NURS 8002 LOCATING AND CRITICALLY ANALYZING PRIMARY RESEARCH ARTICLES

NURS 8002 LOCATING AND CRITICALLY ANALYZING PRIMARY RESEARCH ARTICLES

NURS 8002 LOCATING AND CRITICALLY ANALYZING PRIMARY RESEARCH ARTICLES

One of the major activities that a DNP nurse participates in is research, usually evidence-based research. As indicated earlier, my interest is in researching reducing catheter-associated urinary tract infection (CAUTI). This condition is a clinical issue that needs to be mitigated to ensure that the patients have better health outcomes. This write-entails a summary and synthesis of two peer-reviewed articles obtained through the Walden Library search pertaining to reducing catheter-associated urinary tract infections.

Summary of The Articles

One of the articles with the title “Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomized controlled trial” reported by Fasugba et al. (2019) entails reducing CAUTI. The report compares the efficacy of the use of normal saline and 0.1% chlorhexidine solution in cleaning the meatal area prior to inserting urinary catheters in lowering the incidences of CAUTI. The study used a cross-sectional randomized control trial in the hospitals for a period of three weeks, with a total of 1642 research subjects recruited in three hospitals (Fasugba et al., 2019). While 58% of them were in the intervention period, the remaining 42% were in the control phase. Among the findings is that among the control group, 13 cases of CAUTI were recorded as compared to only 4 cases among the intervention group; hence the intervention was connected to a 94% reduction of the rates of catheter-associated urinary tract infections.

More recently, a study has been reported by Nassikas et al. (2020) with the title “Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections” This study purposed to determine whether the use of rounding checklist in an intensive care unit lowers the incidences of catheter-associated urinary tract infections. These researchers used a retrospective before-and-after study design. Done in an academic community hospital with a 16 bed ICU unit, the intervention used was an ICU rounding checklist which ensured that the caregivers addressed the use of the indwelling catheters. Analysis was then done to compare the pre-intervention duration with the post-intervention after implementing the checklist. Pre and post-intervention strategy is one of the best ways of determining the efficacy of an intervention in the management of a condition or disease (Spurlock, 2018).  Among the findings obtained from the research is that before the intervention, the unit recorded nineteen CAUTI cases per one thousand catheter days. The rate was found to reduce to 2.12 after the intervention from 4.62 before the implementation of the checklist.

Synthesis of The Sources

The findings of Fasugba et al. (2019) implies that by taking care of the meatal area through thorough cleaning, the rates of CAUTI incidences can greatly be reduced. By employing the normal intervention of using the 0.9% saline solution, whose efficacy has also been shown in previous studies (Khahakaew et al., 2019), this current research was able to demonstrate that the use of 0.1% chlorhexidine solution is more efficacious hence introducing better evidence to practice. Indeed, the findings are in agreement with other studies (Mitchell et al., 2019). However, the findings also differ from other reports where the use of chlorhexidine did not lead to lower incidences of CAUTI, even though that study was a single-site randomized control site.

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Several interventions exist for controlling CAUTI. Patients at the ICU particularly need to be free from the infections to give them a better chance of healing; therefore, the study by Nassikas et al. (2020) is significant. They were able to demonstrate that using the checklist in the ICU setting can be vital. These findings can be generalizable in an ICU setting in other locations since the intervention focuses on just using a checklist. It is important to note that this intervention is relatively cost effective, even though at first it may lead to increased use of indwelling catheters, eventually it allows for lower usage rates. The findings are also supported by other studies. For instance, a study done to combine checklist and education intervention effectively reduced the rates of CAUTI (Menegueti et al., 2019).

References

Fasugba, O., Cheng, A. C., Gregory, V., Graves, N., Koerner, J., Collignon, P., … & Mitchell, B. G. (2019). Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial. The Lancet Infectious Diseases, 19(6), 611-619. Doi: 10.1016/S1473-3099(18)30736-9.

Khahakaew, S., Suwanpimolkul, G., Wongkeskij, T., Punakabutra, N., & Suankratay, C. (2019, October). 1151. A Comparison of Periurethral Cleaning Between Normal Saline and Savlon Solutions Before Indwelling Urinary Catheterization in Reducing Catheter-Associated Bacteriuria: A Randomized Controlled Study. In Open Forum Infectious Diseases (Vol. 6, No. Supplement_2, pp. S411-S411). US: Oxford University Press. https://doi.org/10.1093/ofid/ofz360.1015

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S. R. M., … & Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine, 98(8). Doi 10.1097/MD.0000000000014417.

Mitchell, B. G., Fasugba, O., Cheng, A. C., Gregory, V., Koerner, J., Collignon, P., … & Graves, N. (2019). Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection: a cost-effectiveness analysis. International journal of nursing studies, 97, 1-6. https://doi.org/10.1016/j.ijnurstu.2019.04.003.

Nassikas, N. J., Monteiro, J. F. G., Pashnik, B., Lynch, J., Carino, G., & Levinson, A. T. (2020). Intensive Care Unit Rounding Checklists to Reduce Catheter-Associated Urinary Tract Infections. Infection control and hospital epidemiology, 41(6), 680-683.  Doi: 10.1017/ice.2020.43

Spurlock Jr, D. R. (2018). The single-group, pre-and posttest design in nursing education research: It’s time to move on. Journal of Nursing Education, 57(2), 69-71. Doi: https://doi.org/10.3928/01484834-20180123-02.

