Literature Review Strategy for Evidence Based Practice (EBP)

Literature Review Strategy for Evidence Based Practice (EBP) Introduction Evidence based practice (EBP) is an approach to health care in which health professionals use the most appropriate information available to make clinical decision for providing high quality patient care (McKibbon, 1998). EBP has shifted the focus of health care professionals from a traditional approach on authoritative opinions to a stress on facts extracted from previous research and studies (Sackett et al, 1997). It has been suggested by that nursing practice based on evidence enhances patient care, as compared to traditional practices (Majid et al, 2011). In addition, as nurses are increasingly more involved in clinical decision making, it is becoming essential for them to make use of the best evidence in order to make effective and justifiable decisions (Majid et al, 2011). To discuss the evidence for a clinical skill, this essay will investigate the antiseptic preparations for surgical site antisepsis. The rationale for selection of this topic is its significance for the clinical nursing practice as nurses are frequently involved in the surgical site preparation (Dizer et al, 2009). Surgical site infection (SSI) is a type of healthcare-associated infection in which a wound infection occurs following an invasive (surgical) procedure. It has been suggested by National Institute of Health and Care (NICE, 2004) that surgical site infections account for almost 20% of all of healthcare-associated infections. It has been further highlighted that nearly 5% of patients undergoing a surgical procedure develop a surgical site infection antiseptic preparations. NICE (2008) has recommended that aqueous or alcohol based solution with chlorhexidine or iodine can be used for prevention of SSI. However, it does not favour or recommend one solution over the other. This essay will explore the literature for evidence about efficacy of these preparation in comparison to one another. It is important for the nurses to be aware of the best available evidence regarding antiseptic preparations to minimise the risk of surgical site infection. Research Question and Literature Search The research question for the current essay will be formulated on the PICO framework as suggested by Sackett et al (1997): P Population or problem Clean-contaminated surgical procedures I Intervention Chlorhexidine gluconate C Comparison or comparator Povidone-iodine O Outcome Surgical site infection The question formulated for the current essay using PICO framework would therefore be: In surgical procedures, is chlorhexidine gluconate more effective in comparison to povidone-iodine in reducing surgical infections? To answer the question, literature search for the available evidence for was done. The author identified a list of key search terms and synonyms that can result in a large number of hits and combined these with Boolean terms AND/OR. Terms made up of of two words were looked for by making use of speech marks so that they were are not searched for separately, and truncation was used for terms identified to have multiple endings. The key words used were surgical site infection anti-septic preparations iodine and chlorhexidine. In order to make sure that an in-depth search was done, which would elicit the largest number of studies more than one academic search engines were searched by the researcher. Cinahal: Contains an index of nursing and allied health literature and is helpful for use in a thorough search (Glazsiou, 2001). Medline: Suggested to be used in healthcare systematic reviews (Glazsiou, 2001). NHS Information Resources and NHS Evidence: Is a widely used database resource containing evidence-based reviews and specialist research from reliable sources. NHS evidence was searched separately. Cochrane Library: Provides a list of systematic reviews and RCTS that have been published or are in a process of publishing (Glazsiou, 2010). Pubmed: It is a commonly used internet resource for healthcare professionals with a large international coverage. The results of the search generated a large number of article however these had to be reduced in order to generate an appropriate research article which can answer the question formulated. Therefore, an inclusion and exclusion criteria was set to narrow down the large number of articles generated. The guidelines from NICE (2008) in which both preparation have been recommended in 2008 hence the research was done for studies published after that. Only randomised controlled trials (RCTs) have been included as they provide the best evidence. The articles which were not in English and published before 2009 were therefore excluded. Also, the studies in which preparations for a particular type of surgical procedure were studied were also excluded as the