Research Critiques and PICOT Question Guidelines- Qualitative and Quantitative Studies

Research Critiques and PICOT Question Guidelines- Qualitative and Quantitative Studies

Healthcare-associated infections (HAIs) are a significant issue of concern in hospital settings that continuously threatens patient safety. HAIs directly lead to preventable patient harm and suffering, increase the patient’s length of stay, increase the cost of delivering care to the patient, and increase the risk of patient mortality (Serra-Burriel et al., 2020). HAIs are preventable with proper prevention and control (IPC) protocols within hospital settings. Hand hygiene is the most applied and effective IPC approach hospitals employ to prevent HAIs. However, the adherence to hand hygiene protocols among healthcare workers (HCWs) usually fades over time. This paper presents an updated PICOT question and provides a summary and comparison of four peer-reviewed articles that can help develop evidence to answer the PICOT question and help address the nursing problem identified.

Updated PICOT Question

In healthcare workers (P), does hand hygiene education (I) compared to regular hand washing protocols (C) improve adherence to hand hygiene protocols (O) over six months?

Background of Studies

The article by Douno et al. (2023) aims to develop qualitative insights on knowledge, attitudes, and practices on health hygiene among HCWs that support the planning and implementation of the WHO hand hygiene strategy in Faranah Regional Hospital, Guinea. The article identifies the gap in qualitative evidence on HCWs’ knowledge, attitudes, and practices of hand hygiene. The article presents a foundational qualitative study on the topic. The article is significant to nursing as it presents an in-depth assessment of HCWs’ knowledge, attitudes, and practices towards hand hygiene to develop suggestions on how to implement and improve compliance with the WHO’s hand hygiene protocols. The study has no clear research questions but employs observations and interviews for data collection.

In their article, Hammerschmidt and Manser (2019) explore the influence of individual and organizational factors on compliance with hand hygiene among nursing home nurses. The article aims to provide insights into the organizational factors that should be considered to improve hand hygiene in nursing homes. The article argues that despite hand hygiene being a major measure in preventing HAIs, nursing homes remain in compliance with set protocols. This article is significant in nursing as it focuses on various organizational factors that determine nurses’ knowledge behavior and influence compliance with hand hygiene, which can guide nurse managers to improve adherence to hand hygiene practices in nursing homes. The research questions used in the study explored the nurses’ and nursing managers’ hand hygiene knowledge, practices and compliance, and behaviors, as well as organizational factors influencing hand hygiene behaviors. For instance, “What knowledge do nurses have concerning hygiene management and infection prevention?” and “What are the perceptions of nurses and nursing managers of organizational structures and processes supporting hand hygiene?”

The article by Stangerup et al. (2021) explores changes in compliance with hand hygiene practices among HCWs with time, as well as the adherence trends before and during the COVID-19 pandemic. The article aims to identify factors and management approaches that influence the adherence to hand hygiene (HH) among HCWs. The authors argue that adherence and compliance trends to hand hygiene protocols differ during and after a pandemic. This article is significant to nursing as it identifies factors for changes in HH adherence among HCWs under various conditions. The study utilized three hypotheses focused on how termination of HH interventions makes HCWs less aware and compliant with HH during their clinical work routines, HH compliance during pre-pandemic and during the COVID-19 pandemic, and HH compliance during day and night.

In the article by Van Nguyen et al. (2020), the authors aim to determine how the knowledge and attitudes of HCWs influence their compliance with WHO’s hand hygiene protocols in a Vietnamese central general hospital. The authors argue that the levels of knowledge and attitudes of HCWs toward hand hygiene protocols influence their compliance levels. The article is significant in nursing and provides evidence of the relationship between knowledge of hand hygiene protocols and HCWs’ attitudes protocols to compliance with the protocols. It also highlights training as a solution to HH adherence issues. The article has no specific research question but utilizes the hygiene knowledge questionnaire for data collection.

How the Four Articles Support Solving the Nursing Adherence to Hand Hygiene Problem

The four articles selected can help answer the PICOT questions as they all present quality evidence on the factors that influence how nurses and HCWs adhere to hand hygiene protocols across various care settings and how to improve their adherence to the protocols. For instance, Douno et al. (2023) identify the HCWs’ knowledge, attitudes, and practices toward hand hygiene as major influencing factors for compliance with HH protocols. In this case, training and mandating can improve compliance. Similar views are presented by Van Nguyen et al. (2020), in which the authors identify and relate attitudes and knowledge of protocols with the levels of adherence to such protocols. Van Nguyen et al. also argue that training and promoting positive attitudes can improve compliance levels among HCWs. The evidence presented in the article by Stangerup et al. (2021) identifies factors such as workload, work pressure and stress, time and resource availability, and changes in practice routines to reduced levels of compliance. Further, Hammerschmidt and Manser (2019) also identify knowledge levels and behaviors to comply with protocols and suggest modeling HH-compliant behaviors by nursing managers to improve compliance.

