Unit 4 Assignment Literature Review 5-6p due 3/30/22
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Unit2-IntroductiontoEvidencePracticeProblem1.docx6
Evidence-Based Practice Topic
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Evidence-Based Practice Topic
The selected evidence-based practice topic is "The effects of proning therapy in COVID-19 patients." A common symptom of COVID-19 is respiratory distress, and the prone position is a conventional intervention for handling such issues. It requires practitioners to monitor patients while they lie on their abdomen. Essentially, the prone position involves lying face down to alleviate respiratory distress. The prone position is a direct opposite of the supine position, which requires individuals to lie flat on their backs. However, the prone position is better than supine in respiratory distress; the supine position compresses the lungs, leading to low oxygen levels due to inhibited air exchange.
The outbreak of the Sars-Cov-2 virus resulted in acute respiratory failure in some of the patients infected with the virus. The COVID-19 pandemic is characterized by causing respiratory problems in infected patients. Some of the symptoms evident in the disease are respiratory failure, fever, and dyspnea. However, of fundamental interest to the selected evidence-based topic is acute respiratory distress syndrome (ARDS) resulting from worsening symptoms. Although other complications may arise, such as pulmonary edema and multi-organ failure, ARDS is the most prevalent among critically ill patients affecting approximately 17% of COVID-19 patients (Ghelichkhani & Esmaeili, 2020).
Therefore, the selected evidence-based topic intends to probe the effectiveness of using prone therapy to alleviate the worsening symptoms of COVID-19 patients. Analyzing the effectiveness of prone therapy is essential since there currently is no definitive cure or treatment for the Sars-Cov-2 virus. Consequently, practitioners have to depend on therapies such as proning to combat the effects of COVID-19. The prone position is usually a therapy for patients presenting with ARDS as an intervention to improve ventilation. Notably, the practitioners apply the prone position to improve oxygenation in patients suffering from ARDS. Thus, it is essential to determine if it can address the ARDS symptoms associated with COVID-19 that usually lead to ventilator use.
Significance of Evidence-Based Practice Topic
The issue of proning therapy mainly affects individuals suffering from COVID-19 who have symptoms of ARDS. As mentioned above, approximately 17% of COVID-19 patients suffer from ARDS. Thus, prone therapy can effectively alleviate the symptoms of non-intubated patients suffering from ARDS. Proning therapy is attractive because it requires minimal resources and does not require additional investment from either institutions or individuals. Consequently, it can benefit society by making COVID treatment affordable for everyone and reducing resource strain on medical institutions.
The alternative use of ventilators is more expensive overall and will lead to disparities in care for those with server COVID-19 symptoms. The supply of ventilators to combat respiratory distress largely depends on the financial capabilities of institutions. The pandemic created a massive demand for ventilators, personal protective equipment, and additional units. These financial burdens contributed to 22 healthcare organizations' declaration of bankruptcy in 2019 (Anoushiravani et al., 2020). In addition, the rise in demand for ventilators has also created a global problem. Ventilator shortage has meant that COVID-19 patients who would typically survive in the presence of a ventilator end up dying because ventilators are not available (White & Lo, 2020).
Proning therapy can also provide benefits for the health of COVID-19 patients. It improves lung functioning by reducing compression and redistributing blood and airflow evenly, improving gas exchange. The improved lung functioning means that COVID-19 patients do not depend on a ventilator to obtain optimum oxygen levels. The prone position can also improve heart functioning in some individuals, increasing its effectiveness and efficient transmission of oxygenated blood. By eliminating the need for ventilators, prone therapy eliminates the financial burden on health institutions while simultaneously reducing the mortality rate of COVID-19 patients with acute respiratory failure (Golestani-Eraghia & Mahmoodpoo, 2020).
PICOT Question
The PICOT question is created around the evidence-based topic "The effects of proning therapy in COVID-19 patients." A PICOT question is essential for evidence-based practice and is crucial at systematically inquiring the clinical elements of the evidence-based topic (Gray et al., 2021). The type of question in this scenario is a foreground question because of its specificity, and the key information required is for making clinical decisions. The PICOT question also falls in the intervention or therapy category because it assesses if proning therapy translates to better outcomes for COVID-19 patients (Gray et al., 2021).
The first component of the PICOT question is population; prone therapy will affect are patients infected with COVID-19 with serve symptoms. The second component is intervention and, as already established, is prone therapy to alleviate respiratory distress. Next is the alternative therapy, which was mentioned as the direct opposite of the prone position, the supine position. Notably, the outcome element in the PICOT question constitutes intubation and mortality; assessing these elements will highlight the effectiveness of the therapy. Lastly, the last component of the PICOT question is time, and in this case, the timeframe begins when a patient is suffering from COVID-19 is admitted.
A representation of all the components of the PICOT question are represented below;
P: Covid- 19 positive patients with the ICU.
