Abstract
The increased numbers of central line bloodstream infections cases are increasing as more people spend almost their life time at hospital ICU’s area. If a solution could be found about how to prevent such cases, more lives would be saved and the cost of healthcare practices would go down. The following research proposal aims at investigating how effective line bundle protocol is in preventing central line associated bloodstream infections in ICUs compared to the normal standard precautions. The research will make use of quantitative research methods through primary data collection tools like questionnaires, interviews, and surveys. In addition, the proposal gives the best theory that the research should adopt in determining the best nursing practice.
Table of Contents
Nursing theoretical framework. 6
Justification of the method. 11
Validity and reliability of data collection tools. 12
Questionnaires and interviews. 14
Introduction
Bloodstream infections caused by central line infections have a maturity rate of 12% to 25%, which makes them the most deadly infections in the world. Such patients are treated in Intensive Care units (ICUs) because they require thorough intervention and their lives are always in danger. Quality health is a right for every human being and not a privilege. The health services have offered in hospitals should concentration on preventing incidences such as central line bloodstream infections that are very dangerous in a patient’s life. As such, individuals should have a right to health preventive practices. The amount of Americans expenditure on CLABSI cases has an approximate value of 20% of the family budget. The spending results to high rate of poverty especially to people who leave below the poverty line, and citizens in developing countries. In addition, health care system in United States lacks the element of patient-doctor centric and it is quite uncoordinated.
Prevention is a key need for quality health; this ensures that individuals receive the service in an adequate manner and that the services are of high quality. Creating a room for the privilege in CLABSI cases may introduce an element of discrimination on the level of services that an individual receives. In using effective prevention measures such incidences would be reduced. According to Centre for Disease Control and Prevention (2012), best practices have been introduced regarding the practices of preventing the CLABSI infections and strategies for determining the best practices. Therefore, hospital ICUs being a right ensures that individuals receive an equal and standard level of services to avoid sudden deaths. In addition, prevention of CLABSI cases minimizes the amount of individual expenditure in hospital bills and saves the government a lot of revenue in catering for the bed ridden people (Shi & Singh, 2008).
CLABSI cases need effective facilities that prevent their occurrence; as such, the government should take an active role in the management of the infections that result to CLABSI. This involves educating of physicians and medical practitioners or better healthcare practices that prevents the spread of CLABSI to patients. The management at hospitals should safeguard the health of patients by ensuring physicians, doctors, and nurses use the appropriate tools while handling patients, especially during injection processes. According to Comprehensive unit-based Safety program (CUSP) and HAI (2011), hospitals should ensure they offer the best healthcare practices that minimize certain infections through adopting effective programs, which ensure the live of patients is not put at risk. The following research proposal will investigate on the suitability of using central line bundle protocol in prevention of central line associated bloodstream infections in hospitals ICU”s. the research will make use of quantitative research methods on gathering the necessary information that will be of importance for the proposal. In addition, the research will use the most effective nursing theory that guides it through justifying the use of the nursing technique proposed.
Background
The use of central venous catheters (CVCs) in the administration of intravenous fluids, medications, blood products, and parental nutrition together with the monitoring of various blood activities inside the body is a common practice in today’s healthcare centers. Many venous and arteries are required in identifying pathophysiologic factors that help in determining the efficiency of any therapy in a healthcare centre. The use of such processes leads to serious bloodstream infections referred to central line-associated bloodstream infections. These infections are now highly preventable when proper guidelines are followed for the collect administration of the required medication and other substances. The type of infections developed by a patient when receiving certain care in a healthcare centre might cause many troubles if allowed to grow and expand to other parts of the body. Hospital ICU’s use either central line bundle protocol or no bundle protocol with standard precautions in preventing central line associated blood infections (Centers for Disease Control and Prevention, 2005).
The establishment of line bundle protocol process will introduce an element of prevention, among the bloodstream infection cases. This will aid in motivating them and an algorithm that will aid health care cost reduction and improvement of the service delivery will emerge. This, in turn, will aid in improving the nation’s health care, and families will save their earnings on health care costs. In addition, the process will aid in solving societal problems of health care delivery system. The key challenge for the issue presented is the ability of different health care centers to adopt the process in the technology, and develop a system of making health care affordable and efficient.
