Research Critiques and PICOT Question Final Draft Paper

Research Critiques and PICOT Question Final Draft Paper

Hospital-associated infections (HAIs) are among the most prevalent causes of death globally. According to Hague et al. (2020), about 1.7 million people acquire hospital-associated infections annually, leading to approximately 90000-99000 deaths. Besides increasing mortality and morbidity rates, HAIs result in a massive economic burden, lengthy hospitalization, and compromised quality of life. Healthcare organizations implement strategies to prevent hospital-acquired infections, including hand hygiene compliance, environmental hygiene, risk assessment, and surveillance activities. However, the effectiveness of these strategies is consistent with contextual factors like organizational culture, availability of resources, and healthcare professionals’ knowledge, attitudes, and behaviors that influence the level of compliance with preventive measures. Therefore, this paper aims to critique four articles (two qualitative and two quantitative studies) that provide insights into the PICOT question: Hospital-associated infections (P), does implementing hand hygiene (I), compared to other preventative measures (C), prevent Hospital-associated infections (O), within three months of implementation (T)?

Background of Studies

The selected qualitative and quantitative research studies are consistent with the PICOT question, which aims to compare hand hygiene practices with other preventative measures for hospital-acquired infections. In a qualitative study, Ahmadipour et al. (2022) aimed to understand healthcare professionals’ barriers to hand hygiene compliance during the COVID-19 pandemic. The researchers presented hand washing as an effective strategy for preventing contamination and disease transmission. Therefore, the study’s overall purpose was to investigate individual beliefs, attitudes, experiences, and intentions influencing compliance with hand hygiene protocols. The subsequent findings from the study are profound in establishing a habit of hand hygiene to complement other preventative approaches such as monitoring and controlling nosocomial infections.

In the second qualitative study, Haque et al. (2020) performed a narrative review of literature from bibliographic databases, such as Google Scholar and PubMed, that provide insights into various strategies to prevent healthcare-associated infections, including hand hygiene, maintaining safe and hygienic hospital environment, screening and categorizing patients into cohorts, public health surveillance, antibiotic stewardship, and adherence to patient safety guidelines. The findings from this study are profound in informing organizational strategies for preventing and managing hospital-acquired infections.

In a randomized clinical trial (RCT), Montero-Vilchez et al. (2022) aimed to compare the impact on the skin barrier function of different hand hygiene measures in healthcare workers. The researchers compared water and soap sanitation and alcohol-based hand sanitizers (ABHSs) to determine the most effective strategy for preventing viral load during the COVID-19 pandemic. The study provided insights into the two different practices for hand hygiene and sought to settle on the most effective hand washing approach for preventing COVID-19 transmission in healthcare settings.

Finally, Szczuka et al. (2021) conducted an observational study to assess whether self-reported adherence to handwashing guidelines recommended by the World Health Organization (WHO) affects the trajectory of the COVID-19 pandemic. The outcome variable for this study was the cross-sectional handwashing adherence, while participants’ COVID-19 pandemic-related situation was the control variable. The study’s findings provided insights into individual-level and environmental factors that affect adherence to handwashing guidelines.

How do These Four Articles Support the Nursing Practice Problem?

The four articles are consistent with the PICOT question because they provide insights into the effectiveness of hand washing practices alongside other preventive interventions in preventing hospital-acquired infections. For instance, the study by Ahmadipour et al. (2022) presents hand washing as a profound strategy for preventing HAIs. Therefore, it investigates individual beliefs, attitudes, experiences, and intentions influencing compliance with hand hygiene protocols. In the same breath, Haque et al. (2021) argue that hand hygiene is the best yet simple strategy for preventing HAIs. Therefore, the study validates the rationale for studying other preventative measures such as maintaining a safe and hygienic hospital environment, screening and categorizing patients into cohorts, public health surveillance, antibiotic stewardship, and patient safety guidelines.

Similarly, the selected quantitative studies support the PICOT question by comparing various hand washing practices and investigating individual-level and environmental factors affecting adherence to handwashing guidelines. For instance, Montero-Vilchez et al. (2022) compared the impact on the skin barrier function of different hand hygiene measures in healthcare workers. On the other hand, Szczuka et al. (2021) assessed whether self-reported adherence to handwashing guidelines was associated with trajectories for the COVID-19 pandemic. It is essential to note that these studies provide statistically significant information regarding control and outcome variables. Further, they explain the association between adherence to handwashing guidelines and reduced prevalence of hospital-acquired infections.

