Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
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Evidence-Based Project, Part 1: Identifying Research Methodologies
NURS – 6052: Essentials of Evidence-Based Practice
Evidence-Based Project, Part 1: Identifying Research Methodologies
| Full citation of the selected article | Article #1 | Article #2 | Article #3 | Article #4 |
| Azab, S. F. A., Sherbiny, H. S., Saleh, S. H., Elsaeed, W. F., Elshafiey, M. M., Siam, A. G., Arafa, M. A., Alghobashy, A. A., Bendary, E. A., Basset, M. A. A., Ismail, S. M., Akeel, N. E., Elsamad, N. A., Mokhtar, W. A., & Gheith, T. (2015). Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle”: A cohort study. BMC Infectious Diseases, 15(1), 4–10. https://doi.org/10.1186/s12879-015-1062-1 | Burja, S., Belec, T., Bizjak, N., Mori, J., Markota, A., & Sinkovič, A. (2018). Efficacy of a bundle approach in preventing the incidence of ventilator-associated pneumonia ( VAP ). Bosnia Journal of Basic Medical Science, 18(1), 105–109.
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Mahmoodpoor, A., Hamishehkar, H., Hamidi, M., Shadvar, K., Sanaie, S., Golzari, S. E., Khan, Z. H., & Nader, N. D. (2017). A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients. Journal of Critical Care, 38, 152–156. https://doi.org/10.1016/j.jcrc.2016.11.007
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Triamvisit, S., Wongprasert, W., Puttima, C., Chiangmai, M. N., Thienjindakul, N., Rodkul, L., & Jetjumnong, C. (2021). Effect of a modified care bundle for prevention of ventilator-associated pneumonia in critically-ill neurosurgical patients. Acute and Critical Care, 36(4), 294–299. https://doi.org/10.4266/acc.2021.00983
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| Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest) |
The clinical issue I am focusing on is the application of ventilator care bundle (VCB) to address the rising cases of ventilator-associated pneumonia among critically ill patients. I have selected the Azab et al. (2015) article to support the background of my PICOT (population, intervention, comparator, outcomes, time) question. The authors described VAP as a severe complication in infants in artificial ventilation, which makes up for >30% of nosocomial infections among neonates. The article emphasizes the effects of VAP, including the associated medical costs, mortality, morbidity, and prolonged hospital stay. The article also recognizes the need for the implementation of the VAP care bundle, entailing the concurrent evidence-based activities frequently supported by a checklist. |
The article was selected as it directly addresses my PICOT question. The introduction part contextualizes the problem of VAP among severely sick patients, who are mechanically ventilated and intubated. It also recognizes the presence of numerous VAP preventive measures described in the form of a VAP care bundle, including initiating enteral nutrition as soon as possible, spontaneous awakening trials, maintenance of tracheal cuff pressure, and elevation of the head of the bed. There is no description of ethical requirements followed in the study possibly due to the retrospective nature of the research; however, the authors observed confidentiality and anonymity of the participants’ data. | The content of the paper offers me a context for my clinical question. The background highlights the seriousness of VAP among patients in the ICU, associating it with an elevated risk of inpatient mortality, increased medical costs, and extended hospital and ICU stay. The article highlights the pertinent function of ETT and the aspiration of subglottic secretions in the pathophysiology of VAP. The authors also recognize the potential superiority of novel ETTs, like the TaperGuard tubes, over conventional ones in mitigating VAP. Notably, the latter allows only irregular suction of intraluminal secretions without any change on subglottic secretions. | Like Azab et al. (2015), the introductory section of the Triamvisist et al. (2021) highlights the significance of VAP, highlighting that artificial ventilation and intubation is a core predictor of developing VAP among critically-ill patients, with individuals intubated for >24 hours having 6 – 21 times higher odds of VAP than not-intubated patients (Azab et al., 2015). The article also describes the VAP care bundle as six evidence-based elements, which have been tested 5and confirmed to improve clinical outcomes of artificially ventilated patients diagnosed with VAP. The elements include oral care with 0.12% chlorhexidine four times daily, intermittent monitoring of endotracheal tube (ETT) cuff pressure thrice daily, enforcing ventilator weaning protocol, checking residual gastric content before feeding, exercising proper hand hygiene, and elevation of the head of the bed by at least 300. The study was conducted in line with the ethical principles of research involving human subjects. |
| Brief description of the aims of the research of each peer-reviewed article | The authors of the study focused on neonates, citing the distinct physiology, anatomy, comorbid ailments, and invasive procedures they undergo compared to older children and adults. In the above light, the authors sought to evaluate the efficacy of VCB in reducing the occurrence rates of VAP among newborns. Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies | The study was conducted in a 12-bed adult intensive care unit (ICU) of a tertiary hospital in Bosnia. The following VCB elements were launched at the hospital: maintaining ETT cuff pressure at 25 cmH2O, use of closed suction systems, daily evaluation for extubation and the necessity for proton-pump inhibitors, subglottic suctioning every 4-hours, oral care with chlorhexidine twice daily, and raising the head of the bed at least 300.
