Running Head: PICOT STATEMENT 1 PICOT Statement NRS 490 Grand Canyon University Date 10/21/2018 PICOT STATEMENT 2 Introduction Formulation of a PICOT statement comes in handy when identifying the clinical problem in focus, that is, an increase in mortality rate among adults following cardiac arrest. This research into the intervention that can be applied and its effectiveness on acting on the clinical problem will come in handy once it has been compared with the hands plus breathing CPR, and its effectiveness in the same case. The PICOT statement plays an important role in clarifying the issue at hand, especially the medical issue in focus. The PICOT statement, in this case, covers an evidence-based solution, nursing intervention, patient care, health care agency, and nursing practice with regard to the hands-only CPR being provided to adults for the sake of attempting to reduce the mortality rate (Lynn, 2010). The PICOT statement effective in this case is: P – Patient (adult) I – Intervention (Hands-only CPR) C – Comparison (hands-plus-breathing CPR) O – Outcome (reduced mortality rate in adults) T – Time required to realized outcome achievement The clinical problem, in this case, is the issue of an increase in mortality rate. The mortality rate remains high, or increases due to the failure of the right first aid measures being applied, or failure of the right way of giving a patient CPR, or failure of knowing the measures to apply to a person who requires assistance with breathing. The outcome can turn from negative to positive in PICOT STATEMENT 3 such a case when hands-only CPR is applied to a person who does not have the ability to breathe on their own. A person is then required to assist this patient when a medical responder is absent. Evidence-Based Solution The evidence-based solution in the event that an adult stops breathing is performing CPR (cardiopulmonary resuscitation) on them to help them breathe back to life. This is based on such a situation as a person suffering from cardiac arrest. The evidence-based solution carries the patient population in question (adults), as well as the intervention to be applied (hands-only CPR) (Field, A.C.E.P., & A.H.A., 2012). Nursing Intervention The most effective nursing intervention to be applied in the event of an adult’s lack of breath is the hands-only CPR. When an adult experiences cardiac arrest, a bystander may help them out by performing hands-only CPR. It is an effective method because it does not require training to perform, and it has been found to be successful in the application, as opposed to performing rescue breathing with chest compressions. Chest compressions may be interrupted by the rescue breathing when the person performing it is untrained. Patient Care Patient care can be provided, in the event of cardiac arrest, through performing hands-only CPR. Bystanders should also take it upon themselves to perform CPR, especially in the absence of a medical responder, and until the responder arrives to keep the person alive. Once the responder arrives, the bystander can now leave it to the trained professionals. PICOT STATEMENT 4 Health Care Agency The healthcare agency in charge, after arrival at the scene, can aid in the performance of hands-only CPR while using a defibrillator, followed by taking the patient to the hospital once oxygenated-blood starts getting to the brain, and they start breathing again. The hospital can take a closer look at the issue with their health, and help the patient recover. Hands-only CPR cannot be used on a patient with a Do Not Resuscitate order from the doctor. Nursing Practice To perform hands-only CPR, several steps ought to be followed for effective performance. Following the collapse of an adult or a teenager, it is important first to dial 911. It is then encouraged that a person performs CPR through pushing fast, and hard at the patient’s chest center. CPR ought to be performed following the beat to the song “Stayin’ alive.” The rate used on pushing on the chest is 100-120 compressions every minute. Training a person to perform CPR has been found most effective when they have to remember a song whose beats aid in effective performance (Nord, 2017). PICOT STATEMENT 5 References Field, J. M., American College of Emergency Physicians., & American Heart Association. (2012). The textbook of emergency