Research Paper Sample on Ventilator-Associated Pneumonia

Introduction

Ventilator-associated pneumonia (VAP). The incorporation of evidence-based practice (EBP) in the prevention of VAP in mechanical ventilation adult settings is necessary to improve health outcomes. Nurses must equally place preventive strategies for adults in mechanically ventilated settings. Chlorhexidine intervention, for example, is a preventive and control strategy for VAP. The purpose of this paper is to discuss the change proposal components of the prevention and control of VAP using chlorhexidine intervention.

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Background

Mechanical ventilation is an intervention that can help to save patient’s lives. In the process of ventilation, however, patients might acquire pneumonia. In 2016, the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) reported that in America, the mortality rate for VAP was 13% (Wu et al., 2019). The prevention and control of VAP are dependent on education the of nurses’ mechanical ventilation settings and the application of evidence-based strategies. Giomuso et al. (2015) indicated that distributing evidence-based research to nursing staff improves clinical outcomes. Furthermore, leadership is a significant aspect of creating an EBP environment. Makaroff et al. (2014) talked about ethical leadership, which helps to advance healthcare outcomes. Also, Stetler et al. (2014) stated that in EBP implementation, strategic leadership is needed for success. The processes involved in an EBP include establishing the problem that needs change, reviewing relevant literature, identifying research evidence to support the change, and implementing the change.

Clinical Problem Statement

VAP can cause serious consequences for patients. Wu et al. (2019) described VAP as acquired pneumonia that occurs 48 hours after mechanical ventilation. In 2015, the Centers for Disease Control and Prevention (CDC) surveyed acute care hospitals across America and found that pneumonia was the common infections and that 32% were ventilator-associated (Centers for Disease Control and Prevention, 2020). VAP is a cause of high mortality rates in the hospital since nurses are sometimes unable to prevent and control the infection.

Purpose

The purpose of the change proposal is to examine how healthcare professionals can reduce the rates of VAP at the facility. The proposal discusses the prevention and control of VAP using chlorhexidine intervention. The expected benefit of the change is that patients on mechanical ventilation will have an improved quality of life and will reduce mortality rates.

Literature Search

The literature strategy employed involved a search for keywords that could manage to retrieve accurate results. Some of the keywords used included ‘ventilator-associated pneumonia,’ ‘chlorhexidine,’ and ‘evidence-based practice.’ The search strategy incorporated the keywords that were listed in peer-reviewed databases only.

Evaluation

When conducting the search, I only selected literature that related to the PICOT question and the EBP project. I used three processes to evaluate the literature and find the most suitable ones for this project. The first step included the search of the credentials and affiliations of the authors, the usefulness of the topic, and the reliability of the information.

Change Theory

The change theory that is suitable for my EBP intervention is the trans-theoretical model of change. Prochaska & DiClemente’s trans-theoretical model of change, the model describes how past behavior can be modified to a new one (Currentnursing.com, 2012). The stages include pre-contemplation (not ready for a change), contemplation (thinking of change), preparation (ready for a change), action (making the change), and maintenance (staying on track) (Currentnursing.com, 2012). Since the prevention of VAP requires nurses to contemplate the best solution, it is agreeable that the trans-theoretical model of change will be suitable in my EBP implementation.

Strategic Implementation Plan

Competency-based teaching for staff – multiple scientific and quality resources such as database searching, online tutorials, and continued library education will be availed to nurses. The outcome measure is to enable staff to develop knowledge that would develop the PICOT question for the project.

Monitoring system for tracking EBP outcomes – a database will be developed to track the project and its outcomes on EBP grounds. The data tracked on the monitoring system will include the hospital where the project is taking place, stakeholders, the PICOT question, the status of the project, outcomes, and the implementation plan.

Communication strategy for translating evidence into clinical practice – the communication plan will include meetings once a week to discuss the progress of the project and any issues that arise. The outcome measure is to make EBP part of daily clinical practice.

Intervention Plan

The first step was to identify the problem, which is the rise of VAP infections in patients. The next step was to gather the best credible research from peer-reviewed databases that have been used in the prevention and control of VAP. Evidence-based practice determines what interventions work and can improve patient outcomes (Spruce, 2015). After careful analysis of the literature, chlorhexidine was the best practice used to prevent and control VAP.

