EBP Problem, Searching the Evidence, and Appraisal Paper

EBP Problem, Searching the Evidence, and Appraisal paper

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EBP Problem, Searching the Evidence, and Appraisal paper

Summary of Clinical Evidence-Based Problem: wound care in adults

Wound infection is a clinical issue that home health care settings frequently encounter. Infection management in home health settings, including prevention, is challenging and has a negative impact on the patient, relative, health care personnel, and employees. This issue results in thousands of dollars in annual expenses for the home health setting to care for these people. Numerous studies have been conducted on how to minimize patient rehospitalization owing to wound infection, the majority of which have been conducted in the home health care setting, and there has been some implementation that has resulted in a reduction in wound infection. The research that this writer proposes is on how to improve the use of wound assessment in nursing practice in order to continue to reduce the rate of rehospitalization for wound infection in adults, which benefits patients emotionally, psychologically, and improves their quality of life, while also saving money for the agency, patient, and family members.

To achieve an Evidence-Based result to wound infection in home health care settings, research studies will require to be done and data will be gathered. Despite there has been a lot of study regarding wound infection and how it can be prevented. Various home health patient is still faced with this dilemma. Hence, causing longer hospital stays for patients and result in higher medical costs and increase mortality risk and can cost an organization. This PICO will air the wound assessment tool to reveal how it can be appropriately executed. The aim of Evidence Based practice is to boost safe cost-efficient outcomes for clients, relatives, and the healthcare providers (Grove, Gray, & Burns, 2015). Evidence based practice can be executed by Searching for the greatest evidence, critically evaluating the evidence and recommend a practice change, Phase, Integrate the evidence with clinical skill and patient/relatives’ preferences and standards and Assessing the outcomes of the practice decisions or changes based on the evidence.

Nursing Intervention

  To conduct a research study on wound infection in particular concerning the utilization of wound assessment tool which are: Medical condition. be mindful of patient's clinical status when completing a wound assessment, Site and category of wound. Site may be tricky at times to distinguish, Sizes, Tissue type, Odor, exudate, Peri wound skin. and evidence-based nursing practice for wound care, the writer desires to look at what nursing intervention would help accomplish a zero-wound infection in the Apicon home health settings. (Grove, Gray, & Burns, 2015). Some of the interventions that can be applied are teachings the health care worker about the significant application of evidence-based approach, standard practice and wound assessment tool, four eyes initiative so as ensure all providers are on the same page and making sure that wound infection prevention techniques are well implemented and followed.

Patient Care Good Wound Care Helps Prevent Skin Infections. Extremely infected wounds are triggered by microbial colonization, come from either from the natural flora on the skin, or microbes from other parts of the body or the outer environment. The highly popular infection causing microorganisms is Staphylococcus aureus and other types of staphylococci. Daily, clean and wrap draining or exposed wounds with clean, dry bandages. Hands should be washed often with soap and water or, if washing is not practicable, with an alcohol-based hand massage. Proper cleaning, debridement practices are essential components of efficient wound bed preparation. When debris and foreign substance are present in a wound bed, less organisms are necessary to produce an infection. The best wound dressing ought to maintain a warm, humid healing environment and handle exudate efficiently so that the dressing can be left on the wound for as long as possible. Dressing selection should be based on the specific wound characteristics. In order to distinguish those who are at risk of infection as well as the signs and symptoms of wound infection, nurses in all care settings must have a fundamental understanding of the process of wound healing as well as the science of microbiology.