cardiovascular care and CPR. Lynn, P. B. (2010). Taylor's handbook of clinical nursing skills. Philadelphia, Pa: Lippincott Williams & Wilkins. Nord, A. (2017). Bystander CPR: New aspects of CPR training among students and the importance of bystander education level on survival. Linköping: Linköping University Electronic Press. Literature Evaluation Table Student Name: Change Topic (2-3 sentences): How to reduce the occurrence of urinary tract infections in intensive care units within hospitals. Criteria Article 1 Article 2 Article 3 Article 4 Author, Journal (PeerReviewed) , and Permalin k or Working Link to Access Article American Nurses Association, ANA Journals, and https://www.nur singworld.org/p racticepolicy/workforc e/what-isnursing/thenursingprocess/ Bhatia, Daga, Garg, and Prakash; Journal of Global Infectious Diseases; and https://www.ncbi.nlm.n ih.gov/pmc/articles/PM C2889669/ Chenoweth, and Saint; Critical Care Clinics; and https://www.criticalca re.theclinics.com/artic le/S07490704(12)000826/abstract Article Title and Year Published The Nursing Process, 2009 Urinary Catheterization of medical wards, 2010 Research Questions (Qualitati ve)/Hypot hesis (Quantita tive), and Purposes/ Aim of Hypothesis is identifying the nursing process. Aim is to identify the steps taken in achieving the nursing process. Hypothesis is to determine the inappropriate use of catheterization in medical wards in the US, and the frequency of this use. Aims are determination of inappropriate Burton, Edwards, Srinivasan, Fridkin, and Gould; Infection Control & Hospital Epidemiology; https://www.cambridg e.org/core/journals/inf ection-control-andhospitalepidemiology/article/t rends-incatheterassociatedurinary-tractinfections-in-adultintensive-careunitsunited-states19902007/836CC1A3 539F70A4F0BF1EC A6F374229 Trends in catheterassociated urinary tract infections in adult intensive care units-United States, 1990-2007; 2015 Hypothesis is to identify changes in CAUTI event rates. Aim is change examination in CAUTI event rates in adult ICUs in the United States, from 1990 to 2007. Preventing catheterassociated urinary tract infections in the intensive care unit, 2012 Hypothesis is to identify the most effective strategies for dealing with UTIs in ICUs. Aim is to prevent catheterassociated urinary tract infections in the intensive care unit. © 2015. Grand Canyon University. All Rights Reserved. Study catheterization frequency within medical wards together with reasons, and inappropriate catheterization inappropriate catheterization. Quantitative – descriptive design Design (Type of Quantitati ve, or Type of Qualitativ e) Qualitative Ethnographic research Descriptive design Experimental design Setting/Sa mple Hospital Hospital-based Hospitals Methods: Interventi on/Instru ments Patients, assessment by nurse or diagnosis Methods, or instruments applied were patients in tertiary care hospital medical wards, and patient profiles, too, were used. Analysis The status of the patient, and the nursing care effectiveness ought to undergo continuous evaluation, and undergo modification, when needed. Urinary catheter use limitation; urinary catheters insertion, and catheters through aseptic techniques; urinary catheter perioperative management; antieffective catheter use, and use of indwelling urinary catheters as alternatives. Many health care facilities have failed to adopt CAUTI prevention practices leading to an increase in patients being infected by UTIs. Urinary catheters are responsible for the greatest portion of UTIs. There is a likelihood of attention towards prevention of CAUTI increasing with time. Key Findings Nurse’s care plan of the Wide prevalence of inappropriate catheterization even in the case of a tertiary care medical center. Patients who did not require catheterization were catheterized, thus ended up acquiring CAUTI when diagnosed. Better infection control is required, thus calling for aseptic techniques being implementation on more stringent grounds. A symptomatic urinary tract infection only CAUTI event identification was conducted using standards methods, by the infection preventionists; poissom regression was used in percent change estimation; and pooled mean annual SUTI and ASB rates. With the decline in the CAUTI rates among adults in ICU, it is important to look into strategies applied, so that the decline can carry on, and prevention guidelines of CAUTI can further be implemented. 