evidence for general surgical procedures was being looked for. Abstracts of the studies generated from the search of different data bases engines were thus read so that the articles which do not satisfy the inclusion criteria of this essay can be excluded. This resulted in selection of one article which satisfied the inclusion and exclusion criteria of the current work. The study by Darouiche et al (2010) is a RCT which compared the efficacy of two surgical preparations i.e. chlorhexidine–alcohol with that of povidone–iodine for preventing surgical site infections. In order to achieve this, preoperative skin preparation was done for adults undergoing clean-contaminated surgery in six hospitals with either chlorhexidine–alcohol scrub or povidone–iodine scrub and paint in a random way. The primary outcome was any surgical-site infection within 30 days after surgery. This study will be critically analysed to identify its strengths and weaknesses. It has been suggested by Burls (2009) that critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. The critical skills appraisal programme (CASP) tool (Appendix 1) for randomised controlled trials (RCTs) will be used as the selected study is a randomised controlled trial. Screening questions 1. Did the trial address a clearly focused issue? Yes, the study addressed a clearly focused issue with clear problem to be explored, comparison groups and outcomes being investigated using a PICO framework to formulate the research question thereby increasing the rigour of the study (Huang et al, 2006). 2. Was the assignment of patients to treatments randomised? Yes, the assignment to treatment and placebo group was carried out randomly in a ratio of 2:1. This will increase the validity of the study. Literature suggests that random allocation of patients to study groups help to minimize both the selection bias as well as the impact of any confounder present (Cormack, 2000). It has also been observed in the study that in order to match the two groups and deal with possible inter-hospital differences, randomization was stratified by hospital by using computer-generated randomization numbers without blocking. This is a strength of the study as stratified randomisation can help to attain maximum balance of significant characteristics without compromising the benefits of randomisation (Altman and Bland, 1999). 3. Were all of the patients who entered the trial properly accounted for at its conclusion? Yes, the trial was not stopped early and the patients were analysed in the groups to which they were randomised. The study has done both intention-to-treat analysis for both groups as well as per protocol analysis. This accounts for the drop outs in the study an also been reported thus accounting for these drop-outs which may decrease the internal validity of the study. According to the Cochrane Collaboration (2014) intention-to-treat analysis minimised the presence of bias which may exist due to loss of participants, thus upsetting the baseline similarity attained by randomisation. Detailed Questions The study by Darouiche et al (2010) does not explicitly mention whether the personnel involved in the study were blind to the treatment groups. However, it has been mentioned in the study that the operating surgeon became aware of which intervention had been assigned only after the patient was brought to the operating room. In addition, both the patients and the site investigators who diagnosed surgical-site infection on the basis of standard criteria stayed unaware of the group assignments. This minimises the bias in the study and increases its validity as differential treatment or evaluation of participants can possibly introduce bias in the study at any phase of a trial (Karanicolas et al, 2010). Hence, it is a strength of the study. According to Berger (2006), in addition to randomisation, it is important to keep the baseline variables of the study groups similar at the commencement of the trial as it is essential for a RCT to compare groups that differ only with reference to the treatment they receive. The baseline characteristics of both groups have been reported in the study and did not show any significant difference between the two intervention groups reflected by their insignificant p values. It appears from the study that both chlorhexidine and iodine groups were treated the same way other then intervention. In order to determine the treatment effect, clear pre-defined primary end point has been given by Darouiche et al (2010). The primary outcome was defined on the basis of a standard criteria given by the CDC hence it increases the reliability of study. The results of the study found that the overall rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5% vs. 16.1%; P = 0.004). In order to find the results, the study undertook multiple statistical considerations