PICOT Statement and research critiques

This article is the final paper of both the Analysis Critical Paper and the PICOT Declaration. Among the critical research is the following: The Journal of Clinical Nursing, which qualitatively investigates the interaction between catheter-associated urinary tract infection and blockage in individuals with long-term indwelling urinary catheters (Wilde, McMahon, Crean, & Brasch, 2017). The essay further provides a detailed study of the article that clinicians carried out on the prevention of catheter-associated urinary tract infection. The Nurses used the Journal of Acute and Critical Care to make a PICOT argument. This article is a guideline used to prevent catheter-associated urinary infection (Conway & Larson, 2011). 

Nursing Practice Problem and PICOT Statement

Researchers have not studied well the use of long-term catheters, and there is a high chance that persons using this device for persistent urinary retention may suffer from related diseases if the doctors misused the catheters. Urinary catheters have an adverse impact on the patients if it is used incorrectly or used for more than the expected time. Clinicians claim that patients who use catheters for a long time may experience the problem of kidney failures, due to pressure exerted on their kidneys as a result of long-term use of indwelling catheters. UTI has been one of the commonest complication that occurs as a result of catheter usage. Other complications include those of septicemia, bladder stones, and blood in the urine, kidney damage, and injury to the urethra. Besides there are some patients allergic to catheters, and this may pose a major problem during the treatment (Feneley, Hopley, & Wells., 2015). Currently, there is a high rate incidence of central venous catheter infection and related bacteria which affects critically ill patients, and this may result in morbidity. However, current research has shown that antiseptic catheters containing chlorhexidine-silver sulfadiazine having the capacity of reducing catheter-related diseases and therefore patients can tolerate well during the treatment (Wassil, Crill, PharmD, & Phelps, 2007).

PICOT Statement

Prognosis\/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time (C) influence the risk of Catheter-associated urinary infections (O) during the first ten weeks of indwelling catheter usage (T)?

The PICOT question correlates with the Nursing practice problem. Most patients in healthcare facilities acquire urinary tract infections linked to the use of the indwelling catheter. The duration of catherization affects the formation of biofilms which is the major determinant of bacterial development. Using the catheters multiple times increases the chances of formation of biofilms and bacterial growth which in turn increases the substantial burden attributed to the infections (Conway & Larson, 2011). About 50% episodes of acquired urinary tract infection are due to long-term care facility. The PICOT question also correlates with the evidence-based practice change. The EBP gives a leeway on how the catheter-related infections are minimalized with the use of antiseptic catheters containing chlorhexidine-silver sulfadiazine.

Qualitative Study

The primary clinical research problem in this study is Catheter-associated urinary tract infection; this study qualitatively analyses some of the ways used to prevent CAUTI diseases. The aim of this study is to critique and analyze the article presenting the issues and find a solution to catheter-associated urinary infections. The researchers based this work on a survey carried out using 203 persons over a period of 12 months; the analysis was later analyzed using secondary data sources (Wilde, McMahon, Crean, & Brasch, 2017). The following is a hypothesis question formulated in this paper: Do the use of catheters for much longer time influence the risk of Catheter-associated urinary infections during the first ten weeks of indwelling catheter usage? This essay will answer the question to the hypothesis envisioned earlier and present it in the form of an evidence-based practice change through an experimental process.<

Methods of Study

A case Study qualitative approach was used in this paperwork. Out of 203 pediatric patients, only a sample of them was used in the methodology to conduct research. The clinicians used secondary data analysis as a design method, and they performed a randomized clinical sample from 203 patients. A descriptive study is applied in this methodology; a zero-inflated negative binomial model is employed and used to conduct logistic regressions and evaluate the possibility of CAUTI occurrence. There were both Quantitative and Qualitative studies of the literature review that is related to the focus of the survey (Sandelowski, 2010). The investigation concentrated on the central venous catheter infections as one of the top causes of infections in the bloodstream. Besides, the review highlights that diseases not only pose harm to the individual but affect the economic growth of the country because of an increased hospital costs. There is some weakness in this article regarding this methodology. The author did not indicate whether they used a qualitative approach to obtain a description of the nurses’ perception. Also, there is no transparency on the research report, and the authors did not present the Pros and Cons of the methodology used. This is a limitation to the reproduction and replication of the study. The fact that this study is a systematic research where data collection as well as data analysis led to the emergence of the PICOT solution qualifies it as a grounded form of framework study.

Results of the Study

There is a correlation between the blockage of the catheter and catheter-association urinary infections. In twelve months, over 50% of the cases reported were those of the patients with Catheter-related urinary infections, and some of these patients experience leakage, sediments, and bladder spasms (Wilde, McMahon, Crean, & Brasch, 2017). Less than 50% of the patients encountered problems with kinks, dislodgement, and catheter pain. Regression analysis showed that there is a significant relationship between bladder spasms, sediment amount, and catheter-associated urinary tract illness. In general, there is a clear illustration of the study. However, the analysis lacks graphical presentation of the findings, and neither the modeling of the themes is used in the analysis. The analysis of this study has important implications for nursing practice. Nurses can track and manage any possibility of catheter-associated infections occurrence, and they can do this by monitoring any leakage or formation of sediments. The prevention of CAUTI as addressed in this study is an important goal of Nursing practices and prevention programs. Currently, there is no proper method used to prevent catheter-related infections. This is an opportunity for Nurses and researchers who wish to find appropriate preventive measures.

Ethical Consideration

The experiment conducted in this study received ethical approval from IRB; there is full protection of patient’s identity following moral concern. The clinicians use vulnerable patients in this experiment because relevant bodies and some ethical agencies approve it as ethically acceptable. Also, the authors in this article appear to have maintained a sense of confidentiality throughout the experiment; this shows how the Nurses are fully informed on ethical issues (Scotland, 2014).

