NUR 302 Nursing

• Defend how this EBP?research- In patients receiving Intravenous medications, does the use of chlorhexidine dressings or Gluconate clothes decrease the risk of central venous line associated infections compared to patients who do not have chlorhexidine dressing application? is consistent with FNP
• Defend how this topic In patients receiving Intravenous medications, does the use of chlorhexidine dressings or Gluconate clothes decrease the risk of central venous line associated infections compared to patients who do not have chlorhexidine dressing application?is of importance to the FNP program—scholarly references are required.
• Identify an initial PICOT/PICo question that reflects you area of interest (In patients receiving Intravenous medications, does the use of chlorhexidine dressings or Gluconate clothes decrease the risk of central venous line associated infections compared to patients who do not have chlorhexidine dressing application?) for the evidence-based practice proposal that is required

2.In patients receiving Intravenous medications, does the use of chlorhexidine dressings or Gluconate clothes decrease the risk of central venous line associated infections compared to patients who do not have chlorhexidine dressing application?

Will you be using a quantitative or qualitative approach for your EBP project proposal?

Explain why this approach is the best one to provide information for your area of interest.

Create a PICOT/PICo question using the PICOT/PICo format for quantitative and PICo for qualitative approaches.

Identify your practice question, being sure to include the following.

For a quantitative approach

A questioning part such as "what is," "what are," "is there," or "are there"

Population being studied

Variables being studied

Suggestion of the relationship between variables

For a qualitative approach

Phenomenon or concept of interest

Group or population of interest

Suggestion of which qualitative research design is being used

3.Select any single-study quantitative research study article related to FNP and provide the permalink to the article. Then discuss each of the following items.

Identify whether the research study design is experimental, quasiexperimental, or nonexperimental. Provide the rationale for your answer.

Identify the appropriate representation for the research study article you selected using the nomenclature of X for intervention, O for observation and data collection, and R for random a assignment to a research study group.

Identify the type of sampling (probability vs. nonprobability) that was used in the research study article you selected.

Identify one advantage and one disadvantage to the sampling type used (probability vs. nonprobability).

Identify whether there was random assignment to research study groups in the research study article you have selected.

If random assignment to groups was used, how does this strengthen the research study design?

4.With the focus on qualitative design and sampling, this is a great opportunity to compare and contrast quantitative and qualitative research approaches. For each of the following areas, apply information that considers one advantage and one disadvantage regarding

control over study conditions with the quantitative research approach;

control over study conditions with the qualitative research approach;

extending or generalizing results from a sample to a larger group or population with the quantitative research approach; and

extending or generalizing results from a sample to a larger group or population with the qualitative research approach.

Be sure to include scholarly references to support your information.

5.Refine your PICOT question.( from question2)

Explain your specific research approach (qualitative or quantitative or mixed methods) and how it has the potential to answer your research question.

Discuss you data collection method, addressing strengths and identifying one potential weakness.

Identify the actions you are proposing that will help ensure that quality data may be produced by your EBP project.

6.Distinguish between statistical and clinical significance of results.

Would it be possible to have research study results that supported the acceptance of the null hypothesis and demonstrate clinical significance? Provide a hypothetical example that supports your answer.

If you question the credibility of the results from a qualitative study, would the information have clinical significance for FNP? Why or why not? Provide a hypothetical example that supports your answer.

7.Using the following steps found within the translation phase of the Practice Evidence Translation (PET) model developed by Johns Hopkins, select a research result reported in a journal article that supports your PICOT/PICo question. Please respond to the following steps. Please note that wording of the steps may have been modified slightly from the PET so that they help with this posting. Include the permalink at the end of your posting.

Using references, identity the research result that you could use in your practice setting.

Determine fit, feasibility, and appropriateness of the result for your practice setting.

Using Plan-Do-Study-Act (PDSA), outline an action plan.

Identify the resources (physical, personal, technology) needed to implement your action plan.