Subsequently, the interventions and comparison groups focused on the articles are similar to those identified in the PICOT question. All articles selected focus on HCWs, including nurses as the main sample, as in the developed PICOT question. The major interventions identified by the articles, for instance, by Stangerup et al. (2021)  and Douno et al. (2023), identify training as the main intervention. Comparatively, the PICOT question focuses on hand hygiene education as the main intervention.

Method of Studies

Four articles were selected where: the article by Douno et al. (2023) used qualitative, the article by Hammerschmidt and Manser (2019 used mixed methods and the other two articles used quantitative methods, the article by Stangerup et al. (2021) and the article by Van Nguyen et al. (2020). The qualitative methods employ a more human-centered approach to study. Data is usually collected using interviews. The researchers using qualitative studies aim to explore the participants’ thoughts, feelings, and experiences to understand the studied phenomenon and identify similarities and differences in perception and interpretation of experiences. Data is majorly analyzed using thematic and concept analyses. On the other hand, quantitative methods focus on exploring observable causes and effects and are thus more outcome-oriented. Numerical data is utilized and statistically analyzed to determine patterns of data. Finally, the mixed methods approach combines both qualitative and quantitative methods. It aims to overcome the methods’ shortcomings, provide a deeper exploration of a phenomenon, and make better-informed generalizations.

One key benefit of the qualitative approach is that it enables the researcher and others to develop an in-depth understanding of a specific problem or phenomenon. However, the results developed using qualitative methods can be too subjective and hard to generalize. On the other hand, the quantitative methods allow for the statistical analysis of data from a large population sample, allowing for better results and generalizability. However, the quantitative methods are limited by their rigid and structured approaches to exploring a research problem. Combining the qualitative and quantitative methods, the mixed methods, enables researchers to explore a research problem both qualitatively and quantitatively. However, the approach can be too expensive to employ in low-resource research settings.

Results of Studies

Stangerup et al. (2021) found that compliance with hand hygiene was highest and lowest at 58% and 34% during and past the pandemic, respectively. The article also found compliance depends on workload, work pressure stress, time, and resource availability. These findings support hand hygiene interventions past a pandemic. Subsequently, Van Nguyen et al. (2020) found that HCWs have enough knowledge and positive attitudes toward the WHO’s hand hygiene protocols and training could improve adherence to the protocols in high-risk and high-exposure settings. The study has implications for nursing practice in applying multimodal strategies to improve adherence to HH protocols.

Hammerschmidt and Manser (2019) found that 79% of the nurses included in the study understood the need for hand hygiene, while 61% understood hygiene standards. 56% of staff noted that ensuring hand hygiene while caring for residents is always possible. Additionally, 61% of the nurses link the availability of organizational factors to adherence levels of hand hygiene protocols. The interview also found that nurses find it easy to understand and follow printed protocols, while nurse managers identified the need for frequent communication on hygiene standards. These results have implications for the development and implementation of isolated interventions to enhance hand hygiene protocols, even in unique settings like nursing homes.

Douno et al. (2023) found that HCWs view hand hygiene as essential in preventing the spread of HAIs and, thus, critical for ensuring patient and provider safety. A majority of the HCWs noted that adhering to hand hygiene protocols supports the delivery of quality and is a strategy to improve patient trust. Additionally, adherence to hand hygiene protocols is based on HCW knowledge and attitudes. Both were found to be facilitated through training and modeling-related behaviors. The results of this article have implications for training and improving adherence and compliance towards hand hygiene.

Ethical Considerations

The two ethical considerations in conducting research are informed consent and confidentiality. Informed consent focuses on ensuring the participants to help them make participation decisions. Confidentiality ensures that the privacy of the participants is upheld. For instance, Stangerup et al. (2021) provide approval for meeting the ethical standards in research gained from the Ethics Committee and the Danish Data Protection Agency. On the other hand, Van Nguyen et al. (2020) obtained approval from the Scientific Panel of the Institute for Preventive Medicine and Public Health at Hanoi Medical University Decision No. 61/QDYHDP&YTCC while Hammerschmidt and Manser (2019) ensured privacy and informed consent by storing collected information as per the standards of the University Hospital Bonn, Germany. Douno et al. (2023) note that their research was approved by the Comité National d’Ethique pour la Recherche en Santé, Guinea, and go-ahead permission was granted by the local health authorities. They also noted that all participants were educated on the aims of the study, and verbal consent was obtained.

