Prepare this assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).  Research Critiques and PICOT Statement Final Draft Paper Example

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to \”Research Critiques and PICOT Guidelines – Final Draft.\” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

General Requirements

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Important——
Research Critiques and PICOT Question Guidelines – Final Draft

Use this document to organize the content from your four studies into your final draft.

Quantitative and Quantitative Studies

Background

Summary of studies. Include problem, significance to nursing, purpose, objective, and research question.

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

Discuss how these articles will be used to answer your PICOT question.

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

Method of Study:

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

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

Results of Study

Summarize the key findings of each of the studies into a comprehensive summary.

What are the implications of the four studies you chose in nursing practice?

Ethical Considerations

Discuss two ethical consideration in conducting research.

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

Outcomes Comparison

What are the anticipated outcomes for your PICOT question?

How do the outcomes of the four articles you chose compare to your anticipated outcomes?

 Research Critiques and PICOT Statement Final Draft

Ventilator-associated pneumonia (VAP) is among the most common type of hospital-acquired infection (HAI) and a common nursing practice problem in hospitals. VAP is a respiratory infection affecting patients who are mechanically ventilated (Timsit et al., 2017). Patients acquire VAP approximately 48 hours after being mechanically ventilated. VAP has been demonstrated to result in increased mortality rate, prolonged period of hospital stay, and also increases healthcare costs. VAP is most common among ICU patients (Wu et al., 2019). Because of the significant impacts associated with VAP, the prevention of VAP should be prioritized in ICUs. Various interventions have been demonstrated to be effective in reducing the rate of VAP. An example of this intervention is the repositioning of patients under mechanical ventilation to a semi-recumbent position (30-45 degrees). Therefore, the positioning of mechanically ventilated patients is a vital step in the progressive early mobility of this patient population. This paper will discuss the relationship between the PICOT question, the research articles, and the nursing practice issue.  Research Critiques and PICOT Statement Final Draft Paper Example

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Nursing Practice Problem PICOT Statement

Among ventilated patients (P), does elevating the head bed to a semi-recumbent position (I), compared to horizontal (supine) placement (C), minimize the possibility of contracting ventilator-associated pneumonia (VAP) (O)?

All selected articles support the PICOT question by providing evidence that supine position predisposes patients to the risk of VAP while elevating the head-bed of patients to 45 degrees angle reduces the risk of the patients contracting VAP.

Background of Studies

According to Attia & Badr (2018), VAP is a respiratory infection that occurs 48 hours after being admitted to a hospital, intubation, or after undergoing mechanical ventilation. Attia & Badr (2018) also add that VAP is a very common HAI in the ICU and it is associated with increased healthcare costs, increased mortality and morbidity, and a prolonged period of hospital stay. According to Mehta & Pamar (2017) patients with a head injury have altered cardiopulmonary functions and this may interrupt the oxygenation treatment. Therefore, the positioning of the patients with head injury may affect the oxygenation levels and the risk of VAP.

Ghezeljeh et al (2017) support this and adds that the rate of VAP is common in patients in the ICU and mechanically ventilated. The bed position for patients under mechanical ventilation directly impacts their respiratory function because the position leads to an increased mechanical load, which outweighs the respiratory system airflow (Martinez et al., 2015).

Ghezeljeh et al (2017) sought to compare the effectiveness of lifting the head-bed of patients to VAP at 30 and 45 degrees while the aim of Martinez et al (2015) was to evaluate how various head angles affect the respiratory mechanics for mechanically ventilated patients. Attia & Badr (2018) aimed to explore the risk factors associated with increased risk of VAP for children in the ICU while Mehta & Pamar (2017) aimed to examine the oxygen levels in patients in the ICU with head trauma and how the head positioning affected the oxygen levels.

Methods

Ghezeljeh et al (2017) and Martinez et al (2015) are quantitative studies. Ghezeljeh et al (2017) utilized a randomized controlled trial (RCT) and was performed in an ICU with a sample size of 120 patients under mechanical ventilation. the Braden scale, APACHE II, and the clinical pulmonary infection score were used to collect the data. Ghezeljeh et al (2017) used ANOVA and Scheffe ad hoc tests were used to collect data. The study by Martinez et al (2015) was also conducted in an ICU. Similarly, the study sample in Martinez et al (2015) included patients under mechanical ventilation. Martinez et al (2015) collected the data by obtaining respiratory mechanics’ values of patients who were under mechanical ventilators. ANOVA tool and Friedman analysis tool were used to analyze data in Martinez et al (2015). The two quantitative studies cited current and latest studies as recommended in nursing research.

