Research Critiques and PICOT Statement Final Draft

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 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 explanation 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.

ANSWER

PICOT Question Final Draft

Nursing Practice Problem

Hospital-acquired infections are contaminations that are acquired in the hospital during or after surgery.  Hospital-acquired infections are a global problem and especially among elderly patients who have a lower immune system. The adult population between the ages of 45 to 75 years is at higher risk of acquiring infections during treatment after surgery.  This is a nursing problem as nurses are required to practice hygiene as they care for the patients. Therefore, nurses must practice hygiene when dealing with patients to prevent hospital-acquired infection and reduce the rate of readmission.

PICOT QUESTION: do hand hygiene protocols compared to gloves reduce health-acquired infections among elderly patients after knee replacement surgery?

Summary Qualitative and Quantitative Analysis

It is important in clinical practice to reduce the number of readmission following hospital-acquired infections. The number of readmissions following infections among elderly patients after knee replacement has gone high. Therefore, nurses need to ensure they practice hand hygiene when tending to the wounds, especially those of elderly patients after surgery. Hospital-acquired infections lead to longer hospital stays, leading to the patient spending a lot of time and money in the hospital. It is therefore important that evidence-based interventions are developed to reduce the number of readmissions from hospital-acquired infections.

Hospital re-admission following a knee replacement surgery affects affect adult patients between the ages of 45 to 80. In every ten surgical operations, three re-admissions were likely to be reported during my clinical practice (Lasater & McHugh, 2016). The postoperative infection causes poor wound healing, elongates hospital stays, requires additional interventions such as treatment with antibiotics, increases healthcare costs, and leads to reduction of reimbursements. Moreover, infections after surgery cause surgical complications, for instance, organ failure, sepsis, and death. Therefore, the problem is of concern to the entire hospital. Also, the problem is significant to nursing practice. Postoperative readmission rates are a measure of quality; hence, more readmission is a threat to the quality of care provided, which may affect reimbursement of the hospital and the care staff. Conversely, reducing postoperative readmission brings many benefits such as reduced care cost, improved quality, high success rates of surgery, better wound healing, and elimination of complications. How can nurses utilize hand hygiene to prevent hospital-acquired infections and reduce the number of readmissions among elderly patients after knee replacement?

Generally, all studies have been used to answer the picot question. Ghaffari et al. (2020) have presented the determinants of hand hygiene and how they rate Hospital-acquired infections, while Chatfield et al. (2016) has focused on the nurses’ experiences to offer knowledge on hand hygiene interventions. The comparison group consists of nurses within different healthcare settings. The hand hygiene intervention discussed in both studies and the PICOT question focuses on nurses who have been used to examine the importance of handwashing and sanitization to prevent the spread of infections. Considerably, compliance with the hand hygiene procedures and guidelines is essential in controlling and preventing hospital-associated infections. Lasater & McHugh (2016) focused on creating a conducive environment for nurses to provide quality care. The hospital environment should be stocked with the required hand hygiene equipment such as clean water and soap.

Method of Study

Ghaffari et al. (2020) conducted a qualitative study through a content analysis tactic. The study relied on 16-in-depth semi-structured interviews with the nursing workforce of Shariati Hospital of Tehran University of Medical sciences. Convenient sampling was conducted, and all interviews were conducted for 25-35 minutes in a private context. The data was subsequently evaluated through a directed qualitative content study based on the landsman and Graham method. Chatfield et al. (2016) also conducted a qualitative study with eight nurses employed in different patient care roles. The study relied on an interpretative phenomenological analysis method to examine how the nurses describe their lived familiarities with hand hygiene. The mean time for the interviews was around 56 minutes. The interviews were audio-recorded and transcribed before data analysis.

Semi-structured interviews are essential for open-ended responses from participants to acquire more in-depth information. The method allows the researchers to obtain open-ended data to explore feelings, thoughts, and beliefs about a certain topic. However, the limitation of a semi-structured interview is that it’s non-standardized since the respondents may be asked different questions. On the other hand, in-depth interviews are used to obtain a rich and more detailed understanding of the topic of interest. They allow the respondents to share their experiences and opinions without bias from other respondents.  However, the respondent can give misleading and limited answers, and the data cannot be generalized. Therefore, in-depth interviews are better compared to Semi-structured interviews. The interviewer has a list of topic questions in an in-depth interview and is more focused than the wide-ranging and general semi-structured.  They allow the respondents to communicate more freely and offer detailed descriptions as compared to the semi-structured interviews.

Lasater & McHugh (2016) used a quantitative method of study where they used previous data collected on the rates of admissions depending on the environment of the nurses. The study involved data collected from Medicare patients who had previously been readmitted after a knee replacement surgery. The data collected concluded that readmissions are connected to nursing and the environments created for the nurses. Consequently, Rutala et al (2017) conducted quantitative analysis on the microbial burden and contaminated environmental surfaces involved in transmitting diseases in hospitals. Both authors used samples acquired from the hospitals. Rutala et al (2017) acquired samples from highly touched hospital surfaces.