22,973 ASB, and 36, 282 SUTIs episodes It was found that hospital leadership, Hospital-based © 2017. Grand Canyon University. All Rights Reserved. patient. Recomme ndations Provision of continuous care to patient when hospitalized, and before discharge. Explanati on of How the Article Supports EBP/Caps tone Project How best to play the nurse’s role in providing treatment to patients with UTIs (American Nurses Association, 2009). Criteri a Author, Journal (PeerReviewe d), and Permali nk or Workin g Link to affected 22.4% of the patients, with a similarity in the organism causing the infection, with 30.4% of the patients developing asymptomatic urinary tract infection. Majority of patients suffered from asymptomatic UTIs, with E.coli being the most pronounced organism in patients with BCFC. Sensitization of physicians on need evaluation in patients before taking on the catheterization intervention. How best to catheterize patients in medical wards, thus reducing infections (Bhatia, Daga, Garg, & Prakash, 2010). resulted from the study. Significant declines were identified in SUTI, and ASB rates. intervention bundles, and collaborative are used in health care infection prevention initiative implementation since they are powerful tools. Prevention strategies used in CAUTI rate reduction to be further assessed, and new CAUTI prevention guidelines to be implemented. Provide understanding about how best to deal with the UTIs at different stages, based on the trends following, and to know whether, or not there is improvement in treatment (Burton, Edwards, Srinivasan, Fridkin, & Gould, 2011). Encouraging avoidance of urinary catheter placement, and appropriate promotion of early removal of urinary catheters. How best to deal with UTIs, and the strategies to put in place in order to deal with the issue of UTIs (Chenoweth, & Saint, 2013). Article 5 Article 6 Article 7 Article 8 Conway, Pogorzelska, Larson, and Stone; American Journal of Infection Control; and https://www.sciencedire ct.com/science/article/pi i/S0196655311012569 Magill, Edwards, Bamberg, Beldavs, Dumyati, Kayner, Lynfield, Maloney, McAllister-Hollod, Nadle, Ray, and Thompson; The New England Journal of Medicine; and Marra, Camargo, Goncalves, Sogayar, Moura, Guastelli, Rosa, Victor, santos, and Edmond; American Journal of Infection Control; and https://www.sciencedire ct.com/science/article/pi i/S0196655311001611 Infectious Diseases Society of America; Oxford Academic; and https://academic. oup.com/cid/artic le/46/2/i/461733# © 2017. Grand Canyon University. All Rights Reserved. Access Article Article Title and Year Publishe d Adoption of policies to prevent catheterassociated urinary tract infections in United States intensive care units, 2012 Researc h Questio ns (Qualita tive)/Hy pothesis (Quantit ative), and Purpose s/Aim of Study Hypothesis is to identify the relation between CAUTI incidence rates, and prevention policies. Aim is adherence, and recognition of CAUTI prevention policies, to help with relationship determination between CAUTI incidence rates, and prevention policies in place. Design (Type of Quantit ative, or Type of Qualitat ive) https://www.nejm. org/doi/full/10.105 6/NEJMoa1306801 Multistate pointprevalence survey of health careassociated infections, 2014 Preventing catheterassociated urinary tract infection in the zerotolerance era, 2011 Clinical Infectious Diseases, 2008 Hypothesis is to identify intervention effect. Aim is the prevention of urinary tract infection of a catheter-associated nature in the era of zero tolerance. Hypothesis is identification of the clinical infectious diseases. Aim is giving detailed information on the clinical infectious diseases. Descriptive design Hypothesis is the generation of estimates updated, regarding the national burden that is the infections. Aim is the conducting of a health careassociated infection pointprevalence survey on a multistate level. Descriptive design Experimental design Experimental design Setting/ Sample Hospitals Hospitals Critical care part of the hospital Different people around the world Methods : Interven tion/Inst ruments 441 hospitals used in the study, National Health care Safety Network Intensive care unit, stepdown units, performance monitoring, evidencebased practices, and