Azza et al (2018) and Mehta & Parmar (2017) are qualitative studies. Azza et al (2018) used a descriptive exploratory methodology to explore the risk factors associated with VAP. The study by Azza et al (2018) was conducted in a pediatric ICU in a pediatric hospital in Egypt. The sample includes 54 infants who were mechanically ventilated. Standardized observational checklists and risk factors assessment sheets were used to collect data in Azza et al (2018). Thematic analysis was used to analyze the data. Mehta & Parmar (2017 adopted an observational cross-sectional design as the methodology. The study sample in Mehta & Parmar (2017 included 30 patients from the ICU. The outcome measures in this study were SpO₂, respiratory rate, pulse rate, and blood pressure (Mehta & Parmar, 2017). While Azza et al (2018) used current studies, some sources cited by Mehta & Parmar (2017) are not current. The descriptive exploratory method is very flexible while cross-sectional designs are easy to implement and cost-effective.

Results

The results from Ghezeljeh et al (2017) indicate that elevating the patient’s head-bed to 45 degrees can reduce the rate of VAP for patients undergoing mechanical ventilation when compared to lifting the head-bed to 30 degrees. Rreesults from Martinez et al (2015) show that there was a reduction of resistive airways pressures for patients whose heads were placed at higher angels. According to the findings from both Martinez et al (2015) and Ghezeljeh et al (2017), the placement of the head angle in patients who are mechanically ventilated affects the respiratory mechanics. These findings show that the position of head-bed impacts the risk of patients developing VAP.  Research Critiques and PICOT Statement Final Draft Paper Example

The findings from Attia & Badr (2018) indicated that the mortality rate of infants placed in the supine position was higher when compared to patients positioned at a semi-upright position of 30 to 45 degrees. Elevation of the head-bed for the infants was an important factor in lowering aspiration and thus reducing the rate of VAP. Findings from Mehta & Parmar (2017) indicated that positioning patients at a semi-upright position increases oxygen saturation, in comparison to the supine position or left/right lying positions. Increased saturation levels reduce the risk of VAP.

Ethical Considerations

The most important ethical considerations in research studies include informed consent and the privacy and confidentiality of the research participants. Informed consent ensures that study participants are provided with full and informed consent before they participate in the study. Respecting the privacy and confidentiality of the study patients is also very crucial in research studies. Moreover, in every research involving human subjects, it is important to obtain approval from the suitable research ethics committee before starting a study is important. In all the four articles, informed consent was sought from the study subjects before they were involved in the study. Moreover, the anonymity of the study participants was maintained and their information was not revealed to unauthorized individuals to respect their privacy and ensure confidentiality.  Finally, for all the four journal articles, approvals were obtained from the relevant research ethics committees.

In the proposed project, approval will be obtained from a research ethics committee, and also an informed consent will be gotten from all parties who will take part in the project. Lastly, confidentiality and privacy of the identity of the study participants and their information will be protected and will not be revealed to unauthorized parties.

Proposed Evidenced-Based Practice Change

According to Martinez et al (2015), the head angle of patients undergoing mechanical ventilation has an impact on patients’ respiratory mechanics. Martinez et al (2015) thus support the EBP change by presenting evidence about how the head position affects the respiratory mechanics of patients with VAP. The study by Ghezeljeh et al (2017) indicates that elevating the head-bed of patients reduced the rate of VAP. Accordingly, this article supports the EBP change by showing how elevating the head-bed of patients helps in reducing the rate of VAP as per the objective of EBP change.

Azza et al (2018) show that supine placement of patients is associated with an increased rate of VAP while the study by Mehta & Parmar (2017) shows that the upright positioning of patients increased oxygen saturation. Therefore, both Azza et al (2018) and Mehta & Parmar (2017) support the EBP change by supporting upright positioning of patients to lower the rate of VAP and prevent VAP among hospitalized patients.

Conclusion

In summary, all four articles support the elevation of patients who are mechanically ventilated in order to reduce their risk of developing VAP. VAP is associated with an increased mortality rate, longer period of hospital stay, and increased healthcare costs. Therefore, elevating the head bed to 45 degrees can be used as a preventative measure to reduce the rate of VAP in this patient population.

References

Azza A. Attia, M.D., F., & Ahmed M. Badr, M.D., N. (2018). Exploring Risk Factors with Ventilator-Associated Pneumonia among Infants in Intensive Care Units. The Medical Journal of Cairo University, 86(December), 3505-3518. doi: 10.21608/mjcu.2018.60591

Ghezeljeh, T. N., Kalhor, L., Moghadam, O. M., Lahiji, M. N., & Haghani, H. (2017). The Comparison of the Effect of the Head of Bed Elevation to 30 and 45 Degrees on the Incidence of Ventilator-Associated Pneumonia and the Risk for Pressure Ulcers: A Controlled Randomized Clinical Trial. Iranian Red Crescent Medical Journal, 19(7). Retrieved from https://www.researchgate.net/publication/318005572_The_Comparison_of_the_Effect_of_the_Head_of_Bed_Elevation_to_30_and_45_Degreess_on_the_Incidence_of_Ventilator_Associated_Pneumonia_and_the_Risk_for_Pressure_Ulcers_A_Controlled_Randomized_Clinical_Tr