Determine the criteria that you would use to determine whether the implementation of your project was successful.

Identify one future research study that would be useful in extending knowledge of your selected project result.

• This topic is important for the FNP program as central line venous catheters (CVCs) care is important for the critically ill and hospitalized patients for the nurses to draw blood for sampling, medication infusion and hemodynamic measurement. They are the leading cause for the healthcare-associated bloodstream infections (BSIs) that are implicated into life-threatening illnesses. It is important for the nurses as thousands of BSIs occur every year contributing to the burden of disease. This is the reason, it is important for the nursing program to use chlorhexidine solution for bathing that reduces the BSIs in the patients receiving intravenous medications.
• PICOT question- Does in adult of high complexity settings; the use of antiseptic chlorhexidine dressing is effective and has the potential to prevent the potential central venous catheterization (CVC) infections?Nurses and healthcare professionals provide chlorhexidine bathing to CVC patients to reduce the central venous infections receiving intravenous medications.  

PICOT question-

In critically ill patients (P), does use of chlorhexidine bathing (I), as compared to those who do not have chlorhexidine bathing (C), aid in reducing CVC line infections (O) in 6 months (T)?

Questions for the survey

1. What is the frequency of chlorhexidine bed-bath in CVC patients?
2. What is the duration of time bed-bath in CVC patients?
3. What cleansing agents are used for the bed-bath?
4. At what time patients are given bed-bath in ICU?
5. What are the factors like organizational and patient illness have an impact on bed-bath in the ICUs?

• The population to be studied for the study will be patients in the ICUs having variables total days of CVC, infection rates and hospital and study period. The variable is related in a way where they will be studied for the infection rates before and after the intervention.

• http://www.sciencedirect.com/science/article/pii/S0002934312000149
• The research design is quasi-experimental as it lacks the feature of experimental design method like random assignment to control or treatment.
• The study article represented the intervention(X) where they conducted in three different phases. Pre, active and post intervention phases were used where they observed the infection rates in the CVC patients (O) and data was collected through Poisson regression (D) There was no randomised control trail in the setting. In the pre-intervention phase, the patients were bathed with water and soap or by using non-medicated bathing cloths. In the active intervention phase (phase 2), the patients were bathed with chlorhexidine gluconate (2%) bathing cloths and the third phase comprised of post-intervention phase to assess whether the chlorhexidine bathing is continued or not.
• Non probability samplingwas used in the research study article. Patients were selected from respiratory and medical Intensive Care units in a tertiary Care Hospital. Sample was divided into three phases; pre, active and post intervention among the patients in respiratory and medical care units of a tertiary care unit in four community hospitals (Lampard & Pole, 2015)
• Advantage of non-probability sampling methodis a technique used for smaller sample size from a large population (Uprichard, 2013). It is helpful in generalizing to a population called probability sampling method. It is advantageous due to its ease of use and accurate presentation in context to the larger population (Brannen, 2017).
• The disadvantage of non-probability samplingis that the entire population is not included in the sample group. There is low level of generalization of the research findings as compared to the probability sampling method. There is difficulty in estimating the variability of the sampling method and identification of the possible bias (Uprichard, 2013).

4.Quantitative control over study (advantage)

In quantitative studies, the control over study conditions is measured and evaluated accurately. It is generalized to the population and reproduction of the control over study conditions can be done (Taylor, Bogdan & DeVault, 2015). There is prediction and control over the study conditions in quantitative studies.

Disadvantage- When the research is done in hospital, there is no control over the extraneous variables. In quantitative studies, the data cannot be collected under controlled conditions and accurately to rule out the possibility variables as compared to other studies that account for the relationships identified (Sekaran & Bougie, 2016).

Qualitative control over study

in qualitative studies the goal is to understand and predict the control of a study conditions. There are similarities and contrasts used for the study (Sekaran & Bougie, 2016). In qualitative studies the observation and interpretation is given more importance as compared to quantitative studies (Taylor, Bogdan & DeVault, 2015).

