The first step of the EBP process is to develop a question from the nursing practice problem of interest.
Select a practice problem of interest to use as the focus of your research.
Start with the patient and identify the clinical problems or issues that arise from clinical care.
Following the PICOT format, write a PICOT statement in your selected practice problem area of interest, which is applicable to your proposed capstone project.
The 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).
Conduct a literature search to locate research articles focused on your selected practice problem of interest. This literature search should include both quantitative and qualitative peer-reviewed research articles to support your practice problem.
Select six peer-reviewed research articles which will be utilized through the next 5 weeks as reference sources. Be sure that some of the articles use qualitative research and that some use quantitative research. Create a reference list in which the six articles are listed. Beneath each reference include the article’s abstract. The completed assignment should have a title page and a reference list with abstracts.
Suggestions for locating qualitative and quantitative research articles from credible sources:
- Use a library database such as CINAHL Complete for your search.
- Using the advanced search page check the box beside “Research Article” in the “Limit Your Results” section.
- When setting up the search you can type your topic in the top box, then add quantitative or qualitative as a search term in one of the lower boxes. Research articles often are described as qualitative or quantitative.
To narrow/broaden your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Diabetes and pediatric and dialysis. To determine what research design was used, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods.
In adult patients in ICUs, will the daily use chlorhexidine bath as an antiseptic compared to the use of ordinary soap and water, reduce the Central-Line Associated Bloodline Infections (CLABIs) for a period of three months?
Population (P): Adult patients in Intensive Care Units
Intervention (I): Daily use of chlorhexidine
Comparison (C): Use of ordinary soap and water
Outcome (O): Reduction of Central-Line Associated Bloodline Infections
Time (T): Three months
Nursing Practice Problem
In recent times, CLABSIs have been a major problem for patients in ICUs. These infections not only prolong patients’ stay in hospitals but also increase health care cost while reducing the quality of life of the patients (Rabindran & Gedam, 2016). Rahmqvist et al. (2016) report that each episode of CLABSIs infection increases the healthcare cost of an individual from about $33, 000 to about $ 75, 000. Additionally, CLABSIs increase nursing workload resulting in poor patient outcomes as well as poor patient satisfaction. The microorganisms enter the blood stream during catheter insertion, when a catheter is accessed during flushing, medication or tubing, prolonged insertion of catheters, or when cleaning the insertion area (Banach & Calfee, 2013). It is recommended that practitioners should use aseptic techniques during these procedures. Most clinicians use normal soap and water but still, the CLABSIs occur, this has called for the use of a stronger antiseptic agents with chlorhexidine being on studies.
Jackson, A., & Cooper, S. (2012). Zero central-line infections in a 550-bedded district general hospital. British Journal of Nursing, S24-8.
The authors acknowledge that the dominance of CLABSIs currently has far-reaching effects which prompted surveillance to be conducted on how to prevent the infections. The application of bundle care that is an insertion of catheters based on the indications, observation of antiseptic catheter care, and prompt removal are some of the important strategies for reducing the prevalence of CLABSIs.
McPeake, J., Cantwell, S., Malcolm G,., & Malcolm, D. (2012). Central line insertion bundle: Experiences and challenges in an adult ICU. Nursing in Critical Care, 17(3), 23-129. doi:10.1111/j.1478-5153.2012.00491.x.
The source outlines some of the challenges by clinicians in relation to CLABSI in the ICUs. They highlight that use of invasive devices is associated with high morbidity, mortality, and cost. A multi-facet care bundle is developed so that is can be used to reduce CLABSIs. The intervention recommends that a clear aim should be set and staff should understand the change process during patient hospitalization.
Smith, N. (2010). CNE: Continuing nursing education. Prevention of hemodialysis central line- associated bloodstream infections in acutely ill individuals. Nephrology Nursing Journal, 37(5), 523-529.
The study was conducted in a medical center in Pacific Northwest where measures were developed to reduce central line infections in patients. One of the measures involves implementing a bundle of care which focuses on maintaining antiseptic stands during insertion, cleaning, and removal of invasive devices, the use of evidence based antiseptic techniques such as chlorhexidine is recommended.
Climo, M. W., Yokoe, D. S., Warren, D. K., Perl, T. M., Bolon, M., Herwaldt, L. A., & … Wong, E. S. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. The New England Journal of Medicine, 368(6), 533-542. doi:10.1056/NEJMoa1113849
The authors point out that chlorhexidine gluconate (CHG) is an antiseptic agent that possess broad-spectrum of activity against several microorganisms such as enterococcus and Staphylococcus aureus. It is superior to other antiseptic agents because it possesses antibacterial activity that reduces the microbial load on the skin and prevents secondary contamination from the environment. They note that daily use of CHG reduces the number of Vancomycin Resistant Enterococcus (VRE) by log 2.5 as compared to normal soap and water. Chlorhexidine also reduces VRE contamination on the hands of clinicians by 40 percent.
Denny, J. (2016). Chlorhexidine Bathing Effects on Health-Care-Associated Infections. Biological Research for Nursing.
This article highlights that the nosocomial infections that patients acquire during hospitalization have been a major burden in the health care sector. As a solution, nurses have resulted in using (CHG) to minimize the cutaneous burden of microorganisms. This technique has proven to have quite outstanding results in the fight against health care associated infections such as CLABSIs.
Karki, S., & Cheng, A. C. (2012). The impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. The Journal of Hospital Infection, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005
This study was
conducted to determine the impact of impregnated (CHG) in reducing the
bacterial load on the skin of patients. It was found out that use of non-rinse
CHG induced a significant reduction of Surgical Site Infections (SSIs),
CLABSIs, and MRSA colonization.
Banach, D. B., & Calfee, D. P. (2013). Central Line-Associated Bloodstream Infection. Healthcare Associated Infections: A Case-based Approach to Diagnosis and Management.
Rabindran, R., & Gedam, D. S. (2016). Central line associated Bloodstream Infections. International Journal of Medical Research and Review, 4(08).
Rahmqvist, M., Samuelsson, A., Bastami, S., & Rutberg, H. (2016). Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements. American journal of infection control, 44(5), 500-506.