 Health Care Agency

Health Care Agencies are frequently funding to ensure that patients receive quality, and effective knowledge on how to improve them. The idea of preventing wound infection should begin prior to sustaining any type of wound. Organization are responsible to make sure all employee to undertake frequent educations utilizing current wound infection guidelines. Healthcare providers have an imperative obligation to stimulate, support, and Educating patient about prevention of wound infection, healthy practices and wound infection care through evidence-based practice is an ethical obligation of all health care professionals. Infection Control in Nursing Practice Management of wound infection is an appropriate management plan which should be developed after the patient has been diagnosed with a bacterial infection and any antibiotic sensitivities have been identified, with the primary goals being to improve the patient's general health status, reduce the bacterial burden, facilitate healing, and reduce the risk of cross-contamination. The utilization of this nursing study is vital for the production of information about the nurse function, and the findings of this study have the potential to influence nursing practice and contribute to the nursing body of knowledge that all nurses are required to learn (Grove, Gray, & Burns, 2015). Nurses can also educate patient and relatives about the importance of prevention of infection at home by explaining, providing a pamphlet, and involving patient in care. In addition, home health agency and supervisor can also implement protocols to sustain the continuous adequate wound care to prevent infection. In Addition, Nurses play a crucial part in avoiding wound infection, not only by guaranteeing that all qualities of their nursing practice are evidence based, nevertheless also via nursing study and patient teaching.

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Practice Question

PICOT QUESTION: Does the use of Wound Assessment tool and standard practice reduce 

hospitalization due to wound infection in an adult patient? 

P: Home Health care patient with wound

I: Required education on wound care management

C: Standard Practice and Use of wound Assessment tool

O: Decrease in re hospitalization due to wound infection.

T: within 6weeks of sustaining the wound

Development and Implementation of a Search Strategy

Keywords; A vascular, clean wound, necrotic tissue, partial thickness, sinus tract, slough, closed wound edges, dead space, epidermis and full thickness.

Identification of the Articles

Coming up with articles that can be used for clinical evidence-based practice should focus on the right audience. Making such consideration during the development and implementation of the DART program is must in the nursing profession as far as evaluation and examination of articles is concerned. In this connection, literature examination and evaluation were conducted on three articles and which had a relevant connection to the PICOT question above. The keywords associated with this clinical problem and the PICOT question were combined with other terminologies of clinically based practices for wound care in adults in order to create a comprehensive list. Using this information, it was possible to determine the similarities and differences between these articles and clinical evidence-based practices. The articles were evaluated and analyzed according to the Question Development Tool Appendix B, (Dearholt& Dang, 2017) and John Hopkins Tool Kit.

Appraisal of the articles 

Documentation Style of the Selected Articles

Article 1	Wiseman, J. T., Fernandes-Taylor, S., Barnes, M. L., Tomsejova, A., Saunders, R. S., & Kent, K. C. (2015). Conceptualizing smartphone use in outpatient wound assessment: patients' and caregivers' willingness to use technology. journal of surgical research, 198(1), 245-251.
Article 2	Bellingeri, A., Falciani, F., Traspedini, P., Moscatelli, A., Russo, A., Tino, G., ... & Peghetti, A. (2016). Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT. Journal of Wound Care, 25(3), 160-168.
Article 3	Karahan, A., AAbbasoğlu, A., Işık, S. A., Çevik, B., Saltan, Ç., Elbaş, N. Ö., & Yalılı, A. (2018). Factors Affecting Wound Healing in Individuals with Pressure Ulcers: A Retrospective Study. Ostomy/wound management, 64(2), 32-39.
Article 4	Chan, L. N., & Lai, C. K. (2014). The effect of patient education with telephone follow-up on wound healing in adult patients with clean wounds: A randomized controlled trial. Journal of Wound Ostomy & Continence Nursing, 41(4), 345-355.

Relationship of the Article and the PICOT Question

Article 1 

According to this article by Wiseman et al (2015), Patients' prognosis and transitional care could be improved by using cellphones to remotely monitor incisional wounds via digital images and collect postoperative symptom information. In connection with the PICOT question, with the advancement of technology transforming health care communication, It has been demonstrated that a smartphone-based postoperative monitoring program can and will be adopted by a cohort of patients with high comorbidity. Success of this strategy will be heavily reliant on patient education and the participation of family and friends. In this regard, the use of a cell phone can aid in the improvement of difficult wound management through the use of a wound assessment tool, as it can influence operational efficiency, cost of care, and treatment outcome at home.

