Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice
Identifying a Researchable Problem
Increased awareness of the morbidity and potential mortality of hospital-acquired infections (HAIs) had led enormous efforts in preventing infections. According to Wang and Layon (2016), bathing with CHG reduced the incidence of blood stream infections (BSIs) in the medical intensive care unit (MICU). Similarly, the use of CHG-impregnated cloth bathing was associated with lower rates of surgical site infections (SSI) in surgical settings. CHG bath solution and the CHG no-rinse wipes have similar indication – to prevent infection. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.
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The purpose of this assignment is to present my questions that targets the goal of my research as it relates to saving money while improving healthcare. I will identify the problems I am observing in my nursing practice regarding the use of a costly product as opposed to using a more economical product, nonetheless, still provides a similar results. I will outline my questions relating to my query and how its feasibility can successfully attain the answers in my query. I will also identify the keywords that I will be using on my database research.
Identification of the Problem
My nursing background is critical care, but I am currently working at same day surgery unit. The use of chlorhexidine gluconate (CHG) bath is now the common practice in most health care settings, mainly in critical care, and at the peri-operative settings as well. Graling (2013), stated that the Centers for Disease Control and Prevention guidelines in preventing infection includes the use of CHG bath. Nonetheless, Donskey and Deshpande  (2016) claimed that there is a need to develop proper strategies to shed the light on the challenges involved in providing effective bathing. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice. The use of CHG no rinse cloth is becoming more frequent to some facilities, however the use of the CHG bath soap solution is still being practiced in other large health care facilities.
Aside from the advantage of preventing the occurrence of infection after surgery, some positive aspects of using the CHG wipes in the critical care setting is avoiding to expose patients to potentially contaminated bath basins (Johnson, Lineweaver &  Maze, 2009), and no rinsing of the skin is required. As such, the CHG wipes also provides convenience for nurses and techs, as it provides lesser bath time for critical care patients. However, this can be costly. Shah, Schwartz and Cullen (2016) asserted that the nursing use of 2% CHG impregnated cloths results in a 10-fold increase in cost. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice. On the other hand, the CHG bath soap solution are still being utilized by some intensive care units in other large healthcare facilities, and yet maintaining a low infection rate, otherwise, a zero rate.  In the pre-op setting, depending on what type of surgery, patients are being advised to apply the no-rinse CHG wipes on the night before and the morning of their surgery. I was a surgical patient myself for a major surgery in another facility and I was given the Hibiclens, a CHG bath soap solution to use prior my surgery. One could only imagine how one would feel to use a no-rinse CHG wipes prior to surgery.
My Questions and its Feasibility

Does the frequency of use before surgery affects the cost effectiveness of using between two products?

I would need to acquire information of how often patients are instructed to use the CHG cloth prior their surgery. I will also need to know how many baths are preop patients advised prior to their surgery, and what techniques do they use. I will need to inquire about the costs of each products. By having access to my organization’s policies and to ask the involved personnels,  I may be able to obtain these information. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

What is the reason why my facility’s administration prefers chlorhexidine wipes over chlorhexidine bath soap solution, if chlorhexidine wipes are considered more expensive? Does this correlates to our patient population in the same day surgery unit? Does this associate with our present hospital acquired infection rate?

Hospital-wide policy differs from unit-based policy. I will investigate if the CHG wipes is associated with our patient population in the same day surgery unit as opposed to the other unit’s practice such as in critical care unit. I also need to examine if the practice is based on tradition, or are they based on systematic evidence that supports the efficacy. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

What is the comparison in reducing the contamination of bacterial flora between using chlorhexidine wipes over chlorhexidine bath solution?

This inquiry requires searching for data evidencing the  product’s effectivity in reducing bacterial skin flora prior to surgery. I will need to gather accurate information from scholarly research articles, study literatures and also talk to experts in my facility – such as the infection control liaisons.

How long does chlorhexidine bind in the skin if 2% CHG wipes is used versus using the 4% CHG bath soap solution before surgery?

A need for a research of quantitative information is needed with this area of query. This should include information from various control strategies and information that is gathered from deductive reasoning that is analyzed and measured (Polit & Beck, 2017).

What does other healthcare facilities’ practice about their processes in helping them incorporate CHG bathing into their protocols?Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.

