401167 Applied Research In Health Care

Literature Review Overview

Patients undergoing dialysis are at risk of contracting central catheter infections(Marques et al., 2017). The risks of infections in the dialysis units are mainly due to prolonged and frequent exposures to many possible contaminants in both hemodialysis units and during the process of dialysis(Amer et al., 2015). The increased risks is precisely due to close proximity with other patients, frequent and prolonged blood exposure during the process of hemodialysis, reduced immunity of patients due to the disease process, constant contact with nurses and other health care workers who often move from one patient to another, prolonged hospitalization and poor adherence to prevention recommended practices(Saha and Allon, 2017). Major sources of infections in a dialysis unit include equipment, contaminated water, other infected patients, contaminated nurses and other health care providers and environmental surfaces(Lindberg et al., 2013). Nurses should always practice standard precaution strategies when caring for patients undergoing haemodialysis to prevent contamination.

Research Aim

The primary aim of this research is to evaluate effective nursing interventions that can be used to prevent the central catheter-related infections in a dialysis unit.

Research Question

This study seeks to answer the following question;

What nursing intervention prevents permcath related infection within the in-center dialysis unit? 

Methods

To address catheter-related infections in a dialysis unit, most studies have used observational research design using qualitative research methods(Trépanier et al., 2014). This includes the review of medical records and analyzing how the patients have treated, which prevention methods have been used and which have been found to be more effective(Freshwater, 2017). Qualitative research methods involve a description of phenomena based on personal experience or perspectives(Polit and Beck, 2013). In addition, some studies have used phenomenological descriptive design to study nurse’s experience in the dialysis units.

Findings

Most studies have found that hand washing is a significant nursing intervention when it comes to the prevention of infections in in-center dialysis units (Marques et al., 2017). Other interventions include proper spacing of patients, implementation and use of standard precautions, reporting patients who have prolonged catheter to be changed, advocating for fistula catheters, appropriate dressing, and cleaning of the catheter(Amer et al., 2015).

Limitations

Various limitations have been found to be associated with the study. These include the unwillingness of nurses and other healthcare workers to participate, a poor method of storage, little number of participants and time consuming when taking the interview and analyzing data(Hickman, 2015).

Conclusion

Most studies have concluded that prevention of infection in dialysis units is crucial(Saha and Allon, 2017). Proper hand washing and observing standard precautions are the key interventions nurses can use to prevent central catheter-related infections in the dialysis units(Infection Prevention and Control Nova Scotia (IPCNS), 2015).

Research Hypothesis

Central catheter infections are common in patients undergoing hemodialysis. This study is intended to provide various nurses interventions used to prevent such infections. The results of the study will be used to provide recommendations for other nurses working in the dialysis unit for better care.

Introduction

Various nursing interventions have been used to prevent permcath infections in an in-center dialysis unit(Saha and Allon, 2017). However, patients in the dialysis unit die day by day due to healthcare-associated infections(Kosa et al., 2017). Due to this fact, a gap has been created for further research. This study seeks to provide an approach that can be used to determine various nursing strategies that can be used to prevent central catheter infections in a dialysis unit. The study will provide a research design, sample and recruitment process, data collection process and data analysis.

Research Design

The research design in the study will be used in addressing the research objectives and answering the research question(de Chesnay, 2015). In this study, a phenomenological descriptive design will be used to evaluate nurses experiences and interventions they use when caring for patients with central catheters in an in-Centre dialysis unit(Marques et al., 2017). In addition, the design will be used to examine what are nurses’ perceptions or what they think are the best interventions for infection prevention in the dialysis units. This design fits the research as it involves the description of strategies and situations as explained by those who practice them. The qualitative research will form the basis of the study. This is because the qualitative research uses the description of a given scenario or phenomenon(Hickman Director, 2015). This includes a collection of rich narratives materials using interviews which address broadly stated questions about human experiences and realities(Doorenbos, 2014). In this study, qualitative research will be applied by evaluating nurses’ day to day strategies and their experiences through generating one’s clinical practices in relation to preventive interventions in the dialysis units.

Research methods

Research methods involve the use of different techniques a researcher used to gather and analyze the research aim and question(Shin, 2017). The research methods are considered as the strategy of the whole research as compared with the research design that guides the researcher in planning(Shin, 2017).  The study will use qualitative research methods since it involves a description of various strategies the nurses in the dialysis uses to prevent central catheter-related infections. In this study, the research should be carried out in the dialysis units where nurses take care patients with central catheters.  The dialysis units should have both male and female adults. The collection of data will be carried out in two hospitals which have dialysis units that have functioned for more than ten years. The nurses in the dialysis units should include those who are specialized in intensive care and those who have received a continuous medical education and practice concerning the care of patients with central catheter

Target population  

The target population in research includes a group of participants the research question is concerned with(Raines, 2013). In this study, the target population comprises all licensed nurses practicing in the in-center dialysis units. All the nurses in the units should be having extra knowledge on critical care and an experience of more than two years in the dialysis units.

Sample and recruitment process

A sample is selected from a small number of the population for a study whereas sampling is the process of choosing a group of individuals to represent a given population in a specific study(Raines, 2013). Purposive sampling will be used in the study which involves the use of researcher judgment on which participants highly fits the study and will give the maximum information(Pan and Bai, 2016). In this research, licensed and registered nurses with more than two years of working experience in a dialysis unit will be recruited as they are expected to be having more knowledge and skills on central catheter preventive strategies since they have adequate exposure. In addition, two hospitals will be selected with a minimum of ten year operating dialysis units since they likely to have own and different strategies.  A total number of twenty dialysis nurses (n=20) will be selected.  Choosing a bigger sample will be time-consuming, and the relevant information may not be taken. A small sample is appropriate since this study involves the use of in-depth discussions and comprehensive interviews about the interventions used. The researcher will request a list of critical care nurses in the dialysis units from both hospitals and those above two years of experience will be selected. The nurses will then be issued with letters asking them to participate in the research. Those who will reply and be willing to participate will be recruited.