Problem statement
` Central Line-Associated Bloodstream Infection (CLABSI) is a serious health problem that affects more than 41,000 victims each year in United States. The infections cause prolonged hospital stay and are associated with increased mortality risks and health costs. Various healthcare centers use different methods of preventing cases of CLABSI, but research has not yet determined the best protocol to adopt. The high risks of blood stream infections results from poor practices that hospital use in preventing such infections. Blood stream infections increase the duration of hospitalization by almost 21 days leading to increased cost of medication. On the other hand, the more the infections the more death cases are reported because the patient stays in a very critical conduction needing special care. The following research investigates how a hospital ICU using central line bundle protocol is more efficient in preventing central line associated blood stream infection (Klevens et al, 2007).
Research objectives
The objective of the research is to determine the effectiveness of hospital ICU’s use of central line bundle protocol over the standard precautions in the prevention of central line associated bloodstream infection.
Nursing theoretical framework
The research will use an integrative nursing theoretical framework.
The theoretical framework will take control of both clinical and administrative processes in addressing the issue of CLABSI and the preventive practices. The integrative theoretical framework serves as a guide in making various decisions necessary for the advancement of the healthcare industry. In addition, the theoretical framework enhances communication with patients and staff, and assists in identifying solutions to most pressing issues affecting disease prevention practices (Schmieding, 1990). The theory will assist in looking at the CLABSI concept in a way that generates the necessary outcomes that agree with the null hypothesis. In addition, it will give a wide range of suggestions when more people will be interviewed and increases experiences in nursing practice. The integrative theory provides a framework of materials that a researcher requires in gathering the necessary information about the impact of bloodstream infection prevention measures. Operational structure in best-practice that most hospitals should follow since it acts as the major driving force for attainment of the organization goals, and improvement in the performance level. The structure stipulates role expectations of various individuals found within the organization. In addition, the structure provides a coordinated system of the correlation among the various units of the organization. The research will be guided by the nursing concept that discusses the importance of carrying out nursing researches.
The theory will cover all nursing philosophies that will play a great in understanding their environment and designing the best approaches to follow. Nursing philosophy will address a broad area and more information concerning the best practice will be gathered. According to Alligood (2006), nursing philosophy is a discipline that provides direction, forming foundation for research development, and clarifying values that one requires in the healthcare industry. In addition, the theory will help in choosing the target group for the research because it forms the most important component of the proposal. In addition, the theory provides a base line for generating the main ideas that a researcher should have before facing the respondent group.
On the other hand, the integrative theory will assist in discovering characteristics of people involved in the research and determine the best approaches to these people in order to gather information. The theory helps in integrating various life aspects that are needed in understanding the human psychology in order to make the respondent feel the need for carrying out this research. It identifies the guiding objectives, which a research needs to adopt to improve on quality of data collected, they encourage individual performance output level, and they give a structure for evaluating the research progress (Hertz, 2006). However, these goals need an outline in a quantitatively, measurable, time-bound, realistic, and applicable manner, for them to guide actions for the organization. On the other hand, the mission of an organization provides feedback to what the organization has done or intending to undertake.
The nursing theory proposed will also ensure the type of data collected is more substantial and capable of helping even future researchers in the same discipline. Conceptualization will aid inn coming up with the most appropriate research aims and objectives that will ensure every aspect of the research topic is covered and the generated recommendations fits the suffering society.
Hypothesis
H1: Central line bundle protocol offers more effective prevention of central line bloodstream infection. The following hypothesis backs the fact the central line bundle protocol should be used in most hospitals ICU’s in preventing bloodstream infections.
H2: Central line bundle protocol is not effective in preventing central line associated bloodstream infections; instead hospitals ICU should use standard precautions.