Quantitative Study

The primary clinical aim of this study is to find an efficient method of preventing CAUTI. Many Doctors have had an insightful urge to come up with effective ways following several reported cases of UTI infection. Currently, catheter-related diseases have shown high resistance to antimicrobials. This study is purposed to impact positive change in the Nursing field using useful information regarding preventive measures. The authors of this study noted some Medicare rule changes used to prevent CAUTI. The Question addressed in this study is to find out whether the urethral catheters are left as per the guidelines. This issue is related to the PICOT statement and is answered in the evidence-based practice change (Nicolle, 2005).

Methods of Study

The methodological process took place over a lifespan of seven years from 2007 to 2014. The researchers collected data from various sources, including those of MEDLINE and Science Direct Journal articles. Primarily, participants were hospitalized and placed in a vesical catheterization. Administration of the biotherapy to prevent UTI was one of the independent experiments in this study. The doctors examined and monitored the vesical catheterization and the duration at which there is a possible occurrence of urinary tract infection. A meta-analysis of 224 prospective studies among adults was used to assess the risk of intravascular catheter-associated BSI. The clinician examined the rate of infection BSI per 100 catheters versus infections per 1000 catheter days. The clinicians compared these rates with the derived data from NNIS and other institutions (Meddings, Rogers, Macy, & Saint, 2010).

Results

Tables were used to present the results of this study. The researcher selected the literature review and specified each according to the author, participants, interventions results, and design. Despite the fact that the results appeared to be true due to the manner in which they were presented, there is no clear presentation and accessibility of the findings (Alexandra & Fernandes, 2016). The clinicians reported the key element transparently to eliminate the issue of biasness.

Ethical Consideration

Ethical approval of the study by IRB is not mentioned in this study. However, the patients received confidential treatment that is in line with the ethical consideration. This study also focused on the safety of the participants, and neither the identity of the patient was revealed (Scotland, 2014).

Evidence-Based Practice Change

To solve the PICOT question, the clinicians should only catheterize those in need of the remedy to avoid further damages in the urinary tract system. Before conducting the catheterization process, the specialist sterilized the equipment and carried out the procedure of catheterization in an aseptic area. Using a female patient, the doctor places hand hygiene and places the patient in a supine pose, and the clinician cleaned the genital area with soap and water. After each urethral fondle, a doctor discarded the swab into a designated waste bag and removed the catheter wire. Following the procedural guidelines, the doctor lubricated the catheter and inserted it into the urethral opening upward at about 30 degrees until urine begins to flow. To avoid contamination, the doctors examine the patients under the care of indwelling catheter every two weeks. This process protects patients from CAUTI infections (J., 2013).

Conclusion

The thesis in this study is entirely applicable to the nursing practice. Based on the findings, doctors should prioritize cleanliness and maintain an aseptic environment while carrying out the process of catheterization (Wassil, Crill, PharmD, & Phelps, 2007). The fact that there has been no proper technique used to eliminate the chances of CAUTI opens an opportunity for further research studies in this area.

References

Alexandra, F., & Fernandes, V. (2016). Prevention of catheter-associated urinary tract infection:Implementation strategies of international guidelines. Retrieved on October 2,2017 from http://www.scielo.br/pdf/rlae/v24/0104-1169-rlae-0963-2678.pdf

Conway, L. J., & Larson, E. L. (2011, Sep). Guidelines to prevent catheter-associated urinary tract infection. 41(3), 271-283. Retrieved on October 3, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362394/

Feneley, R., Hopley, I., & Wells., P. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engeneering & Technology, 39(8), 459-470.

J., P. (2013). Urinary Incontinence and the importance of catheter fixation. Journal of Community Nursing, 27(5), 24-29. Retrieved on October 3, 2017 from http://www.southernhealth.nhs.uk/_resources/assets/inline/full/0/70589.pdf

Meddings, J., Rogers, M. A., Macy, M., & Saint, S. (2010, semptember 1). Systematic Review and Meta-Analysis: Reminder Systems to Reduce Catheter-Associated Urinary Tract Infections and Urinary Catheter Use in Hospitalized Patients. Clinical Infectious Diseases, 51(5), 550-560. Retrieved on October 3, 2017 from https://academic.oup.com/cid/article/51/5/550/333837

Nicolle, L. E. (2005). Catheter-Related Urinary Tract Infection. 22(8), 627-639. Retrieved on October 3, 2017 from https://link.springer.com/article/10.2165/00002512-200522080-00001

Sandelowski, M. (2010). What’s in a name? Qualitative description revisited. Research in Nursing & Health, 33(1), 77-84.

Scotland, N. S. (2014). Targeted literature review: What are the key infection prevention and control recommendations to inform a urinary catheter insertion quality improvement tool? Retrieved on October 3, 2017 from HPS wb pages: http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=5551

Wassil, S. K., Crill, C. M., PharmD, & Phelps, S. J. (2007). Antimicrobial Impregnated Catheters in the Prevention of Catheter-Related Bloodstream Infection in Hospitalized Patients. The Journal of Pediatric Pharmacology and Therapeutics, 12(2), 77-90. Retrieved on October 3, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462094/

Wilde, M. H., McMahon, J. M., Crean, H. F., & Brasch, J. (2017). Exploring relationships of Catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters. Journal of Clinical Nursing, 26(17-18), 2558-2571. Retrieved on October 3, 2017 from http://onlinelibrary.wiley.com/doi/10.1111/jocn.13626/abstract