How influential are the nurses’ roles in controlling chest infections in the ICU to reduce the frequency and prevent their spread compared to nurse aids?

This module is assessed thorough the following piece of coursework: Coursework 1: Critically review the research literature pertaining to an area of your professional practice. Rationale The coursework aims to provide students with the opportunity to undertake an in-depth exploration of the research evidence through the completion of a literature review. This question must be relevant to your professional practice and have clear connections to local and / or national priorities in health and social care.

PRESENT YOUR REVIEW The review should normally be structured and presented in the format below. Title page Include your student number, title, module details, word count etc as usual Table of contents List of appendices Including: data extraction table, evidence of supervision sessions (min. 5 hours) The assignment does NOT include an introduction or conclusion. Rationale for Question (200 words) The section should state what your question is and why is it important for nurses or midwives to know the evidence based answer to the question. How might know this information improve practice. Method (around 1000 words) The section should be an account of the search strategy used to scope and retrieve the research literature for review which must demonstrate that you have taken a comprehensive approach. The account should contain sufficient details and information for the search to be replicable. The following should be evident: • The databases searched. • Search terms used including key words and subject headings • Number of hits obtained from each search. This must be presented using a PRISMA diagram. • Details of how studies were limited through inclusion and exclusion criteria and other limiters. • Data extraction process, using the data extraction table (from 4015NHS). Some of this information may be presented in table and/ or figure form. Tables and figures are NOT included in the word count. Critical Appraisal (around 500 words) A summary of the critical appraisal tool answers for each paper and a summary of the paper’s quality and relevance to the review question. The appraisals should be done using a critical appraisal tool. The full appraisal can be put within the appendix. Findings (around 1500 words in total) The findings section should include: o An overview of the papers found; which country; who are the participants; what settings are involved etc (500 words) o A presentation of key themes which are common across the papers identified and address the review question. Themes can be identified using a data extraction tool which can be included within the main body or as an appendix. Themes may include:  Common theoretical and conceptual frameworks in the research  Common findings in the research  Common methodological approaches in the research Application to practice (around 800 words) Discuss how the evidence you found in answering your question impacts of your practice as a future nurse or midwife. Critically evaluate the implications of the themes and concepts that you determined from your review. Include: • Recommendations for person-centred practice • Implications for local and national priorities in health and social care • Recommendations for further research, where gaps in knowledge exist. • Consideration of the limitations of the literature review References You must reference your work using the Coventry University Harvard Reference System. Details can be found at the following web address:http://www.coventry.ac.uk/study-at-coventry/studen… Appendices Avoid too many appendices as all information should be presented as a coherent account, with illustrations, tables, etc appearing where they are discussed in the main body of the assignment. You must include a copy of your data extraction table and evidence of your supervision hours (min. 5 hours) as an appendix. Total word count is 4000 words (+/- 10%). In line with university policy, there will be a deduction of 10% of the mark (after internal moderation) for work breaching the stipulated limit by 10%. However, the title page, abstract, any acknowledgments, table of contents, tables containing data/information, figures, reference list, any bibliography and appendices are NOT counted as part of the overall word count. All citations and any quotations are included.

the papers are attached as well as the work I need it to be rewritten following the feedback

all instruction attached as well

Requirements: 4000

How influential are the nurses’ roles in controlling chest infections in the ICU to reduce the frequency and prevent their spread compared to nurse aids?

Student’s Name:

Institutional Affiliation:

Course Name:

Instructor’s Name:

Date:

 

Research Proposal: How influential are the nurses’ roles in controlling chest infections in the ICU to reduce the frequency and prevent their spread compared to nurse aids?

The following are the four papers

Al-Sayaghi, K. M. (2021). Critical care nurses’ compliance and barriers toward ventilator-associated pneumonia prevention guidelines: Cross-sectional survey. Journal of Taibah University Medical Sciences, 16(2), 274-282.

Bhalerao, J. D., & Tambey, R. (2021). Ventilator associated pneumonia in intensive care unit of a tertiary level hospital. Global Journal For Research Analysis, 21-24.