Qualitative study (generalization of results)

in qualitative studies, it is concerned with changing dynamics and nature of reality. In qualitative studies, the goal is not to generalize the results rather to create a contextualized and rich understanding of human experience intensive study in special cases (Flick, 2014).

Quantitative study

Whereas in quantitative studies, generalization is an act of reasoning when a person draw broad inferences from observations that is widely acknowledged in quantitative research. However, quantitative research is controversial then qualitative research (Merriam & Tisdell, 2015).

• Quantitative approach is used for the evidence based project proposal.

It is the best approach for this project as it provides information in closed-ended questions in unstructured and structured interviews and questionnaire. The sample (CVC patients) will be divided into two groups, control and study group. Control group will be bathed with normal soap and water and the study group will be bathed with chlorhexidine. After the study, the data will be analyzed to evaluate the infection rates reduction among the CVC patients compared in the control and study group.

The data analysis is easy in quantitative approach and highly standardized (Riff, Lacy & Fico, 2014). This information is useful as it can be generalized to the whole population and comparison of the information is done extensively (Lampard & Pole, 2015). It is useful as it has a targeted population and differences associated with it. Therefore, the surveys and questionnaires to be used for the EBP project will help to explore the use of chlorhexidine bathing in CVC patients for the reduction of infections.

• The data will be collected through questionnaires and surveys given to patients of a tertiary Care Unit regarding the use of chlorhexidine bathing CVC line patients.The data will be analyzed to study the rate of CVC infections before and after the intervention to evaluate the chlorhexidine bathing for reduction of healthcare associated bloodstream infections.
• The advantage of quantitative design approachis that it can be generalized to the population about the information that is acquired through the results. The samples are selected for the quantitative study in such a way that the results can generalized to the whole population (Creswell, 2013). There will be clear documentation of the survey instruments that will be helpful to assess the validity of the result findings. It is a standardized approach to study the chlorhexidine bathing and reduction of CVC infections overtime period to produce comparable research comparable findings. One disadvantage of this Quantitative approach is that the self-reported information from survey and questionnaires may be incomplete or inaccurate (Mackey & Gass, 2015). It is also time consuming and expensive and obtained results are not available for an extensive period.
• Clinical auditingcan be done at regular intervals to ensure the quality of the data that will be produced through the EBP project. The auditing will be done to check the frequency of the  chlorhexidine bed bath in CVC patients along with the duration, the cleansing agents and the time required for the bed bath in ICU patients.

• The null hypothesis is based on the statistical test that has no significant difference within the population that are being selected as the sample size of the elements. There is a high chance of experimental errors due to limitations within the process of sampling. This can be major issues in all types of clinical experiment as no accurate result can be obtained and the quality of the research is compromised (Mackey & Gass, 2015).   
• It can be possible to get a research study where the null hypothesis is proved and there is no significant relationship between the two variables. If the null hypothesis is proved, the hypothesis for the study is rejected and the results are of no significance.

• This research results can be used in the practical settings as it would be helpful in reducing the rate of CVC infections in patients in ICU patients in critical settings.
• The feasibility, fit and appropriateness of the results in the practical settings will be used in the assessment of the reduction of BSI infections and central line CVC among the patients in ICU through chlorhexidine bathing.

Feasibility can be measured in a way that it is technically profitable and can be achieved within the cost. Chlorhexidine bathing is technically feasible and legally acceptable.

The methodology used is appropriate as the results of clinical significance and leading.

The results are fit for practical settings and can be helpful in reducing the healthcare associated infections in CVC patients.

• PDSA Cycle- In the planning stage, the chlorhexidine bathing timings, duration and sessions will be planned out. For this, the FNP will be trained and recruited for the bathing process. In the Do stage, the nurses will perform the bathing procedure according to the planned timings, duration and sessions. Clinical auditing will be done to check the effectiveness of the chlorhexidine bathing process. If there is any a loophole or non-compliance to the process, there will again be conducting of the process in the Act stage.
• PDSA cycle:  This method can be used for the testing of the change (reduction in infection rates) by developing a plan to test the change (plan), test done (Do), observation and learning from the (study) and determination of modifications required for the test (Act).

