Research Critique and Ethical Considerations Essay Paper
People who are hospitalized often suffer from urinary tract infections (UTIs), and one of the most prevalent causes of these infections is the use of catheters. If the catheter is allowed to remain in place for an extended period, the risk of infections is significantly increased. CAUTIs are linked to undesirable outcomes such as damage to the kidneys, which may occur as a result of persistent or recurrent infections (Fauziah et al., 2018). The goal of this paper is to provide an analysis and critique of two quantitative publications that relate to my 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 Critique and Ethical Considerations Essay Paper
ORDER A PLAGIARISM -FREE PAPER HERE
Background of the Studies
In the article “Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients,” by Davies et al. (2018), their research is based on the fact that CAUTIs (catheter-associated urinary tract infections) are a prevalent hospital-acquired infection in healthcare institutions. When it comes to CAUTI rates, the Centers for Medicare and Medicaid Services (CMS) started levying monetary sanctions in 2015. These fines are imposed on institutions whose CAUTI rates are greater than projected. The surveillance criteria for CAUTI, on the other hand, is not a medical diagnosis and might instead indicate bacteriuria without symptoms (Davies et al., 2018). The research question used in this study is: Is there a correlation between the use of bundled interventions and a decrease in the incidence of urinary catheterization and CAUTI?
In the other article “Auditing CAUTI best practices bundle adherence in a 24-bed neurovascular/cardiovascular/intensive care unit,” the authors Witwer et al. (2019) base their research on the increasing reports of CAUTIs in the United States. According to the authors, prior research has demonstrated the importance of tracking and documenting auditing catheter care strategies. The researchers performed audits of CAUTI bundle adherence between March 1st and October 30th, 2018, and examined the link between bundle adherence and the prevalence of CAUTI to minimize CAUTI prevalence in the Cardiovascular, Neurovascular, and Intensive Care Unit (ICU). The goal of the study was to answer the question, “Does auditing of CAUTI bundle compliance lower CAUTI rates?”
Support for the Nursing Practice Problem
These publications examine the effectiveness of the bundle approach in preventing and controlling CAUTIs in acute care facilities. In this sense, they provide reinforcement to the nursing practice problem of CAUTI in patients who are critically ill. The study by Davies et al. (2018) addresses how the incorporation of a CAUTI prevention bundle may enhance both safety of patients and the overall efficiency of healthcare organizations. On the other hand, Witwer et al. (2019) study presents evidence on why complying with a CAUTI bundle is the ideal approach to CAUTI prevention and treatment.
Method of Studies
Davies et al. (2018) used a retrospective review to evaluate trauma patients. The bundled intervention optimized the urinary catheterization process and culturing practices to reduce false positives. The CAUTI rate was defined as a positive surveillance CAUTI divided by total catheter days multiplied by 1,000 days. The notable benefit of a retrospective review, which was used in this investigation, is that it does not need watching and interviewing the subjects of the research. As a result, the gathering of data requires less effort, both in terms of time and money. However, the use of this research method presents a major limitation, in that it is not possible to quantify some essential statistics, and the choice of controls might be subject to considerable biases Research Critique and Ethical Considerations Essay Paper
In Witwer et al. (2019), the CAUTI tracing instrument by the Joint Commission was used for each of the weekly three patient audits that were performed on patients who had catheters left in the bladders. On-the-spot verbal feedback was provided to personnel on the unit floor. Weekly reports on compliance were sent to the administration of the institution. To assess whether or not there was a link between the different components of the CAUTI tracing tool and the CAUTI rates, a Poisson regression analysis was carried out using SAS version 9.4 as the software platform. The main benefit of using the Poisson regression model is that it is able to solve a few of the issues that are present in the standard model. Because of this, it is an excellent choice for a distribution in which the value that is most usual or the mean is somewhat near 0. The most significant drawback associated with it is the fact that data do not match a Poisson distribution very well in settings in which a significant number of patients are never hospitalized.
Results
The findings that were presented by Davies et al. (2018) included the fact that the adoption of a bundled intervention emphasized the most appropriate method for catheter insertion as well as the most suitable patients to undergo the procedure. The standardization of urine culturing techniques contributed to a combinatorial reduction in catheter insertion that resulted in a 37% decrease in the CAUTI rate. There was no statistically significant difference in the CAUTI rate, but the findings still have clinical value. For instance, the post-CAUTI rate among trauma ICU patients in 2013 was 1.08, which was lower than the NHSN target of 2.7 for a large medical and surgical teaching ICU. This contributed to an improvement in the general performance of the institution.
According to the findings of the research carried out by Witwer et al. (2019), the link between adhering to the whole bundle of care and CAUTI rates was shown to be very close to being significant. During this time frame, there was a rise in the number of CAUTI cases in the ICU, but the audit compliance did not change. The researchers concluded that the prevention of CAUTI in facilities should place a greater emphasis on initial education on appropriate procedures than it does on regular maintenance audits.
Ethical Considerations
Several ethical considerations were taken into consideration by the researchers when conducting the investigations. The researchers demonstrated a commitment to a number of guiding concepts, including beneficence, respect, impartiality, honesty, and transparency. In both of these investigations, the researchers first obtained the participants’ informed consent before beginning their work. They operated in a manner that was congruent with the principle of beneficence by ensuring that the participants in the research gained something from it and were shielded from any hazards that could have been involved.
Conclusion
The prevention of CAUTI is a continuous problem that calls for measures to be taken from a wide variety of viewpoints. They consist of the proper criteria for use, the accurate maintenance practices, the timely termination of usage, and the adoption of a new concept of urine culturing. The process of establishing consistent criteria for the elimination of urine culture works in tandem with the optimization of the practical components of catheter insertion. It’s possible that a multi-pronged solution will be effective in lowering CAUTI rates in critically ill patients Research Critique and Ethical Considerations Essay Paper
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
Fauziah, W., Rochana, N., & Juniarto, A. Z. (2018). The effect of catheter associated urinary tract infection (CAUTI) bundle of care: A systematic review. Proceedings of the 1st International Conference of Indonesian National Nurses Association. https://doi.org/10.5220/0008205901230131
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.
In this assignment, you will write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment (or two new articles based on instructor feedback in Topic 1) to complete this assignment. In a 1,000–1,250-word essay, summarize two quantitative studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. 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.
ORDER YOUR PAPER HERE
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)?
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 Research Critique and Ethical Considerations Essay Paper
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). 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.
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 Critique and Ethical Considerations Essay Paper
BUY YOUR PAPER HERE
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.
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 Critique and Ethical Considerations Essay Paper
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
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
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 Critique and Ethical Considerations Essay Paper