Research Critique – Part II
Research Critique – Part II
Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.
Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.
In a 1,000–1,250 word essay, summarize two quantitative 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.
SAMPLE ANSWER
Research Critique – Part II
Quantitative Studies
Article 1
Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler,
- P. (2015). Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial. JAMA, 313(4), 369-378. Doi:10.1001/jama.2014.18400
- Research Critique – Part II
Study Problem
Infections acquired during hospitalizations are the major causes of high mortality rates and increased the length of stay, which leads to increased healthcare costs for both patients and the health institutions. Health associated infections also result in increased healthcare system costs in the nation. The skin of patients in the Intensive Care Unit acts as a reservoir for pathogens (Noto, et al. 2015). Significant efforts are put to prevent and reduce the rate of infections through health practices designed to decrease the transmission of pathogens. Such practices include care of devices, bundles for insertion, isolation of multidrug-resistant organism’s patients, and hand hygiene (Noto, et al. 2015). Chlorhexidine can be used as one of the interventions in reducing bacterial burden, thus decreasing the rate of infections.
Significance of the Study to Nursing
Nurses should consider Chlorhexidine as a significant intervention in reducing the rate of infections for hospitalized patients. Chlorhexidine has a broad-spectrum topical antibacterial agent which decreases the bacterial burden, thus reducing the rate of infections when used daily during baths(Noto, et al. 2015). Various studies have reported that daily baths with Chlorhexidine are associated with reduced skin colonization with organisms that have multidrug resistance, reduced clostridium difficile infections, and reduced bloodstream infection rates.
Purpose of the Study
The main objective of the study was to assess if daily bathing with Chlorhexidine reduces associated healthcare infections for patients in the intensive care unit.
Research Question
Does daily bathing with Chlorhexidine reduce associated healthcare infections for patients in intensive care units?
How does the Article Answer the PICOT Question?
The PICOT question compares the effectiveness of daily bathing with Chlorhexidine and the effectiveness of daily bathing with soap and water in reducing the rate of Central Line-Associated Bloodstream Infections in patients admitted in the intensive care unit. The article answers the PICOT question by examining whether daily baths with Chlorhexidine reduces the rate of health-associated infections in patients admitted to the intensive care unit.
How the intervention and Comparison Groups in the Article Compare with those Identified in the PICOT Question
The PICOT question uses Chlorhexidine as an intervention. Chlorhexidine and soap and water are the comparison groups in the PICOT question. On the other hand, the article uses Chlorhexidine as the intervention group in reducing the rate of hospital-acquired infections.
Article 2
Holder, C., &Zellinger, M. (2009). Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections. JCOM, 16(11), 509-13. https://pdfs.semanticscholar.org/ace2/d11dfa4fab260bb5639c782b9baa0a1addad.pdf
Study problem
Approximately 80,000 patients in the intensive care unit in the United States are reported to have Central Line-Associated Bloodstream Infections every year. The cost of treating one patient is approximately 40,000 US dollars per patient every year. Most of the infections are preventable. Recent studies report that the use of Chlorhexidine wipes in hospitals reduces the rate of Central Line-Associated Infections (Holder & Zellinger, 2009). Therefore, daily baths with chlorhexidine wipes in traditional bathing procedures in the Intensive Care Unit should be considered as a significant intervention in the prevention of Central Line-Associated Bloodstream Infections.
Significance of the Study to Nursing
An academic medical center called Emory University conducted research that found out that the use of Chlorhexidine wipes for daily baths reduced the rate of postoperative sternal wound infections for patients in the cardiovascular surgery intensive care unit. As a result, interdisciplinary teams from various hospitals decided to incorporate a 2% chlorhexidine in daily baths for patients in the ICU(Holder &Zellinger, 2009). Therefore, nurses should consider the use of Chlorhexidine as a primary intervention in the prevention and reduction of Central Line Bloodstream Infections in hospitalized patients.
The Objective of the Study
The primary purpose of the study was to define a quality intervention for the acquisition of multidrug-resistant organisms and reduction of rates of Central Line Bloodstream Infections by using chlorhexidine wipes in daily baths of patients in the Intensive Care Unit.
