Benchmark Research Critique and PICOT statement

ASSIGMENT WEEK 5 Prepare this assignment as a 1,500-1,750-word paper using the instructor feedback from the Topic 1, 2, and 3 assignments and the guidelines below. PICOT Statement Revise the PICOT statement you wrote in the Topic 1 assignment. The final PICOT statement 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 In the Topic 2 and Topic 3 assignments you completed a qualitative and quantitative research critique. Use the feedback you received from your instructor on these assignments to finalize the critical analysis of the study by making appropriate revisions. The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT statement. Refer to “Research Critique Guidelines.” 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 statement, 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. 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. Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. Benchmark Research Critique and PICOT statement

• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Method of Study: • Were qualitative methods appropriate to answer the research questions? • Did the author identify a specific perspective from which the study was developed? If so, what was it? • Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? • Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. • Did the author evaluate or indicate the weaknesses of the available studies? • Did the literature review include adequate information to build a logical argument? • When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Results of Study • What were the study findings? • What are the implications to nursing? • Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Quantitative Study Background of Study: • Benchmark Research Critique and PICOT statement

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Methods of Study • Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? • Was informed consent obtained from the subjects or participants? • Did it seem that the subjects participated voluntarily in the study? • Was institutional review board approval obtained from the agency in which the study was conducted? • Are the major variables (independent and dependent variables) identified and defined? What were these variables? • How were data collected in this study? • What rationale did the author provide for using this data collection method? • Identify the time period for data collection of the study. • Describe the sequence of data collection events for a participant. • Describe the data management and analysis methods used in the study. • Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? • What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses? Results of Study • What is the researcher’s interpretation of findings? • Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? • What limitations of the study were identified by researchers? • Was there a coherent logic to the presentation of findings? • Benchmark Research Critique and PICOT statement

What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing? • What suggestions are made for further studies? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Reference Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier. Running head: Clostridium difficile infection Article Review Clostridium difficile infection Article Review NRS – 433V Introduction to Nursing Research Institution Professor: Student name Date Clostridium difficile infection Article Review 2 Introduction Upon reading the article, “Infection Prevention and Control in Nursing Homes: A Qualitative Study of Decision-Making Regarding Isolation-Based Practices”, there was a close look at Clostridium Difficle and patients in nursing homes. “Clostridium difficile colitis results from disruption of normal healthy bacteria in the colon, often from antibiotics. C-difficile (Cdiff) can also be transmitted from person to person by spores. It can cause severe damage to the colon and even be fatal. As the bacteria overgrow, they release toxins that attack the lining of the intestines. C-diff is highly contangous; EBP proves there is a need to place these patients on isolation precaution” (Mayo, 2016). This ariticle looks at 10 different nursing homes with 73 different interviews (six to eight interviews per facility) lasting appx. 45 minutes long. This study showed that isolation-based practices differed from nursing homes (Cohen, 2015). Background of study “C-diff is one of the most common causes of infectious diarrhea in the United States” (Mayo, 2016). There is a difference from nursing homes and how they treat patients with infectuous diseases. “Interviewees discussed practice decisions in the context of organism transmission risk in specific situations and among individual residents. Most nursing home’s isolation practices incorporated the concept of organism ‘containment’, that is, low perceived transmission risk. This was a factor when staff decided the degree to which an infected resident would be limited in social and environmental contact. For example, anything that can be Clostridium difficile infection Article Review 3 contained, like MRSA (methicillin-resistant Staphylococcus aureus), or VRE (vancomycinresistant enterococcus) in a wound. Or if a patient has MRSA or VRE in the urine, it is contained within the bag. So, if it’s contained, they can be cohorted” (Cohen, 2015). The purpose is to explore decision-making in isolation based infection prevention and control pracitices in nursing homes. The hypothesis is that isolation precautions are recommended in order to prevent spreading pathogens that are associated with high morbidity; for example, multidrug resistant organisms (MDRO) (Cohen, 2015). Benchmark Research Critique and PICOT statement

Methods of study This article is a qualitative method of study; “it is used to gain an understanding of underlying reasons, opinions, and motivations. Qualitative research is also used to uncover trends in thought and opinions, and dive deeper into the problem. Some common methods include focus groups (group discussions), individual interviews, and participation/observations” (Wyse, 2011). This method of study was conducted with staff, for example, staff nurses, infection prevention directors as well as directors of nursing “employed in purposefully sampled US nursing homes. Semistructured, role-specific interview guides were developed and interviews were digitally recorded, transcribed verbatim, and analysed using directed content analysis. The research team discussed emerging themes in weekly meetings to confirm consensus”(Cohen, 2015). There has been a research study with 10 different nursing homes and 73 different interviews (six to eight interviews per facility) lasting appx. 45 minutes long. This study included confining an MDRO infected patient within a private room during all activities to prevent organism transmission in order to prevent this organism from being tranmitted to patients that are Clostridium difficile infection Article Review 4 not affected. Standard precautions guidelines will be used when in contact with infected patients. For example, hand hygiene, use of gowns, gloves and other personal protective equipement depending on the anticipated exposure (Cohen, 2015). Results of study Within this study there was a variation in the nursing homes practices regarding which patients were isolated, at which point the isolation started, how the isolation was implemented, and these nursing homes setup the isolation for each patient. The patients that were interviewed clearly made decisions dependant upon the healthcare staff preceptions of acceptable transmission risk and patient’s quality of life. Some other influencing factors which influenced decision making was availability of private rooms, and how much time staff devoted to isolation based practices and communication tools. This study revealed a lack of knowledge of key infection prevention and control concepts (Cohen, 2015). Resources are more constrained in nuring homes, which can have an effect on infection prevention and control guidelines within the nursing home setting. There have been some studies that have established that placing a patient in isolation can have negative psychological effects if they are in semiprivate or private isolated rooms. “These adverse effects may be of greater concern in a nursing home facility since it is also a primary residence” (Cohen, 2015). Nursing home facilites have to balance the benefits verses the drawbacks of decreasing the spread of infectious diseases and patients experiencing negative psychological effects of being on isolation. Benchmark Research Critique and PICOT statement

