the field of HAI prevention in general [12]. Therefore, in © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.NRS 433 GCU Health Care Associated Infections Research Paper
Health Care Associated Infections Research Paper. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Musuuza et al. BMC Infectious Diseases (2017) 17:75 order to reduce the health and economic burden of HAIs, there is urgent need for the translation and sustainability of proven efficacious interventions into healthcare practice. Implementation research is critically needed to facilitate translation of evidence into practice [13], and this research has not been done for daily CHG bathing. For an efficacious intervention such as CHG bathing, it is important to understand all the factors that can influence its successful adoption and sustainability. Sustainability generally refers to the continuation of an intervention or its effects [14, 15]. It is an essential consideration in HAI prevention interventions in order to maintain the initial momentum that occurs when the intervention first gets implemented. The long-term viability of an HAI prevention intervention is important because the hospital leadership will allocate scarce resources to efficacious and successful interventions [15, 16]. Crucial factors that influence sustainability of health care interventions include 1) factors in the broader environment; 2) those within the organizational setting; and 3) project design and implementation factors [14]. Sustainability of an intervention can be assessed in various ways such as 1) examining whether its pertinent activities and resources continue to support its primary objectives [17]; 2) examining whether there is continuation of its implementation strategy [18]; and 3) examining whether it is accepted in the institution particularly by those who actually carry it out [19, 20]. Since daily CHG bathing is a nursing task, understanding nursing staff’s perspectives and experiences with CHG bathing is key to understanding the factors that impact its sustainability. As part of a quality improvement project to assess compliance to daily CHG bathing, we conducted direct observations of the bathing process, gathered data on CHG usage, and examined electronic medical records (EMR) for documentation of CHG bathing. After observing lower than expected compliance to daily CHG bathing (results not shown in this paper), we embarked on a qualitative inquiry to find out factors that might explain results from this prior project. The objective of this project was to describe the process of daily CHG bathing in the ICU of a Veterans hospital from the perspective of nursing staff, and identify factors that impact its adoption and sustainability. In addition, we specifically asked about participants’ views about adding daily CHG bathing to the patient’s order set as an intervention to improve compliance to CHG bathing by nurses. Methods Overview and design of the project Setting and participants This study was conducted in the ICU of a 129-bed Veterans Hospital (VA) in Wisconsin, USA. This hospital Page 2 of 11 provides tertiary medical, surgical, neurological, and psychiatric care, and a full range of outpatient services. At the time of this project, it had two ICUs—the medicalsurgical ICU with 7 beds and the cardiac ICU with 6 beds. This VA facility implemented daily CHG bathing in the ICUs in May of 2014 and uses Hibiclens® soap (Hibiclens® 4%). Training on CHG bathing was provided during four weekly staff meetings one month prior to switching from regular soap to CHG soap.NRS 433 GCU Health Care Associated Infections Research Paper
Health Care Associated Infections Research Paper. During training, staff were informed about the steps involved in the process of CHG bathing and situations when CHG bathing would be contraindicated. Staff were also provided with written material covering various topics about CHG bathing and CHG frequently asked questions. The bathing process involved several steps starting from gathering the needed supplies to application of a lotion to keep the patients skin moisturized after the bath. Staff were required to document completion of the bath in the EMR. Participants in this project included nurse managers (NMs), registered nurses (RNs) and health care technicians (HCTs) or certified nursing assistants (CNAs) working in the ICU. In this paper we use the term HCTs rather than CNAs, and also, for clarity, RNs and HCTs are referred to as nursing staff. Study procedures and data collection Nurse Managers introduced the first author to the unit and granted him permission to access the unit. The aims of the project were presented to the staff who were invited to participate. Interviews were scheduled with all willing nursing staff. We used an interview guide (appendix) and conducted semi-structured interviews in a quiet room on the unit. Questions in the interview guide were broadly framed using the Systems Engineering Initiative for Patient Safety (SEIPS) model as the main framework. The SEIPS model is a sociotechnical systems approach that can be used to effectively address contextual factors necessary for the successful design and implementation of an intervention [21, 22]. It focuses on five interacting elements of the work system— person, tasks, tools and technologies, physical environment, and organizational factors. Interactions of these elements can affect care processes (e.g. patient bathing), which result in patient outcomes such as quality of care and patient safety, and organizational outcomes such as efficiency and acceptance of interventions. The five work system elements served as topics in the interview guide. This enabled us to ask about who was involved [Person]; what they did [Tasks]; the kind of tools/technologies they used [Tools/ technologies]; issues related to patient rooms and the unit in general [Environment]; and organizational factors, for example leadership that influences the CHG Musuuza et al. BMC Infectious Diseases (2017) 17:75 bathing process [Organization]. Examples of questions (related to organization) were: 1) “How do you communicate with the other nursing staff that a chlorhexidine bath for a given patient was done?” and 2) “Please tell me what you know about the chlorhexidine bathing policy.” The SEIPS model was appropriate for this project because it informs contextual factors that impact implementation and sustainability of interventions [21]. Based on our previous work examining CHG bathing practices in this hospital, we hypothesized that an intervention that involved adding daily CHG bathing to the patient’s order set might increase compliance to CHG bathing. Consequently, we specifically asked participants for their views about such an intervention. Convenience sampling was used for the recruitment of participants; almost all the nursing staff on the units willingly participated in the interviews.NRS 433 GCU Health Care Associated Infections Research Paper
