Title and Abstract
The title of the article, “An intervention to improve the catheter-associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure,” identifies the general idea of the study very clearly. The Authors of the paper, Janet M. Galiczewski and Kathleen M. Shurpin hold positions at Stony Brook University School of Nursing and Long Island Jewish Medical Center in the United States, respectively.
Unfortunately, the paper does not provide any further information to determine if the authors are qualified to study the topic since the reviewer has the information only about their associations and not about their qualifications. As for the abstract, it is concise and rather clear, addressing five milestones of every study: background, aim, methods, results, and conclusion. However, at some points, there is a lack of information (for example, which type of analysis was used). Nevertheless, it can be considered an advantage rather than a shortcoming since it invites the reader to engage with the paper further.
The research problem is quite substantiated and formulated clearly enough. The authors express the problem statement precisely, formulating the problem sufficiently narrow in order for it to be grasped in one study. The problem is significant, and the authors acknowledge it. It is known from international studies that from 30 to 40% of nosocomial infections are associated with the urinary tract (Mody et al., 2017). More than half of these infections are due to the use of urinary catheters (catheter-associated urinary tract infections, CAUTI) and, in particular, the indwelling Foley catheter (Li et al., 2019).
In this case, bacteria can enter the bladder during the installation of the catheter along its lumen or from the external environment surrounding its outer part (Li et al., 2019). The authors addressed this issue in their quasi-experimental study aiming at finding out whether direct observation as a method of intervention during the procedure can help maximize protocol adherence and, as a consequence, decrease the prevalence of CAUTI in clinical settings. Thus, the project is significant and researchable: for the most part, the stated goals and objectives are realistic and feasible. The Project seems implementable in terms of the adequacy of resources, the timing, and the content of the work.
Literature Review and Theoretical Framework
The authors use both primary and secondary sources for the literature review, including current and pertinent references. The authors demonstrate possession of up-to-date information about the main world scientific competitors and the current state of research in the field as a whole, but there is no analysis of the relevant information. With this formulation of the question, it was also necessary to consider current research in the field of social psychology, social sciences, and management of organizations. Direct observation of the procedure is also a social mechanism while being a medical one (see, for example, Alteren et al., 2018; Lunsmann et al., 2019; Alam et al., 2020).
Thus, despite the use of versatile references to authoritative publications, the authors of the project show only a fragmentary knowledge of theoretical and methodological developments in the direction. The theoretical framework proposed in the paper, i.e., a physiology theory of the chain of infection, is relevant for the study only in terms of physiological and epidemiological findings. However, the study addresses a broader spectrum of issues, including clinical practice guides, which also deal with the streams of research outside the scope of physiological theories.
Research Design Elements
The study is a quasi-experimental case-control. The research design included two phases: first included retrospective analysis of the already available data on catheter usage and the rate of subsequent infection rates. The second phase involved the addition of direct observation intervention in clinical practice. Further, the data is compared to reveal whether the change in clinical practice led to significant patient outcomes.
The hypotheses are clearly stated: “urinary catheter utilization and infection rates would decrease during the intervention phase compared to the pre-intervention phase” (Galiczewski & Shurpin, 2017, p.29). Thus, the study assumes both categorical (frequencies) and continual (means and standard variations) variables. The variables included standard demographic data (age, sex) and clinical variables (for example, CAUTI identified). The former were dependent variables, whereas the latter were dependent ones.
Study Settings and Instruments
The study was conducted in clinical settings. More specifically, as the authors state, it was “conducted in the medical ICU of a 603 bed tertiary academic medical center located in the northeastern section of the United States” (Galiczewski & Shurpin, 2017, p. 28). The authors established the validity of the study by developing a specific checklist based on the APIC and CDC guidelines for the prevention of CAUTI (Galiczewski & Shurpin, 2017, p. 29). Although such a way of obtaining information is appropriate, it arguably does not reflect the real world. It is not clear how much research settings influenced the outcome in terms of increased adherence to protocols and how likely a colleague’s observation would affect future practice. In addition, this approach can lead to either hiding protocol errors or worsening relationships in the workplace.