Bhandari, S., Sharma, M., & Shrestha, G. S. (2021). Knowledge of nurses working in critical care areas regarding ventilator associated pneumonia prevention bundles in a tertiary level cardiac centre. Journal of Institute of Medicine Nepal, 43(1), 36-42.

Yin, Y., Sun, M., Li, Z., Bu, J., Chen, Y., Zhang, K., & Hu, Z. (2022). Exploring the nursing factors related to ventilator-associated pneumonia in the intensive care unit. Frontiers in Public Health, 10.

How influential are the nurses’ roles in controlling chest infections in the ICU compared to nurse aids?

Student’s Name: Ayah Alhowaidi

Student ID: 10516416

Words count: 4130.

Table of Content Contents

 

Rationale for Question

One of the healthcare concerns affecting patients in the ICU is chest infections. Nurses are equipped to deal with chest infections to improve patient safety and health outcomes. Thus, it is essential to explore the role of nurses in treating chest infections by answering a research question. The research question under consideration is “How influential are the nurses’ roles in controlling chest infections in the ICU compared to nurse aids?” This question is essential in clinical practice because the incidence of ventilator-associated pneumonia has been increasing significantly, thus increasing the number of patients with complications of healthcare-related infections. In this regard, answering this question helps to understand the roles played by nurses in diagnosing chest infections. It also helps understand how nurses implement nursing interventions to prevent and reduce cases of chest infections such as ventilator-associated pneumonia (VAP). More importantly, it is essential to answer this question to understand the contribution of nurses in controlling chest infections, primarily for patients in the intensive care unit (ICU). 

The prevalence of VAP continues to increase in ICU. The incidence of chest infection is 5 to 40%, thus making it one of the most frequent ICU-acquired infections. It is also a significant health concern for patients with prolonged ICU stay when they are mechanically ventilated. Thus, answering this question will help reduce the incidence and prevalence of VAP in the ICU. The mortality rate associated with VAP in ICU is approximately 10%. Therefore, addressing the research question will help nurses to reduce deaths caused by a chest infection.

Additionally, the research question is essential in clinical practice because it explores evidence-based practices nurses need to implement to prevent and reduce VAP. Thus, nurses or midwifes should know the evidence-based answer to the question to minimise ventilator exposure. The information will improve clinical practice because nurses will provide excellent oral hygiene care as an evidence-based practice for controlling VAP. Answering this question via evidence-based practices also helps nurses to coordinate care for subglottic suctioning. Nurses will also learn how to maintain optimal positioning and encourage VAP patients’ mobility. 

Methodology

The method applied is the inclusion and exclusion criteria in the search strategy. The approach assisted in the critical analysis of keywords when applied together with each published source relevant to the research question. These search strategy helped to reduce the probability of accessing irrelevant articles that do not reflect an evidence-based answer. The search strategy also focused on using currently published sources not older than five years (Mohamed Shaffril et al., 2021). Thus, the sources used were published in 2019 upwards. This was the inclusion criteria for the published sources utilised to answer the research question. The exclusion criteria in the search strategy involved eliminating all the sources older than five years to ensure all the information used is updated to the current evidence-based practices for helping nurses control chest infections in the intensive care unit.

Another inclusion criterion in the search strategy is ensuring that all the published sources used are published in English to eliminate language barriers in answering the research question. More importantly, the search strategy mainly utilised asterisks that helped to highlight keywords (Mohamed Shaffril et al., 2021). Some keywords and subject headings used in the search strategy include nursing roles, intensive care unit, chest infections, ventilator-based pneumonia, controlling chest infections, and nurses’ impacts in reducing VAP.

