Clinical issue of interest arises from my unit hospital policy to provide a CHG bath per shift to all patients
1) reply needed
My clinical issue of interest arises from my unit hospital policy to provide a CHG bath per shift to all patients with a Foley catheter or central line. Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are problems in hospitals. I wanted to know the best clinical practice to address the issue. I anticipated that there would be plenty of research on CLABSI and CAUTI therefore, I decided to only focus on CLABSI. In the US, about 80,000 infections and nearly 28,000 death result from CLABSI, thus, staying up to date with best practices is important (Reynolds et al., 2021).
according to Davies (2011), there are different frameworks to formulate a question leading to EBP, PICOT was the first published framework and one I decided to use to develop my question. The mnemonic PICOT stands for (P) patient or problem, (I) intervention, (C) comparison, (o)outcome, and (T) timeframe. My formulated PICOT question is: In a step-down unit for adults with a central line, does a CHG bath compared to no CHG bath decrease CLABSI rates in 3 months?
I started my search by selecting the subject of nursing, which consists of 5 main databases: CINAHL Plus, Embase, Medline, ProQuest Nursing, and PubMed. I then Opened each database and typed “CLBSI and CHG”. CINAHL Plus had advanced options that include “Evidence-Based Practice” and had the most options for selecting a search. Medline had to the option of selecting “controlled clinical trial.” ProQuest also had advanced options, but the only relevant ones were selecting a timeframe and peer-reviewed. I used CINAHL Plus and Medline. Each database yields over 100 articles with the selected options mentioned above. I selected two research articles from each database to answer my foreground question, \”those that can be answered from scientific evidence about a patient\’s treatment, diagnosis, prognosis, or health experience\” (Melnyk & Fineout-Overholt, 2023, p.42).
References:
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80.
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Reynolds, S. S., Woltz, P., Keating, E., Neff, J., Elliott, J., Hatch, D., Yang, Q., & Granger, B. B. (2021). Results of the chlorhexidine gluconate bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections study (changing baths): A stepped wedge cluster randomized trial. Implementation Science, 16(1), 1-16. https://doi.org/10.1186/s13012-021-01112-4.
2) reply needed
Workplace violence in healthcare has become a growing concern worldwide, and occupations within the healthcare sector experience some of the highest rates of workplace violence in the United States. According to Lim et al. (2022), the Occupational Safety and Health Administration (OSHA) defines workplace violence as “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.” The World Health Organization (WHO) reported that at some point in their careers, approximately 8%-23% of healthcare workers have suffered from physical violence (World Health Organization, 2020). Many factors contribute to the high prevalence of workplace violence against healthcare workers, such as high-stress environments, long working hours, understaffing, inadequate security measures, and the presence of patients with a history of aggression or mental health issues (Gates et al., 2019).
The two databases that I used were CINAHL and ProQuest. My initial broad search was “healthcare” and “violence,” which yielded 10,471 search results in CINAHL and 8,699 in ProQuest. To narrow my research, I added search terms using Boolean operators to specify healthcare workers and workplace violence (Walden University Library, n.d.). Additionally, I added other words using “or” to describe violence, such as aggression or hostility. This narrowed my results to 2,420 in CINAHL and 1,803 in ProQuest. To ensure that the articles were up to date, I changed the publication date parameters from 2018-2023 to be within the last five years. This further narrowed my research in CINAHL to 1,227 articles and 776 in ProQuest. Since only original research articles were to be used for this class, I further narrowed the search to research articles. This returned 336 articles in CINAHL and 233 in ProQuest.
Some of the strategies I used to increase the rigor and effectiveness of finding research for my PICOT question was seeing what research had been done on the various interventions regarding workplace violence against healthcare workers, and this further narrowed my search to 78 articles in CINAHL and 21 in ProQuest. Additionally, I wanted to investigate violence specifically in the emergency department since this is the setting I work in and consists of the highest incidence of violence in healthcare. This gave me 102 research articles relevant to my clinical issue within the last five years. The opportunity to specify research only in the United States was also an option. Some of the first research articles were based on interventions to address workplace violence in the emergency department, such as screenings, risk assessment tools, and programs on workplace violence prevention. As of now, my PICOT question is as follows:
P: Emergency Department (Staff, Patients, Patient family)
I: Violence prevention programs or risk assessments
C: No prevention program or risk assessments
O: Reduction in workplace violence, physical and nonphysical, against ED staff
T: Not applicable
In the emergency department, does implementing a violence prevention program or risk assessment, compared to no violence prevention program or risk assessment, reduce the prevalence of workplace violence against emergency department staff?
References
Gates, D. M., Gillespie, G. L., & Kowalenko, T. (2019). Workplace violence in healthcare: Recognized but not regulated. International Journal of Emergency Medicine, 12(1), 9. doi: 10.1186/s12245-019-0221-6
Lim, M. C., Jeffree, M. S., Saupin, S. S., Giloi, N., & Lukman, K. A. (2022). Workplace violence in healthcare settings: The risk factors, implications, and collaborative preventive measures. Annals of Medicine & Surgery, 78. https://doi.org/10.1016/j.amsu.2022.103727
Walden University Library. (n.d.). Evidence-based practice research: CINAHL search help. https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
World Health Organization. (2020). Addressing violence against health workers. https://www.who.int/activities/preventing-violence-against-health-workers
Answer preview to Clinical issue of interest arises from my unit hospital policy to provide a CHG bath per shift to all patients
APA
374 words