and tests. The study increased its statistical power by increasing the sample size in each group which gives the study 90% power to identify a significant difference in the frequency of surgical-site infection between the two groups, at a significance level of 0.05 or less. In addition, as mentioned above intention-to-treat and per protocol analyses were performed which further increases study validity. The study also carried out a pre-specified Breslow–Day test for homogeneity to find whether the results were consistent across the six participating hospitals. This was also a strength of the study as literature suggests that involvement of multi-centre patients can compromise the external validity of the RCTs (Rothwell, 2010). This is due to potential effect of differences between health-care systemswhich result in different treatment affects, values and confidence intervals have also been reported where required. Regarding the application of the results in the settings in UK, it has been highlighted by that the study by Darouiche et al (2010) was done in the US and used an aqueous solution of iodine. However, in the UK, the most widely used skin preparations are alcohol-based solutions of 0.5% chlorhexidine or 10% iodine (Tanner, 2012). This is because aqueous-based solutions are thought to be less effective than alcohol-based solutions. Hence, to make the study applicable to the UK settings, 2% chlorhexidine in alcohol should have been compared with 0.5% chlorhexidine in alcohol or 10% povidone iodine in alcohol. The benefits of the study are definitely superior to the harms as SSI not only causes significant unwanted outcomes and distress for the patient but also results in increased costs for the patient, the healthcare and the wider economy (Tanner, 2012). Thus, a number of factors increase the external validity and internal validity of the study including stratified randomisation, blinding of study personnel, intention-to-treat analysis, keep the baseline variables of the study group’s similar, sample size and a number of statistical tests. In addition, clear pre-defined primary end point increased the reliability of the study. The study thus has very low risk of bias and can be therefore rated as 1++ according to NICE hierarchy of evience (NICE, 2004). Hence, alcoholic chlorhexidine solution is significantly more effective in reducing SSIs than povidone iodine. However, the results should be applied to UK settings with caution. References: Altman, D.G. and Bland, J.M. (1999) How to randomise BMJ. 11;319(7211), pp. 703-4. Berger VW. (2006) A review of methods for ensuring the comparability of comparison groups in randomized clinical trials. Rev Recent Clin Trials. 1(1), pp. 81-6. Burls, A. (2009) What is critical appraisal? London, Hayward Group. Cochrane Collaboration (2014) Glossary, [Online] Available from: http://www.cochrane.org/glossary [Accessed 29 January 2014] Cormack, D. (2000) The research process in nursing, 4th ed., Wiley-Blackwell: Oxford. Crookes, P.A. Davies, S. (1998) Research into Practice. London: Balliere Tindall. Darouiche, R.O., Wall, M.J. Jr, Itani, K.M., Otterson, M.F., Webb, A.L., Carrick, M.M., Miller, H.J., Awad, S.S., Crosby, C.T., Mosier MC, Alsharif A, Berger DH. (2010) Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. . N Engl J Med. 362(1), pp. 18-26. Dizer B, Hatipoglu S, Kaymakcioglu N, Tufan T, Yava A, Iyigun E, Senses Z. (2009) The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery. J Clin Nurs. 18(23), pp. 3325-32. Glasziou, P. (2001) Systematic reviews in health care: a practical guide, Cambridge; Cambridge University Press. Huang, X., Lin, J. and Demmer-Fishman, D. (2006) Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc, pp. 359-63 Karanicolas, P.J., Farrokhyar, F., Bhandari, M. (2010) Practical tips for surgical research: blinding: who, what, when, why, how? Can J Surg. 53(5), pp. 345-8. Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.L., Chang, Y.K., Mokhtar, I.A. (2011) Adopting evidence-based practice in clinical decision making: nurses perceptions, knowledge, and barriers. J Med Libr Assoc. 99(3), pp. 229-36. McKibbon, K.A. (1998) Evidence-based practice, Bull Med Libr Assoc. 86(3), pp. 396–401. NICE (2004) Reviewing and grading the evidence [Online] Available from: http://www.nice.org.uk/niceMedia/pdf/GDM_Chapter7_0305.pdf [Accessed 9 February 2014] NICE (2008) Surgical site infection Prevention and treatment of surgical site infection, London: NICE. Rothwell, P.M. (2006) Factors That Can Affect the External Validity of Randomised Controlled Trials, PLoS Clin Trials. 1(1): e9. Sackett D.L, Richardson W.S, Rosenberg W.M.C, Haynes R.B.(1997) Evidence-based medicine: how to practice and teach EBM.Edinburgh, UK: Churchill Livingstone. Tanner J (2012) Methods of skin antisepsis for preventing SSIs. Nursing Times; 108: 37, 20-22.