bladder bundles. Patients around the world. Analysis SPSS version 19 used in analysis of data. Other analyses were conducted via mean, and median of CAUTI rates; generalized linear regression, and bivariate analysis made use of One-day surveys, use of trained data collectors, hospital personnel, use of survey, and sample data of patients on infections acquired. Version 9.3 of SAS software was used, and versions 2.3.1, and 3.01 of openEpi Software; patient comparison was conducted; discharge 2-sided statistical tests applied, generalized linear model, windows 17.0 SPSS used to conduct analyses, and Poisson distribution used. Wide distribution of infections caused by P. Knowlesi, nonPC7 serotypes caused increase in infections in 2002, mortality © 2017. Grand Canyon University. All Rights Reserved. Mann-Whitney tests; bivariate analyses were conducted; and odds ratios, too, were used in analyses. weighting was used; burden estimates were used; log-binomial regression was also applied; and mid-P exact method, too. Key Only a small portion of Findings the ICUs within the hospitals that were surveyed had policies implemented to aid in the UTI prevention. 51.9% of patients within hospitals that were surveyed were scheduled for anti-microbial agents. 1 of every 25 patients on inpatient has an infection that is health care associated, and within acute care hospitals. Health care associated infections epidemiology, and prevention success trends’ to be better understood. Identification of the most affected states, and how best to deal with the issue of infections in these states (Magill, Edwards, et. al., 2014). Recom mendati ons Explana tion of How the Article Support s EBP/Ca pstone Further research on clarity in relationship identification between CAUTI incidence rates, and prevention recommendations’ adherence. Viewing the effect that prevention policies will have on catheterization, and whether, or not infections will reduce as a result (Conway, Pogorzelska, Larson, & Stone, 2012). There was significant reduction in CAUTI from 7.6/1000 catheterdays to 5.0/1000 catheter-days. higher in patients with vancomycin, mortality rate associated with CoNS native valve endocarditis related to that in S. aureus. Increase in infections in the presence of certain biological agents. CAUTI prevention ought to be further researched into. Increase in application of combination antiretroviral therapy. Effects that the zero tolerance era had on infections, and how to go about dealing with the infections in the same manner (Marra, Camargo, et.al., 2011). Gaining knowledge about clinical infectious diseases, to understand UTIs, and know how to deal with them (Infectious Diseases Society of America, 2008). © 2017. Grand Canyon University. All Rights Reserved. References American Nurses Association, Nursing World. The Nursing Process (2009). American Nurses Association. http://www.nursingworld.org. Bhatia, N., Daga, M. K., Garg, S., & Prakash, S. K. (2010). Urinary catheterization in medical wards. Journal of global infectious diseases, 2(2), 83. Burton, D. C., Edwards, J. R., Srinivasan, A., Fridkin, S. K., & Gould, C. V. (2011). Trends in catheter-associated urinary tract infections in adult intensive care units—United States, 1990–2007. Infection Control & Hospital Epidemiology, 32(8), 748-756. Chenoweth, C., & Saint, S. (2013). Preventing catheter-associated urinary tract infections in the intensive care unit. Critical care clinics, 29(1), 19-32. Conway, L. J., Pogorzelska, M., Larson, E., & Stone, P. W. (2012). Adoption of policies to prevent catheter-associated urinary tract infections in United States intensive care units. American journal of infection control, 40(8), 705-710. In This Issue, Clinical Infectious Diseases, Volume 46, Issue 2, 15 January 2008, Pages i, https://doi.org/10.1086/526495 Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., ... & Ray, S. M. (2014). Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine, 370(13), 1198-1208. Marra, A. R., Camargo, T. Z. S., Gonçalves, P., Sogayar, A. M. C. B., Moura Jr, D. F., Guastelli, L. R., ... & Edmond, M. B. (2011). Preventing catheter-associated urinary tract infection in the zero-tolerance era. American journal of infection control, 39(10), 817-822. © 2017. Grand Canyon University. All Rights Reserved.
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