Thus, the study targeted to examine the effectiveness of the VCB elements at decreasing the incidence of VAP cases. |
The authors reviewed published evidence on the utility of TaperGuard tubes and noted inconsistency in the literature. Consequently, the authors sought to fill the gap in available literature by examining the impact of tapered-cuff ETT with the potency to aspirate subglottic secretions in decreasing the occurrence of VAP infections among critically sick patients. | The authors of the article submit that recognize that numerous medical facilities are using continuous cuff pressure monitoring, which has been demonstrated to be more effective than discontinuous cuff pressure monitoring in preventing VAP, although it is more expensive than the latter (Rouzé et al., 2015). Besides, the authors also noted that offering oral care four times daily is time-consuming; thereby, necessitating a modification of the VAP care bundle. Thus, the study aimed at evaluating the efficacy of the modified VCB over the previously described VAP care bundle. |
| Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific. | The authors conducted a quantitative pre-post prospective study. A total of 143 newborns were enlisted to participate in the study, including 62 in phase I and 81i phase II. The collected data were analyzed statistically using student t-test and Chi-square to determine continuous and categorical variables, respectively. | The authors performed a retrospective study, a type of longitudinal study that involves quantitative techniques to collect and analyze data. In particular, the authors performed a post-hoc analysis of outcome data and compared data of all mechanically ventilated patients with ETT before the launch of the VCB and mechanically ventilated patients with an ETT post-implementation of the VCB. The eligibility benchmarks were the presence or absence of VAP and mechanical ventilation with an ETT. | The study involves a prospective randomized controlled trial, a quantitative research design that is considered the hallmark for studies of screening interventions. The study involved a 1:1 random assignment of 276 critically ill adults into either intervention group E or control group C. The treatment cohort received intubation with TaperGuard tubes while those in the placebo cohort received traditional high-volume low-pressure ETTs. All the other VCB elements were performed equally for both cohorts except for the ETT cuff pressure. The results were analyzed statistically using the Chi-square test to compare VAP incidences between the two groups. | The authors adopted a prospective cohort research design, a quantitative research method where adult neurological patients aged ≥18 years with no prior indications of VAP and were placed on assisted ventilation for at least 24 hours were followed from November 2018 – June 2020. A sum of 145 patients was placed in the modified VCB group and compared with 146 patients in the control cohort. Clinical features of the patients were documented and presented numerically as mean ± standard deviation, percentage, and frequency, and statistically analyzed by Fischer’s exact probability to examine for group differences. |
| A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. | The authors investigated a clearly defined clinical question, with a detailed explanation of the intervention, population, comparator, and outcomes of interest. Except for the small sample size that threatens the reliability of findings, the researchers followed a succinct research protocol and the Foglia et al. (2007) criteria to enhance the external validity of the findings. | The efficacy of a clinical intervention is best evaluated by prospective studies, either longitudinal or randomized clinical trials. Thus, while the findings of Burja et al. (2018) support the effectiveness of the studied VCB elements in decreasing the risk for VAP suggesting a possible cause-and-effect relationship, the retrospective design increases the threat to the validity of the results, which, in turn, restrict the deduction and extrapolation of findings. | The authors followed all the necessary steps to ascertain the validity of the results. For example, the block randomization technique was used in assigning the eligible participants into their respective cohorts based on web-based software. All respondents who were enrolled in the study were accounted for at the conclusion, and only data collection personnel were blinded to the study. Besides, the study cohorts were similar at the baseline, and the effects of the TaperGuard tubes were reported comprehensively. | The study asked a clearly defined clinical question, with the population identified as critically-ill adult patients with neurological conditions, modified VCB as the evidence-based intervention, traditional VCB as the comparator, and VAP incidences and length of hospital stay as outcomes. While the authors warned against the generalization of findings due to numerous factors, including selection bias affecting the control cohort, the aspect that some of the researchers work in the study setting might also limit the validity of findings. |
| General Notes/Comments | In addition to the small sample size, the study was conducted at a single neonatal hospital in Egypt. Therefore, despite the findings showing evidence of effective control of VAP cases using VCB elements, there is a need for multicenter prospective studies to achieve a larger sample size and to assess the cost-efficacy/feasibility of the intervention. | The findings of the study showed that the enforcement of VCB elements in adult ICU substantially decreased the risk of VAP. However, the generalization of the findings is limited by the small sample size, single-center, and retrospective nature of the research design. | Among all the four reviewed articles, Mahmoodpoor et al. (2017) offer the most valid findings supporting my clinical question. The authors deduced that the use of novel ETT tubes with intermittent drainage of subglottic secretion is more efficient and effective in decreasing the odds of VAP among artificially ventilated and intubated critically ill patients. | Irrespective of the study limitations, the results of the study, which are supported by findings of meta-analyses, showed that the amended VCB was superior in decreasing the occurrence of VAP than the conventional VCB. The modified form entails decreasing the time of oral care to thrice daily and increasing the time for intermittent ET cuff pressure monitoring to six times daily. Thus, it is necessary for nurses handling patients in ICU to re-evaluate the efficacy of specific elements of their VCBs. |
Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
Is there a difference between “common practice” and “best practice”?
When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.
Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.
Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice? Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.
To Prepare:
- Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course.
- Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
- Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.
- Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.
Part 1: Identifying Research Methodologies
After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:
- The full citation of each peer-reviewed article in APA format.
- A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.
- A brief (1-2 paragraph) description of the aims of the research of each peer-reviewed article.
- A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
- A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected. Assignment: Evidence-Based Project, Part 1: Identifying Research Methodologies
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