Results of study

Chatfield et al. (2016) identified three super-ordinate themes: risky business, practical hygiene, and hygiene on trial. According to the participants, practical hygiene was obtained through water and soap, primarily through soap and sanitizer. The nurses described the work environment as a generally risky business due to a contaminated environment, which leads to hygiene challenges. In addition, the nurses described their understanding of rules and personal familiarity with hand hygiene. Regarding hygiene on trial, most nurses argued that 100% adherence to hand hygiene was unrealistic due to the conditions such as high workloads and low staff.

Ghaffari et al. (2020) revealed three major themes: attitude, perceived behavioral control, and subjective norms. Eight other themes were linked to hand hygiene: education, personality, environment, perceptions, salience, and organizational culture. Ghaffari et al., (2020) found out that all participants have a positive attitude towards hand hygiene. The participants mentioned that peer effect, doctor’s belief, and supervisors’ attention to hand washing are effective factors. Awareness and education are among the themes that promote hand hygiene behavior. The organizational culture, personality, and lifestyle have played a major role in hand washing.

Rutala et al (2017) & Lasater & McHugh (2016) collected samples from the hospitals, and both compared the environmental factors leading to the high rates of readmissions from hospital-acquired infections.

The studies have acknowledged the significance of hand hygiene as an intervention that might encourage the reduction of Hospital-acquired infections. Hand hygiene is a great way of preventing infections since nurses must clean their hands to prevent the spread of hospital-associated infections.

Ethical considerations

Among the ethical considerations in carrying out researches were confidentiality of data and informed consent. Informed consent entails the legal and ethical agreement for research through informing the participants about the major components of the research study. Confidentiality of data entails the researcher’s contract to store, manage, and share the study data to be limited to those authorized. Ghaffari et al. (2020) confirmed consent and confidentiality through voice recording and manual note-taking. Chatfield et al., (2016) confirmed consent through a written informed consent and signatures before the interview. Lasater & McHugh (2016) ensured the data collected from the patient sites were safe and that the names of the patients were not leaked. Rutala et al (2017) ensured that he had the consent of the hospital management to carry out his study in the various hospitals he did. The names of patients used during the data collection were also kept private.

Outcome

The anticipated outcomes of the PICOT questions are lower rates of readmissions due to hospital-acquired infections. Nobody wants to go to the hospital and continue staying due to a disease they acquired during recovery or surgery. The adaptation of washing hands using soap by nurses will ensure that the quality of care is better because there will be few numbers of hospital-acquired infections. Ghaffari et al., (2020) focused on answering how hygiene helps in the reduction of hospital-acquired infections hand while Chatfield et al., (2016) concerned themselves with nurses training on the importance of hand hygiene and the use f soap and water to reduce the spread of infections.

Proposed evidence-based practice change

Nurses play a significant role in helping prevent hospital-acquired infections. The key to reducing the number of readmissions due to infection is the adaptation of infection control policies. Some of those policies include hand washing and hand hygiene. Hand hygiene is one of the most important elements of infection control. Due to the development of tough infections, healthcare workers are going to the basics, which are hand hygiene. The use of hand sanitizers and gloves is one of the methods of preventing infections, but the use of soap and water is more effective, and therefore hospitals are adopting a system where hospital waiting areas and patient rooms are provided with soap and clean water for handwashing. This involves patients, healthcare workers, and hospital visitors.

An improved working environment for nurses will also lead to the provision of quality care for the patients. If nurses are constantly under pressure and the working environment does not favor them, there is a high probability of poor quality healthcare, leading to hospital reimbursements. A conducive environment for the nurses creates a good environment for patients as they are likely to provide better care and be more careful when dealing with patients, reducing the rates of hospital-acquired infections and reducing the rates of readmissions. Low rates of readmissions mean that the hospital will be recognized for providing quality care.

References

Chatfield, S. L., Nolan, R., Crawford, H., & Hallam, J. S. (2016). Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE open medicine, 4, 2050312116675098.

Ghaffari, M., Rakhshanderou, S., Safari-Moradabadi, A., & Barkati, H. (2020). Exploring Determinants of Hand Hygiene among Hospital Nurses: A Qualitative Study.

Lasater, K. B., & Mchugh, M. D. (2016). Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement. International Journal for Quality in Health Care, 28(2), 253-258.

Rutala, W. A., Kanamori, H., Gergen, M., Sickbert-Bennett, E., Knelson, L. P., Chen, L. F., … & Weber, D. J. (2017). Quantitative Analysis of Microbial Burden on Hospital Room Environmental Surfaces Contributing to Healthcare-Associated Infections. In Open Forum Infectious Diseases (Vol. 4, No. suppl_1, pp. S192-S192). US: Oxford University Press.