Infection Prevention In Critical Care Setting Discussion Paper
A Systematic Review
Clearly Focused Questions
Discuss About The Infections Prevention Critical Care Setting.
The CASP tool checklist selected for above article found through CINHAL is “systematic review checklist” (CASP SR Checklist, 2018) as it there is no specific checklist for integrative review. The rationale for the choosing this checklist is the “integrative review methodology” of the above paper which uses studies mainly quantitative and is considered similar to systematic review (Munn et al., 2014).Therefore, the chosen checklist is justified.
Galiczewski & Shurpin (2017) did not present any clear focused questions. However, it is evident from the background and the significance section that the research is focused on the patients with Catheter associated urinary tract infections or CAUTI. The purpose was to focus on the interventions given to reduce the CAUTI rates and its effectiveness when given in the intensive care units. However, having the clear focused questions would have enabled readers to learn the objective of the paper in first stance (Moher et al., 2010). Infection Prevention In Critical Care Setting Discussion Paper
According to Zeng et al. (2015), best review would consider studies that address the clearly focused questions with appropriate study design and evaluation of the interventions. The author had chosen appropriate research papers for meeting the study objectives (CASP SR Checklist, 2018). It is evident from clearly defined the inclusion criteria including the study types considered, which is the primary research articles available in full text on CAUTI patients in ICU setting. This is sure to provide the valid evidence. Further, the review included studies published between 1998 and 2014. However, the drawback is the lack of details on the methodology of the papers included for integrated review (LoBiondo-Wood & Haber, 2017). It is difficult for the readers to ensure that the chosen study methodologies were indeed a right type. However, it was worth continuing with further reading.
It appears that the authors had included important and relevant studies as evident from the search strategy that includes use of electronic databases such as Cochrane Review, PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL). These databases are popular for collection of high quality studies that facilitate evidence-based health care decision-making (Henry, 2018). The review excluded the non-English language studies, and those involving in intermittent urinary catheterisation and prophylactic use of antibiotics for the prevention of CAUTI. There were no clear details if the researcher had followed up the studies through reference list or had personal contact with the experts to enquire about unpublished studies, which makes the relevancy one again questionable (Moher et al., 2010).
Right Type Of Papers
According to the chosen CASP framework, the review must assess the rigour of the identified studies as poor rigour may affect the validity of the study (Munn et al., 2014). The studies included did meet the inclusion criteria and to ensure the reliability and validity the researcher reads the studies in its entirety. It may be considered a drawback as there were no details on assessment of quality (CASP SR Checklist, 2018). The studies were not scored for the quality or determined the k coefficient as recommended by Zeng et al. (2015) for including only moderate to strong studies. This may be considered the weakness of the article.
The author did consider if the results from study to study was similar and well displayed the results of all the included study as stated in the CASP framework. The author did present the well composed tabular chart of studies extracted based on their purpose, design, intervention, results. Although it was not mentioned earlier in the method section, the author did consider the studies from different study designs such as meta-analysis, quasi-experimental study, Secondary data analysis, Randomised control trial, and the sequenced non-randomised studies. It was observed while critique that the results from the different results were similar. Therefore, the overall results were categorised into two separate themes. The variation in the results was not discussed which may be considered a limitation (LoBiondo-Wood & Haber, 2017). However, it can be considered relevant to combine the results of the review.
The author had clearly presented the overall results of the review. It is easy for the readers to detect the review’s bottom line results (CASP SR Checklist, 2018). The results discussed as narrative review due to heterogeneity of the study results. Therefore, it was justified to make the comparison with two themes that are, “Implementation of a bundle of interventions to control and prevent CAUTI” and “implementation of a single intervention to control and prevent CAUTI” in catheterised patients. The reviewer evaluated the outcome of these interventions on patient outcomes. There was no need to measure the numerical appropriateness of the results since there was no meta-analysis. Therefore, the descriptive presentation of themes was appropriate. Due to the same reason, there is no relative risk identified or odd ratio calculated (Zeng et al., 2015; LoBiondo-Wood & Haber, 2017). Thus, the overall results are justified to address the research question as it was found that the CAUTI infection rates could be decreased by discontinuance of urinary catheters in less than seven days or daily review of catheter.
ORDER A PLAGIARISM-FREE PAPER HERE
Inclusion Of Relevant Studies
The precision of the results are doubtful as the confidence intervals are not reported in the integrative reviews. However, some of the study results did present the odd results and evaluated the interventions (Henry, 2018). The overall results may be considered reliable and give valid evidence about the interventions to reduce CAUTI infection rates (Durant, 2017).
The application of the results of the review was critiqued for its application locally. It was found that the interventions cannot be provided in another setting other than ICU although the population would be same as the review. The results of the review considered the intervention for the CAUTI patients and the outcomes when given in ICU setting. Therefore, it can be applied in ICU and not in long-term nursing units (Durant, 2017; Henry, 2018). Moreover, all the interventions are not integrated in the review that may minimise the risk of CAUTI in catheterised patients. The patient covered by the review may be different to my population to cause concern. The local setting also may be different from the review.
