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Christie KleinertPICO PaperNursing 350AbstractThis paper will discuss the PICO question of does applying a CHG tegaderm versus a regular tegaderm dressing decrease the rate of infection in patients with invasive lines? There are a high number of invasive line infections and it is important to know if a product can decrease a patient’s rate of infection. This paper will analyze the information found and explore how evidence based practice is useful to nurses. IntroductionThis paper will discuss how evidence based practice effects nursing practice and how nurses can apply what they learn to their practice. Evidence based practice is a great way to improve the quality of care we provide. “Evidence based practice means using the best available research findings to make clinical decisions that are most effective and beneficial for patients” (Chitty & Black, 2011, p.258). By allowing nurses to participate in research and development, we are able to see firsthand how effective our intervention can be. Nurses run into all kinds of problems on a daily basis and they are able to share their experience and expertise to help develop a better way to solve a problem. Clinical QuestionThroughout this semester we were asked to chose a PICOT question and analyze another student’s information. The PICOT is an acronym standing for P- patient population, I- intervention, C- comparison intervention and current practice, O- outcome, and T- time you would like to achieve the goal (Nieswiadomy, 2012, p. 282). The PICOT question I chose to explore was does applying a CHG tegaderm versus a regular tegaderm dressing decrease the rate of infection in patients with invasive lines? I decided to keep my original question and explore it further because I deal with invasive lines and dressings on a daily basis and want to know if there are any benefits to my patient. I have found working in ER different physicians do different things. I noticed many have switched to using a CHG tegaderm when inserting a central line or art line, while some physicians continue to use a standard tegaderm. I wondered if the CHG had any benefits to decreasing infection with patients. Anytime we insert something foreign into the human body we are putting them at risk for infection. As a nurse, it is our job to try to decrease the infections our patients are exposed to and provide the best possible care for the patient.Looking at the PICOT question does applying a CHG tegaderm versus a regular tegaderm dressing decrease the rate of infection in patients with invasive lines, we can see if there is evidence based practice to support using the CHG tegaderm. If there is ample research to support the decreased infection rates while using the CHG tegaderm opposed to the regular tegaderm, I believe there should be more compliance with the use of the product. Anytime we can decrease a patients risk for infection we should. This decreases the amount of time they need to be hospitalized and prevents never events from occurring. Patients have higher satisfaction rates when they are treated effectively and efficiently. MethodologyFor this paper the research design is to examine the cause and effect relationship between CHG tegaderms and decreased infection rates (Nieswiadomy, 2012). To find information to answer the PICOT question, I have utilized the Ferris State University library databases. I have searched several databases to find accurate up-to-date information. I have focused on experimental designs based on hospitalized patients. I chose to find sources that could have external validity and be beneficial to the entire population (Nieswiadomy, 2012).The databases used to find pertinent articles were on Ferris State University’s library link. The ones I chose were CINHL, COCHRANE library, Pub Med, and ERIC. Using theses, I was able to locate nursing articles that could provide me information on the topic and had evidence to base their findings on. Nursing research was used because this topic directly affects my daily practice and I wanted to find articles to support the rationale. When using the tegaderms nurses are required to do dressing changes and ensure the site is clean and report any suspicion of infection to the physician. The articles I focused on needed to show how the infection rates were affected when using the CHG tegaderm, so I could see how important it was to use this product versus another. I know there are many nurses at my facility who were unsure of the implications of using a specialized tegaderm versus a regular tegaderm and I wanted my findings to be easily shared and validated. LiteratureRandom Sample The first article I chose to review used a randomized sample with a control and test group. The setting was a major Midwestern hospital who used 63 patients who had consented to participate in the trial. These patients also had PICC lines, IJ’s, subclavian or femoral lines. The study observed the use of the CHG tegaderm and found there was more compliance with using the tegaderm due to the ease of placing it, being able to continue to visualize the line, and