Research Critique and Ethical Considerations
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Institutional Affiliation
Research Critique and Ethical Considerations
Background of Study
Article I
The article by Melo, Santiago, Noguiera and Vasconcelos (2019) applies a quantitative approach in assessing health professionals’ knowledge on the prevention of ventilator-associated pneumonia in critically ill patients. The study points out that the Intensive-Care Unit is one of the areas with high rates of health-related infections. The authors argue that the complexity of managing patients in the Intensive care Unit increases the vulnerability of the occurrence of adverse events. They postulate that one of the most prevalent health-related infection is ventilator-associated pneumonia. Prevalence rates of the condition range from 9 to 67 per cent among patients under mechanical ventilation. The researchers point out that the prevention of ventilator-associated pneumonia can help in reducing the number of patients affected by the condition. Successful intervention could also reduce the rate of medication and a significant reduction in the length of stay in the Intensive Care Unit. They suggest that in effectively managing the condition, it is essential to ensure that healthcare practitioners have the required knowledge pertaining its prevention.
Ventilator-Associated Pneumonia is likely to occur when healthcare practitioners do not have the required skill sets. Because of this condition, the study seeks to assess the competence levels of nurses in the prevention of ventilator related pneumonia in critically ill patients admitted in intensive care units. The study also provides advocacy for continuous training for professional on the prevention of ventilator-associated pneumonia. The contribution of the study in nursing practice is essential for enabling health professionals in preventing the development of ventilator-associated pneumonia.
Article II
Dale, Rose, Carbone, Smith, Burry, Fan, and Sutherland (2019) study compares oral health and bundle approach intervention in preventing ventilator-associated pneumonia. The authors posit that oral hygiene practice, including the use of oral chlorhexidine rinse, does not reduce the occurrence of ventilator-associate pneumonia and may contribute to an increase in mortality rates. The authors, therefore, suggest that application of bundle approach.
The study is significant to nursing practice as aims to identify the effective strategy in preventing ventilator-associate pneumonia. The study focuses on the effectiveness of the two primary interventions in the prevention of ventilator-associated pneumonia.
How do these two articles support the nurse practice issue you chose?
The PICOT question was formulated to investigate how Intensive Care Unit patients can be careful to prevent hospital-based infections. The study addressed the measures that may be used to reduce the occurrence of ventilator-associated pneumonia.
Given the purpose of the study, the article by Dale, Rose, Carbone, Smith, Burry, Fan, and Sutherland. (2019) supports the research issue under investigation. The article findings point out that bundle care is more effective in reducing the occurrence of Ventilator-Associated Pneumonia. The study provides evidence on why bundle care is more effective relative to oral hygiene in managing ventricular-associated pneumonia.
The second journal article explores nursing professionals’ knowledge on the prevention of ventilator-associated pneumonia in the intensive care unit. The researchers, therefore, sought to explore the competency levels of the nurses in managing the issue as well as managing the contributing factors such as the growth of tracheal bacteria.
Method of Study
The studies explored in the paper applied diverse methodologies in developing the topic. Dale, Rose, Carbone, Smith, Burry, Fan, and Sutherland (2019) applied a quantitative method in comparing variables in the study. Quantitative approach in the study enabled the implementation of clustered studies exploring clustered groups. The second study applies a qualitative research methodology using questionnaires. The qualitative approach allows for the exploration of variables that cannot be numerically tabulated.
Consider the methods you identified in your chosen articles and state one benefit and one limitation of each technique.
The first study by Dale, Rose, Carbone, Smith, Burry, Fan, and Sutherland (2019) applies a quantitative approach and integrating Cluster Randomized Surgical Trial. The advantage of using the method is that the wedge design enables the research to include all participants in the research, thus including larger sample size. However, the method is disadvantageous as data is complex to analyze, and there are concerns about the issue of informed consent and burden to the patient as it involves repeated trials.