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However, the four articles are inconsistent regarding the elements of control groups. For instance, the two qualitative studies do not have intervention or control groups. Instead, they focus on reviewing literature that supports their research objectives. On the other hand, the selected quantitative studies have functional intervention and control groups. For example, Montero-Vilchez et al. (2022) randomly assigned participants to either hand washing with water and soap or rubbing their hands with alcohol-based hand sanitizers (ABHSs). The intervention and control groups of this study differ from those in the PICOT question because they focus on establishing the difference in effectiveness between strategies for hand hygiene.

Method of Studies

The researchers in the selected qualitative studies adopted a conventional content analysis and a narrative review research design, respectively. On the other hand, the quantitative studies’ research designs were randomized clinical trials (RCT) and correlational. When comparing the qualitative and quantitative research methods applied in the four articles, it is vital to argue that conventional content analysis and a narrative review enabled researchers to qualitatively analyze opinions, perspectives, and experiences regarding handwashing protocols. Conversely, randomized controlled trials and correlational methods allowed researchers to establish the statistical significance of the association between outcome and control variables.

Although qualitative and quantitative methods were consistent with the studies’ objectives, they exhibited various limitations. For instance, Ahmadipour et al. (2022) identified a small sample size as the study’s primary limitation. Equally, Haque et al. (2020) argued that a narrative review approach was not all-inclusive, affecting the study’s overall validity. Montero-Vilchez et al. (2021) identified a lack of follow-up and the ability to test only one type of hand hygiene as some limitations that affected the study’s generalizability. Finally, the small effect sizes of the predictors in handwashing at the population level and the use of cross-sectional data limited the validity and generalizability of the study by Szczuka et al. (2021). These limitations prompt further study on the topic.

Result of Studies

The four articles revealed findings consistent with the studied topics and objectives. In a qualitative study, Ahmadipour et al. (2022) argued that lack of knowledge of handwashing protocols, wrong behavioral patterns, improperly designed wards, a lack of equipment, unsuitable training, and heavy workloads compromise adherence to handwashing guidelines. Therefore, the researchers recommended healthcare organizations address these barriers to facilitate adherence to handwashing guidelines. Secondly, Haque et al. (2020) study revealed that hand hygiene is the most effective, simplest, and cheapest measure to prevent HAIs. However, compliance with hand hygiene remains low among healthcare professionals. The researchers recommended organizations implement strategies for addressing low compliance with hand hygiene practices.

On the other hand, the randomized clinical trial (RCT) by Montero-Vilchez et al. (2021) revealed that bacteria and fungi colony-forming unit (CFU) count reductions were lower for the water and soap group than for ABHS and disinfectant wipes. Therefore, daily hand hygiene with ABHS showed the lowest skin barrier disruption rates and the highest CFU reduction. The study validated the rationale for using alcohol-based hand sanitizers (ABHSs) as the primary handwashing practice to prevent hospital-acquired infections.

Finally, the study by Szczuka et al. (2021) revealed that higher levels of total cases of COVID-19-related morbidity and mortality were related to lower handwashing adherence. Also, researchers identified participants’ exposure to information about handwashing, their professional experiences, country-level policies, and socio-demographic characteristics like gender, age, and marital status as variables influencing adherence to handwashing guidelines. Therefore, the study underscores the need to address individual and organizational factors compromising compliance with hand hygiene protocols.

Ethical Considerations

The four articles applied different mechanisms for incorporating ethical considerations and research standards. The two qualitative studies integrated research ethics by adhering to inclusion criteria for selecting relevant articles for review. On the other hand, researchers in the quantitive studies complied with ethical standards for nursing research by seeking approval from relevant ethics committees consistent with research settings. Also, they provided information to participants and avoided deceptive strategies for convincing participants to participate in the research processes.

