Research Critic Picot Statement Essay

Research Critique Guidelines

Qualitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes?This gap in knowledge is the research problem.
How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.
Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
Were the purpose and research questions related to the problem? Research Critic Picot Statement Essay
Method of Study:

Were qualitative methods appropriate to answer the research questions?
Did the author identify a specific perspective from which the study was developed? If so, what was it?
Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?
Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.
Did the author evaluate or indicate the weaknesses of the available studies?
Did the literature review include adequate information to build a logical argument?
When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings?

Results of Study

What were the study findings?
What are the implications to nursing?
Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?
Ethical Considerations

Was the study approved by an Institutional Review Board?
Was patient privacy protected?
Were there ethical considerations regarding the treatment or lack of?
Conclusion

Emphasize the importance and congruity of the thesis statement.
Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
Integrate a summary of the knowledge learned.

Quantitative Study

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes?This gap in knowledge is the research problem.
How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.
Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
Were the purpose and research questions related to the problem?
Methods of Study

Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?
Was informed consent obtained from the subjects or participants?
Did it seem that the subjects participated voluntarily in the study?
Was institutional review board approval obtained from the agency in which the study was conducted?
Are the major variables (independent and dependent variables) identified and defined? What were these variables?
How were data collected in this study?
What rationale did the author provide for using this data collection method?
Identify the time period for data collection of the study.
Describe the sequence of data collection events for a participant.
Describe the data management and analysis methods used in the study.
Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?
What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?
Results of Study

What is the researcher’s interpretation of findings?
Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?
What limitations of the study were identified by researchers?
Was there a coherent logic to the presentation of findings?
What implications do the findings have for nursing practice? For example, can the findingsof the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?
What suggestions are made for further studies?
Ethical Considerations

Was the study approved by an Institutional Review Board?
Was patient privacy protected?
Were there ethical considerations regarding the treatment or lack of?
Conclusion

Emphasize the importance and congruity of the thesis statement.
Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011).Understanding nursing research(5thed.).St. Louis, MO: Elsevier.

Research critiques and PICOT statement

PICOT statement

The PICOT statement is presented that: “For hospitalized adult patients (P), does use of the CAUTI Bundle/Guide (I) compared with CAUTI without the use of Bundle/Guide (C) reduce the rate of CAUTI (O) within 180 days of process improvement implementation (T)?”

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Proposed evidence-based practice change

The high incidence ofcatheter-associated urinary tract infection (CAUTI)among inpatients is a source of concern for any medical facility. That is because it not only has a negative effect on care outcomes, but it also increases care costs. Perhaps the most distressing aspect of CAUTI is their avoidable nature that can be realized through deliberate actions. In particular, favorable results can be realized through CAUTI bundles and guides that synthesize the most current evidence to direct catheter use among hospitalized patients.It is undeniable that CAUTI is a source of concern in inpatient care settings, particularly for long-term care units. That is because indwelling urinary catheters are common invasive medical devices used in both non-acute and acute care settings. Despite the need for these catheters within care setting, it cannot be overlooked that they are a source of infection. It is this awareness that has necessitated the presentation of comprehensive CAUTI care bundles that use converging strategies to improve hygiene levels and reduce CAUTI rate. As a result, the PICOT statement was presented that: “For hospitalized adult patients (P), does use of the CAUTI Bundle/Guide (I) compared with CAUTI without the use of Bundle/Guide (C) reduce the rate of CAUTI (O) within 180 days of process improvement implementation (T)?” This statement acknowledges that although CAUTI care bundles can reduce the incidence of infections associated with indwelling catheters use, their effectiveness is influenced by the presence and use of established evidence-based guides. In essence, catheters are an important medical tool that medical facilities cannot do without, especially in the inpatient care setting. However, there is a concern that although using catheters is necessary, it is accompanied by risks that include urinary tract infection. Given that inpatient care settings cannot function without catheters, then it is proposed that using bundles and guides that deliberately target CAUTI would be instrumental in producing favorable care outcomes.Krein et al. (2013) supports these sentiments by noting that catheter use is expected to remain high among inpatients unless an alternative medical device that could serve the same function is presented. This means that since catheter use is expected to remain high, then there is a need to ensure that they are not accompanied by any unintended negative effects. Oman et al. (2012) similarly notes that catheter use is linked to unintended infection incidences that can be significantly reduced through nurse-led interventions. The present paper explores the contributions that Oman et al. (2012) and Krein et al. (2013) make towards understanding the research topic and PICOT statement.