Article 2

According to this study by Bellingeri et al (2016), The authors found that surfactants may aid in the debridement process of chronic wounds. Individuals with pressure ulcers (PU) or vascular leg ulcers were treated with either a propylbetaine-polihexanide (PP) solution or a normal saline (NS) solution to determine which was more effective at reducing inflammation and wound size. In response to the PICOT question, the authors discovered that cleaning the wound with PP solution is significantly more effective than cleaning the wound with NS solution in reducing inflammation and speeding up the healing of vascular leg ulcers and pressure ulcers. A new treatment protocol for chronic wounds should be developed as a result of the evidence presented in this study.

Article 3

This article by Karahan et al (2018) A retrospective study of data from adult pressure ulcer patients was done in order to discover characteristics that may affect their healing. In regard to the PICOT question, the article demonstrates there is a high healing rate once the Bates-Jensen Wound Assessment Tool (BWAT) was used and there is reduced hospitalization. This predicts that the implementation of wound assessment can also contribute significantly to better patient outcome outside hospitals.  

Article 4

In their research article, Chan et al (2014) sought to determine whether clean dressing technique had an impact on wound healing in patients managed by sterile dressing changes by professional nurses in a general care outpatient clinic following a patient education program and telephone follow-up in a sample of adult patients. Patients who underwent Bates-Jansen Wound Assessment (BWAT) saw a significant reduction in their hospitalization time by 2 weeks. The mean BWAT score dropped from 27.26 to 15.15 in just 2 weeks. Wound healing did not differ between patients who dressed their wounds at home using clean techniques and patients who dressed their wounds by professional nurses in a general outpatient clinic using sterile techniques, indicating that patients can choose to treat their wounds at home and achieve the same results as those who are admitted to a hospital. As a result, the number of patients admitted to the hospital is reduced.

Level of Evidence, Research Study, and Study Design

Wiseman et al (2015). This is a level II article regarding evidence contained regarding the reviews undertaken. This is a level II article regarding evidence contained.  This makes this research method to be qualitative. The study design is descriptive.

Bellingeri et al. (2016). This article can be considered to be at level II as it is a primary study. The study measures outcome without random assignment or comparison group. Therefore, we can suggest that the study was quasi-experimental. The study design, uses a single-blinded randomized controlled trial (RCT) the study involved a sufficient sample size that was studied. Besides, the data were statistically analyzed through descriptive techniques.

Karahan et al (2018). The level of evidence in this article is II. Based on the study design of this article, primary data, sufficient samples collected, analyzed and results described. The research design employed was a both qualitative and quantitative. The research results was based on quantifiable identities in the form of percentages.

Chan et al (2014). This is a level II piece of writing. The study assesses outcomes without using an intervention group and control group. In addition, descriptive statistics were used to examine the data. The study's sample size was adequate. Data was gathered on the basis of demographics and adult wound care. A descriptive analysis of the obtained data yielded well-explained results, which were then presented in table form. An important link is made in this section between theory and practice by drawing on findings from a diverse medical team. 

Application of “Framework for How to Read and Critique a Research Study for the Selected Articles

Article 1: 