All the important outcomes have been considered but are mostly related to the patient and health care professional’s outcome. It can be applied, which is indicating the need for practice implications. Overall the results have given insufficient evidence. The nature of the interventions is inconclusive. There is a need to consider the interventions for CAUTI infections in different hospital settings and on different population of patients (Durant, 2017). It will help develop multidirectional approach to treat patients based on evidence-based interventions.
It appears that the benefits are more than harm if the interventions are given for similar population in similar setting. However, it may lead to cost increase as different interventions may be applicable in different setting for different population. Thus, there is a need of multidimensional approach, in which these interventions can be incorporated. In conclusion, the benefits may not worth the harm and cost as the evidence is insufficient (LoBiondo-Wood & Haber, 2017).
Qualitative studies help identify useful themes through interviews and verbatim quotes. The CASP qualitative checklist is used for this article as the methodology of the above article is qualitative interview. It is useful to critique the article (CASP-Qualitative-Checklist, 2018).
Prinjha et al. (2016) had presented the clear statement of research aims while detailing the need of research supported with existing literature in this area. The goal of the research was to explore the information needs of the catheterised patients (indwelling urinary catheter) and outcome of the inadequate information and interventions to address the needs. The research aims is justified as there is lack of appropriate methods to meet the needs of the information needs of long-term indwelling catheter users. Therefore, the research aims are relevant.
Assessment Of The Quality
According to CASP-Qualitative-Checklist (2018) this method is appropriate to interpret or illuminate the actions or subjective experiences of research participants. The interview was collected using the narrative approach. Thus, the methodology is appropriate for addressing the research goal. It is because the interview will help interpret the subjective experiences and emotions of the research participants who are catheterised when they lacked adequate information.
The author had selected a qualitative interpretative research design with the thematic analysis. It is appropriate as the qualitative research uses participant’s responses instead of statistics to gather data around the topic. It is the essence of the qualitative research. It looks at social phenomena to interpret what people do and rationale (Hannes, 2011). Thus, the research design is appropriate for addressing the research goals. The author had discussed that the method of interview will help researcher collect the oral history of the participants’ priorities, meanings, and concerns. It is appropriate to meet the research aims and may be considered the strength of the study.
To ensure that the recruitment strategy is appropriate to meet the research aims, the researcher must explain the how the participants were recruited (Hannes, 2011). The author had explicitly presented the selection criteria of the patient. Adult men and women living in the UK with indwelling urinary catheter, more than three months were selected. The researcher justified taking diverse participants with collection of broad range of patient’s experiences. In addition, it was also succinctly mentioned that the potential participants were recruited by through specialist nurses, expert advisory panel members, urologists, support organizations and through personal contact. Potential participants with interest in narrating their experiences where chosen. Thus, there were the most appropriate to gather desired data (CASP-Qualitative-Checklist, 2018). However, the drawback is no highlights on people refusing to participate in the study.
Data must be collected from the participants in the way that should address the research issue (LoBiondo-Wood & Haber, 2014). The setting for interview that is patient’s home is justified for in-depth interview as the patients would be comfortable in their home than in any hospital setting to freely narrate their issues. Thus, the patients may be more willing to deliver authentic personal information (CASP-Qualitative-Checklist, 2018). The interviewers are anthropologists and medical sociologists, so, there may not be any interviewer effect or bias (Hannes, Lockwood & Pearson, 2010). Further, the researcher seems to have collected reliable information from the participants by using topic guide, as mentioned by Ritchie et al. (2013). The researcher has explicitly discussed this section stating that interview lasted for two hours and used videos and or audio recorders for transcription and analysis (Prinjha et al. 2016). The saturation point was collection of desired and diverse range of experiences. Thus, a valid data may be obtained for devising appropriate interventions. Each step of data collection was conducted as per evidence-based protocol and also predetermined questions. Senior researchers were involved in study along with project advisory panel (LoBiondo-Wood & Haber, 2014).
Results Combined
There must be adequate consideration of the relationship between the participants and the researchers as per the CASP framework (CASP-Qualitative-Checklist, 2018). Before the interview, the researcher successfully established a strong rapport with the participants to help them develop clarity about the usage of the information collected. This indicates the role played by him in data collection. However, there was no data on the bias and influence. Lack of succinct details on responding to the interview events and changes on research design decreases the reliability of the results (Hannes, 2011).
To ensure the credibility of the ethical research issues must be considered Ritchie et al. (2013). The author took informed consent from all the participants included in the study. Prior to interview, respondents were informed about the research purpose and interview process. Also, the research was approved by the Berkshire Research Ethics Committee. So there is no issues related to the welfare of the participants, however, not justified by the researchers. Though the author directly does not explain if the confidentiality was mentioned, it can be assumed to have so because the author stated that “Pseudonyms are used in reporting the results” (Prinjha et al., 2016). However, there should have been succinct details confidentiality or handling of participants after the study to ensure reliability and validity (Hannes, 2011).