I: Proning therapy
C: supine position
O: Reduced intubation and mortality of COVID-19 patients
T: during hospital admittance.
In the sentence format, the combined PICOT question is:
For COVID-19 positive patients, has the use of proning therapy been effective in reducing mortality and intubation rates?
Selected Articles
The first article that addresses the topic problem is by Rahmani et al. (2020). The purpose of the article is to assess the effects of the prone position in treating COVID-19 patients. According to Rahmani et al. (2020), the prone position is conventional to enhance oxygenation for patients suffering from ARDS who require a ventilator. The article asserts that the prone position leads to homogenous ventilation and reduces patients' mortality rate. Rahmani et al. (2020) assert that proning is non-invasive ventilation with contradictions and is only effective when coordinated by a healthcare team.
The second article is by Ghelichkhani & Esmaeili (2020), assessing the prone position as an alternative for managing COVID-19 patients. The article's authors assert that ARDS is the primary COVID complication proning should address. According to Ghelichkhani & Esmaeili (2020), the effectiveness of the proning position is affected by; patient selection, initiation and duration of placement in the prone position. Therefore, it is crucial to select specific patients for the intervention and monitor their duration in the position. Finally, Ghelichkhani & Esmaeili (2020) assert that early initiation of proning in ARDS patients can decrease mortality. In addition, the authors recommend that proning should last a minimum of 12 hours a day for effectiveness.
The third article is a quantitative research conducted by Hallifax et al. (2020) to determine if awake proning in COVID-19 patients who require respiratory support leads to positive outcomes. The study had a total of 565 patients admitted for COVID-19 who provided data that awake proning leads to positive outcomes for patients with non-invasive respiratory assistance. In addition, the authors also acknowledge that there is high mortality among COVID-19 patients who used respiratory support.
Strategies to Select Articles
Refining the search required selecting a criterion for articles that have been published in the last five years. Additionally, the articles have to mention proning therapy specifically as an intervention to combat COVID-19. Another acceptable criterion were articles that assessed the effectiveness of using prone therapy to combat acute respiratory distress syndrome. The search process also involved perusing the works cited a list of articles to determine if they contained relevant articles. Eventually, the three articles selected directly assess prone therapy as an intervention to combat ARDS symptoms of COVID-19.
The search for scholarly articles involves ensuring that they are credible. Apart from the date, other areas assessed were author, presence of references, and consistency of assertions. The author of an article is a vital component of determining its credibility. Some articles do not contain the author's name or indicate an institution as the creator; these articles are not valid. The presence of a reference list also indicates credibility and is an indication that an author performed due diligence when creating an article. Therefore, the articles selected have valid references.
Conclusion
The selected evidence-based practice topic is "The effects of proning therapy in COVID-19 patients." There exist scholarly articles that assess the effectiveness of the prone position as an intervention against serve symptoms impacting COVID-19 patients. The primary symptom that the prone position addresses are acute respiratory distress syndrome (ARDS). Therefore, prone therapy focuses on addressing respiratory distress in COVID-19 patients. Prone therapy is an alternative to the supine position and ventilator use, and it requires minimal financing and improves patient outcomes. Notably, research indicates that the prone position reduces the mortality of COVID-19 patients. However, proning is effective when monitored by health professionals, paying attention to the duration and applied to select patients as early as possible.
References
Anoushiravani, A. A., O’Connor, C. M., DiCaprio, M. R., & Iorio, R. (2020). Economic Impacts of the COVID-19 Crisis. The Journal of Bone and Joint Surgery. American Volume. https://doi.org/10.2106/JBJS.20.00557
Ghelichkhani, P., & Esmaeili, M. (2020). Prone Position in Management of COVID-19 Patients; a Commentary. Archives of Academic Emergency Medicine, 8(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158870/
Gray, J., Grove, S. K., & Sutherland, S. (2021). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). Elsevier.
Hallifax, R. J., Porter, B. M., Elder, P. J., Evans, S. B., Turnbull, C. D., Hynes, G., Lardner, R., Archer, K., Bettinson, H. V., Nickol, A. H., Flight, W. G., Chapman, S. J., Hardinge, M., Hoyles, R. K., Saunders, P., Sykes, A., Wrightson, J. M., Moore, A., Ho, L.-P., & Fraser, E. (2020). Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respiratory Research, 7(1), e000678. https://doi.org/10.1136/bmjresp-2020-000678
Rahmani, F., Salmasi, S., & Rezaeifar, P. (2020). Prone Position Effects in the Treatment of Covid-19 Patients. Caspian Journal of Internal Medicine, 11(Suppl 1), 580–582. https://doi.org/10.22088/cjim.11.0.580
White, D. B., & Lo, B. (2020). A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. https://doi.org/10.1001/jama.2020.5046