The title provided by Wiseman et al (2015) provides a descriptive knowledge of the article's subject matter. The material contained in the abstract part serves as a representative of the entire paper, from the introduction through the methodology, results, and findings, and finally to the conclusions. Wiseman and his colleagues make it simple to comprehend the introduction to the book. The authors conduct a study on a vulnerable patient population in order to assess their smartphone capacity and readiness to utilize smartphone technology in the context of clinical evidence-based practices, which they find to be promising. The authors are able to convey this medical breakthrough to the audience as a result of their efforts. In their explanation, the authors state that their survey reveals that an older patient cohort with considerable comorbidities is capable of and ready to implement a smartphone-based postoperative monitoring program. The success of this intervention will be determined by the level of patient instruction and engagement by caregivers. This is also represented in the study topic, which has served as a guiding principle for this investigation throughout its course. It is also important to note that the paper contains a well-developed theoretical framework that assists readers in visualizing the response process as it is measured by the wound evaluation instrument. Furthermore, the review of the literature offered in this literature is relevant in emergency situations due to the fact that it is precise enough to corroborate the statements made in the literature. The sample size employed in the article is sufficient. The information was gathered on the basis of demographic data and wound care in adults. Results were presented in table form after a descriptive analysis of the data was conducted. The results were well explained and presented in table form. When it comes to the discussion section, there is a strong connection made between the theoretical framework, the objective of the study, and the significance of the data for the multidisciplinary medical team. Despite the fact that the study's limitations are not stated in the article, the authors agree that wound assessment through the use of smartphone technology is a useful program in the management of wounds, and that future studies should examine and evaluate its impact on patient outcome, cost of care, and cost savings.

Article 2

  By Bellingeri et al. (2016), This study compares the therapeutic efficacy of a propylbetaine-polihexanide (PP) solution to a normal saline (NS) solution in patients with pressure ulcers (PUs) or vascular leg ulcers. The inflammatory symptoms and wound size reduction were assessed in patients with PUs or vascular leg ulcers. It provides an overview of the paper, beginning with the purpose, moving on to the study design, results, discussion, and conclusion. Bellingeri et al. provide a thorough presentation of this clinical issue, as well as a full explanation of why they are investigating the efficacy of this treatment in ulcer patients. In this regard, the authors present a theoretical paradigm for how the critical response system should be activated in clinical scenarios. As a result of reading this paper, I believe that the literature cited by Bellingeri et al. is relevant to the nursing field, and that contemporary publications have been used to support their arguments and discoveries. In terms of technique and study design, a single-blinded randomized controlled trial (RCT) was adopted, and it was found appropriate for the purposes of this investigation. The sample size employed by the authors was adequate. Due to the fact that the authors conducted a structured review in order to publish their findings using descriptive statistics, the data acquired is genuine and credible. The authors have developed a detailed discussion based on the findings, which combines the relationship between the theoretical framework, the research purpose, and the implementation of the findings in clinical settings. On top of that, Bellingeri and colleagues discuss some of the study limitations they faced, including the generalizability and validity of their findings. This article comes to the conclusion that the trial results demonstrated that the PP solution was much more effective than the NS solution in lowering inflammatory symptoms and speeding the healing of vascular leg ulcers and pressure ulcers. It is supported by this research that current protocols for the treatment of chronic wounds should be updated.

Article 3

  By Karahan et al (2018) looked at a A study that looked at data from adult patients who had pressure ulcers was undertaken in order to find characteristics that could have an impact on their healing. Karahan et al(2018) provide a title that, in a nutshell, summarizes the content of the study. More than that, the abstract presented in this article represents the problems that have been covered throughout the essay. When the clinical issue under consideration is presented in the introduction section, it is evident what the paper is trying to accomplish. This study demonstrates that the authors' research questions have been well defined, leaving no space for interpretation. Using the results of this article's evaluation, the writers have developed a comprehensive theoretical framework. It is via the use of this framework that the author has introduced and defined conceptualizations that explain the clinical issue under investigation. The literature review employed in this article is consistent with the findings of the study. The literature has met all of the requirements for this investigation. Patients were assessed using the Bates-Jensen Wound Assessment Tool, hence descriptive statistics were utilized in this investigation. This was a suitable study design given the nature of the patients' assessments (BWAT). The authors used a sufficient sample size that was appropriate for the research design they were using. The information was gathered based on practicable training abilities, and the participants were evaluated based on their level of confidence. According to my understanding, the results may be relied on in the majority of cases because there is little bias in them. The criteria for data analysis are consistent with the goal of the study and the design of the study. The tabulation approach has been utilized to present the data that has been gathered. Aside from that, percentages have been utilized to convey the data or information that has been gathered. Patients with healed wounds had considerably higher hemoglobin and mean arterial pressure, improved mobility, received oral nourishment, and were more likely to be discharged from the hospital than patients with unhealed wounds, according to the discussion and findings part of the study. A relationship is demonstrated here in terms of the research question/purpose study's and its applicability in the nursing profession. The study suggests that greater research into the risk factors for non-healing pressure ulcers is required, including studies with high sample sizes to allow for multivariate analysis to be conducted.