Martinez, B. P., Marques, T. I., Santos, D. R., Salgado, V. S., Nepomuceno Júnior, B. R., Alves, G. A., Gomes Neto, M., & Forgiarini Junior, L. A. (2015). Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients. Revista Brasileira de Terapia Intensiva, 27(4), 347–352.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738820/

Mehta, J., & Parmar, L. (2017). The effect of positional changes on oxygenation in patients with head injury in the intensive care unit. Journal of Family Medicine and Primary Care, 6(4), 853. doi: 10.4103/jfmpc.jfmpc_27_17

Timsit, J. F., Esaied, W., Neuville, M., Bouadma, L., & Mourvllier, B. (2017). Update on ventilator-associated pneumonia. F1000Research, 6, 2061. https://doi.org/10.12688/f1000research.12222.1

Wu, D., Wu, C., Zhang, S., & Zhong, Y. (2019). Risk Factors of Ventilator-Associated Pneumonia in Critically III Patients. Frontiers in pharmacology, 10, 482. https://doi.org/10.3389/fphar.2019.00482

Suggested Outline with APA headings

for the Week 5 Paper

You required using the GCU APA template for the Week 5 assignment, just as you have done for the Week 2 and 3 papers. In I am providing a suggested outline for the Week 5 Final paper to help students as they are preparing the final paper in order to avoid omissions of required content and to help improve the organization/flow of papers. You do not have to use this outline it is optional.

For this paper, you will need to review the feedback from the Week 1-3 written assignments. You will review and revise content from the Week 2 and 3 papers. Do not just copy and paste content from the previous papers, you will need to revise in order to avoid self-plagiarism and high similarity in your LopesWrite report.

This outline also has the APA headings included, just make sure to remove the intro and thesis statement heading before submitting for grading. No heading is required nor acceptable in APA, only provided here so you remember to include.

Again, this outline is optional, no deductions or negative consequences for not using. Just provided in response to my review of errors and omissions in the Week 2 and 3 paper. So, use the GCU APA template no abstract, as required and you are also make you own outline.

If you did not provide the correct qualitative or quantitative research articles for the Week 2 or 3 paper, you can send me articles via the Private forum to confirm prior to you submitting in the final paper. I am willing to do this, but must send to me before the last Wednesday of the course.

Lastly, effective time management. During Week 4, you only have the two discussion questions, no paper. So, use your time wisely so you can complete this assignment on or before the deadline, which is also the last day of course. Once the course ends, the link to upload will no longer be available to you.

Hope you find this helpful in completing the last assignment.

Suggested Outline to use with the

GCU APA Template

The Roman numerals are provided for outline, but should be removed before submitting paper for grading.

1. Introduction and Thesis Statement (Remove this heading before submitting for grading)

Provide an introduction for the Week 5 paper and a thesis or purpose statement.

Make sure NOT to provide a heading for the intro, it is understood the paragraph following the title of the paper is the intro.

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1. Nursing Practice Problem PICOT Statement

PICOT question clearly articulates a nursing practice problem using substantial supporting information from numerous reliable sources. Provide your PICOT and the information used to support, you provided this content in the Week 1 Literature Evidence Table.  Research Critiques and PICOT Statement Final Draft Paper Example

• Background of Studies

Background of studies, including problem, significance to nursing, purpose, objective, and research questions, is thorough with substantial relevant details and extensive explanation.

1. Qualitative studies
2. Quantitative studies

1. Methods

Discussion of method of studies, including discussion of conceptual/theoretical framework, is thorough with substantial relevant details and extensive explanation. Make sure to provide the specific type of qualitative or quantitative design of each study

1. Qualitative studies
2. Quantitative studies

1. Results

Discussion of studies results, including findings and implications for nursing practice, is thorough with substantial relevant details and extensive explanation.

Remember when reporting qualitative findings; provide the common themes identified by the researchers. Quantitative results are reported using numerical or statistical data

1. Qualitative studies
2. Quantitative studies

1. Ethical Considerations

Discussion of ethical considerations associated with the conduct of nursing research is thorough with substantial relevant details and extensive explanation. Review your four studies from Week 2 and 3 assignments and discuss the ethical principles of research noted and how you will plan for your proposed project.

1. Qualitative studies
2. Quantitative studies

• Proposed Evidenced Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

Conclusion

Conclusion summarizes utility of the research from the critical appraisal, knowledge learned, and the importance of the findings to nursing practice.

Research Critiques and PICOT Statement Final Draft Paper Example