There is a gap in literature when it comes to deciding when and how to implement isolation precautions for patients with infections diseases within the nursing home setting. Clostridium difficile infection Article Review 5 Ethical Considerations “Ethical considerations are the principles of respect for persons, beneficence, and justice relevant to the conduct of research” (Grove 503). The privacy of all subjects that participated within this study were protected. There were no identifying factors that would have lead to a Health Insurance Portability and Accountability Act (HIPAA) violation (Grove 99). The only ethical consideration within this study would be the fact that there are some unknown factors, for example, at which point the isolation started, how the isolation was implemented, and these nursing homes setup the isolation for each patient. This study has eithics approval by Columbia University Medical Center Institutional Review Board, University of Pittsburgh Institutional Review Board and RAND Corporation Institutional Review Board. Conclusion In conclusion, “current clinical guidelines are not specific enough to ensure consistant practice that meets care goals and resource constraints in nursing homes” (Cohen, 2015). Within nursing homes there is a wide variation in how and when isolation based infections preventions and control practices are implemented. It is clear that there is additional training and research that needs to be implemented within the staff providers in nursing homes, with emphesis on isolationbased infection prevention and control practices that are associated with the lowest infection risk among nursing home residents. These research studies would help clinicians’ decision making regarding transmission risk and appropriate practices for individual residents, especially in cases of colonisation, cohorting and other organism containment practices. “New Clostridium difficile infection Article Review evidence on these topics is required to ensure high-quality, consistent care for this vulnerable population” (Cohen, 2015). PICOT Statement In health care-acquired C. diff infected patients (P), what is the effect of limiting unnecessary antibiotic use (I) compared to unregulated antibiotic use (C) on decreasing the rate of C. diff infections (O) within the course of a year (T)? 6 Clostridium difficile infection Article Review References: Cohen, C. C., Pogorzelska-Maziarz, M., Herzig, C. T. A., Carter, E. J., Bjarnadottir, R., Semeraro, P., . . . Stone, P. W. (2015). Infection prevention and control in nursing homes: A qualitative study of decision-making regarding isolation-based practices. BMJ Quality & Safety, 24(10), 630. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1136/bmjqs2015-003952 Grove, Susan, Jennifer Gray, Nancy Burns. Understanding Nursing Research, 6th Edition. Saunders, 092014. VitalBook file. Mayo Clinic Staff. (2016). C. difficile infection. Retrieved August 06, 2016, from http://www.mayoclinic.org/diseases-conditions/c-difficile/home/ovc-20202264 Wyse, S, E., Benchmark Research Critique and PICOT statement

Difference between Qualitative Researches vs. Quantitative Research. (2011). Retrieved August 06, 2016, from http://www.snapsurveys.com/blog/what-is-theDifference-between-qualitative-research-and-quantitative-research/ 7 Clostridium difficile infection Article Review 8 Peer reviewed research articles 1.- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805733/ 2.- http://ccn.aacnjournals.org/content/34/4/24.abstract 3.- https://www.americanjournalofsurgery.com/article 4.- http://jlpm.amegroups.com/article/view/ 5.- https://www.hindawi.com/journals/bmri/2018/8414257/ 6.- https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6109a3.htm 1.- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805733/ Clostridium difficile (C. difficile) infection (CDI) is the most common cause of healthcareassociated infections in US hospitals. The epidemic strain NAP1/BI/ribotype 027 accounts for outbreaks worldwide, with increasing mortality and severity. CDI is acquired from an endogenous source or from spores in the environment, most easily acquired during the hospital stay. The use of antimicrobials disrupts the intestinal microflora enabling C. difficile to proliferate in the colon and produce toxins. Clinical diagnosis in symptomatic patients requires toxin detection from stool specimens and rarely in combination with stool culture to increase sensitivity. However, stool culture is essential for epidemiological studies. Oral metronidazole is the recommended therapy for milder cases of CDI and oral vancomycin or fidaxomicin for more Clostridium difficile infection Article Review 9 severe cases. Treatment of first recurrence involves the use of the same therapy used in the initial CDI. In the event of a second recurrence oral vancomycin often given in a tapered dose or intermittently, or fidaxomicin may be used. Fecal transplantation is playing an immense role in therapy of recurrent CDI with remarkable results. Fulminant colitis and toxic megacolon warrant surgical intervention. Novel approaches including new antibiotics and immunotherapy against CDI or its toxins appear to be of potential value. 2.- http://ccn.aacnjournals.org/content/34/4/24.abstract Clostridium difficile has become the leading cause of nosocomial diarrhea in adults. A substantial increase has occurred in morbidity and mortality associated with disease caused by C difficile and in the identification of new hypervirulent strains, warranting a high clinical index of suspicion for infections due to this organism. Prevention of infection requires a multidisciplinary approach, including early recognition of disease, effective contact isolation precautions, adherence to disinfectant policies, and judicious use of antibiotics. Current treatment approaches are based on the severity of illness. As hypervirulent strains evolve, unsuccessful treatments are more common. Complicated colitis caused by C difficile may benefit from surgical intervention. Subtotal colectomy and end ileostomy have been the procedures of choice but are associated with a high mortality rate because of late surgical consult …