The study conducted by Melo, Santiago, Noguiera and Vasconcelos (2019) applied a survey method in collecting data for the study. Given that it was a qualitative method, the study used a smaller sample population. Surveys provide reliable data through the generation of first-hand data. Applying survey research, however, can lead to the collection of inaccurate data as the respondents may give wrong responses to questions or skips questions.
Results of Study
Findings from the study have various revelations pertaining to the research question. The study question was “For hospitalized patients, are usual oral health measures or bundling more effective in reducing the incidence of ventilator-associated pneumonia within a three-month period?” The study by Melo, Santiago, Noguiera and Vasconcelos (2019) found that less than fifty per cent of health professionals in intensive care units were aware of VAP prevention. Thirty-six per cent indicated that they had participated in intervention while ninety-six per cent expressed interest in receiving training on the practice. The numbers revealed that there was a weakness in knowledge for the prevention of ventilator-associated pneumonia in intensive care units. Through the research, Melo, Santiago, Noguiera and Vasconcelos (2019) pointed out that there is a need for professionals to intentionally learn provision of oral care as an emerging prevention measure for ventilator-associated pneumonia.
Dale, Rose, Carbone, Smith, Burry, Fan, and Sutherland. (2019) found that the provision of oral hygiene using chlorhexidine reduces mortality associated with VAP outcome at primary level. The key findings of this study can be summed to the fact that the provision of oral care collaborated with chlorhexidine reduces mortality associated with VAP outcome at primary level. Ideally, a significant difference was noted between the patients were oral care was provided and those were the intervention was not provided (Dale, Rose, Carbone, Smith, Burry, Fan, & Sutherland, 2019).
What are the implications of the two studies in nursing practice?
The key implications of the research studies are underlined by the need to enhance practitioner knowledge of various infections likely to occur in the intensive care unit. Nurses need to be trained on the multiple measures of managing bacterial infections as well as hospital-based infections, especially for patients under mechanical ventilation. The findings of the study offer clinical awareness on the management of ventilator-associated pneumonia as well as the selection of the most suitable approach of care.
Ethical Considerations
Conducting research in the Intensive Care Unit raises several ethical questions. The ethical considerations in researching such a facility include:
- Vulnerable subjects
Conducting research on a terminally ill patient brings up concerns that the patients may be incapable of giving fully informed consent, voluntary participate in the study or may be at high risk of unexpected side effects due to the study. The study could also compromise the healthcare quality and comfort of the patient.
- Principle of Beneficence
During the research, the methods of data collection should not harm the patients. The ethical principle is concerned with the reduction in risk and increasing benefits to the patients by participating in the research. In nursing research, the study ought to be in the best interest of the patient and family.
Describe how the researchers in the two articles you choose took these ethical considerations into account while performing their research.
In addressing the potential ethical implications of the study, the research studies were approved by the Committee of Ethics in Research with Human beings for the first research and the Ethics Review System for the second research. Patients and their families were notified of the intervention through writing and oral delivery. The researchers received written permission from clinicians and patients or families before they participated in the study.
References
Dale, C. M., Rose, L., Carbone, S., Smith, O. M., Burry, L., Fan, E., & Sutherland, S. (2019). Protocol for a multi-centered, stepped wedge, cluster randomized controlled trial of the de-adoption of oral chlorhexidine prophylaxis and implementation of an oral care bundle for mechanically ventilated critically ill patients: the CHORAL study. Trials, 20(1), 1-8. https://doi.org/10.1186/s13063-019-3673-0
Melo, M. M., Santiago, L. M. M., Nogueira, D. L., & Vasconcelos, M. D. F. P. (2019). Ventilator-Associated Pneumonia: the Knowledge of Health Professionals Towards Prevention and Educational Measures/Pneumonia Associada à Ventilação Mecânica: Conhecimento dos Profissionais de Saúde Acerca da Prevenção e Medidas Educativas. Revista de Pesquisa: Cuidado é Fundamental Online, 11(2), 377-382. https://dx.doi.org/10.9789/2175-531.2019.v11i2.377-382