The data extraction process was also applied to obtain evidence-based published literature via a SRDR (Systematic Review Data Repository) as data extraction tool (Saldanha et al., 2019). Data been extracted by screening the abstract and full text of sources to determine whether they were published sources. The following eligibility criteria were used during the data extraction process. First, full-text publications showing the NLP strategy for data extraction related to publish sources to answer the research question were used. Data extraction also involves using scholarly articles published from 2019 until the present day to ensure the information used to address the research question is updated. All the sources were written in English, but it was possible to translate non-English publications to extract data. Overall, the data extraction process ensured that data contained in the published sources contained texts from randomised controlled trials, meta-analyses, comparative cross-sectional studies, control studies, and comparative cohort studies to provide different levels of evidence. The approach used in data extraction ensures the information from published sources is aligned to the high accuracy to demonstrate the roles and impacts of nurses in controlling chest infections in the ICU. 

The sources used in the research were obtained from databases via an inclusion criterion that made sure the four papers are published sources. For example, published scholarly sources were searched from various databases to obtain evidence-based information for answering the questions. The method also used the PICO tool to set the research question.

The search strategy incorporates various databases to obtain published scholarly sources that provide an evidence-based answer to the research question (Al-Sayaghi, 2021). As a researcher of a healthcare topic, it is essential to search for published literature from several healthcare and social care databases. First, it involves using different databases because no single database provides a complete and comprehensive search from published scholarly sources to answer the research question. Thus, it is essential to rely on multiple databases to obtain evidence-based published literature that captures the research from a broad collection of sources. Data presented in the paper helped distinguish reviews from published sources since published paper contains author’s ideas, research, and present new data from author’s experiment. It also used multiple databases to distinguish systematic reviews from traditional literature reviews, thus reducing bias as much as possible. Based on that, the following databases were used in search strategy. 

First, Medline Database was used because it provides information relating to biomedical information, life sciences, wellness issues, and health conditions. Medline Database was used because of its distinctive feature of indexing records with NLM’s controlled vocabulary to make it easy to find relevant published literature. Medline Database was also viable and feasible as a search strategy because it contains Medical Subject Headings (MESH) to provide relevant published sources (Mohamed Shaffril et al., 2021). Medline Database was used as a search strategy because it is freely available through PubMed. The second database used is Embase. This database was essential in providing published scholarly sources related to the topic. It is also highly used when looking for biomedical information. The third database used was Cochrane Library, which provided a high level of evidence of published literature on randomised control trials to address the research question in an evidence-based manner. Another database used to search for published literature is Web of Science-Clarivate Analytics (Mohamed Shaffril et al., 2021). It helped to search for highly cited articles related to the research question. The current research also applied Google Scholar and PubMed as search engines for obtaining published literature on nurses’ impacts in reducing or controlling ventilator-associated pneumonia. Google Scholar helped to locate more superior published sources related to the research question than those obtained through PubMed.

Nonetheless, the priority of the database will be presented as a PRISMA diagram. PubMed Database is prioritised in the search strategy because it focuses on nursing information, topics, and insights relating to the research question. Thus, the following PRISMA diagram demonstrates the priority of databases used in the search strategy. 

Apart from using the databases, the search strategy also relied on critical concepts and terms to obtain published literature for the research question. When using keywords to research information relating to the research question, the keywords were restricted to subject headings and to the key terms related to healthcare concerns. The search strategy helped reduce bias when connecting to the desired published scholarly sources and expanding the scope of the topic to provide an evidence-based answer. 

Critical Appraisal

The critical appraisal will focus on the four published papers presented to address the research question on the roles of nurses in controlling VAP. The critical appraisal also summarises the relevance and quality of the paper used to review and answer the research question (Mohamed Shaffril et al., 2021). The critical appraisal used to select the four papers involved five steps. The first step involved asking the research question. The critical appraisal then involved obtaining published papers that would provide the best research literature. The third step involved critically appraising the published papers. The fourth step involved integrating the evidence from the research papers into the research question. Lastly, the outcomes were evaluated to determine whether the published papers thoroughly answered the research question.

The research question is answered by four papers found in the databases. Each paper has unique information to demonstrate the nurses’ impacts in controlling or preventing VAP. Thus, it is essential to present the findings of each paper in line with the research question. 