Data collection and instruments

In this study data collection involved the gathering of information from nurses in two in-center dialysis units that address the research question. The study will use interviews as a method of data collection(Raines, 2013). The researcher will act as the instrument of the research who will use the theoretical knowledge in guiding the discussions towards the research objectives. In addition, the interview sheets approved by the university research department will be sued together with the audio recorders and recording tapes. Prior to the day of data collection, the researcher should visit the dialysis unit manager and the chief nurse with a letter asking them for permission to conduct the research.   In addition, the dialysis unit representative should be given a brief explanation of the study. All nurses should later be issued with the informed consent forms that state they are aware of the research and they are willing to participate. Each of the selected individuals should then be interviewed privately after signing the consent forms. The interview sheets should have both open and close-ended questions. Audio tapes will be used to record the interviews where they will remain anonymous

Data Analysis Approach

Data analysis in this study will intend to pull all the gathered information together in order to present a clear picture of the whole research. In this research, Data analysis will involve observing the participants as they demonstrate the proper ways of prevention. The following are the major sections that will be used in analyzing the data; re-reading all the interview sheets and listening to audios to extract the required information, obtaining the most relevant significant details, understanding the meaning of derived data, organizing and formulating the meaning into clusters and themes, and validating the formulated descriptions to make a conclusion.  

Conclusion

Most of the patients undergoing hemodialysis die every year due to healthcare-related infections. Various nursing intervention has been used, but a gap remains for further research. This study has provided an approach that can be used to conduct an investigation on which nurses intervention are effective in the prevention of central catheter infections in an in-center dialysis unit in two hospitals using a sample of twenty nurses.

References

Amer, H. A. et al. (2015) ‘Amer, H. A. et al. (2015) “Improving environmental cleaning process in hemodialysis unit at King Saud Medical City”, Antimicrobial Resistance and Infection Control, 4. Available at: https://www.embase.com/search/results?subaction=viewrecord&from=export&id=’, Antimicrobial Resistance and Infection Control, 4. Available at: https://www.embase.com/search/results?subaction=viewrecord&from=export&id=L72039007.

de Chesnay, M. (2015) ‘Nursing research using ethnography: Qualitative designs and methods in nursing’, (2015) Nursing research using ethnography: Qualitative designs and methods in nursing xxvii, 344 pp New York, NY, US: Springer Publishing Co; US. Available at: https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=psyc11&AN=2014-32768-000.

Doorenbos, A. Z. (2014) ‘Mixed Methods in Nursing Research?: An Overview and Practical Examples.’, Kango kenkyu. The Japanese journal of nursing research, 47(3), pp. 207–217. doi: 10.1016/j.biotechadv.2011.08.021.Secreted.

Freshwater, D. (2017) ‘Perspectives: Reciprocity and integration in nursing and mixed methods research’, Journal of Research in Nursing, 22(4), pp. 328–331. doi: 10.1177/1744987117709928.

Hickman Director, L. (2015) Mixed methods research, Nursing Standard.

Infection Prevention and Control Nova Scotia (IPCNS) (2015) Routine Practices and Additional Precautions, Infection Prevention And Control Resource: Guidelines for Long-Term Care Facilities.

Kosa, S. D. et al. (2017) ‘Hemodialysis Infection Prevention Protocols Ontario—Shower Technique (HIPPO-ST): A Pilot Randomized Trial’, Kidney International Reports, 2(2), pp. 228–238. doi: 10.1016/j.ekir.2016.11.001.

Lindberg, C. et al. (2013) ‘Embracing collaboration: A novel strategy for reducing bloodstream infections in outpatient hemodialysis centers’, American Journal of Infection Control, 41(6), pp. 513–519. doi: 10.1016/j.ajic.2012.07.015.

Marques, R. et al. (2017) ‘How can information systems provide support to nurses’ hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections’, BMC Medical Informatics and Decision Making, 17(1), pp. 1–16. doi: 10.1186/s12911-017-0410-z.

Pan, W. and Bai, H. (2016) ‘Propensity score methods in nursing research’, Nursing Research, pp. 421–422. doi: 10.1097/NNR.0000000000000189.

Polit, D. and Beck, C. (2013) Nursing Research Principles and Methods, Lippincott. doi: 10.1017/CBO9781107415324.004.

Raines, D. (2013) ‘Research paradigms and methods’, Neonatal Network, 32(6), pp. 425–429. doi: 10.1891/0730-0832.32.6.425.

Saha, M. and Allon, M. (2017) ‘Diagnosis, treatment, and prevention of hemodialysis emergencies’, Clinical Journal of the American Society of Nephrology, pp. 357–369. doi: 10.2215/CJN.05260516.

Shin, I. S. (2017) ‘Recent Research Trends in Meta-analysis’, Asian Nursing Research, pp. 79–83. doi: 10.1016/j.anr.2017.05.004.

Trépanier, P. et al. (2014) ‘Survey of Infection Control Practices in Hemodialysis Units: Preventing Vascular Access–Associated Bloodstream Infections’, Infection Control & Hospital Epidemiology, 35(7), pp. 833–838. doi: 10.1086/676862.