how it secured the line to the patient. The study was not conclusive on decreasing the rate of infections. The CHG was shown to have microbial properties but no statistics were given about the decreased infection rate (Olson & Heilman, 2008). Lab Study The next article I reviewed was a lab study. The study took samples off a silicone membrane and human donor skin and attempted to calculate the antimicrobial activity. The study showed the antimicrobial properties lasted for 7 days and the release began 30 minutes after application. This article supported the decrease of infection with the use of the CHG tegaderm, but since it was not tested on live subjects, there is room for discrepancies (Karpanen,? Casey, Conway,? Lambert,? & Elliott, 2011).Observational Study An additional article I chose to review was an Observational study with human subjects who were post-op. This article supported the theory of using CHG tegaderms. The study observed these patients and took samples of bacterial growth using a regular tegaderm and the CHG tegaderm. The study concluded using the CHG dressing could prevent gram-negative bacilli infections. This article was the most beneficial to me. It supported using the CHG dressing opposed to a normal tegaderm (Kawamura,?Takahashi,?Takahashi,?& Taketomi,?2014). The article addressed how these were more expensive and nurses needed to keep in mind the potential costs, but the decreased risk of infection took priority for the patient. Significance to NursingNursing research is developed to attempt to solve a problem or make something better. Evidence based research is the building block to why we do certain things for our patients. I chose to find out how effective a CHG tegaderm was when used on a patient with an invasive line because I want to limit the amount of infections my patients’ experience. After concluding my research, I should find more studies that support the use of CHG tegaderms; but, at this point I would continue to use them due the findings of decreasing the gram-negative bacilli. If by using the specialized tegaderm, we give our patients a little more protection, I believe we should. When reading about evidence based practice it is important to know what is in our scope-of-practice. Just because we read something, does not mean we can implement changes within our facility. Nurses should complete research to learn why we are making changes and to help guide new ways of doing things. The ANA recommends asking if something is in the scope and standards of practice, if it follows state law and regulations, if you are following your institution policy and procedure , and the potential professional liability before acting (2014).We should also try to do what is best for the patient and advocate for them. If you have done research and something is in your scope of practice you can always recommend the change to the physician. This will allow for patient satisfaction and quality care. Evidenced based practice explores current evidence and allows for collaborative care (Hunt, 2012). We use EBP to analyze quality information and apply it to make something better or safer for the patient (Hunt, 2012). ConclusionEvidence based practice allows for nurses to have more of a say in how to improve things. Nursing is one of the few professions that allow for changes and is continually evolving. Nurses should be informed on the different research that is occurring to ensure best practices. With the evolving medical advancements it is important to keep up with the changes. There are constantly new medications and treatments out there and we need to know how these affect our patients. This project has taught me a lot about finding information and how to apply it to my practice. We should always be advocating for our patient and we should allow them the best care possible. ReferencesAmerican Nurses Association. (2014). Determining Scope of Practice for Advanced Practice Registered Nurses (APRNs). Retrieved from , K. K., & Black, B. P. (2011). Professional nursing: Concepts & challenges. Maryland Heights, Mo: Saunders/Elsevier.Hunt,?D. (2012). QSEN competencies: A bridge to practice. Nursing Made Incredibly Easy!, 10(5), 1-3. doi:10.1097/01.NME.0000418040.92006.70Karpanen,?T., Casey,?A., Conway,?B., Lambert,?P., & Elliott,?T. (2011). Antimicrobial activity of a chlorhexidine intravascular catheter site gel dressing. The Journal of Antimicrobial Chemotherapy, 66(8), 1777-1784. doi:10.1093/jac/dkr191 Kawamura,?H., Takahashi,?N., Takahashi,?M., & Taketomi,?A. (2014). The differences in microorganism growth on various dressings used to cover injection sites: inspection of the risk of catheter-related bloodstream infections caused by Gram-negative bacilli. Surgery Today. doi:10.1007/s00595-014-0935-zNieswiadomy,?R.?M. (2012). Foundations of nursing research (6th?ed.). Boston: Pearson.Olson,?C., & Heilman,?J. (2008). Clinical performance of a new transparent chlorhexidine gluconate central venous catheter. Journal of the Association for Vascular Access, 13(1), 13-19. doi:10.2309/java.13-1-4 ................
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