Infection Prevention Practices: Qualitative Research Critique

Introduction

For the purposes of this assignment, the author founds two qualitative research articles in the field of nursing and analyzed them. The PICOT question that guided the search was as follows: Will patients suffer more from healthcare-associated infections, if they will be treated in an ICU department that is understaffed with nurses in comparison with the unit that has a 1:1 nurse to patient ratio? While this question is better suited for quantitative analysis, some articles can be found that discuss the matter qualitatively. They tend to focus on the personal experiences of healthcare providers or the overall narrative surrounding healthcare prevention. This essay will analyze and critique both of the studies in detail to determine their usefulness in answering the question. Their relevance, methods of study, results, and ethical considerations will be evaluated.

Background of the Study

The first study reviewed discussed the implementation of infection prevention practices in European hospitals, as the name suggests. Clack et al. (2018) investigated the barriers and facilitators to the adoption of improved practices related to the adoption of catheter-related infection prevention strategies. Their research questions were “(1) what are the main barriers and facilitators to successfully implementing CRBSI prevention procedures?; and 2) what role do contextual factors play?” (Clack et al., 2018, p. 771). As such, they could understand what problems to expect in both low- and high-income nations, which makes the findings potentially relevant to the US. The second study aims to evaluate the problem of healthcare-associated infection at a broader scale. Haque et al. (2020) intended to understand the strategies commonly employed worldwide to prevent infection of all varieties. Their research question can be summarized as “What updates have been made to strategies used globally to prevent healthcare-associated infections”? From them, they aimed to determine the most effective approaches and the issues related to their implementation.

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Nursing Practice Issue Support

The first article can be used to help explain why understaffed intensive care units perform worse than ones where there is a 1:1 nurse per patient ratio. The underlying causes of the staffing problem can be determined, and interventions that take the problems in consideration and address them can be deployed. Additionally, other factors can be considered to design a more comprehensive organizational initiative that improves outcomes further. With that said, it should be noted that the environment discussed is European, which can create some significant differences from the US environment even though the target populations and interventions are the same. The second article provides potential strategies for reducing healthcare-associated infections despite staffing shortages. Moreover, it can offer specific adjustments and actions that can be taken to overcome the problem without incurring excessively high expenses. A notable advantage is that the interventions used and populations compared are the same in many regards, potentially enabling direct transfers of the results once the differences between the global and local contexts are accounted for.

Methods of Study

The first study was conducted through a set of interviews with hospital administrators as well as infection prevention and control and intensive care unit management and staff. Additionally, the authors observed the procedures at each facility they visited and made extensive notes that were also included in the analysis. The data was used to create summaries for each site and conduct a thematic analysis of the findings. The second is instead a narrative review of literature gathered through searches of different databases. The authors collected several critical articles, then snowballed references cited by them, and used them to create a framework of the scholarly understanding of the overall infection prevention picture. The primary advantage of the first approach is its ability to gather specific and firsthand data, but this tendency also has the side effect of potentially limiting the usefulness of the findings to the specific environment where the data was collected. Conversely, the second approach can help understand the broader picture at the cost of the results potentially not being applicable in any specific context without adaptation.

Study Results

The first study found that nurse shortages were present both in lower-income and higher-income countries. Per Clack et al. (2018), the reason for the former is that the 2008 economic crisis led to hiring limits and staff departures that were never replaced, hurting the unit’s performance. In lower-income nations, on the other hand, the crisis led to salary cuts, and many medical workers, including nurses, have to either work multiple jobs or engage in extensive overtime. The second study does not directly cite understaffing as a problem, but Haque et al. (2020) highlight how overwork directly leads nurses not to follow hygiene protocols due to a lack of time to do so. Overall, both studies confirm the hypothesis that understaffing is associated with increased incidence of healthcare-associated infections. They suggest that finding a solution may be challenging without hiring more staff, as existing workers struggle with implementing new strategies due to their current burdens.

Ethical Considerations

The first study had significant ethical implications because it interacted with participants and interviewed them to later process and use the data. As such, it may have manifested many different ethical issues, such as the publication of confidential information about the participants or other misuse of the information. To address this problem, Clack et al. (2018) followed standard ethical guidelines, which included ensuring that every respondent’s participation was voluntary and showed informed consent. To confirm the latter, the researchers collected written informed consent notes from each participant after familiarizing them with the purposes and process of the study. The second study collected information via a literature review and, consequently, did not incur the same problems. As such, it does not discuss ethics, and the basic framework such as the avoidance of plagiarism has already been taken into consideration.

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Conclusion

Overall, the two studies have not necessarily addressed the PICOT question directly, instead considering a broader framework of issues in ICU infection prevention. The reason for this result is likely the qualitative focus of the research, which does not lend itself well to such highly specific questions. With that said, they still provide some valuable insights that can benefit the research and nursing practice as a whole. The two articles are distinct and of high quality, using different methods and collecting large amounts of information while observing ethical guidelines to come to their conclusions. In particular, the studies highlight the reasons for the current nursing shortages in many nations, even high-income ones, and the effects that this understaffing has on adherence to hygiene practices. The information discovered can help discover effective interventions to address the lack of staffing in many intensive care units.

References

Clack, L., Zingg, W., Saint, S., Casillas, A., Touveneau, S., da Liberdade Jantarada, F., Willi, U., van der Kooi, T., Damschroder, L. J., Forman, J. H., Harrod, M., Krein, S., Pittet, D., & Sax, H. (2018). Implementing infection prevention practices across European hospitals: An in-depth qualitative assessment. BMJ Quality & Safety, 27(10), 771-780.

Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F.M., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T.S., Coccolini, F., & Charan, J. (2020). Strategies to prevent healthcare-associated infections: A narrative overview. Risk Management and Healthcare Policy, 13, 1765-1780.

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