Article 4 

By Chan et al (2014); In this study, the primary goal was to determine the impact of clean dressing technique in a home-care setting after a patient education program and telephone follow-up in a group of adult patients on wound healing in patients managed by sterile dressing changes by professional nurses in a general care outpatient clinic. Background, methods, findings, and conclusions are all contained in the abstract, as well as other sections. The abstract reflects the overall tone of the entire paper. The intervention group was assigned to 61 participants in a random fashion, whereas the control group was assigned to 61 participants. Chan and his colleagues do an excellent job of explaining everything at the outset. A wound assessment tool, the Bates-Jensen Wound Assessment Tool (BWAT), was used to measure progress toward wound healing as part of therapeutic evidence-based procedures. The authors are able to better explain this medical advancement to their audience as a result of doing so. Researchers found that even patients who received patient education and use a smartphone-based postoperative monitoring program, responded better, according to their findings. The involvement of patients and technology will be critical to the intervention's success. The research topic that has served as a compass for this investigation reflects this as well. It's critical to note that the paper includes a thorough theoretical foundation to assist readers in visualizing how the wound assessment tool responds to the patient's treatment. Aside from that, the literature review offered in this piece is useful in an emergency because it goes into great length to back up the statements that are being made. The study's sample size was adequate. Data was gathered on the basis of demographics and adult wound care. A descriptive analysis of the obtained data yielded well-explained results, which were then presented in table form. An important link is made in this section between theory and practice by drawing on findings from a diverse medical team. It is concluded in the article that there were no differences in wound healing between patients who dressed their wounds at home using clean techniques and patients who had their wounds dressed by professional nurses in a regular outpatient clinic, using sterile techniques.

Conclusion

As a result of the above-mentioned literature and amended articles, the investigations done are applicable in my nursing practice settings. They help and showcase how, as a nurse, one can better patient outcomes, reduce death rates, reduce treatment cost, and improve patient safety and generally a better work environment. Therefore, these results and recommendations suggested in these articles can be used in clinical practices since they form part of clinical evidence-based practice. By this, the implementation and integration of assessment in hospital-based response system and home care for adult patients are essential and can aid in the decision-making process on how adults’ patients wound injuries can be managed.

References

Bellingeri, A., Falciani, F., Traspedini, P., Moscatelli, A., Russo, A., Tino, G., ... & Peghetti, A. (2016). Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT. Journal of Wound Care, 25(3), 160-168.

Chan, L. N., & Lai, C. K. (2014). The effect of patient education with telephone follow-up on wound healing in adult patients with clean wounds: A randomized controlled trial. Journal of Wound Ostomy & Continence Nursing, 41(4), 345-355.

Grove, S. K., Gray, J. R., & Burns, N. (2015). Understanding Nursing Research Buliding an Evidence-Based Research. St. Louis, MI: Elsevier Saunders. Rachel Pless, Periann Rogers.

Karahan, A., AAbbasoğlu, A., Işık, S. A., Çevik, B., Saltan, Ç., Elbaş, N. Ö., & Yalılı, A. (2018). Factors Affecting Wound Healing in Individuals with Pressure Ulcers: A Retrospective Study. Ostomy/wound management, 64(2), 32-39.

Wiseman, J. T., Fernandes-Taylor, S., Barnes, M. L., Tomsejova, A., Saunders, R. S., & Kent, K. C. (2015). Conceptualizing smartphone use in outpatient wound assessment: patients' and caregivers' willingness to use technology. journal of surgical research, 198(1), 245-251.