Research critiques

Qualitative Study

Background of study

Krein et al. (2013) acknowledges that catheters are necessary in inpatient care settings. However, it adds that their use is responsible for avoidable CAUTI incidences. The major concern is that 10% of inpatients report contracting hospital acquired infection with CAUTI significantly adding to that number. Based on this awareness, it is only logical that medical facilities should develop strategies for reducing CAUTI incidence since their primary concern is to improve care outcomes. In addition, the article mentions that halting unnecessary use of catheters would significantly reduce the infection rate by eliminating opportunities for infection. Also, it led to the development of bladder bundles that amalgamate the best evidence to guide catheter use. Besides that, it notes that although bundles have been applied to reduce catheter use by 30%, there are opportunities that can be leveraged to present better results (Krein et al., 2013). As a result, the study sought to identify the specific barriers to the bundles use with the intention of improving their use to reduce CAUTI incidence.

Method of study

Krein et al. (2013) applied a qualitative research methodology to evaluate the factors influencing the successes and failures in applying Bladder Bundle. The study was conducted from May 2009 to February 2011. It first applied purposive sampling to recruit participants from 3 hospitals. The inclusion criteria was the use of Bladder Bundle. The participants were subjected to semi-structured phone interviews that evaluated their perceptions concerning the bundle, particularly its facilitators and hindrances. In addition, data was collected through observing the bundle in use. All the interviews and observations were transcribed as primary data. Once the primary data was collected, it was subjected to thematic analysis that noted how the application of the bundles in each one of the three facilities influenced infection incidences (Krein et al., 2013). Using a qualitative research methodology ensured that the study collected the required primary data that allowed it to examine the prevailing themes.Research Critic Picot Statement Essay

Results of study

Krein et al. (2013) identified two themes from the collected data. Firstly, the bundle application was either supervised by an infection preventionist or a care team. Secondly, bundle implementation faced unique barriers to include difficulty with engaging nurses and physicians, patients and their families presenting preferences that are contrary to the bundle, and unclear role of the emergency department with regards to catheter insertion. The results further noted that although there was evidence to support the use of these bundles since they produced the desired outcomes, nurses and physicians were generally unwilling to buy into the bundle use. Also, it mentioned that some patients and their families insisted on the bundle being used despite contrary advice presented by the bundle and even refusing to accept a replacement. Besides that, the study noted that an unclear role of the emergency department with regards to catheter insertion, the participants noted that the emergency department personnel were under the false perception that every patient getting into the department would require a catheter before being transferred to other departments (Krein et al., 2013).

Ethical considerations

Krein et al. (2013) mentions that ethical approval was sought for the study. The approval was sought and received from institution review boards of the University of Michigan, VA Ann Arbor Healthcare Systems, and the hospitals that participated in the study. This is an indication that the researchers has placed ample measures in place to ensure that the participants were protected from intentional or incidental harm. Although there is not mention about whether or not the participants sighed an informed consent before inclusion in the study, the fact that the study received approval to proceed from the institutional review board is an indication that the participants were well protected and informed consent could have been receive even if not mentioned (Krein et al., 2013). In this respect, it can be assumed that the participants were protected during the course of the study Research Critic Picot Statement Essay.