Literature review
Most hospitals try to develop processes that improve the safety of patients in hospitals especially those at ICUs. According to Institute of Medicine, the US department of Health and Human Services (HHS) came up with a development plan that monitored various infection prevention strategies but none of them was very effective in preventing central line associated blood stream infections. With all the progress by the HHS there has been limited progress on the processes and systems for preventing bloodstream infections. The central bundle protocol was tested and found to yield more positive results from the number of patients tested. In an effort to increase ICU quality of care given to patients, research from Johns Hopkins University School of medicine developed a model that that carried out interventions of the rate of CLABSI. The teams used central bundle protocol that recorded a dramatic decrease in CLABSI cases in the 103 participants used (Arias & Carrico, 2009).
On the other hand, most of the bloodstream infections are caused by poor nursing practices where physicians use untreated tools for disease diagnosis. Practices for the insertion of central line have been promoted that indicates the best methods. A bundle approach to prevention of CLABSI was also introduced that ensured several cases of infections were reported in patients suffering from line bloodstream infections. Out of 158 Pennsylvania healthcare centers investigated in 2009, those that consistently followed the use of line bundle practices showed reduced cases of CLABSI. The bundle practices adopted were the use of maximal sterile barriers during insertion, chlorhexidine site preparation, and documentation of daily review that facilitated early removal (Advis PPS, 2010; Casey et al, 2003). The following practices indicated positive results though the researches never used line bundle protocol that seems to be more effective.
The standard precaution for CLABSI prevention is also effective, but has some limitations. The practice only prevents cross transmission of infections across the body leading to contamination of body fluids. Hospital-acquired Infections forms the largest killing agents in America. CLABSI is caused by such infections and the use of common antibiotics cannot cure the infection. Implementing the right protocols will make healthcare centers reduce risks of CLABSI and save more lives. According to McCaughey (2006), these infections can be prevented using central line bundle practice because it contains the necessary disinfectants that can cope with the infections. In addition, central line bundles come in different standards that meet different environmental conditions for each country’s healthcare facility’s preferences and protocol (IHI, 2008). CLABSI is an avoidable situation when especially when the line bundle protocol is used in ICU patients.
The cure of CLABSI is very costly where most people ignore it and let their loved ones die on hospital beds. There are many devices and products available in the market used in the prevention of CLABSI condition. These products are not recommended because the also block the blood vessels restraining blood movement to different body parts. According to the Health & Development Information Team, some of the methods used in accessing arteries, like use of needles increase the infection rates (2005). The team recommends the use of needless systems, like line bundle protocol, to access I.V tubing because they assist in preventing bloodstream infections. In addition, the Occupation Safety and Healthy provides recommendations for the best systems that hospital ICUs should use in preventing bloodstream infections depending of the amount of risk exposure. When needles systems are used line bundle protocol process forms the most effective method in preventing CLABSI (2012).
Method
Philosophy is a crucial process in the methodology design that aids in identification of a system for adoption in the methodology of a research that has no dependence on other systems. The philosophy identifies the process, the content, language, and knowledge of the methodology needed for a given research (Midgley, 2000). In addition, philosophy aids in making judgments that outline the boundaries of the research methodology process. The philosophy of methodology demands that the methodology adopted be stated and explanation, as well as analysis takes place effectively (Chiara 1997).
The methodology adopted will entail quantitative research methodologies. Quantitative method is a subjective research approach, which has a characterization of identification of new knowledge (Appleton, Briggs, and Rhatigan 1978), participation in the fieldwork, and use of the researcher as the key source of primary data. In the research process, the personnel conducting the research aim at getting the meaning of existence of a phenomenon and nature of reality. Moreover, the researchers have limited concerns on the outcomes and have more concerns of the research process. Quantitative method finds use as a descriptive study approached in an inductive manner. However, the analysis of quantitative data may use statistical tools that aid in making accurate inferences concerning the collected data.
Justification of the method
Qualitative research is a subjective method for data collection that aids in identification of new knowledge. On the other hand, quantitative research limits the chances of new knowledge discovery. Quantitative research creates an opportunity for discovery of the meaning and understanding of the issues that relate to social life or human beings behaviour. This occurs since quantitative research has an element of descriptive and the respondents provide data deemed to reflect personal perceptions. Moreover, rapport and trust play a significant role in the data collection process in any kind of research. Quantitative research benefits in establishing the two elements in data collection process. As such, the data collected has an element of reliability.
