Please read carefully. These are 3 assignments that are related. I need this by Saturday. Please pay great attention to details.

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Home >Nursing homework help >Please read carefully. These are 3 assignments that are related. I need this by Saturday. Please pay great attention to details.

PICOT Question

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External Ventricular Drain is one of the best method to lower CSF pressure and then monitor it in intensive care unit, special care units and wards in patients with acute brain injury (Muralidharan, 2015`). External ventricular drain infection is a major complication after surgery, leading to the early removal of the drain or delay in the insertion of ventriculoperitoneal or other shunts. It also adds to the misery of the patient, can become a source of septic shock, and can increase hospital stay and cost (Abayomi Sorinola, 2019). Risk factors identified for the development of infection include long operative time, longer durations of drain placement, and frequent CSF sampling, reduced CSF glucose at the time of catheter placement and short tunnel length (Pengwei Lu, 2019).

A study conducted by Sein Lwin introduced measures for both doctors and nurses to reduce external ventricular drain infections. For doctors, the measures included introduction of proper surgical techniques, education of young doctors about CSF sampling and decreasing the duration of EVD placement. For nurses, measures taken included conduction of EVD care workshops and assuring the practice of standard care operating procedures by nurses. This decreased the infection rate from 6.1% to 3.8% (Sein Lwin 1, 2012). Other studies also have also shown that proper handling of EVD, sterile gloving and decreased CSF samplings can decrease the rate of CSF infections post-surgery (Humphrey, 2018). A combined effort from both doctors and nurses is required to identify the risk factors and work to reduce them (Ady Thien, 2020). A study also showed that antibiotic administration via EVD can reduce the rate of infection (Champey, 2018).

The nursing problem identified here is the improper handling of EVD by nurses, not knowing sterile gloving and CSF sampling techniques. Nurses should be taught proper handling and sampling techniques, and study should be conducted post-intervention to see if improving only nursing practices could bring any change in the infection rate. Rate of retention of knowledge should also be checked (Paulo, 2020).

PICOT QUESTION

Population: Post-operative neurosurgical patients who have undergone placement of external ventricular drain (EVD)

Intervention: Nursing staff with pre-op education about EVD, Sterile gloving technique, CSF sampling from EVD and EVD handling.

Comparison: Retrospective review of the patients who developed EVD/CSF infection prior to the intervention

Outcome: Number of patients developing post-operative fever with positive CSF cultures.

Time: Till the time EVD is placed

PICOT Question: Good nursing practices can decrease the rate of EVD infection in post-operative neurosurgical patients

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	(Ady Thien, 2020)	(Sein Lwin 1, 2012)	(Champey, 2018)
How Does the Article Relate to the PICOT Question?	The research introduces an effective strategy (program risk stratification) to decrease the rate of EVD related infections, and also quantitatively assess the rate of decline after intervening the strategy	The article introduces measures that should be taken by both doctors and nurses to reduce EVD infection	This article tells ways and introduces a strategy called “EVD care bundle” to reduce the rate of EVD infections post-op.
Quantitative, Qualitative (How do you know?)	Quantitative	Quantitative	Qualitative
Purpose Statement	To assess the efficacy of a pragmatic risk-stratification pathway for external ventricular drain (EVD) management, allowing for surgical decision making, in reducing the rate of VRIs (ventriculitis related infection)	Strategies for the reduction of external ventricular drain related infections	Retrospective study to identify the strategies for reducing the rate of external ventricular drain related infections.
Research Question	Will program-risk stratification help in handling EVDs and reducing the counts of EVD related infections?	Would the proposed strategies/ interventions reduce the rate of infection?	What measures should be taken to reduce EVD infections post-operatively?
Outcome	EVD infections decreased from 6.8% to 0 after introduction of program risk stratification technique.	Reduction of the rate of EVD infection after taking interventions	EVD care bundle, including regular CSF sampling and intrathecal antibiotic administration can reduce the rate of infection
Setting (Where did the study take place?)	National Neuroscience Institute	Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore	3 French university hospital ICUs in Grenoble, Marseille, and Saint-Etienne, with 9 ICU beds and 4 intermediate care beds, 20 ICU beds and 12 intermediate care beds, and 24 ICU beds, respectively
Sample	Patients with EVD	Patients with EVD at the hospital over 1 and a half year eriod.	EVD patients staying longer than 24 hours in the ICU were included in this study
Method	Retrospective and Prospective Study	An audit was first conducted to see the rate of EVD infection in the hospital and interventions were then done to reduce them	Retrospective study
Key Findings of the Study	· EVD infection rate decreased from 6.8% to 0% after application of pragmatic evidence based risk stratification pathway. All hospitals should conduct a survey to know the risk factors of infection in their hospital and find a way to resolve them.	· The infection rate reduced from 6.1% to 3.8% after taking interventions for both doctors and nurses. · Silver lining of EVD can further decrease the rate of infection	· Achieving low rates of EVD infection is possible with IT administration of antibiotic and regular CSF sampling.
Recommendations of the Researcher	Program risk stratification pathway should be used in hospitals to control EVD related infections	Combined effort of hospital administration, doctors and nurses can decrease the rate of infection, and thus measures should be taken to improve their practices	· EVD care bundle should be used to decrease the rate of infection

Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	(Humphrey, 2018)	(Paulo, 2020)	(Pengwei Lu, 2019)
How Does the Article Relate to the PICOT Question?	The article introduces nursing knowledge, attitudes and practices related to EVD care very well.	This article assesses the knowledge retained by nurses after introducing them to EVD care measures	Risk factors related to EVD infection are identified.
Quantitative, Qualitative (How do you know?)	Qualitative	Quantitative	Qualitative
Purpose Statement	How do nurses care for patients of neurosurgery with external ventricular drains	Knowledge of exte4nal ventricular drain retained by nursing professionals	Analyze risk factors for ERI (External Ventricular Drain Related Infections) in pediatric patients post-brain tumor surgery
Research Question	How EVD works, and how are nurses involved in EVD handling and management	How much knowledge are health-care professionals able to retain after being introduced with EVD care techniques	What are the factors that contribute to the development of infection after the insertion of external ventricular drain
Outcome	The research article concludes that though the care of EVD is difficult, but successful patient outcomes can be seen with understanding of it’s key elements and functioning. This includes knowing infection control policies about its handling, knowing how to assess patients for infection, knowing the on and off position of the stop clock, knowing indications and complications of EVD, and being able to assess patient’s GCS	Significant knowledge retention was seen among nurses in the first week after intervention but not after three months. Knowledge retention was significant between the first and second phases (p-0.004). Knowledge regarding pathophysiology was poor. Knowledge about device handling was good.	Study showed that patients with longer durations of surgery and EVD placement, pre-op VP shunts, and frequent CSF sampling developed more EVD infections.
Setting (Where did the study take place?)	Review article	Syrian-Lebanese Hospital	Beijing Tiantan Hospital, Capital Medical University
Sample		38 nurses were included in the study who worked in a general adult ICU in a private hospital in São Paulo, Brazil and participated in the EVD care training.	147 patients <18 years old from January 2016 to December 2017 with a confirmed diagnosis of intracranial infection after tumor resection
Method	Review article	quasi - experimental study	Retrospective study

REFERENCES

Abayomi Sorinola, A. B. (2019). Risk Factors of External Ventricular Drain Infection: Proposing a Model for Future Studies. Front Neurol., 226. doi:10.3389/fneur.2019.00226 Ady Thien, S. S. (2020). The National Neuroscience Institute External Ventricular Drain Study: A Pragmatic Multisite Risk-Stratification Pathway to Reduce Ventriculostomy-Related Infection. World Neurosurg., e126-e136. doi:10.1016/j.wneu.2019.11.070 Champey, J. (2018). Strategies to reduce external ventricular drain–related infections: a multicenter retrospective study. JOURNAL OF NEUROSURGERY. doi:https://doi.org/10.3171/2018.1.JNS172486 Humphrey, r. E. (2018). Caring for neurosurgical patients. Nursing Times [online]. Retrieved from https://cdn.ps.emap.com/wp-content/uploads/sites/3/2018/03/180328-Caring-for-neurosurgical-patients-with-external-ventricular-drains.pdf Muralidharan, R. (2015`). External ventricular drains: Management and complications. Surg Neurol Int., S271–S274. doi:10.4103/2152-7806.157620 Paulo, S. (2020). Retaining knowledge of external ventricular drain by nursing professionals. Rev Cuid. doi:https://doi.org/10.15649/cuidarte.784 Pengwei Lu, R. W. (2019). Risk Factors of External Ventricular Drainage-Related Infections: A Retrospective Study of 147 Pediatric Post-tumor Resection Patients in a Single Center. Front Neurol., 1243. doi:10.3389/fneur.2019.01243 Sein Lwin 1, S. W. (2012). External ventricular drain infections: successful implementation of strategies to reduce infection rate. Singapore Med J.