Protection of Human Subjects
The research was conducted in an ethical manner following standard ethical guidelines. The authors obtained the approval of the Quality Improvement/Nursing Research Committee before starting the research. At the same time, the study did not imply obtaining informed consent since the project used only de-identified aggregated data without changing the standards of care (Galiczewski & Shurpin, 2017, p.28).
Sample and Descriptive
The sampling was non-probable and included the entire population of the target group. Based on the study, the sampling method was appropriate; however, it is too early to conclude that the results represent the entire target population outside the sample. It may also be due to the fact that different ICUs can vary in their professional practices and patterns (Kohn et al., 2017). The description of the subjects is used to describe the study rather than the sample. At the same time, it seems that the gathered data about the patients is insufficient for the reason that the subjects could have had additional diseases and comorbidities that might have influenced the outcome (for example, diabetes). Although this study is aimed at repeating experimental logic in real life, one cannot disregard such important factors forming the patients’ proneness to CAUTI.
Study Results and Understanding
The statistical results are not significant with p=0.232; however, the authors acknowledge it (Galiczewski & Shurpin, 2017, p. 32). Thus, although the study has a clear clinical significance, it is not significant in terms of statistical outcomes. It is also partially linked to the sampling method. As authors clearly state themselves, “While the results of this study were not statistically significant (p = 0.253), they may be clinically relevant” (Galiczewski & Shurpin, 2017, p.32).
Conclusions, Limitations, and Existing Knowledge
The conclusion of this paper is not logically linked to the hypothesis since it discusses the reason underlying the possible decrease in CAUTI rates, including the “ability to provide immediate constructive feedback that improves practice” (Galiczewski & Shurpin, 2017, p. 33). Nevertheless, the study does not address any factors apart from physiological processes, and, thus, the statements formulated in the conclusion need further justification. The authors compare the results of the study to the existing knowledge and mostly confirm the previous research. Also, the authors identify the limitations of the study, however, they miss some crucial points which could have influenced the outcomes of the study.
For example, it is not clear how long and with what frequency the observation should be carried out (is it enough once per employee, or should such observation be carried out every time the procedure is performed). It also raises doubts about the statement that it costs nothing to the hospital: “This allowed the intervention to take place on both the day and night shift and capture all eligible patients at no additional cost to the institution” (Galiczewski & Shurpin, 2017, p.28) since this does not take into account the increased workload on employees who will need to monitor the procedure (Ross et al., 2019). However, the study’s results are potentially essential for national healthcare system development.
Professionalism and Formatting
The writing style is clear, exhibiting proper use of grammar. The paper follows the format correctly. The references are appropriately formatted according to APA style.
Alam, J., Aamir, S. M., & Shahzad, S. (2020). Continuous Professional Development of Secondary School Teachers through Peer Observation: Implications for Policy & Practice. Research Journal of Social Sciences and Economics Review (RJSSER), 1(1), 56-75.
Alteren, J., Hermstad, M., White, J., & Jordan, S. (2018). Conflicting priorities: observation of medication administration. Journal of clinical nursing, 27(19), 3613-3621.
Galiczewski, J. M., & Shurpin, K. M. (2017). An intervention to improve the catheter-associated urinary tract infection rate in a medical intensive care unit: direct observation of catheter insertion procedure. Intensive and Critical Care Nursing, 40, 26-34.
Li, F., Song, M., Xu, L., Deng, B., Zhu, S., & Li, X. (2019). Risk factors for catheter‐associated urinary tract infection among hospitalized patients: A systematic review and meta‐analysis of observational studies. Journal of advanced nursing, 75(3), 517-527.
Lunsmann, C. J., Beck, J. S., Riddle, D. R., Scott, C. E., & Adkins, A. B. (2019). Extending the apprenticeship of observation: How mentee experiences shape mentors. Mentoring & Tutoring: Partnership in Learning, 27(3), 342-363.
Mody, L., Greene, M. T., Meddings, J., Krein, S. L., McNamara, S. E., Trautner, B. W.,… & Saint, S. (2017). A national implementation project to prevent catheter-associated urinary tract infection in nursing home residents. JAMA internal medicine, 177(8), 1154-1162.
Ross, C., Rogers, C., & King, C. (2019). Safety culture and an invisible nursing workload. Collegian, 26(1), 1-7.