Marketing Strategy Place of Company Nikon Essay

Advertising is key to successful implementation of the strategic plan. The more often employees hear about the plan, its elements, and ways to measure its success, the greater the possibility that they will undertake it as part of their daily work lives. It is especially important that employees are aware of the measurement systems and that significant achievements be rewarded and celebrated. This positive reinforcement increases support of the plan and belief in its possibilities. Without buy-in from the head of a company, it is unlikely that other members will be supportive in the planning and eventual implementation process, thereby dooming the plan before it ever takes shape. Commitment and support of the strategic-planning initiative must spread from the president and/or CEO all the way down through the ranks to the line worker on the factory floor. Just as importantly, the strategic-planning team should be composed of top-level managers who are capable of representing the interests, concerns, and opinions of all members of the organization. As well, organizational theory dictates that there should be no more than twelve members of the team. This allows group dynamics to function at their optimal level. The components of the strategic-planning process read much like a laundry list, with one exception: each piece of the process must be kept in its sequential order since each part builds upon the previous one. This is where the similarity to a flow chart is most evident, as can be seen in the following illustration. The only exceptions to this are environmental scanning and continuous implementation, which are continuous processes throughout. This article will now focus on the discussion of each component of the formulation process: environmental scanning, continuous implementation, values assessment, vision and mission formulation, strategy design, performance audit analysis, gap analysis, action-plan development, contingency planning, and final implementation. After that, this article will discuss a Japanese variation to Strategy Formulation, Hoshin Planning, which has become very popular.

Nursing Home Administrator Essay

The delivery of Healthcare is a high touch enterprise that calls for interaction among every stakeholder within the healthcare sphere. Communication, whether interpersonal or intrapersonal, is a crucial part of these dealings and may be transformed by the intellectual use of communication tools. Information is the means of support of healthcare. Therefore, communication systems are the backbone that supports the whole idea. Care of patients in the nursing homes now almost unavoidably entails many different people, all with the need to share patient information and talk about their organization. As a result there is an ever increasing attention in the information and communication technology that sustain health services. There exists a huge gap in the wide understanding of the function of communication services in the delivery health care. This paper will review different types of communication methods for the health care organization, including the advantages and disadvantages of using traditional, electronic, and social media for health care communication. The review will then discuss effects of HIPAA and other regulations on the use of these media for health care communication. The significant role that communication plays among people in healthcare is often neglected. Basic and very important to all healthcare managerial functions, communication is the means used in the transmission of information and additionally makes an individual understood by the target audience. In a situation in which a nursing home faces transition of management and the residents are unable to communicate effectively, have no local family, and have not indicated that they approve the release of their medical information is a crisis many health care administrators face every day. In such situations, communication is a key challenge for administrators for they are solely mandated to provide information, which consequently affects performance in the organization. A communication system is any formal or informal structure that an organization uses to sustain its communication requirements. The system involves components like people, the message that is needed to be conveyed, the technology that mediates a conversation, and an organizational structure that characterizes and limits the conversation that occurs. They are therefore bundles of different kinds of components and the utility of the general system is measured by the correctness of all the components combined. The situation above poses a challenge due to the barriers between reception and feedback. Most of the people to be displaced have no idea why and may even lose their privacy in the process. In order to solve the crisis above, it is mandatory to review the pros and cons of different kinds of communications. Electronic communications are fast, they are cost-effective and quite convenient. However, these attributes enclose intrinsic disadvantages. The technology that helps people to keep on the go also may invade privacy and cut into valuable time meant for other social activities. Devices such as cell phones with mobility technology and portable computers facilitate communication at all times. This allows one to work and visit sites in public locations, such as trains and other social gatherings. This has enabled people to stop traveling long distances to work and may do so from home. The technology also encourages productivity, for instance, a person intending to meet a professional deadline may save valuable time by working on a mobile gadget before getting to the workplace. Electronic communication is also convenient and instantaneous. It distributes with the need to