Outcomes Comparison

The anticipated outcomes for the developed PICOT question include outcomes related to how hand hygiene education would lead to improved adherence to hand hygiene protocols. These include a better understanding of the protocols and better attitudes towards the protocols. The outcomes will also relate to leaving the current regular hand-washing protocols and observing if they maintain similar hand-washing behaviors or lead to reduced adherence to hand hygiene protocols. Consequently, the anticipated results compared to the results of summarized studies create similar patterns. For instance, training and education on hand hygiene protocols improve attitudes and adherence to such protocols (Douno et al., 2023); Van Nguyen et al., 2020)]. Additionally, reduced focus on the protocols over time reduces adherence to the protocols (Stangerup et al., 2021).

Proposed Evidence-Based Practice Change

The link between the PICOT question, the research articles, and the nursing practice problem I identified is that the PICOT question explores issues of adherence to hand hygiene protocols and how education on such protocols can help improve the levels of adherence. The research articles summarized also focus on approaches to improve adherence to these protocols. Based on this information, the proposed evidence-based practice change for my nursing setting is making it a requirement for all nurses to have weekly reminders over an app with updated details of ways to maintain hand hygiene.

Conclusion

In conclusion, hand hygiene is a critical and most effective IPC in nursing settings for the prevention of HAIs. Adherence to set hand hygiene protocols can fade with time. Therefore, various strategies, such as regular training, can help sustain adherence to hand hygiene protocols. Notably, a PICOT question provides a guide for literature search and can help with the development of evidence-based approaches to addressing adherence issues towards hand hygiene protocols and help prevent HAIs.

References

Douno, M., Rocha, C., Borchert, M., Nabe, I., & Müller, S. A. (2023). Qualitative assessment of hand hygiene knowledge, attitudes, and practices among healthcare workers prior to the implementation of the WHO Hand Hygiene Improvement Strategy at Faranah Regional Hospital, Guinea. PLOS Global Public Health, 3(2), e0001581. https://doi.org/10.1371/JOURNAL.PGPH.0001581

Hammerschmidt, J., & Manser, T. (2019). Nurses’ knowledge, behavior and compliance concerning hand hygiene in nursing homes: A cross-sectional mixed-methods study. BMC Health Services Research, 19(1), 1–13. https://doi.org/10.1186/S12913-019-4347-Z/FIGURES/2

Serra-Burriel, M., Keys, M., Campillo-Artero, C., Agodi, A., Barchitta, M., Gikas, A., Palos, C., & López-Casasnovas, G. (2020). Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PLOS ONE, 15(1), e0227139. https://doi.org/10.1371/JOURNAL.PONE.0227139

Stangerup, M., Hansen, M. B., Hansen, R., Sode, L. P., Hesselbo, B., Kostadinov, K., Olesen, B. S., & Calum, H. (2021). Hand hygiene compliance of healthcare workers before and during the COVID-19 pandemic: A long-term follow-up study. American Journal of Infection Control, 49(9), 1118–1122. https://doi.org/10.1016/J.AJIC.2021.06.014

Van Nguyen, H., Tran, H. T., Khuong, L. Q., Van Nguyen, T., Ho, N. T. N., Dao, A. T. M., & Van Hoang, M. (2020). Healthcare Workers’ Knowledge and Attitudes Regarding the World Health Organization’s “My 5 Moments for Hand Hygiene”: Evidence From a Vietnamese Central General Hospital. Journal of Preventive Medicine and Public Health, 53(4), 236. https://doi.org/10.3961/

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Prepare this assignment as a 1,500-1,750-word paper using the instructor’s feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).

Research Critiques

In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.

General Requirements

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

PROFESSOR’S QUESTIONS AND FEEDBACK

In high-exposure populations such as children and healthcare workers (P), what are the individual, organizational, and environmental factors that influence compliance to and the effectiveness of hand hygiene (I) in infection prevention and control (O)? This is not a PICO question. You need a nursing intervention with a specific population and a measurable outcome. You could ask: Will educating healthcare staff about hand hygiene compared to no education result in decreased HAIs in hospitalized patients in 3 months? Please revise