NR 449 RUA Topic Search Strategy Solved

The paper will include the following sections:
a. Clinical Question (45 points/28%)
• Describe the problem. What is the focus of your group’s work?
• Explain the significance of the problem in terms of patient outcomes. What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations.
• PICOT question in support of the group topic.
• State the purpose of your paper. What will your paper do or describe? This is similar to a problem statement. “The purpose of this paper is to . . .”
b. Levels of Evidence (20 points/13%)
• Identify the type of question being asked (therapy, prognosis, meaning, etc.).
• What is the best type of evidence to answer that question (e.g., RCT, cohort study, qualitative study, etc.)?
c. Search Strategy (65 points/41%)
• List search terms and results.
• Databases used (start with the CU library). Link your search with the PICOT question

described above.
• Refinement decisions. As you did your search, what decisions did you make in refinement to get your required articles down to a reasonable number for review? Were any limits used? If so, what?
• Identification of two (2) most relevant articles (primary sources published within the last 5 years).
d. Format (30 points/18%)

In research, the literature review describes existing knowledge about the topic, reveals gaps and further research questions to be answered, and provides a rationale for engaging in a new study. The literature review provides evidence to answer clinical questions and make informed decisions in evidence-based practice. Quality improvement studies also begin with searching the literature to gather available knowledge about a problem and explore interventions used in other settings. The appearance of journals that predatory publishers publish has introduced the danger that reviews of the literature include inadequate, poorly designed, and low-quality information being used as “evidence”—raising the possibility of risky and harmful practice. A helpful literature review requires searching various reliable and credible databases such as MEDLINE (through PubMed or Ovid) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), among others relevant to the topic. The ease of searching using a web browser (now commonly referred to as “googling”) has increased the risk of finding sources published in predatory. Low-quality journals that have not met the standards of research and scholarship can be regarded as credible and reliable evidence ( Oermann, Wrigley, Nicoll, Ledbetter, Carter-Templeton, & Edie, 2021).

RUA Topic Search Strategy

Patients infected by Covid19 virus experience a wide range of health problems that lower their quality of life and health outcomes. Respiratory symptoms are the most common experiences of patients with Covid19. Some patients affected by the disease often require intensive care management for the disease. Often, intensive care of covid19 encompasses respiratory support through mechanical ventilation. Mechanical ventilation increases the risk of ventilator-associated complications. Therefore, this paper proposes an evidence-based practice approach intervention that can be used to prevent and lower the risk of ventilator-associated complications in patients suffering from covid19 in nursing practice.

Description of the Clinical Problem

The global pandemic Covid19, has caused significant pressure on the public health systems across the world. Countries continue to acquire insights into the pathophysiology of covid19 and the effective treatment interventions that can be used to prevent morbidity and mortality rates associated with the disease (Monpara et al., 2020). Covid19 is associated with adverse health problems that include acute respiratory syndromes that increase the need

for ventilator support for the patients. According to statistics, up to 80% of the patients with covid19 who are admitted to the intensive care units require invasive mechanical ventilation (Maes et al., 2021). Mechanical ventilation predisposes patients to ventilator associated complications such as nosocomial pneumonia, pulmonary embolism, pulmonary edema, and barotrauma (Carter et al., 2020). According to Póvoa et al. (2020), covid-19 patients are highly at a risk of developing ventilator associated pneumonia than any other ventilator associated complication. The enhanced risk is attributed to the fact that pathogenic microorganisms in the oropharyngeal section can reach the lower respiratory tract via the space between the endotracheal tube and the tracheal wall. Intubation has also been shown to interfere with the mucociliary clearance, which cause biofilms formation on the endotracheal cannula, hence the increased risk of ventilator associated pneumonia (Póvoa et al., 2020). Nurses have a critical role to play in the prevention of ventilator associated complications in covid19 patients. Nurses and other healthcare providers utilize evidence-based practice interventions to minimize the risk of their patients developing ventilator-associated complications.

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Significance of the Clinical Problem

According to Póvoa et al. (2020), covid-19 patients on mechanical ventilation are highly at a risk of developing ventilator associated complications such as pneumonia. The occurrence of ventilator-associated complications such as pneumonia worsen the clinical status of the covid19 patients and increase their risk of mortality. The invasive involvement of the lung tissues in patients who survive the respiratory syndrome of covid19 are likely to stay more in hospital for the effective management of their condition. The increased hospital stay also implies that the cost of hospitalization will rise significantly (Póvoa et al., 2020). The ventilator associated complications due to covid19 also cause dysregulation of the immune system. The dysregulation arises from the enhanced production as well as the circulation of cytokines that cause hyper-inflammation and defects in the lymphoid function. Besides the elevated levels of cytokines, covid19 patients on mechanical ventilation that develop complications have been shown to have T-cell exhaustion (Blot et al., 2020). Therefore, the combination of immunopathogenesis of covid19 with complications associated mechanical ventilation increase the risk of poor outcomes, increased hospital stay, high costs of hospitalization, and mortality in covid19 patients.