Research Critique – Part II
Research question
Does the use of chlorhexidine wipes in daily baths act as a quality initiative in the acquisition of multidrug-resistant organisms and reduction of Central Line-Associated Bloodstream Infections for patients in the Intensive Care Unit?
Research Critique – Part II
How does the Article answer the PICOT Question?
The PICOT question researches the effectiveness of using Chlorhexidine in daily baths in reducing the rate of Central Line-Associated Bloodstream Infections in patients in the Intensive Care Unit. The article answers the PICOT question by describing the use of chlorhexidine wipes in daily baths in reducing the rate of Central Line Bloodstream Infections in patients admitted in the Intensive Care Unit.
How the Intervention and Comparison Groups in the Article Compare to those in the PICOT Question
The PICOT question considers the use of Chlorhexidine in daily as an intervention in reducing the rates of Central Line-Associated Bloodstream Infections in patients admitted in the ICU. Similarly, the article considers the use of chlorhexidine wipes in daily baths as an intervention in reducing the rate of Central Line Bloodstream Infections for patients admitted in the Intensive Care Unit.
Methods used in the Two Studies and how different they are
The article on Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial by Noto, et al. (2015) used a pragmatic cluster randomized crossover study method. The study used patients admitted in five different intensive care units for medical centers in Tennessee, Nashville between 2012 and 2013.
On the other hand, the study on Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections by Holder and Zellinger, (2009) used a study method where nurses came up with a bathing procedure which included bating frequency, technique, contraindications, required documentation, and bathing technique.
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Benefits and Limitations of the two Study Method
The main benefit of the study by Noto, et al. (2015) is that the crossover events enabled the assessment of control periods and two separate interventions which allowed intercluster variability as well as seasonal outcome variations. However, the main limitation of the study is that the method of the study did not give a chance for multiple comparisons of the results.
On the other hand, the main benefit of the study by Holder and Zellinger, (2009) is that the study method was controlled by advanced nurses and nursing leaders that ensured the accuracy of the findings. However, the limitation of the study is that use of chlorhexidine wipes was cumbersome to the patients, and they would also not feel as clean if they used it as an antiseptic liquid. As a result, it was difficult to make patients accept the use of chlorhexidine wipes.
Results of the Two Studies and their Implications to Nursing Practice
The results on Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial by Noto, et al. 2015 showed that during the chlorhexidine daily baths period; there was an occurrence of 55 infections. During the controlled bathing, there was an occurrence of 60 infections. No difference in the primary outcome between the two groups was observed after baseline adjustment. After the analysis of the results, there was no difference in primary outcome in individuals in the Intensive Care Unit.
The Implication to Nursing Practice
According to the findings of the pragmatic trial, daily chlorhexidine baths did not reduce the rates of Central Line Bloodstream Associated Infections in the Intensive Care Unit. The results did not support daily showers with Chlorhexidine for patients admitted in the Intensive Care Unit.
The results of the study on Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections by Holder and Zellinger, 2009 showed that the Bloodstream Infections reduced from 3.6 per 1000 patients to 1 per 1000 patients after six months of chlorhexidine bath procedure implementation.
Implications to nursing practice
According to the findings of the study, the use of chlorhexidine baths reduces the rates of Central Line-Associated Bloodstream Infections and resistant organism’s acquisition rates in patients admitted in the Intensive Care Units.
Ethical Considerations
Informed consent is one of the significant ethical considerations when conducting clinical research. Informed consent states that patients involved in research should voluntarily, intelligently, and knowingly give consent to the researchers to use their information in their study. Beneficence is another ethical consideration that includes professional; the mandate of the researchers to do significant and effective research that can better promote the welfare of the community health. The Institutional Review Board approved the two studies. Also, patient confidentiality was maintained. Besides, the patients that participated in the studies voluntarily gave consent to the researchers
References
Holder, C., &Zellinger, M. (2009). Daily Bathing with Chlorhexidine in the ICU to Prevent Central Line-Associated Bloodstream Infections. JCOM, 16(11), 509-13. https://pdfs.semanticscholar.org/ace2/d11dfa4fab260bb5639c782b9baa0a1addad.pdf
Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine bathing and healthcare-associated infections: A randomized clinical trial. JAMA, 313(4), 369-378. Doi:10.1001/jama.2014.18400
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