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Nursing Research- Critique 2 Articles Essay

• Carefully review the study\’s purpose, methodology and results and complete the form for each of the two articles (from the 6 articles selected from previous assignment that will be attached).
• At the end of the CAT and RCA form, write a synthesis paragraph addressing implications for practice based on the evidence the study generated. USE YOUR OWN WORDS, NOT THE WORDS OF THE AUTHOR(S)
• Create a title page in APA format. Include an abstract. Include the article reference in APA format on the top of the

CAT and the RCA form. Since you are identifying the article on the form, a reference page is not necessary for this assignment. Nursing Research- Critique 2 Articles Essay

I will attach the form that will be used to fill in. It is consists of 3 pages with questions to fill in & the 4th page is the grading score for the assignment. In addition, I will attach the previous assignment, which is called exercise one and it has 6 articles that were chosen that you will have to pick 2 articles from the 6 that is already given to complete the assignment. PLEASE INCLUDE TITLE PAGE & ABSTRACT. Reference page is not needed due to reference needing to be \”in APA format on the top of the CAT and the RCA form\” as mentioned earlier.

Exercise Two:  Critical Appraisal Tool Quantitative

Title:

Database from which the article was retrieved:

Study Design:

Aim/Purpose of Study:

Independent Variable:

Dependent Variables:

Target Population:

Study Population

Inclusion/Exclusion Criteria:

Sample Size:

Sampling Method:

Methods:How was the data collected?  Was there an intervention for one group, but not the other?

Data Collection Instruments:  Identify and describe the instruments.  Did the investigator discuss the reliability and validity of the instruments? Nursing Research- Critique 2 Articles Essay

Outcomes/Results:  Include significant values and conclusions.

Strengths and Limitations:  Include what the researcher has identified in addition to what you have identified.

Level of Evidence:

Practice/Policy Bottom Line (Synthesis

Exercise Two:  Critical Appraisal Tool Qualitative

Title:

Database from which the article was retrieved

Rapid Critical Appraisal Checklist for a Qualitative Study

(Code: Yes No Unknown)

• Are the study findings valid/trustworthy/and credible? (Is this good solid research?)
  1. How were the study participant’s chosen?
  2. How were accuracy of data and completeness of data assured?
  3. How plausible/believable are the results?
• Do the findings fit the data from which they were generated? Y N    
• What are the results of the study and are they important?

1. Does the research approach fit the design of the study? Y N U
2. I. How does the researcher identify the study approach?

Are language and concepts consistent with the approach?

Are the data collection and analysis techniques appropriate?

1. II. Is the significance/importance of the study explicit?
2. Does review of the literature support a need for the study?
3. What is the study’s potential contribution?

III.  Is the sampling strategy clear and guided by study needs?

1. Are sources and means of verifying data explicit?

1. Are researcher roles and activities explained?
2. Is the phenomenon clearly defined? (Defend your response)

• Are the data collection procedures clear?
• Are sources and means of verifying data explicit
• Are researcher roles and activities explained
• Are data analysis procedures described?
• Does analysis guide direction of sampling and when it ends? Nursing Research- Critique 2 Articles Essay

1. Are data management processes described? What are the reported results (description or interpretations)?
2. How are specific findings presented?
3. I. Is presentation of the results logical, consistent and easy to follow?

IIDo quotes fit the findings they are intended to illustrate?

III How are overall results presented?

1. I. Are meanings derived from the data described in context?
2. II. Are the results plausible and believable?

III.  Are conclusions consistent with reported study findings?

I∨.  Does the writing effectively promote understanding?

3.  Will the results help me in caring for my patients 

GRADING


Five points for the critical appraisal of each study are distributed as follows:

Abstract

UTIs are undoubtedly some of the most common HAIs (hospital acquired infections) which affect adult hospitalized patients in hospital settings. About 85% of urinary tract infections which are hospital acquired are related to the use of indwelling catheters and have significant morbidity and mortality, prolong patient stays in hospitals and lead to increased medical costs. Research has revealed that effective intervention measures to reduce CAUTIs rates maximize on the urinary catheterization processes and culturing practices. This paper provides a critical review of the purpose of study, study methodology and results for two articles; a qualitative and quantitative article. The implications for policy and clinical nursing practice are also discussed. Nursing Research- Critique 2 Articles Essay 

Exercise Two:  Critical Appraisal Tool Quantitative

Title: “Davies, P. E., Daley, M. J., Hecht, J., Hobbs, A., Burger, C., Watkins, L., & Coopwood, T. B. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American journal of infection control, 46(7), 758-763.”

