Nursing PICOT Statement

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

Hugonnet, S., Chevrolet, J., & Pittet, D. (2007). The Effect of Workload on Infection Risk in Critically Ill Patients [Electronic version]. Critical Care Medicine, 35(1), 76-81.

In clinical experience, it is seen that many patients in the Intensive Care Unit (ICU) are on mechanical ventilation. These patients range from having head trauma, heart surgery and respiratory problems yet there is no clear, concise systematic standard oral care procedures noted on the different floors in the hospital. Oral care is a basic nursing care activity that can provide relief, comfort and prevention of microbial growth yet is given low priority when compared to other critical practices in critically ill patients. The Center for Disease Control reveals that Ventilator-Associated Pneumonia (VAP) is the second most common nosocomial infection that affects approximately 27% of critically ill patients (Koeman, Van der Ven & Hak,

Nurses, especially nurses working on an Addiction Medicine unit, are well-positioned to provide patient and family education on opioid addiction (Manworren, 2015; Painter, 2017). Effective patient and family education can theoretically improve the capacity for patients at risk for opioid dependence and/or patients experience opioid dependence to cope with the problem, reduce risks, and prevent relapse (Costello et al., 2016; McNeil et al., 2015). Nurses working on an inpatient unit provide patient education as part of regular daily care and during the course of discharge planning and management (Costello et al., 2016). Patient and family education related to the patient’s diagnosis and/or reason for admission is standard practice on most units. However, nurses, including nurses working on an addiction treatment unit, may lack sufficient knowledge in opioid addiction prevention and management to provide suitable patient-centered education to patients and their families (Costello et al., 2016). Moreover, there is currently no established model or protocol for nursing-directed patient and family opioid addiction education (Costello et al., 2016; Manworren,

I believe to design a study in which my pico question can be addressed is very easy to perform. I performed a data based search using the terms central line, dressing change and risk of infection. The data based showed more than hundred results of study focusing on the topic of infection control in patient with central line.

Many instances have been noted that healthcare providers are bringing the infection to the patients and not the patients bring the infection to the staff. Furthermore, It is well documented that nosocomial infection occurs (Rice, 2010) and hospitalized individuals face more complications and greater mortality from influenza. Healthcare providers are indirectly causing undo harm to patients that are more susceptible to infections such as influenza. “In nursing home settings, vaccination of healthcare workers has been shown to decrease morbidity and mortality among nursing home residents” (Babcock, et al., 2010, p. 459). One study suggests that there is a higher rate of occurrence of influenza among healthcare providers than residents. “In elder-care settings, influenza among staff precedes illness among residents, suggesting that health care workers introduce the virus into the setting” (Anikeeva, Braunack-Mayer, & Rogers, 2009, p. 25).

Through medical advances in technology and practice, nurses have been afforded the opportunity to provide lifesaving care to patients. However, this lifesaving care comes with the risk of healthcare-associated infections (HAIs). Generally speaking, HAIs are infections directly related with the delivery of healthcare and are often caused by viral, bacterial or

Understaffing of nursing services is one of the prime issues affecting the profession presently. Hospital operations and patient outcomes are dependent on the number of nurses available to deliver the required outstanding care to diverse critical ill patients. Nursing shortage in various healthcare facilities leads to work overload thus reduces the productivity of the available nurses. According to Glette, Aase & Wiig (2017), patient safety is compromised by understaffing. Their research established that there is a relationship between the shortage of nurses in a hospital and the adverse events that occur. The adverse events such as the incidence of nosocomial infections cause a direct impact on the patient outcomes.

Duffin (2012) stated, “The California Nursing Association argues that this [mandated nurse-to-patient ratios] reduces mortality levels and allows nurses to spend more time with patients” (p.7). Duffin also quoted the co-president of the California Nursing Association, who said “A study from the University of Pennsylvania which concluded that New Jersey hospitals would have 14 percent fewer deaths if they matched California’s surgical unit ratios” (p.7). Increased nurse-to-patient ratios have been shown to decrease the infection risks in facilities. The Centers for Disease Control and Prevention (2004) stated, “They have identified a link between improved nurse to patient ratios and lower hospital outbreaks of bloodstream infections”(p 1). Mandated staffing ratios have shown to have many positives but they are not without flaws.

Implementation of patient care practices for infection control is the role of the nursing staff. Nurses are responsible for maintaining hygiene, consistent with hospital policies and good nursing practice on the ward and monitoring aseptic techniques, including hand-washing and use of isolation. It is also in their scope of practice to promptly report to the attending physician any evidence of infection in patients under the nurse’s care and initiating patient isolation and ordering culture specimens from any patient showing signs of a communicable disease, when the physician is not immediately available. Limiting patient exposure to infections from visitors, hospital staff, other patients, or equipment used for diagnosis or treatment and maintaining

Checking in to the hospital comes with a heavy price tag, and sometimes you get more than what you bargained for. As highly trained doctors, nurses, and staff make their way through the hospital, they carry with them microbial agents of disease. Although regarded as centers for treatment and prevention, hospitals are also known to harbor nosocomial, healthcare-associated, bacterial infections. These infections can be a result of overused or inappropriately used antibiotics and the breaching of infection containment policies by patients and staff. Though health-care-associated infections have been decreasing, one infection inciting nosocomial bacterial, Clostridium difficile has been rampant. It is important that inefficiencies in health-care be met with stringent efforts for prevention as they may lead to distressing financial, emotional, and medical repercussions.

Melinda, you have an excellent PICOT question. It is precise and clear-cut. I agree with you, in that the nurses stay for 1-2years and may leave many hospitals. This happens if they are not satisfied with their job (Johnson, 2009). Even the leaders could change within that period.

Ventilator-associated pneumonia is a bacterial infection that occurs in the lower respiratory system within the first 48 hours of endotrachal intubation (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). Although any hospital patient is susceptible to pneumonia, ventilator dependent patients are at the highest risk of acquiring pneumonia. The purpose of this paper is to identify the risk factors, incidences, and preventions of ventilator-associated pneumonia (VAP) using a quantitative research study performed in Malaysia. “The aim of this

As a hospital, quality care should be a priority for patients that are going to be treated for a sickness, or any type of procedure that is going to take place. A lot of times a patient gets an infection while they were at the hospital, on top of being treated for what they original came in for. Health facilities should be environments of healing, which they are, but they also have tons of various types of germs and infections, which grasp onto individuals that have weak immune systems/are sick. Some infections that are at hospitals are Tuberculosis, VRE, VAP, C-Diff, UTI, and MRSA. Preventive measures to stop the spread of the infections is lacking tremendously in the work and aim to provide safety for all patient’s health. The work

through the wound care being performed and missed a major step in caring for that patient, leading to infection. The effect of increased nurses to patients has been shown many times to improve patients’ outcome.