One of the skills that have to be well developed by a DNP student is research skills, as DNP-prepared nurses are required to formulate solutions to various clinical problems. Central to the skill is an appropriate choice of a topic that forms the basis of a problems statement and uses the fundamentals of research to search in various databases to get relevant information. Obtaining relevant literature is not the end, but a means to an end as an individual has to analyze the sources and evaluate how well it relates to the topic or the problem in question (Eriksen, & Frandsen, 2018). The purpose of this week’s assignment is to describe how a literature search related to a topic of interest was accomplished and a summary of the selected articles.

The Literature Search

Prior to accomplishing the literature search, the problem’s keywords were noted down to help in narrowing down the search results. For instance, one of the most common healthcare issues is healthcare-acquired infections such as catheter-acquired urinary tract infections. Controlling them is therefore key. Using Chlorhexidine for meatal cleaning was then considered as a possible intervention. In searching the databases, keywords were used, and a search was done in databases such as Medline, CIHNAL, PsycINFO, web of science, and google scholar. Various keywords such as “CAUTI,” “management,” and “Prevention,” and “chlorhexidine” were used.

Summary of the Chosen Articles

One of the articles obtained from the literature search is work done by Fasugba et al. This research employed a randomized controlled trial to evaluate the effects of utilization of Chlorhexidine for meatal cleaning during catheterization in the prevention of CAUTI. With a sample of 1642, the researchers found a positive effect. For instance, upon the use of the intervention, there was a significant reduction of CAUTI cases from thirteen to only four for every one hundred catheter days. By the end of the study, the intervention was found to reduce the cases of CAUTI by 94% (Fasugba et al., 2019).

Another article retrieved is an article authored by Mitchel et al. to compare the efficacy of using saline versus Chlorhexidine in lowering the rates of CAUTI and the cost associated with each. Using a randomized controlled trial study design, the study revealed that using Chlorhexidine was more efficacious and cost-effective than using saline (Mitchel et al., 2019). The use of Chlorhexidine coincided with a significant drop in the cases of CAUTI in the hospitals, reducing admission days hence leading to reduced costs.

In yet another study, Sarani et al. evaluated the impact of using 2% Chlorhexidine and normal saline in perineal care in a comparative study. Using a quantitative quasi-experimental study design, the researchers managed to obtain some relevant results among women who got admitted to the ICU. While the rates of the groups using normal saline had 77% of CAUTI rates, the use of the 2% Chlorhexidine led to a substantially lower value of only 13%, indicating the importance of using Chlorhexidine (Sarani et al., 2020).

Synthesis of the Articles

The negative impacts of CAUTI are reflected in the research efforts dedicated to finding strategies to control it. The three articles summarized in the previous section show to various degrees the efficacy of using Chlorhexidine for meatal cleaning. While Fasugba et al. focused solely on Chlorhexidine, Mitchell et al. and Sarani et al. did comparison studies to find out how the use of Chlorhexidine compares with the normal saline in controlling CAUTI ((Mitchel et al., 2019, (Sarani et al., 2020)). All three articles reported statistically significant results hence underpinning the importance of using Chlorhexidine for meatal cleaning as an intervention. The level of evidence in these articles is good as they are randomized controlled trials and experimental research studies.

Differences between Summarizing and Synthesizing Research

While the two skills of research summary and research synthesis are both essential for a researcher, the two are different, and it is imperative that a researcher knows the differences. Summarizing research involves restating the key points or findings of research in their own words in a condensed way. On the other hand, synthesizing research entails a combination of ideas from similar sources and bringing in various perspectives and insights through a reflection on the text in question (Gurevitch et al.,2018). The implication is that while through a summary, the important information is pulled together and highlighted, synthesis go steps further to compare and contrast sources, to draw a conclusion, and provide new insights

Conclusion

In conclusion, literature search forms an essential part of the research. A successful and efficient literature search requires that research possesses adept knowledge of using various databases to look for information. In addition, due to the variabilities in the sources obtained, every source must be carefully analyzed and the knowledge synthesized to ascertain if it can be utilized in a setting to solve problems. Therefore, this write-up has focused on literature search, article summary, and a comparison between research synthesis and summary. In addition, a summary of three articles obtained from a database search focusing on a clinical problem has been accomplished.

References

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420. https://dx.doi.org/10.5195%2Fjmla.2018.345

Fasugba, O., Cheng, A. C., Gregory, V., Graves, N., Koerner, J., Collignon, P., … & Mitchell, B. G. (2019). Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomized controlled trial. The Lancet Infectious Diseases, 19(6), 611-619. https://doi.org/10.1016/S1473-3099(18)30736-9.

Gurevitch, J., Koricheva, J., Nakagawa, S., & Stewart, G. (2018). Meta-analysis and the science of research synthesis. Nature, 555(7695), 175-182. https://doi.org/10.1038/nature25753

Mitchell, B. G., Fasugba, O., Cheng, A. C., Gregory, V., Koerner, J., Collignon, P., … & Graves, N. (2019). Chlorhexidine versus saline in reducing the risk of catheter-associated urinary tract infection: a cost-effectiveness analysis. International journal of nursing studies, 97, 1-6. https://doi.org/10.1016/j.ijnurstu.2019.04.003.

Sarani, H., Pishkar Mofrad, Z., Faghihi, H., & Ghabimi, M. (2020). Comparison of the Effect of Perineal Care with Normal Saline and 2% Chlorhexidine Solution on the Rate of Catheter-Associated Urinary Tract Infection in Women Hospitalized in Intensive Care Units: A Quasi-Experimental Study. Medical-Surgical Nursing Journal, 9(2). https://dx.doi.org/10.5812/msnj.106739