Database from which the article was retrieved: EBSCOHost

Study Design: Retrospective Cohort

Aim/Purpose of Study: comparing the rates of CAUTIs and urinary catheterization before and after implementing a bundled intervention.

Independent Variable: catheter associated urinary tract infections

Dependent Variables: age, sex, ethnicity, emergency department vitals, blunt trauma and abbreviated injury scale scores.

Target Population: catheterized patients

Study Population: trauma patients who were admitted between January 2013-2015 in a level I trauma hospital

Inclusion/Exclusion Criteria: patients who had suffered a trauma aged 18-89 years whose medical records were complete were included in the study. Those who were neutropenic and those who had an elevated WBC count on urinalysis were excluded.

Sample Size: 6236 patients

Methods:the study used a retrospective cohort study design. Trauma patients between 18-89 years old from 2013 January-2015January were evaluated. CAUTIs were identified based on the following criterion: recent use or presence (one day) of an indwelling urinary catheter (more than two days), fever (temp of more than 38⁰c), positive urine culture and symptoms (frequency, urgency, suprapubic tenderness, dysuria and costovertebral angle tenderness) with no recognized cause. A multidisciplinary team of pharmacists, physicians and nurses developed a bundled approach to address factors that contributed to CAUTI. The intervention maximized on the process of urinary catheterization and practices of culturing to reduce false positives. Nursing Research- Critique 2 Articles Essay

Data Collection Instruments:  Data on each group was obtained through electronic medical records and the trauma database registry. However, the investigators failed to discuss the validity and reliability of these instruments.

Outcomes/Results:  The study included 6236 patients, 5003 before and 1233 patients after the intervention. Very few patients were given a urinary catheter in the post-bundled group, (25% before vs. 16% after, P < .001). Following the implementation of the bundled approach, CAUTIs rates reduced significantly by more than a third (4.07 before vs. 2.56 after, 0.63 incidence ratio; confidence interval 95% confidence interval, 0.19-2.07). The researchers concluded that the number of catheterized patients decreased significantly as a result of the bundled approach.  In order to prevent an increase in the rates of CAUTIs, maximization of culturing practices is essential. Therefore, CAUTIs care bundle functions synergistically to improve the performance of hospitals and the safety of patients.

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Strengths and Limitations:  Major strengths of this study were as follows: clinical pharmacists were prospectively involved to monitor and intervene on the defined culturing processes. Clinical pharmacists can positively impact the rates of CAUTIs since they are ever-present in specific areas of patient care and are responsible for antimicrobial stewardship.  Besides, the use of a multidisciplinary team was important in ensuring the interventions were sustainable and the oversight of the process was broadened whilst CAUTI prevention was a shared responsibility.  The major weaknesses of the study were that; first, it failed to achieve statistical significance since CAUTIs rarely occur. The retrospective cohort study design on CAUTIs is limited by the ever-changing description of CAUTI which was the cause of unequal sample sizes considering the date of completion of the intervention. Lastly, the collection of data was highly reliant on how accurate and consistent documentation was in the trauma registry and medical chart.Nursing Research- Critique 2 Articles Essay

Level of Evidence: Level IV

Practice/Policy Bottom Line (Synthesis): Hospitals and healthcare organizations should optimize and implement policies that emphasize on the use of bundle interventions to reduced CAUTIs rates and use of urinary catheters. This article will be synthesized into the study as it addresses how CAUTIs and catheter use can be reduced through a bundled intervention.

Exercise Two:  Critical Appraisal Tool Qualitative

Title: “Ravi, P. R., & Joshi, M. C. (2018). Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society, 20(2), 116.”

Database from which the article was retrieved: PubMed

• Are the study findings valid/trustworthy/and credible? (Is this good solid research?)
  1. How the study participant was chosen? All the patients who were admitted to male and female wards between 15-75 years and had an indwelling catheter were selected to take part in the study.
  2. How were accuracy of data and completeness of data assured? To maintain accuracy, the researchers excluded patients with a pre-existing infection, those admitted to hospital with urinary catheters, those on catheters for home-based care and those with a positive urine culture. Besides, the data collected was analyzed using SPSS version 16.

How plausible/believable are the results? To ensure credibility, the researchers limited selection bias using Fisher’s exact test for the independent variable and the unmatched Student t-test for dependent variables, instruments, which had an established validity.