The first paper was written by Al-Sayaghi (2021). The overview of this paper is that Ventilator-associated pneumonia affects many patients in various healthcare units. Therefore, the author researches how critical care nurses contribute to preventing VAP. Critical care nurses must comply with prevention guidelines for controlling VAP to improve health outcomes in the ICU and other critical areas. The articles also focused on the limitations and barriers encountered by nurses as they integrate and implement clinical guidelines for preventing VAP. The author performed the study in the Kingdom of Saudi Arabia, where the main participants were nurses. The author invited 283 nurses to participate in the study. The clinical setting involved in this paper was the ICUs, where critical care nurses and eight ICUs in five public hospitals were involved in determining their contribution to implementing guidelines for preventing VAP.

The second paper used in the research was written by Bhalerao & Tambey (2021). The overview of this paper is that ICU patients are at higher risk of developing VAP, one of the most common nosocomial infections. The paper focused on exploring the case facility rate, risk factors, and incidence of VAP to allow nurses in the intensive care unit to reduce the incidence and prevalence. The study was conducted in a tertiary-level hospital in the United States to understand how nurses can reduce risk factors leading to VAP in ICUs. 

The third paper was written by Bhandari et al. (2021). The overview of this paper is that their clinical knowledge highly influences the role of nurses in preventing VAP. It is also determined by the nursing practices applied to deal with nosocomial and chest infections. This paper mainly focused on assessing ICU nursing knowledge to prevent VAP in a tertiary-level cardiac center. The study was conducted in Nepal, and the clinical setting used was the tertiary-level cardiac center. 

The fourth paper used in the research was written by Yin et al. (2022). The overview of this paper is that nurses have great influence in the ICU because they undertake different activities to prevent, reduce, and control VAP.

Findings

Al-Sayaghi (2021) used a cross-sectional study. For example, the author conducted a cross-sectional descriptive survey utilising a self-administered questionnaire to determine the best strategies for controlling and preventing VAP. Although a cross-sectional study falls at the lowest level of evidence, the article by Al-Sayaghi (2021) was relevant to the research question because it recommended strategies that nurses in the ICU should implement to prevent VAP. It also presented some barriers nurses need to overcome when preventing VAP. The quality of a cross-sectional study used in the article as a critical appraisal tool meets the criteria for addressing the research question because the survey was conducted on critical care nurses at eight ICUs from five public hospitals. This shows that high-quality information was obtained since it involved evidence-based practices used by nurses in ICU to prevent VAP.

Bhalerao & Tambey (2021) used observational study. The authors conducted a prospective observational study to determine the incidence of VAP in ICU. Thus, this article is relevant to the research question because it eludes that nurses play a critical role in preventing chest infections through regular surveillance of antibiotic susceptibility patterns that help eliminate Acinetobacter, which is mainly responsible for VAP. The level of evidence for this article is level 3 since it is an observational study. Thus, the article is of low strength/quality. 

Bhandari et al. (2021) used a descriptive study. The authors used the descriptive study to evaluate the knowledge of nurses working in the intensive care unit to address and prevent VAP. This article is relevant to the research question. According to Bhandari et al. (2021), nurses effectively and successfully participate in preventing VAP due to their high level of knowledge and practices in the clinical environment. The article assessed nurses’ knowledge in critical care and concluded that nurses are highly skilled and knowledgeable in preventing VAP. This article falls under level 6 in the hierarchy of evidence. However, it contains quality information since it recommends additional training for nurses on how to deal with chest infections and prevent VAP. 

Yin et al. (2022) elude that nurses in the ICU perform their roles differently in VAP prevention because they have different levels of seniority, staffing, education, working shifts, and nursing specialisation. These factors determine the quality of care offered by critical care nurses in preventing chest infections. However, this paper recommends that healthcare organisations increase nurses’ allocation in the ICU to reduce the incidence of VAP. The study was conducted in Hebei Province in China. The clinical setting used for the research was the ICU. Yin et al. (2022) used a quantitative study to investigating the factors influencing nursing roles in preventing VAP. This article is relevant to the research question because it presents the contribution of nurses in critical care and the nursing factors that determine nurses’ impacts in preventing VAP. This article is of high quality because it uses questionnaires to collect information from nurses regarding preventing VAP. Yin et al. (2022) argue that all nurses, both experienced and less experienced, play a fundamental role in preventing and reducing VAP as long as the ratio of nurses to patients is adequate to improve the quality of care in the ICU and other critical care areas. 

