Assignment: Evidence-Based Project Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Assignment: Evidence-Based Project Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Introduction & Purpose of the Presentation

vEBP entails implementation of interventions backed by research evidence in care management

vProblem solving Approach in Health Care Settings

vDeveloping and Deploying the framework to identify and execute Interventions

vPurpose of the Presentation

Nurses leverage evidence-based practice (EBP) interventions to address clinical practice problems in their settings. The use of evidence-based practice entails developing and deploying the PICOT framework based on the five stages of the model. The PICOT framework identifies the intervention to solve a clinical or practice issue like health care associated infections. A critical part of leveraging databases for EBP interventions is to seek literature that supports such solutions and their implementation. These databases are helpful based on the search components by nurses who wish to leverage the interventions to improve care quality (Khan et al., 2017). The purpose of this presentation is to develop a PICOT question, identify four databases in carrying out the research on interventions like handwashing and use of hand hubs to control and reduce hospital acquired or association infections (HAIs), and analyze the level of evidence presented in the selected four articles.

Identification & Description of the Clinical Issue

vHospital acquired infections prevalence and Effects

vNeed for Patient Safety and Quality Care

vTypes of hospital associated infections (Nosocomial Infections)

vHandwashing using soap and Water

vHand Hygiene using alcohol-based Rubs

Hospital acquired infection or nosocomial infections are a major concern in healthcare because of their effects on patient safety and quality of care. Hospital acquired infections (HAIs) lead to adverse effects like increased lengths of stay at a facility, increased cost of care, poor quality of care, increased morbidity and even mortality. HAIs are the second most prevalent cause of death for patients. Health care workers like nurses and physicians transmit infections due to poor hand hygiene measures and intervention (Khan et al., 2017). Studies and statistics from various sources in healthcare, including the World Health Organization and the Centers for Diseases Control and Prevention (CDC) show that HAIs account for 7% of all infections in healthcare. Hospital acquired infections like catheter-associated urinary tract infection (CAUTIs) require implementation of effective interventions by nurses and all providers to prevent and control their prevalence (Fernando et al., 2017). The use of handwashing remains the primary and most effective strategy to prevent and reduce the prevalence of hospital associated infections. However, many studies have also demonstrated the efficacy of alcohol-based hand rubs and sanitizers but overwhelming evidence suggests that effective implementation of handwashing using water and soap offers the best approach to controlling and preventing the occurrence of infections in hospitals.

Development of the PICOT Question

vEvidence-based practice (EBP) requires the formulation of PICOT Question to identify the clinical issue, suggest interventions and timelines for implementation

vPICOT is an Acronym which stands for

P-Population, Problem or Patient

I-Intervention or Issue

C-Comparison or alternative

O-Outcome

T-Time for implementing the solution

v PICOT Question: In an acute care hospital, how does hand washing with soap and water compare to alcohol-based hand rubs in reducing hospital acquired infections after one month?”

The development of PICOT question is an important part of the evidence-based practice (EBP) intervention as it helps identify the main issue and suggest interventions to be implemented based on the timelines. Through the use of the PICOT format, one can quickly and efficiently finds the best evidence practice for their research problem and the proposed interventions. PICOT is an acronym that stands for population, interventions, comparison, outcome, and time. In this case, the PICOT for the EBP to reduce hospital acquired infections (HAIs) is “In an acute care hospital (P), how does handwashing with soap and water (I) compare to alcohol-based rubs (C) in reducing hospital acquired infections (O) within 30 days(T)?

Four Databases Used in Conducting Research

vDatabases allows one to access appropriate peer-reviewed articles for EBP projects

vCINAHL Plus

vMEDLINE

vPUDMED

vScience Direct

The use of databases in research is important as it allows one to access informative and peer-reviewed article that have best levels of evidence to implement the EBP project. Consequently, this presentation used various databases to conduct research on the interventions to address hospital acquired infections, especially the use of handwashing with soap and water compared to the utilization of alcohol-based hand rubs and sanitizers. These include CINAHL Plus, Medline, PubMed, and Science Direct. CINAHL Plus is a comprehensive database for nursing research as it has recent and relevant articles on different nursing issues and interventions for population health problems. Medline is a search database that has access to journal articles on issues and evidence in life sciences focuses on biomedicine findings (Melnyk & Fineout-Overholt, 2019). PubMed is a free search engine database that enables researchers to access MEDLINE database of references and abstracts on life science issues and biomedical areas to develop interventions. The database may also offer full access to full articles on different evidence-based interventions in care provision. Science Direct contains current studies’ findings on different nursing and life science interventions and research issues.

Strengths of Systematic Reviews Based on Level of Evidence

vReduce and Prevent Bias and Prejudice

vReliable and Useful than Single Study

vOffer Summaries of Findings from Different Sources

vIdentification of Gaps in Research

vOffers Direction on Effectiveness of the Interventions in Daily Practice Use

The use of systematic reviews and meta analyses is important in EBP projects as they offer enhanced levels of evidence based on their rigor and effectiveness. For instance, randomized control trials allow researchers to get different perspectives of evidence in a study thereby increasing the levels of reliability (Albargouni et al., 2018). Imperatively, systematic reviews and meta-analyses offer the highest level of evidence for any study aimed at addressing different issues like hospital acquired infections, use of handwashing and alcohol-based hand rubs. These studies also offer reliable cause and effect estimates based on reasonable findings. These studies come from various sources that lower prejudices and possible bias. These studies are more likely to produce reliable and useful information than one study (Melnyk & Fineout-Overholt, 2019). They also make concrete and accurate deductions as they are a summary of various findings from multiple studies or sources. The articles also provide direction on the effectiveness of the findings based on how they can applied in nursing practice to reduce HAIs. They also identify research gaps for future research studies.

Citations of the Four Articles for Assignment: Evidence-Based Project Part 2: s

Halm, M., & Sandau, K. (2018). Skin Impact of Alcohol-Based Hand Rubs Vs

Handwashing. American Journal of Critical Care, 27(4), 334–337.

https://doi-org.ezp.waldenulibrary.org/10.4037/ajcc2018727

Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017).

Patients’ hand washing and reducing hospital-acquired infection. Critical care nurse, 37(3),

e1-e8. DOI: 10.4037/ccn2017694

Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., … &

Charan, J. (2020). Strategies to prevent healthcare-associated infections: a narrative

overview. Risk management and healthcare policy, 13, 1765.

DOI https://doi.org/10.2147/RMHP.S269315

Kingston, L. M., O, C. N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene

and alcohol-based hand rub use among Irish nursing and medical students. Nurse

  Education Today, 63, 112–118. https://doi-

org.ezp.waldenulibrary.org/10.1016/j.nedt.2018.01.022