Gathering comparable information about other facility’s guidelines and protocols will help me distinguish the best evidence out there. Being mindful in the area’s character being inquired is essential to avoid a biased judgment. Comparability between units or facilities needs to be fair and ethical inorder to have my research questions feasible (Polit & Beck, 2017).

What are the differences of the advantages and disadvantages of using chlorhexidine wipes over using the chlorhexidine bath solution preoperatively pertaining to patient’s experiences?

This query involves inquiring for a qualitative and quantitative data. Patient’s feedbacks, suggestions or complains through their experiences from surveys as an example, provides meaningful insights that will highlight and address a better delivery of care (LaVela & Gallan, 2014).
PICOT Question
In preop patients, does the use chlorhexidine wipes more cost effective and more efficient in reducing surgical site infection compared to the use of chlorhexidine bath soap solution if used the night prior and the morning of the surgery?
P – Population: Preop patients
I – Intervention: Chlorhexidine wipes
C – Comparison: Chlorhexidine bath soap solution
O – Outcome: Cost effective; Reduced surgical site infection rate
T – Timeframe: CHG bath the night before and the morning of the surgery
Key Words in conducting Literature Search
An excellent technique inorder to successfully find the most relevant articles in the research database is selecting the right keywords to explicitly describe the desired topic (Walden University Library, n.d.b). The keywords that I will be using are as follows: Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.
Chlorhexidine gluconate (CHG), CHG wipes, CHG cloth baths, CHG bath soap solution, Hibeclens, CHG costs, Preoperative patients, Critical Care patients, Preoperative bathing, Same day surgery unit, surgical site infection, Methicillin-resistant Staphylococcus aureus (MRSA), bacterial flora, Multi-drug resistant organisms (MDRO), Skin reactions.
Summary
Embracing EBP has its meaningful purpose in our nursing practice. Through formulation of answerable questions, we, as patient advocates will be able to contribute in rectifying the challenges we are facing in our healthcare system. Our inquiries in our current nursing practice, regardless of its content, whether simple or complex, can give meaningful results through identifying accurate evidences from relevant sources. Essentially, research and EBP not only helps to reduce costs and eliminate obsolete and ineffective practices, but also to provide a higher quality care and improve patient outcome in the future. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice.
 
 
References
Donskey, J., Deshpande, A. (2016, May). Major article: Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature. American Journal of Infection Control, 44(5) e17-e21. Retrieved from https://edsebscohostcom.ezp.waldenulibrary.org/eds/detail/
Graling, P. (2013,May). Effectiveness of 2% CHG cloth bathing for reducing surgical site infections. Association of periOperative Registered Nurses Journal. Vol 97 No 5. Retrieved from wwww.aornjournal.org
Johnson, D., Lineweaver, L., Maze, L.M. (2009). Patients’ bath basins as potential sources of infection: a multicenter sampling study. American Journal of Critical Care, 18:31-40. Retrieved from http://ajcc.aacnjournals.org/content/18/1/31. Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice
LaVela, S.L., Gallan, A.S., (2014). Evaluation and measurement of patient experience. Patient Experience Journal, 1(1), 28-36. Retrieved from http://pxjournal.org/journal/vol1/iss1/5/
Krainovich-Miller, B., Haber, J., Yost, J., & Jacobs, S. K. (2009). Evidence-based practice challenge: Teaching critical appraisal of systematic reviews and clinical practice guidelines to graduate students. Journal of Nursing Education, 48(4), 186–195.
Retrieved from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/detail
Polit, D.F., Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice
Shah, H., Schwartz, J., Cullen, D. (2016, January – March). Bathing with 2% chlorhexidine gluconate: Evidence and costs associated with central line-associated bloodstream infections. Critical Care Nursing Quarterly, Vol. 39 (1), pp 42-50
Academic Guides: Keyword searching: Finding Articles on Your Topic: Searching Basics. (n.d.). Retrieved December 9, 2017, from
http://academicguides.waldenu.edu/library/keyword/searching-basics
Wang, E.W., Layon, J. (2016, Nov 13). Chlorhexidine gluconate use to prevent hospital acquired infections – useful tool, not a panacea. Annals of Translational  Medicine, Vol 5(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253275/ Identifying a Researchable Problem – NURS 5052/NURS 6052: Essentials of Evidence-Based Practice

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