Health Care Associated Infections Research Paper. We mostly conducted individual interviews, but on four occasions nursing staff were interviewed in groups of 2–3, particularly at times when the unit was not very busy. A total of 26 individuals were interviewed: 4 NMs, 13 RNs and 9 HCTs. Four interviews occurred in groups as follows: 3 RNs; 2 HCTs; 1 HCT and 1 RN; and 2 RNs. The duration of the interviews ranged from 15 to 39 min, with group interviews taking slightly longer time than individual interviews. The interviewer (JSM) regularly met with two co-authors (TR and NS) to discuss progress of the interviews. During these meetings the authors analyzed emerging themes and brainstormed about interview questions that would capture best the depth of these themes. We asked probing questions to expand on participants’ responses and to increase on the depth of the interviews. An example of a probe used was: “You mentioned that you are motivated to conduct CHG baths because CHG bathing is hospital policy, tell me more about that.” Ethical considerations The University of Wisconsin Minimal Risk Institutional Review Board exempted this project as it was qualified as quality improvement. All participants were informed about the purpose of the project and voluntarily participated. We obtained permission to audio record interviews; participants were assured that their responses would be kept confidential and that they would not be identified individually in any reports or publications. Those who agreed to participate signed a document indicating their agreement to voluntary participation. Data analysis Professionals from a registered transcription company transcribed all interviews verbatim. We used qualitative content analysis to code and analyze the data [23, 24]. To start, the first author read the transcripts several times to get familiar with the data and noted down initial ideas. This was Page 3 of 11 followed by line-by-line coding in which the text was divided into meaningful units (words, phrases, sentences, or sections), which were labeled with relevant codes. We coded for patterns within the data, including frequency (how often concepts appeared), sequence (the order in which they appeared), correspondence (how they occurred in relation to certain activities), similarity (whether the concepts were happening the same way), difference (how different they were) and causation (if they appeared to lead to another) [25]. The first author regularly met with the co-author (TR) to review the coding process. The next step was to collect related sub-categories into categories or themes. Defining each category or theme and its specifics was an ongoing process. To organize, sort, and code the data, interviews were imported into Dedoose, Version 6.1.18. Los Angeles, CA [26]. Rigor of data analysis Two authors (JSM and TR) met regularly to review and discuss the coding process. Lack of clarity on how to code a certain section of the data was resolved through a discussion until consensus was reached. To further ensure trustworthiness of the interview data analysis and, therefore, scientific integrity, we conducted member checks. We returned a summary of our interview findings to a small number of participants to confirm that we were correctly representing their perspectives. NRS 433 GCU Health Care Associated Infections Research Paper
Health Care Associated Infections Research Paper. We kept an audit trail of all the decisions made during the iterative process of collecting and analyzing data [27, 28]. Results We identified five steps of bathing described by participants: 1) decision to give a bath; 2) ability to give a bath; 3) get assistance to do a bath; 4) delegation of a bath; and 5) decision about which soap to use. The bathing process resulted in one of the following three outcomes: 1) complete bath; 2) interrupted bath; and 3) bath not done. Interactions between the five bathing steps and the resulting three CHG bathing outcomes are summarized in Fig. 1. Generally, participants did not make a distinction between CHG bathing as an infection prevention procedure and CHG being another kind of soap that could be used for patient bathing. Therefore, choosing to use CHG soap was just one of the steps involved in patient bathing. Verbatim illustrative quotations from the interviews (Q) within the five bathing steps are presented in Table 1 (online Additional file 1: Table S1). Decision to give a bath The first step in the CHG bathing process was deciding to give a bath. This step was influenced by the purpose of, and the priority for giving a bath. Participants Musuuza et al. BMC Infectious Diseases (2017) 17:75 Page 4 of 11 Fig. 1 Interrelationships between different conditions needed for completion of a chlorhexidine bath. Legend: the direction of the arrows means that factor (s) in the text box from which the arrow starts influence factors in the box into which the arrow points. Bolded text indicates the five steps of patient bathing described a number of reasons why bathing was important. They believed bathing was a fundamental nursing job duty that primarily provided patients with comfort and attended to patient personal hygiene and dignity. In addition, bathing served a functional purpose for nurses; it provided them an opportunity to perform thorough skin assessments, prompting identification of actual and potential skin issues. Participants also described in some cases that bathing was important for infection prevention (Q1). The priority for a bath was related to its purpose and its fit with other patient needs, timing, and organization of activities on the unit. Because bathing was perceived as a comfort measure amidst the many other activities nursing staff carry out, giving a bath was a low-priority activity (Q2). Patient acuity influenced the level of nursing care required, which in turn influenced the nursing staff ’s decision to carry out a bath. If a patient had other urgent needs, then a bath was delayed. Examples of these needs included preparation for tests or procedures, need for critical, important or time-sensitive medications, and continual or frequent monitoring of hemodynamic stability. In some cases, patients were described as clinically unstable during the bath and some refused baths midway, particularly when they were taking long. In these cases, baths would get interrupted before completion. Furthermore, a number of potentially competing patient needs made bathing a lower priority, such as activities of daily living and the need for ambulation (Q3). The decision to give a bath was also influenced by how long a patient had been on the unit and how often they had received baths during their stay. Patients who had stayed longer on the unit before getting a bath would receive baths before those who had Musuuza et al. BMC Infectious Diseases (2017) 17:75 Page 5 of 11 Table 1 Patterns coded within the data and examples of associated quotations and codes Pattern within the data Notes and quotations Code (s) Frequency This relates to how often concepts appeared in the data. As an example, the code “perception about CHG soap” had the highest frequency, being coded 46 times in all the interviews combined. Therefore, frequency was one way that informed the discussion and conclusions about the importance or significance of perceptions about CHG. Below are examples of quotations associated with this code: Quotation 1: “Yeah, I mean it gives you justification for why you are doing it because sometimes it is nice to say this is why we do it not just you have got to do it. I think people understand why and the importance there and do it more.” Quotation 2: “Because I think it, I just don’t think it’s, I look more from a skin standpoint and how it’s affecting the …NRS 433 GCU Health Care Associated Infections Research Paper
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