Quantitative Study

Background of study

Oman et al. (2012) mentions that CAUTI incidences are common among hospital patients, and they have serious consequences to include both the cost and associated morbidity. This is a concern since 25% of inpatients use catheters and 10% of them report CAUTI incidences. It further mentions that despite the presence of guidelines to reduce CAUTI incidence, their inconsistent application has reduced their effectiveness. To address this concern, the study proposes that nursing personnel can take on a leadership position in directing the guidelines application thus being responsible for consistent application. The underlying intention is to identify the value of nurse-directed interventions in reducing CAUTI (Oman et al., 2012). In this respect, the study explores the contributions that nursing personnel can make to reduce central line-associated bloodstream infection (CLABSI) incidence when they direct interventions as leaders.

Method of study

Oman et al. (2012) applies a quantitative research approach that entailed collecting numerical data that would then be subjected to analysis to determine the strength of relationships between the variables and the significance of that relationship. The study applies a pre-post intervention design to evaluate the effects of evidence-based nurse-led interventions as quality improvement approaches. The participants were recruited from among patients and multidisciplinary care teams in two medical/surgical units within the same facility. The study protocol was applied in three phases. The first phase was conducted over three months and it entailed collecting baseline data from the two units. The second phase involved applying house-wide intervention that entailed integrating the efforts of nursing personnel, patients and family members to apply evidence-based practice in reducing CAUTI incidence among hospitalized patients to be accompanied by data collection Research Critic Picot Statement Essay. The final phase involved applying focused intervention that included educational sessions, competency training and journal clubs to be accompanied by data collection. Data collection focused on demographic data (age, gender, surgical procedure and length of stay in the hospital), CAUTI rates (number of infections for every 1,000 catheter days for the participating patients), IUC duration, and bladder scanner log. The collected data was subjected to statistical analysis that presented the appropriate descriptive statistics and student t-test with the confidence interval set at 95% (Oman et al., 2012). The study methodology is appropriate since it collected numerical data that facilitated direct comparisons thus presenting the statistical significance of the relationship between the study variables.

Results of study

219 patients were recruited in the first phase. 238 patients were recruited in the second phase. 238 patients were recruited in the third phase. Of the 947 medical personnel who attended the health stream module,96% of them completed the module. An evaluation of catheter duration over the three phases showed a reduction for both the pulmonary unit (p=0.076) and general surgery unit (p=0.018) with an average decrease from 400 days to 305 days. CAUTI incidence was maintained at 0.0 in the pulmonary unit but it increased for the surgical unit from 1.9 in phase one to 3.4 in phase two before settling at 2.2 in phase three. Length of stay in the pulmonary unit progressively decreased from 7.39 in phase one, to 7.21 in phase two before settling at 6.72 in phase three. For the surgical unit, the length of stay initially increased from 6.91 in phase one to 8.03 in phase two before reducing to 6.55 in the phase three. The study determined that the program allowed the facility to save $52,000 every year. Although the study did not produce definite results for changes in CAUTI rates, a reduction in catheter-days was achieved to imply that nurse-led interventions can improve nursing care outcomes (Oman et al., 2012).

Ethical considerations

The study was exempted from ethical oversight by the institutional review board. That is because it focused on improving quality while not exposing the participants to any harm. Given that it used medical records as a primary source of information, there was an assurance of the patient data being kept confidential and stored in password-protected locations. Also, information that could identify the participants was not included in the study thus ensuring that they remained anonymous as required by the law. The project was financially supported by a quality improvement small grant from the University of Colorado Hospital and the University of Colorado Denver School of Medicine thus showing that there was no conflict of interest that could unduly influence the results (Oman et al., 2012) Research Critic Picot Statement Essay.

References

Krein, S. L., Kowalski, C. P., Harrod, M., Forman, J., & Saint, S. (2013). Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA Intern Med., 173(10), 881-886. doi: 10.1001/jamainternmed.2013.105

Oman, K. S., Makic, M. B., Fink, R., Schraeder, N., Hulett, T., Keech, T. & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections.Am J Infect Control, 40(6), 548-553.doi: 10.1016/j.ajic.2011.07.018 Research Critic Picot Statement Essay

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