Themes

The four papers present themes that help address the research question and provide an evidence-based answer.

Common findings in the research

The first theme is common findings in the research. This theme is illustrated through nursing roles in critical care areas. This theme is captured by Al-Sayaghi (2021), stating that nurses in the critical care unit embrace compliance guidelines that help in preventing VAP. Nurses’ key roles include invasive mechanical ventilation and tracheal intubation to control VAP. The nurse applies these procedures and guidelines to help intensive care patients who are critically ill. The finding of nursing roles in the critical care areas has been presented by Bhalerao & Tambey (2021) by assessing how nurses help address the incidence and risk factors of VAP. Therefore, adequate nursing staffing is a critical factor that explains the low incidence of VAP in the ICU. Thus, it is essential to ensure nurse to patient ratio is 1:1 to improve strategies for preventing chest infections in the ICU. This theme relates to nursing roles in critical care areas and is effectively captured by Bhandari et al. (2021). This paper presents this theme by demonstrating how practices and knowledge of nursing influence their roles in preventing VAP. Thus, nurses with higher knowledge perform their roles better than those with lower knowledge, thus influencing the healthcare outcome of nosocomial infection patients in critical care areas. Lastly, the nursing roles in the critical care areas have been captured by Yin et al. (2022) by demonstrating how nursing qualifications influence their roles in preventing VAP. Therefore, the roles of nurses are determined by their level of education, staffing, seniority, work shifts, and experience to determine the outcome of addressing nosocomial infections in the ICU. 

The second illustration for the theme of common findings in the research that appears across the four papers is VAP prevention. Each paper presents this theme by focusing on the nursing requirements for preventing chest infections. For example, the theme of VAP prevention has been captured by Al-Sayaghi (2021) stating that nurses should implement prevention guidelines and eliminate barriers that may undermine the prevention process. Some of the guidelines for prevention include mechanical ventilation, incubation, and providing respiratory care to patients in the ICU. Bhalerao & Tambey (2021) demonstrate the theme of preventing VAP by identifying the risk factors that should be addressed to reduce the high incidence and prevalence of the infection. Bhandari et al. (2021) addressed this theme by recommending an increase in the nursing staff and improving their skills and knowledge through adequate training on nosocomial infections and prevention. Lastly, the aspect of preventing chest infection has been captured by Yin et al. (2022) by resolving the shortage of nurses in the ICU. Prevention can also be achieved through other interventions such as mechanical ventilation, but nurses should address complications associated with this intervention when treating ICU patients with chest infections. 

Common methodological approaches in the research

The second theme is common methodological approaches in the research. For example, the research by Al-Sayaghi (2021) and Bhandari et al. (2021) used a descriptive study that involved collecting information via a questionnaire. For example, Al-Sayaghi (2021) applied a cross-sectional descriptive survey. The author also administered questionnaires to allow 283 critical care nurses to present their recommendations on the most suitable strategies for preventing VAP. The questionnaire also invited critical care nurses to identify key barriers undermining the prevention of chest infections. Based on the findings obtained from the questionnaires, critical care nurses argued that hospital cost control policies, forgetfulness, and shortage of nursing staff undermine the prevention of VAP. On the other hand, questionnaires were used by Bhandari et al. (2021) in a descriptive study to allow 57 critical care nurses to present their knowledge in addressing VAP. The findings of the descriptive study by Bhandari et al. (2021) reveal that nursing in the intensive care unit has sufficient knowledge and experience in preventing chest infections. 

