Research Paper on Preventing VAP: Bundle of Interventions Recommended by Intensive Care Society

Hellyer, T. P., Ewan, V., Wilson, P., & Simpson, A. J. (2016). The Intensive Care Society recommended a bundle of interventions for the prevention of ventilator-associated pneumonia. Journal of the Intensive Care Society, 17(3), 238-243.

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Following recent evidence that has widely challenged current practices related to prevention of ventilator-associated pneumonia (VAP), the study was designed to highlight interventions that when implemented consistently can potentially reduce rates of VAP. The study sought to answer the question "what interventions and guidelines can be used ad followed to reduce VAP rates?" The study is was significant in the nursing field because it would set the record right o the interventions and guidelines that sold be followed to reduce VAP rates while at the same time eliminating the confusion over what practices are ineffective in prevention of VAP. The study's main objective was to provide an up to date recommendations on the prevention of VAP.

Chang, I., & Schibler, A. (2016). Ventilator-associated pneumonia in children. Paediatric Respiratory Reviews, 20, 10-16.

Given the much controversy in the existing literature regarding definition, treated and VAP prevention among children requiring ventilator support, the study was designed to suggest useful ventilation care bundles. Specifically, the study aimed at examining ventilation medical care that is effective in controlling VAP in ventilated children. The research question was "What is the effective ventilation medical care strategies in controlling VAP in ventilated children and adults?"

How the Articles Support Nurse Practice Issue of VAP

The proposed research question seeks to establish whether oral hygiene care can be used to reduce the prevalence of VAP among patients that need ventilation to sustain life. The above articles will help in answering this question. Hellyer et al. (2016) affirm that using subglottic secretion drainage as one way of maintaining oral hygiene potentially reduces chances of bacterial pathogens from penetrating the lower respiratory tract hence preventing VAP. Similarly, Chang and Schibler (2016) suggest various VAP prevention strategies which include head elevation, use of non-invasive ventilation, and vigorous and hygiene. Hand hygiene is considered one of the oral hygiene strategies since hand to mouth pathogen transfer is likely. Hence, the study helps in assessing overall oral hygiene strategies in the prevention of VAP.

Also, the articles present interventions and comparison groups that compare to those identified in the PICOT question. Hellyer et al. (2016) compare chances of VAP among patients with longer mechanical ventilation to those who used mechanical ventilation for a shorter time. The intervention is reducing exposure period given the fact that mechanical ventilation predisposes patients to VAP, it is presumed that reduced mechanical ventilation contributes to sustained oral hygiene hence the comparison is similar to that of the proposed PICOT that seeks to compare patients who observe oral hygiene and those who do not to identify effect on VAP prevention. Similarly, Chang and Schibler (2016) reviewed studies that compared patients who observed in oral hygiene to those who paid low attention to oral hygiene which coincides with the intervention measure in the proposed study.

Methods of the Studies

Hellyer et al. (2016) employed clinical observation and meta-analysis of different literature whereas Chang and Schibler (2016) used meta-analysis and observation. The two studies used similar methods.

The methods used in both studies are both benefits and limitations. Meta-analysis provides a better estimate of relationships that exists in the population that a single study may not reveal (Stone & Rosopa, 2017). For instance, meta-analysis can provide a reliable relationship between oral hygiene and the prevention of VAP because of different populations ad a larger sample size altogether. However, a meta-analysis may lead to the inclusion of studies that lack construct, internal and external statistical validity (Stone & Rosopa, 2017).

On the other hand, the observation method provides deeper insights into the participants as the researcher is in direct contact. However, observation as a research method can be disadvantageous as it can inflict the Hawthorne effect on the participants. For instance, participants may alter their behaviors in the presence of the researcher (Jorgensen, 2015).

Results of the Studies

Hellyer et al. (2016) established that Head of bed elevation, interruption of daily sedation, drainage of subglottic secretion, and avoiding scheduled ventilator circuit charges are among the best interventions. Overall, the study highlighted interventions that could help nurses to reduce VAP rates. The results imply that nurses should pay attention to the identified interventions when looking after pneumonia patients.

Chang and Schibler (2016) established that hand hygiene, oral hygiene, suctioning, endotracheal intubation, and semi-recumbent tubing are the most effective strategies in controlling VAP. The results imply that overall, hygiene is very important in the prevention of VAP. Therefore, nurses should employ hygiene, both hand and oral as first-line preventive measures.

Ethical Considerations

When conducting research, especially qualitative, there are several ethical issues to be considered. Most important ones are anonymity and informed consent (Sanjari, Bahramnezhad, Fomani, Shoghi & Cheraghi, 2014). Researchers should ensure that sufficient efforts are in place to ensure that information provided by the participants will not be traced back to them in presentations, reports and any other form of data dissemination. This can be achieved through the use of pseudonyms. Informed consent, on the other hand, implies the ethical obligation for the researcher to gather data from voluntary participants who have consented to allow data for research purposes gathered from them. Informed consent is usually obtained from participants prior to the research by having them read through consent forms and sign if they agree to participate in the study.

Although both Gupta et al. (2016) and Timsit et al. (2017) conducted review studies that did not collect first-hand data from the participants and could not necessarily obtain informed consent, they appear to have observed the ethical principle of anonymity. Both studies do not mention the names of the participants neither do they provide any presentation that can expose the participants or the sources of data. The data has been generalized without direct quotes to particular participants.

References

Chang, I., & Schibler, A. (2016). Ventilator-associated pneumonia in children. Paediatric Respiratory Reviews, 20, 10-16. https://www.sciencedirect.com/science/article/pii/S1526054215000901.

Hellyer, T. P., Ewan, V., Wilson, P., & Simpson, A. J. (2016). The Intensive Care Society recommended a bundle of interventions for the prevention of ventilator-associated pneumonia. Journal of the Intensive Care Society, 17(3), 238-243.https://journals.sagepub.com/doi/full/10.1177/1751143716644461.

Jorgensen, D. L. (2015). Participant observation. Emerging trends in the social and behavioral sciences: An interdisciplinary, searchable, and linkable resource, 1-15.

Sanjari, M., Bahramnezhad, F., Fomani, F. K., Shoghi, M., & Cheraghi, M. A. (2014). Ethical challenges of researchers in qualitative studies: the necessity to develop a specific guideline. Journal of Medical Ethics and History of Medicine, 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263394/

Stone, D. L., & Rosopa, P. J. (2017). The advantages and limitations of using meta-analysis in human resource management research. Human Resouuurce management Review, 27(1), 1-7. https://doi.org/10.1016/j.hrmr.2016.09.001.