Outcomes Comparison

The anticipated outcome of the PICOT question is to prevent hospital-acquired infections through hand hygiene. Conversely, the desired outcomes across the four articles vary from the PICOT question’s outcome. For instance, the desired outcome of the study by Montero-Vilchez et al. (2021) was to test the effectiveness of various hand washing practices in reducing fungi colony-forming unit (CFU) count. Secondly, Szczuka et al. (2021) identified cross-sectional handwashing adherence as the desired outcome. Ahmadipour et al. (2022) perceived the need to address barriers to hand hygiene compliance as the study’s outcome.

Proposed Evidence-Based Practice Change

The four articles highlight hand hygiene as the most profound strategy for preventing HAIs. Although they vary in contexts, research objectives, and desired outcomes, they agree that hand hygiene is a simple and practical approach to preventing hospital-acquired infections. However, some studies identify individual-level and environmental barriers to hand hygiene compliance. Therefore, an evidence-based practice change would emphasize educating and training healthcare professionals, providing equipment, transforming organizational culture, reducing workloads, monitoring disinfection solutions, and providing scientific information regarding the Importance of improving hand hygiene as ideal strategies for eliminating barriers to hand hygiene compliance. These measures will improve individual and organizational capacity to prevent and reduce hospital-acquired infections and their ramifications.

Conclusion

Although hospital-acquired infections (HIAs) result in adverse consequences, hand hygiene remains the most effective yet simple strategy for preventing and reducing these infections. The four reviewed articles realize a consensus contention that hand hygiene is a profound preventive approach. However, they reveal barriers to hand hygiene compliance, including a lack of training and education programs, workloads, a lack of appropriate equipment and resources, and individual experience. Therefore, an evidence-based practice change initiative should entail educating and training healthcare professionals, providing equipment, transforming organizational culture, reducing workloads, monitoring disinfection solutions, and providing scientific information regarding the Importance of improving hand hygiene.

References

Ahmadipour, M., Dehghan, M., Ahmadinejad, M., Jabarpour, M., Mangolian Shahrbabaki, P., & Ebrahimi Rigi, Z. (2022). Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study. Frontiers in Public Health, 10, 1–9. https://doi.org/10.3389/fpubh.2022.968231

Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T. S., Coccolini, F., Iskandar, K., Catena, F., & Charan, J. (2020). Strategies to prevent healthcare-associated infections: A narrative overview. Risk Management and Healthcare Policy, 13, 1765–1780. https://doi.org/10.2147/RMHP.S269315

Montero‐Vilchez, T., Martinez‐Lopez, A., Cuenca‐Barrales, C., Quiñones‐Vico, M. I., Sierra‐Sanchez, A., Molina‐Leyva, A., Gonçalo, M., Cambil‐Martin, J., & Arias‐Santiago, S. (2022). Assessment of hand hygiene strategies on skin barrier function during COVID‐19 pandemic: A randomized clinical trial. Contact Dermatitis. https://doi.org/10.1111/cod.14034

 

Szczuka, Z., Abraham, C., Baban, A., Brooks, S., Cipolletta, S., Danso, E., Dombrowski, S. U., Gan, Y., Gaspar, T., de Matos, M. G., Griva, K., Jongenelis, M., Keller, J., Knoll, N., Ma, J., Miah, M. A. A., Morgan, K., Peraud, W., Quintard, B., & Shah, V. (2021). The trajectory of COVID-19 pandemic and handwashing adherence: Findings from 14 countries. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11822-5

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Requires Lopeswrite
Assessment Description
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.

Research Critiques
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.
Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.
General Requirements
Minimum 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.
PICOT Question:
Hospital-associated infections (P), does implementing hand hygiene (I), compared to other preventive measures (C), prevent hospital associated infections (O), within three months of implementation (T)?
P=Hospital associated infections
I=Hand hygiene
C=Other preventative measure
O=Prevent hospital associated infections
T= Three months of implementation

Clearly use two qualitative research, and two quantitative related to the PICOT question (part of the feedback from the previous order is that only one article was qualitative, and one was quantitative in each paper instead of two). (Do not use the previous orders as a reference).
These are the issues to improve based on feedback.
Two qualitative and two quantitative articles related to the PICOT (4 total)
Introduction
Background of studies.
How Do These Four Articles Support the Nursing Practice Problem You Chose?
Methods of studies
Results of studies
Ethical Considerations.

Note: Do not write on the guideline paper, the draft document is only to organize the essay.