Picot Statement final Draft

Name: Tina McKane

Date: February 23, 2020

Tim,

You discussed the 2 required qualitative studies, but you did not write a paper. You answered or responded to each question, but not in “paper” format. Please do not do this for future papers. Include the information you included, but write it as a paper. You discussed the study problem, how it relates to your PICOT statement, the background, study methods, results of study, and ethical considerations. Please write an introduction and include a thesis statement. Please provide your PICOT question in your introduction. Please review proper formatting of citations, references, and your paper. Please use headings. Please incorporate all feedback into your next paper.

Please see rubric for grade.

Thank you,

June

Your paper should start with an introduction.

Qualitative Studies

Background of Study

1. Summary of studies. Include problem, significance to nursing, purpose, objective, and research question. Comment by June Helbig: The requirement for you is to write a paper, not to

The first study by Carter et al., 2016 was aimed at exploring the actions of nurse managers that led to the facilitation of active involvement in catheter-associated urinary tract infection, CAUTI, prevention programs in the emergency department. The study examines the influence of nurse administrators on how well the prevention programs work and the various themes that would be relayed in emergency departments as the results of action or inaction by these administrators towards the prevention programs. The second study by Krein et al., 2013 was aimed at identifying the various ways in which CAUTI prevention efforts could be enhanced. This study was based on experiences of hospitals participating in a program by Michigan’s Keystone Center. A program termed as bladder bundle was instigated as a safety program and used to find a way to reduce the unnecessary utilization of urinary catheters. The use of these devices can lead to an increased risk of contracting CAUTI.

How do these two articles support the nurse practice issue you chose?

1. Discuss how these two articles will be used to answer your PICOT question. Comment by June Helbig: This should not be included as part of your paper.

The first article looks into the financial costs associated with CAUTI for institutions and will be used to answer my PICOT questions by looking into the various ways CAUTI can be prevented, therefore, reducing the financial costs associated with it and how nurses can be part of this prevention. The article looks into the insertion of catheters in the emergency department and the role of nurses when it comes to prevention as catheter insertion poses a risk of exposure to patients when it comes to CAUTI (Carter et al., 2016).

As explained in the second article, CAUTI is a common infection categorized as health-associated. The prevention of this infection is critical to improving the kind of care that hospitalized patients receive. This prevention is also essential to meeting the goals under a reductions set, for conditions that are categorized as health-associated which is part of a program by the department of health (Krein et al., 2013). The article will be used to answer my PICOT question by looking into the influence that nurses have in CAUTI prevention.

2. Describe how the interventions and comparison groups in the articles compare to those identified in your PICOT question.

The comparison groups and interventions in the first article include nurse managers and nurse engagement. They are comparable to those of my PICOT question as both involve nurses and nurse administrators in dealing with the problem of CAUTI. The prevention of CAUTI is a crucial opportunity for nurse administrators to engage clinical nurses in improvement efforts that are meaningful and effective. The two recognize that clinical nurses are in the best position to examine the insertion workflow of urinary catheters (Carter et al., 2016). There is also a recognition in both that nurses are best positioned in coming up with and suggesting improvements in improving maintenance and placement of these devices and avoiding their use altogether.

The second article compares to the PICOT question through the recognition of barriers for comparison groups and interventions. These barriers include insertion customs and practices for catheters in the emergency department. Requests made by patients and their families, who are common comparison groups for the article and my PICOT question, to have in-dwelling catheters inserted as part of interventions. Lastly, the difficulty of engaging common comparison groups including physicians and nurses (Krein et al., 2013). The interventions in both include engaging physicians and emergency departments as a way to ensure the implementation of processes that are facilitating to indications of appropriate catheter use. Instigating discussions of risk of use of catheters that are in-dwelling with families and patients (Quast et al., 2016). Lastly, inculcating the use of urinary management approaches including the planning of toileting as part of patient safety initiatives.