• Do the findings fit the data from which they were generated? Yes, the findings fit the data from which they were generated since the researchers collected identifiers and allowed the automatic collection of data from a secure data set.                        
• What are the results of the study and are they important? The researchers found CAUTIs incidence rate was 64.72 per 1000 catheter days (IP phase I- 25.47 and IP phase II 18.95). Besides, the incidence of CAUTI reduced by 60.64 following the implementation of a catheter bundle approach and staff education. Under the constant supervision of ICNs, the reduction rate of CAUTIs was clinically significant with 70.72.Nursing Research- Critique 2 Articles Essay

1. Does the research approach fit the design of the study? Yes, the research approach follows the appropriate procedures to protect ethical concerns and critical issues regarding participant rights.
2. I. How does the researcher identify the study approach?

Are language and concepts consistent with the approach? The concepts and language are consistent with the study approach since all the relevant information needed for an evidence-based practice has sufficiently been provided.

Are the data collection and analysis techniques appropriate?the techniques of data collection and analysis used in this study are SPSS 16.It is an appropriate statistical method which correlates well with the measurement level of the variables and the study population.

1. II. Is the significance/importance of the study explicit? The significance of the objective and problem to nursing is evidenced by the researcher’s argument that catheter care bundle approaches and constant supervision of ICNs help to reduce the incidence rates of CAUTIs in hospitals.
2. Does review of the literature support a need for the study? The literature review is relevant for the stated objective as it helps to ascertain the validity and reliability level in the measure of clinical practice. As such, it provides a sold background for the study.
3. What is the study’s potential contribution? With regards to clinical practice, the study is complete and reasonable as it is connected to the study’s limitation and suggests that care providers should utilize catheter care bundles to reduce CAUTIs rates in clinical settings. It also places responsibility of constant supervision of this prevention approach on ICNs

III.  Is the sampling strategy clear and guided by study needs? The sampling strategy was enhanced through representativeness and reduced the likelihood of sample biasness since it eliminated the possibility of restricting participants who were willing to participate in the study of having preference for certain patients to participate in the study.

1. Are sources and means of verifying data explicit? Data verification has been done through explicit means and sources since they meet the congruent operational and conceptual definitions

1. Are researcher roles and activities explained? The role of the researcher as well as their activities has been clearly explained.Nursing Research- Critique 2 Articles Essay

• Is the phenomenon clearly defined? The phenomenon has been clearly definedas the fundamental part of the reduction of CAUTI in hospitals while laying emphasis on roles and responsibilities of ICN nurses
• Are the data collection procedures clear? The data collection procedures are clear because data collection method used minimized any possibility of bias.
• Are sources and means of verifying data explicit, full data verification was done through inspection and analysis.
• Are researcher roles and activities explained? The role of the researcher as well as their activities has been clearly explained.
• Are data analysis procedures described?
• Does analysis guide direction of sampling and when it ends? The data analysis procedures have been clearly described as SPSS 16. This is an appropriate statistical method that correlates well with the level of measurement of the variables as well as the number of groups under comparison.

Are data management processes described? The data management processes described by the use of password and safes to store the data to secure their integrity, credibility and privacy. The reported results have been illustrated using appropriate tables and figures have also been used to provide a visual illustration of the outcome of every research question.

1. How are specific findings presented?
2. I. Is presentation of the results logical, consistent and easy to follow? The specific findings are presented in a logical arrangement based on the study purpose. Therefore, the findings are consistent due to a logical presentation of results and all the procedures required for an evidence-based practice have been sufficiently provided.

IIDo quotes fit the findings they are intended to illustrate? The findings fit the quotes that they are purposed to illustrate as generally presented using tables.

III How are overall results presented? In form of tables

• I. Are meanings derived from the data described in context?The researchers found CAUTIs incidence rate was 64.72 per 1000 catheter days (IP phase I- 25.47 and IP phase II 18.95). Besides, the incidence of CAUTI reduced by 60.64 following the implementation of a catheter bundle approach and staff education. This data meant that catheter care bundles are an effective approach of reducing the rates of CAUTIs among hospitalized patients.Nursing Research- Critique 2 Articles Essay

1. II. Are the results plausible and believable? Since data collection, analysis and presentation minimized the likelihood of bias, the results obtained are highly plausible and believable.

III.  Are conclusions consistent with reported study findings? The conclusions are also consistent with the findings of the study given that it relies on the data gathered to make an empirical interpretation to the hypothesis, thus finding the answers the research question.

I∨.  Does the writing effectively promote understanding? The presentation andwriting promote easy understanding

3.  Will the results help me in caring for my patients? Going by the practical implication of the results, it is evident that the findings can help in the clinical care of my patients since I work in an inpatient where critically ill patients urgently need urinary catheterization. Catheter care bundle can be used to prevent the risks of CAUTIs among these patients in clinical practice.