Proposed Nursing Intervention

The goal of the evaluation is to determine the effectiveness of chlorhexidine to prevent and control VAP. Evaluating the outcomes of a change helps measure its impact (Melnyk et al., 2014). Additionally, implementing EBP requires evaluation of the outcomes (Spruce, 2015). The elements involved in the evaluation plan include the following:

Staff knowledge and skills – a pre-test to evaluate EBP knowledge and skills, as well as gaps in knowledge, will be administered. Knowledge gaps about the chlorhexidine intervention will be identified after evaluating the results of the pre-test. Later, a post-test will be performed to determine if the staff have gained knowledge of the intervention.

Staff compliance – an evaluation of the compliance of staff is needed to sustain the implementation of chlorhexidine. The mechanical ventilation unit auditor will observe, track, and record the submission of chlorhexidine. Some of the aspects the auditor will look out for include ventilator condensate draining and oral care after every hour. The evaluation’s goal is at least 80% compliance during the first two weeks of the project.

VAP surveillance – this last evaluation plan will involve the analysis of patient data by nurses, respiratory departments, and infection control departments. The action will ensure that the VAP rates are minimized or eliminated compared to the pre-intervention stage.

Potential Barriers

Translating EBP into clinical practice - Evidence-informed practice helps to improve patient outcomes (Wheatley et al., 2017). Nevertheless, the staff at the facility have not been used to applying EBP in their practice. Due to that, I fear that even after the successful implementation of the project, they will have difficult times translating research. The strategy for overcoming the barrier is to give the staff continuous access to EBP resources such as the availability of credible databases where they can do research on ways to improve health outcomes of patients in mechanical ventilation.

Lack of motivation from staff - At the facility where the change is taking place, the nursing shortage is a significant problem. Due to that, nurses might feel unmotivated. The Institute of Medicine (2011) reported that one of the healthcare issues is the nursing shortage. The culture of collaboration interprofessional practice enhances the healthcare experience (Wheatley et al., 2017). The strategy for overcoming the barrier is to boost collaboration among interdisciplinary teams to reduce workload and enhance motivation.

Conclusion

Overall, evidence-based research is significant in nursing practice to improve patients’ health outcomes. My project is a long-term adoption of EBP to help improve the health outcomes of patients receiving mechanical ventilation. For that reason, it is critical to measure the potential barriers and find ways to overcome them. Relating to the PICOT question discussed in the paper, nurses can manage to improve the quality of lives of mechanically-ventilated patients. Still, an evaluation plan is necessary for the project to examine its outcomes. The change project is expected to reduce mortality rates and low health outcomes in patients receiving mechanical ventilation.

References

Centers for Disease Control and Prevention. (2020, January). Pneumonia (Ventilator-associated [VAP] and non-ventilator-associated Pneumonia [PNEU]) Event.
https://www.cdc.gov/nhsn/PDFs/pscManual/6pscVAPcurrent.pdf

Currentnursing.com. (2012, January 26th). Stages of change model/Transtheoretical Model (TTM). Nursing Theories. http://currentnursing.com/nursing_theory/transtheoretical_model.html

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
https://doi.org/10.17226/12956.

Giomuso, C. B., Jones, L. M., Long, D., Chandler, T., Kresevic, D., Pulphus, D., & Williams, T. (2014). A successful approach to implementing evidence-based practice. MedSurg Nursing, 23(4), pp. 4–9. https://go.gale.com/ps/anonymous?id=GALE%7CA382083709&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=10920811&p=AONE&sw=w

Makaroff, K. S., Storch, J., Pauly, B., & Newton, L. (2014). Searching for ethical leadership in nursing. Nursing Ethics, 21(6), 642–658.
https://doi.org/10.1177/0969733013513213

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5–15.
https://doi.org/10.1111/wvn.12021

Spruce, L., Van Wicklin, S. A., Hicks, R. W., Conner, R., & Dunn, D. (2014). Introducing AORN's new model for evidence rating. AORN journal, 99(2), 243–255.
https://doi.org/10.1016/j.aorn.2013.11.014

Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence-based practice: Strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence-Based Nursing, 11(4), 219–226. https://doi.org/10.1111/wvn.12044

Wheatley, L., Doyle, W., Evans, C., Gosse, C., & Smith, K. (2017). Integrated comprehensive care - A case study in nursing leadership and system transformation. Nursing Leadership (Toronto, Ont.), 30(1), 33–42. https://doi.org/10.12927/cjnl.2017.25107

Wu, D., Wu, C., Zhang, S., &Wong, Y. (2020). Risk factors of Ventilator-Associated Pneumonia in critically ill patients. Frontiers in Pharmacology, 10(482).
https://doi.org/10.3389/fphar.2019.00482.