The article by Yin et al. (2022) also applied questionnaires in the methodology section. The authors administered questionnaires to collect data from nurses in the intensive care unit. Thirty-two tertiary hospitals in Hebei Province, China, were involved in the questionnaire. Nurses who participated in the questionnaires provided data about the incidence of VAP in the intensive care unit and how nursing staff contributes towards the prevention. The nursing factors influencing the prevention of chest infections were correlated with the incidence of VAP. The findings indicate that cases of chest infections in the intensive care unit increase when the number of nurses assigned to the patients is low. Thus, the questionnaire revealed that increasing the number of nurses in critical care areas is a fundamental milestone in preventing chest infections. 

Mathematical description

Mathematical description has been used in the four papers to present the findings. The mathematical description in the article by Al-Sayaghi (2021) is that the mean compliance score for nursing using prevention guidelines for VAP was 85.9%. Also, over 54% of the nurses exhibited acceptable compliance levels. Mathematical description as a conceptual framework was also used by Bhandari et al. (2021) when the authors stated that 75.4% of nurses involved in the prevention of VAP in the ICU had completed their Bachelor’s degree, thus demonstrating their knowledge. Also, 91.3% of the nurses have over one year of experience in the critical care areas, thus making them qualified and eligible to prevent chest infections. The mathematical description was used as a conceptual framework by Yin et al. (2022) because the mathematical ratio compared the outcome of nurses to patient ratio in preventing VAP. The patient-to-nurse ratio of 2:1 was ineffective in preventing chest infections. Thus, this paper recommended an adequate patient-to-nurse ratio to reduce their risk of chest infections. Lastly, mathematical description as a conceptual framework was used by Bhalerao & Tambey (2021) by recommending a nurse-to-patient ratio of 1:1 to lower the incidence of chest infections in the ICU. 

Application to Practice

The evidence obtained in answering the research question impacts nursing practice as a future nurse in several ways. First, the evidence demonstrated that nurses play critical roles in controlling nosocomial infections in the ICU. As a future nurse, infection control measures and interventions are essential in controlling and preventing chest infections. Therefore, extensive training of nurses is paramount in ensuring the incidence of chest infections in the ICU reduces significantly. The evidence also demonstrated that nurses should embrace safety measures when offering care to ICU patients to reduce and prevent VAP and other nosocomial infections (Bhalerao & Tambey, 2021). The evidence will impact nursing practice for future nurses because it is essential to observe infection control measures in the ICU, such as using personal protective equipment. In other words, it is essential for nurses to prevent chest infections by wearing protective gear such as gowns, masks, and gloves. The evidence also impacts future nursing practice because it demonstrates that nurses should be involved in patient monitoring, patient education, and guiding patients’ family on how to behave when visiting patients in the ICU to reduce and prevent nosocomial infections. As a future nurse, the evidence has emphasized the importance of observing hand hygiene to prevent infections in the ICU. Thus, the papers used to answer the research question provided evidence-based practices that assist future nurses in delivering patient-centered standards of care in critical care areas such as ICUs. 

Another piece of evidence obtained from the papers to answer the research question is that the most fundamental element in controlling ICU infections is ensuring ICU patients are free from chest infections or VAP. The evidence shows that the chest is highly vulnerable to infections, especially in ICU patients. As a future nurse practitioner, this evidence impacts nursing practice because it informs critical care nurses to take full responsibility and utilise every opportunity to perform clinical examination and diagnosis in patients in the ICU. For example, a nurse should assess chest pain to control and reduce chest infections (Bhandari et al., 2021). Chest pain assessment will help future nurses to rule out chest infections from other health problems. As a future nurse, the evidence guides nurses in managing patients in critical care areas to reduce chest infections. The evidence also shows that nurses should follow strict infection control protocols. Thus, the evidence will impact nursing practice for future nurses. Nurses should avoid using contaminated medical devices like suction devices and endotracheal tubes when treating patients with Ventilator-associated pneumonia. Nurses should also observe and practice meticulous hand hygiene prior to using medical devices to assist ICU patients. 