mail or fax a document that can be stored online or on a portable electronic device to protect it against any kind of loss. These advantages facilitate learning and research. A visit to a clinical website may help out an individual with a complicated health problem. Despite the good attributes, modern electronic communications leave individuals vulnerable to cyber-attacks and other forms of online criminal attacks. Additionally, online conversations may pose a physical threat to children. It also exposes people to violent materials and pornography that may become addictive and eventually a health issue. Interruptions and distractions brought about by the modern electronic communications compromise quality time and if left unchecked may damage an individual’s intelligence quotient. Another platform that has received a lot of attention lately is the use of social media in addressing health care issues and extraction of patient information readily available in the social sites. The social media outlets are widespread. An advantage of using it is that it is wide-reaching, user-centric and collaborative in nature. If health care centers embraced the platform, then an interactive channel is guaranteed as most of the users are cooperative. The social sites include blogs, wikis, videoconferencing, multimedia blogging, and the diverse websites. Traditional media usage in health care communication is well embraced due to the minimal threats contained. Traditional methods have a simple system of getting information and allow one to make informed decisions. They are simple to learn and understand. However, the traditional media cannot cover all the patients’ needs because of the lack of services and the one way channel. The traditional means is not interactive and may not always target the right audience. It does not always give accurate information and may be biased. The Health Insurance Portability and Accountability Act (HIPAA) created in 1996 is a charter with mandated regulations that institute standards to guard the privacy of every individual’s independently exclusive health information. Health care centers must conform to these privacy regulations and all the rules on the subject of the way health centers may or may not use or disclose protected health information (PHI). The regulations intend to shelter the identity, personality and privacy of healthcare patients. Consequently, specific aspects of the healthcare employee culture are needed to change in the manner that employees distribute information and discuss their clients. Healthcare establishments are also mandated to put into effect HIPAA fulfillment from within. This creates additional administrative and training costs. Knowledge of HIPAA effects on healthcare organizations helps to assess the costs, effectiveness, and benefits of the HIPAA regulations. Patients must make contact with the administration so that permission for healthcare providers to share information with each other is obtained. It is illegal for healthcare providers to acquire records from social networks. This only poses as a barrier to effective communication. According to this paper, communication is essential for any administrator to solve a health care crisis. Whether the health care patient in a nursing home understands the consequences of a new management or not, he or she is entitled to correct information regarding how the process will transpire. Organizations like the Health Insurance Portability and Accountability Act (HIPAA) are a good establishment to protect their (patient) privacy. However, certain sections of their standard regulations need to be changed for the sake of the illiterate persons without local families and completely unaware of whether to consent to his or her information being shared. With new developments in communications, health car e providers should face smooth communications rather than the old hard system. References HIPAA Compliance Guide: http://www.hipaacomplianceguide.com/ U.S. HHS, Administrative Simplification in the Health Care Industry: http://aspe.hhs.gov/admnsimp/

An Article On Effective Technology Use - 1467 Words

Our classroom text states that â€Å"qualitative research is the collection, analysis, and interpretation of comprehensive narrative and visual data to gain insights into a particular phenomenon of interest† (Gay, Mills, Airasian, 2012, p.7). Qualitative researchers strive to establish validity by eliciting a sense of trustworthiness through neutrality and objectivity, addressing the stability of data, and fair and impartial evaluation (Saldaà ±a, 2013). Researchers favor this method due to its emphasis on observing participants in their natural environment. There are some in the research and education field that feel certain kinds of educational issues and inquiries do not lend themselves to methods that employ numerical analysis and try to control variables in very complex and controlled environments. Qualitative researchers on the other hand state that findings should be resultant upon research done in real-world settings in order to have application in real world settings (Gay, Mills, Airasian, 2012). Research Topic and Purpose Topic The topic of this article explores effective technology use in the classroom and allowing teachers to self-question and unravel their own technology issues. Teachers are in essence the researchers as well as participants. The author supports the use of technology in the classroom and he states that â€Å"the use of technology is a defining characteristic of twenty-first century education and should be requiredShow MoreRelatedmonitor alarm fatigue Essay1248 Words   |  5 Pagesto discuss the research findings of two articles to explore more efficient and effective methods to reduce nurse desensitization to clinical alarms. 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