ORDER NOW HERE
A rigorous data analysis is the hallmark of the reliability and validity of the results (Hannes, 2011). The data was sufficient enough to support the findings. The research lacked the criticism of the own role in the analysis of the data. Qualitative research mainly uses thematic analysis and coding to identify the main themes (Bradshaw & Stratford, 2010) and the same was followed in this article. The grounded theory approach underpinned the data collection approach as mentioned by Thomas & Magilvy (2011). The data was well analysed as evident from well-crafted themes. The author had also succinctly mentioned about the rigour of the study due to methods used of Oxford Health Experiences Research Group, and National Health Service (NHS) Information Standard. It ensures of credibility, validity and reliability is ensured by the data collection process (Thomas & Magilvy, 2011). However, it should have highlighted any contradictory data.
As per CASP framework selected for this article, the paper should have clear statement of findings (Bradshaw & Stratford, 2010). As per the findings, the participants were in dire need of the technical information about catheter to deal with physical problems such as infection, blockage, and leaking. The findings were clear and explicit as there was also well-supported discussion flowing flawlessly. Presence of more than one analyst ensures respondent validation. The discussion was discussed as per the original research question.
Results Of The Review
A research may be highly valuable if the results could be applied locally (CASP-Qualitative-Checklist, 2018). However, in this case, the results may not be applicable; as the participants may have forgotten exactly what information they have needed as some were catheterised 20 years ago. Yet, the results are valuable as they can be used by the health care professionals to impart appropriate knowledge to the patients. Nurses can use this data to offer more support to the patients in future (Koch et al., 2012). The study has contributed to practice and policy. The research may be generalised as a large sample was considered from diverse backgrounds. I feel there should have been more discussion on transferability.
In the first paper the first author Galiczewski, and the second author both works at “Stony Brook University School of Nursing, United States”, and the first author is also associated with the “Stony Brook University School of Nursing, United States”. Lack of author’s qualifications makes the author’s credibility questionable. This paper is the published by Elsevier, in Intensive and Critical Care Nursing ( that has RG impact factor of 1.11, which is not very high). The five year impact factor of Elsevier is 3.279 which is less than standard score of 10. However, it is popular for the evidenced based information. The SJR that is rank indicator of the journal is 0.564 bt H index is 44 > than standard 20-27 and is considered to give reliable information in area of nursing (Scimagojr.com, 2018).
In the second paper, the first author Suman Prinjha is the senior researcher in university of Oxford, and holds Msc and PhD degrees. The second author is the Joanne Mangnall, is an RN with Msc degree and works as “Independent Prescriber/Clinical Nurse Specialist” and Clinical Lead at “Rotherham Centralised Product Prescribing Service, UK”. As both authors hold degrees required for conducting research, the credibility is ensured. Moreover, the paper is published, Journal of Advanced Nursing, which has impact facto of 1.998 and the ranking as per ISI JCR is 2016:13/116. This is not a very highly credible paper in terms of 1.998 tor of as it is too less in terms of journals having impact of 12 (Cao et al., 2018).
References
Bradshaw, M. B., & Stratford, E. (2010). Qualitative research design and rigour. SBN 9780195430158
Cao, Y., Gallagher, R., Hayter, M., Logsdon, C., Noyes, J., & Yu, D. (2018). Journal of Advanced Nursing – Wiley Online Library. Onlinelibrary.wiley.com. Retrieved 20 April 2018, from https://onlinelibrary.wiley.com/journal/13652648
Precision Of Results
CASP SR Checklist. (2018). CASP Systematic Review Checklist 2018. Casp-uk.net. Retrieved 17 April 2018, from https://casp-uk.net/wp-content/uploads/2018/01/CASP-Systematic-Review-
CASP-Qualitative-Checklist. (2018). CASP-Qualitative-Checklist. Casp-uk.net. Retrieved 17 April 2018, from https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist.pdf
Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review. American journal of infection control, 45(12), 1331-1341. DOI: https://doi.org/10.1016/j.ajic.2017.07.020
Fowler, S., Godfrey, H., Fader, M., Timoney, A. G., & Long, A. (2014). Living with a long-term, indwelling urinary catheter: catheter users’ experience. Journal of Wound Ostomy & Continence Nursing, 41(6), 597-603. Doi: 10.1097/WON.0000000000000069
Galiczewski, J. M., & Shurpin, K. M. (2017) An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure. Intensive and Critical Care Nursing, 40, 26-34. doi:10.1016/j.iccn.2016.12.003
Hannes, K. (2011). Critical appraisal of qualitative research. Retrieved from: https://cqrmg.cochrane.org/supplemental-handbook-guidance
Hannes, K., Lockwood, C., & Pearson, A. (2010). A comparative analysis of three online appraisal instruments’ ability to assess validity in qualitative research. Qualitative health research, 20(12), 1736-1743. DOI: https://doi.org/10.1177/1049732310378656
Henry, M. (2018). Evaluation of evidence-based practice of catheter associated urinary tract infections prevention in a critical care setting: An integrative review. Journal of Nursing Education and Practice, 8(7), 22. Infection Prevention In Critical Care Setting Discussion Paper