The questionnaires use scales to aid in achieving the desired response from the respondents. Respondents’ reflections come out clearly, when questionnaires find use in the research work. As such, the respondents give individual perception on the research topic. This is a significant technique of collecting information that has a correlation to the social aspect of human beings. The incorporation of interviews in the research work aid in creating an environment of trust between the interviewee and interviewer. As such, the information collected has a high level of accuracy and reliability.
Mixed method for research work aids in combining several methods to collect the same kind of data. The method ensures that data has no element of bias and that research errors occur rarely. The method creates room for use of both primary and secondary data collection method for the research. The use of several methods in collecting the same data aids in ensuring that the collected data has an element of credibility. Therefore, mixed method provides for checking of any ambiguity in the data collected.
Validity and reliability of data collection tools
To address issues about the quality of data and appropriateness of the methods to use in carrying out the research project, a pilot study will be done. After the pilot study, nursing experts in the faculty of medicine will check instrument for validity and review the items. The experts will then determine whether the instrument will cover the relevant content for which it is intended and will make the necessary adjustments.
Limitations
The research methodology adopted might face various limitations as shown. First, failure of the target group to respond to the questionnaires and interviews will limit the strength of results generated. In addition, some hospital might refuse entry to the ICU areas in fear of interfering with the patients. Second, the research team members might fail the research especially when they do not carry out the research effectively and gives false findings.
Data collection
The primary outcomes for the data collected will form the quarterly rate of CLABSI measured per 1,000 central line days. The infection perfectionists will be independent of ICUs and will be asked to give definitions of the state of bloodstream infections. In data collection process, questionnaires will be formulated. 10 hospitals from 3 districts will be selected at random. In each hospital, the target group will consist of 5 patients in ICUs suffering from CLABSI, 3 nurses, 1 doctor, and 1 physician. The target groups will be expected to respond to questionnaires, and interviews each taking approximately 3 hours. The questionnaires will consist of questions that will elicit a response from the respondent. The questions include factual questions, questions based on the desired information, questions directed to self-perception of the respondent, opinion and attitude based questions, and projective questions (Powell 2004).
The questionnaires that will have to be disseminated will be scaled. This will aid in obtaining the desired response from the respondents. The questionnaires context will have uniformity for better results that will aid in an effective analysis of the trends of the sample population responses. In addition, the questionnaire will contain cross check questions to aid in data analysis. The sample population to respond to questionnaires needs prior examination for identification of any limitations or barriers of ineffectiveness of the questionnaire.
The data collection procedure begins with the establishment of a pre-test for the questionnaire. This is a necessary step that aids in identification of the complexity of the questionnaires to be administered. Pre-test also aids in the formulation of measures to overcome research limitations. This occurs since, in the process of pre-test, possible challenges for the research work are effectively identified. The whole data collection procedure is expected to take one month depending on the nature of the research and patient conditions.
However, the respondents for the questionnaires and the people to be interviewed need a careful selection to elicit reliable and high quality information. Data collected has a base on the information gathered from the respondents. Therefore, the attitude and perception of the respondents towards the research and willingness of the respondents to participate in the research affects the credibility of the data collected extensively.
Questionnaires and interviews
In the data collection process, questionnaires administering will occur. In this, the respondent will be given the questionnaires to fill. The period for filling the questionnaires has a limitation of six hours. This provides enough time for the respondent to fill the questionnaire and return, and collection of the filled questionnaires. On the same note, the time prevents the emergence of situations in which the respondents may discuss the questionnaires.
Interviews will take place in the process of data collection. The interviews will comprise of structured questions that will aid in effectiveness in collecting of the desired data for the research (Weller, and Romney 1988). The kind of the interview will consists of personal interview for the research being carried. Interviews that will take place have a limitation of thirty minutes in each session. This ensures that the research utilizes the time allocated effectively. The location of interviews will vary depending on the organization in which the research is taking place.
Data analysis
After collecting the relevant data an analysis will follow. The analysis will use mathematical statistical tools like graphs and charts in making comparisons. In addition, the collected data will be fed to statistical applications like SPSS that will convert the raw data into a more comprehendible mean.
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