Method of Study:

1. State the methods of the two articles you are comparing and describe how they are different.

The first article is a qualitative analysis that employs a comparative and multisite case study. It looks into six emergency departments, nine focus groups, and fifty-two interviews. The method used is a content analysis where site summaries were developed and data coded to explicate the themes that were observed in the study. The site summaries and codes were then reviewed to allow the identification of actions undertaken by nurse leaders that allowed the engagement of clinical nurses in the prevention of CAUTI (Carter et al., 2016).

These methods are different from the methods of the second article that used qualitative assessment by sampling twelve hospitals. Data was collected from the Michigan hospitals i.e. the study only looked into Michigan, and key informants were interviewed (Krein et al., 2013). Moreover, there is also differentiation in that only three of the twelve hospitals were visited (Quinn et al., 2019). Analysis for this article was mainly concerned with key issues and perceptions identified to be influential to the implementation of prevention practices for CAUTI.

2. Consider the methods you identified in your chosen articles and state one benefit and one limitation of each method.

The advantage of the case study method used in both studies is that it consumes less time and is less costly and can be very efficient for conditions with a long latency period. The disadvantage is that the method can be subject to selection bias and exposure information can be subject to observation bias. Interviewing, as seen in the second article can be beneficial as it allows for first-hand information and can be disadvantageous in that it can be time-consuming (Gupta et al., 2017).

Results of Study

1. Summarize the key findings of each study in one or two comprehensive paragraphs.

The first article found that nurse leaders were crucial to prevention programs for the condition and undertook the following to successfully engage clinical nurses. They held nurses accountable for CAUTI outcome measures and processes. They fostered a culture of teamwork leading to the facilitation of interdisciplinary communication on the alternatives and appropriateness of catheter insertion. The leaders empowered nurses to address and identify improvement opportunities pertinent to the condition (Carter et al., 2016). Lastly, they reframed urinary catheters as devices that could be potentially harmful to patients.

According to the second article, barriers to the appropriate use of catheters and success for the bundle initiative included the following. Custom and norms of catheter use, patient and family request for use of catheters and difficulties engaging physicians and nurses. However, the article proposes solutions to these barriers that include the following (Krein et al., 2013). Engagement of physicians and nurses stationed at the emergency department to implement procedures that allow for indications of appropriate catheter use. Discussions of the risk of catheter use with families and patients (Zengin et al., 2017). Lastly, the utilization of urinary management as part of patient safety programs.

2. What are the implications of the two studies in nursing practice?

The implication of the first study to the nursing practice is that it informs nurse leaders on how to engage clinical nurses in CAUTI prevention. Their engagement can be bolstered through the provision of local data as an indication of the impact that nurse practices have on patient outcomes. The involvement of nurses in the implementation and design of practice changes (Carter et al., 2016). Lastly, shifting focus to the exposure of patients to harm through the use of catheters and therefore shifting the perspective of nurses.

The implication of the second study to the nursing practice is that it encourages the engagement of nurses in programs and initiatives that are geared towards care improvement. An example is the keystone initiative that led to over a third in reductions of catheter use and bolstered the use of practices that promote the timely removal of catheters (Manojlovich et al., 2019). The involvement of nurses in the project made is so successful that it became the model program to be rolled out all over the country.

Ethical Considerations

1. Discuss two ethical consideration in conducting research.

Ethical considerations include respect for privacy and confidentiality. Prior to the study, full consent should be obtained from the participants. There should be a prioritization of respect for the dignity of participants (Zengin et al., 2017). Moreover, participants should not be subjected to harm in any manner whatsoever.

2. Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research.

The first article obtained consent from the participants as did the second article. The first article remained sensitive to consent considerations and enrolled participating facilities, focus groups, and interviewees to the research. There were also reviews undertaken for site summaries and coded data to ensure that the data was obtained ethically and correctly represented the participants of the research (Carter et al., 2016).

The second research remained ethical by considering the workload of nurses and their consideration of other patient safety priorities beyond the risk posed by catheter insertion. The study ensured that it obtained consent from all participants and collaborated with the bundle initiative to ensure that the problem of CAUTI was correctly represented and the efforts of all stakeholders were considered (Krein et al., 2013).

Conclusion

References