PICOT Question

The proposed project aims at implementing an evidence-based practice intervention that will be used to prevent and minimize the risk of ventilator associated complications in covid19 patients. Studies have proposed the use of different interventions to prevent and lower the risk of ventilator complications in covid19 patients. However, the project proposes the use of a prevention bundle in managing patients with covid19 on mechanical ventilation. The prevention bundle will comprise of interventions that include elevation of head of the bed, oral hygiene, assessment of sedation, peptic ulcer prophylaxis, cuff pressure control, endotracheal tube suctioning, and emptying condensate (Mahmudin et al., 2020). Therefore, the proposed PICOT question for the project is:

In covid19 patients on mechanical ventilation, does the use of a prevention bundle reduce the risk of patients developing ventilator associated complications when compared to the standard practice within a six-month period?

Purpose of the Paper

The purpose of this paper will be to investigate the effect of implementing the use of prevention bundle on the risk of covid19 patients on mechanical ventilation developing ventilator associated complications. The paper will compare the outcomes of using the prevention bundles with those of the standard care over a six-month period in an intensive care unit. Through this focus, the paper will provide significant insights into the effectiveness of the prevention bundle in improving the treatment outcomes of covid19 patients on mechanical ventilation.

Levels of Evidence

Type of Question

The question that the project asks is a therapy-based question. The question seeks to determine the effectiveness of the proposed therapy in improving the outcomes of treatment in covid19 patients on mechanical ventilation.

Type of Evidence to Answer the Question

The data on the prevalence, risk factors, prevention, and management of ventilator associated complications of covid19 remains scarce due to limited studies conducted on these aspects of the disease. As a result, the project will rely on evidence provided in quantitative studies to determine the effect of care bundles on ventilator associated complications in covid19 patients. The quantitative studies will include randomized controlled trials, cohort studies and experimental studies.

Search Strategy

List Search Terms and Results

The search terms that were used in this paper include covid19 ventilator-associated complications, covid19 complications, prevention bundles, prevention bundles for covid19 ventilator-associated complications. The search yielded 8 quantitative studies that focused on the use of prevention bundles to minimize the risk of ventilator-associated complications in covid19 patients.

Databases Used

The databases used include CU Library, Google Scholar, Embase, CINAHL, and PubMEd.

Refinement Decisions

Refinement decisions that were made during the selection of the sources of evidence included relevance to the topic, publication date, sample sizes used, and biases in the selected studies.

Relevant Articles

Mahmudin, A. A., Chalidyanto, D., Martanto, T. W., & Semedi, B. W. (2020). Reducing incidence rate of ventilator-associated pneumonia (VAP) using prevention bundle in the ICU. EurAsian Journal of BioSciences, 14(2), 3193–3199.

Monpara, J. D., Sodha, S. J., & Gupta, P. K. (2020). COVID-19 associated complications and potential therapeutic targets. European Journal of Pharmacology, 886, 173548. https://doi.org/10.1016/j.ejphar.2020.173548

Conclusion

Overall, the risk of ventilator-associated complications in covid19 patients on mechanical ventilation is high. Ventilator-associated complications such as pneumonia and barotrauma have significant adverse effects on the health of the patients. The adverse effects include increased hospital stay and costs of care and death. Evidence-based interventions can be used to prevent and lower the risks of ventilator associated complications in covid19 patients. Therefore, it is anticipated that the prevention bundle will improve the risk and rate of ventilator-associated complications in covid19 patients.

References

Blot, M., Bour, J.-B., Quenot, J. P., Bourredjem, A., Nguyen, M., Guy, J., Monier, S., Georges, M., Large, A., Dargent, A., Guilhem, A., Mouries-Martin, S., Barben, J., Bouhemad, B., Charles, P.-E., Chavanet, P., Binquet, C., Piroth, L., & for the LYMPHONIE study group. (2020). The dysregulated innate immune response in severe COVID-19 pneumonia that could drive poorer outcome. Journal of Translational Medicine, 18(1), 457. https://doi.org/10.1186/s12967-020-02646-9

Carter, C., Osborn, M., Agagah, G., Aedy, H., & Notter, J. (2020). COVID-19 disease: Invasive ventilation. Clinics in Integrated Care, 1, 100004. https://doi.org/10.1016/j.intcar.2020.100004

Maes, M., Higginson, E., Pereira-Dias, J., Curran, M. D., Parmar, S., Khokhar, F., Cuchet-Lourenço, D., Lux, J., Sharma-Hajela, S., Ravenhill, B., Hamed, I., Heales, L., Mahroof, R., Solderholm, A., Forrest, S., Sridhar, S., Brown, N. M., Baker, S., Navapurkar, V., … Conway Morris, A. (2021). Ventilator-associated pneumonia in critically ill patients with COVID-19. Critical Care, 25(1), 25. https://doi.org/10.1186/s13054-021-03460-5

Póvoa, H. C. C., Chianca, G. C., & Iorio, N. L. P. P. (2020). COVID-19: An alert to ventilator-associated bacterial pneumonia. Infectious Diseases and Therapy, 9, 417–420.