In the plan stage, there is planning of the chlorhexidine bathing that would be executed in the hospital setting among the CVC patients. The data was collected through literature search to understand the effectiveness of chlorhexidine bathing in reduction of infection rates. 

In the Do stage, the chlorhexidine bathing is carried out in the hospital among the study or intervention group. The observations are documented regarding the reduction of infection rates after chlorhexidine bathing as compared to control group.

In the study stage, results will be studied after implementation of the plan and how the results met the goal of reducing infection rates through chlorhexidine bathing.

In the Act stage, it is observed that the implemented plan worked or not. Moreover, the scope for improvement and modifications in the plan are made in this stage and if it does not work, is the study be spread in the clinical practice.

• Data analysis tools, interpretation equipments for the data obtained through survey and questionnaire are the technology required (Riff, Lacy & Fico, 2014). Gloves, chlorhexidine solution and other personal hygiene products are required for the bathing at the personal level. These are the resources required for the implementation of the plan.
• Clinical auditing can be performed before and after the completion of the project that will help to determine theimplementation of the project and its success (Bernard, Wutich & Ryan, 2016). There should be periodic clinical auditing to measure the practice of chlorhexidine bathing to reduce infection rates.
• The future study of the researchwill be to examine the daily CHG bathing efficacy in non-ICU patients at risk for the BSIs. It also provide scope for determining the optimal frequency, application method and concentration required to produce comparative results in regard to other prevention methods for reducing BSIs.

References

Bernard, H. R., Wutich, A., & Ryan, G. W. (2016). Analyzing qualitative data: Systematic approaches. SAGE publications.

Bowling, A. (2014). Research methods in health: investigating health and health services. McGraw-Hill Education (UK).

Brannen, J. (Ed.). (2017). Mixing methods: Qualitative and quantitative research. Routledge.

Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.

Fenstermacher, K., & Hudson, B. T. (2015). Practice Guidelines for Family Nurse Practitioners-E-Book. Elsevier Health Sciences.

Flick, U. (2014). An introduction to qualitative research. Sage.

Lampard, R., & Pole, C. (2015). Practical social investigation: Qualitative and quantitative methods in social research. Routledge.

Mackey, A., & Gass, S. M. (2015). Second language research: Methodology and design. Routledge.

Merriam, S. B., & Tisdell, E. J. (2015). Qualitative research: A guide to design and implementation. John Wiley & Sons.

Montecalvo, M. A., McKenna, D., Yarrish, R., Mack, L., Maguire, G., Haas, J., ... & Watson, A. (2012). Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability. The American journal of medicine, 125(5), 505-511.- quantitative study

http://www.sciencedirect.com/science/article/pii/S0002934312000149

O'horo, J. C., Silva, G. L., Munoz-Price, L. S., & Safdar, N. (2012). The efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis. Infection Control & Hospital Epidemiology, 33(3), 257-267.

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/the-efficacy-of-daily-bathing-with-chlorhexidine-for-reducing-healthcare-associated-bloodstream-infections-a-meta-analysis/F41E1D335C43683F32A7C40A0A4D03DD

Riff, D., Lacy, S., & Fico, F. (2014). Analyzing media messages: Using quantitative content analysis in research. Routledge.

Sekaran, U., & Bougie, R. (2016). Research methods for business: A skill building approach. John Wiley & Sons.

Taylor, S. J., Bogdan, R., & DeVault, M. (2015). Introduction to qualitative research methods: A guidebook and resource. John Wiley & Sons.

Uprichard, E. (2013). Sampling: bridging probability and non-probability designs. International Journal of Social Research Methodology, 16(1), 1-11.