The theme of common findings in research implies that nurses contribute to preventing chest infections through various control strategies. Some common findings in reducing and preventing VAP via nursing interventions are; reducing ventilator exposure, offering excellent oral and hand hygiene, care coordination for subglottic suctioning, increasing staffing of nurses, and maintaining optimal position. The finding to minimise mechanical ventilator exposure to the patients provides evidence-based practice for reducing and preventing VAP. The theme implies that nurses should use other safer alternatives, such as noninvasive ventilation approaches to reduce complications caused by mechanical ventilators (Bhandari et al., 2021). However, some circumstances require mechanical ventilation, thus making it inevitable in the ICU. It implies that nurses should reduce the duration of using mechanical ventilators via evidence-based care bundles and Ventilator weaning protocols (Bhandari et al., 2021). The common findings indicate that oral hygiene should be prioritised during intubation procedures to minimise the risk of chest infections. The common finding of increasing the staffing of nurses in the ICU implies that hospitals should hire more nurses to reduce the shortage of nurses. A nurse-to-patient ratio of 1:1 is fundamental in minimising the risk of infections, especially in mechanically ventilated patients.

From a person-centered practice, it is essential to recommend healthcare organizations to improve nurses’ working environment and promote interprofessional collaboration to reduce the risk of chest infections in the ICU. In this regard, local and national priorities in health and social care include increasing the number of nurses and allocating adequate resources to equip nurses to treat ICU patients, thus reducing and preventing chest infections. Also, further research on how nurses can work closely with other healthcare providers, such as doctors, therapists, and other health professionals, to control chest infections in clinical units other than the ICU should be embraced. Further study should be conducted to determine the incidence of chest infection in hospitals after nurses have implemented nursing strategies and interventions to control VAP. The study will help assess the effectiveness of infection control measures and protocols in the ICU (Bhandari et al., 2021). Overall, the literature review experienced some limitations. For example, very few sources focused on chest infections, even after using filters and asterisks. Most sources were showing VAP rather than chest infections. Therefore, VAP represents chest infections because it is what most of the published sources displaced in the databases. The search for published sources to answer the question also followed all ethical considerations to eliminate conflict of interests that would undermine the research.

 

References

Al-Sayaghi, K. M. (2021). Critical care nurses’ compliance and barriers toward ventilator-associated pneumonia prevention guidelines: Cross-sectional survey. Journal of Taibah University Medical Sciences, 16(2), 274-282.

Bhalerao, J. D., & Tambey, R. (2021). Ventilator associated pneumonia in intensive care unit of a tertiary level hospital. Global Journal for Research Analysis, 21-24.

Bhandari, S., Sharma, M., & Shrestha, G. S. (2021). Knowledge of nurses working in critical care areas regarding ventilator associated pneumonia prevention bundles in a tertiary level cardiac centre. Journal of Institute of Medicine Nepal, 43(1), 36-42.

Mohamed Shaffril, H. A., Samsuddin, S. F., & Abu Samah, A. (2021). The ABC of systematic literature review: the basic methodological guidance for beginners. Quality & Quantity, 55, 1319-1346.

Saldanha, I. J., Smith, B. T., Ntzani, E., Jap, J., Balk, E. M., & Lau, J. (2019). The Systematic Review Data Repository (SRDR): descriptive characteristics of publicly available data and opportunities for research. Systematic reviews, 8(1), 1-12.

Yin, Y., Sun, M., Li, Z., Bu, J., Chen, Y., Zhang, K., & Hu, Z. (2022). Exploring the nursing factors related to ventilator-associated pneumonia in the intensive care unit. Frontiers in Public Health, 10.

 

Appendix

Appendix 1: Data Extraction Table

6013NHS – Marking Criteria

Total word count is 4000 words (+/- 10%).

% RELEVANCE of the ANSWER ARGUMENT and COHERENCE EVIDENCE Summary First 90, 95, 100 82, 85, 88 72, 75, 78 Innovative response, answers the question fully, addressing the learning objectives of the assessment task in detail. Has followed the set structure of the assignment and clearly identified the key sections of the review in a detailed, concise, and where appropriate replicable manner. Has used appropriate tools and provided examples or copies, as appropriate. Evidence of critical analysis, synthesis, and evaluation. A clear, consistent in-depth critical and evaluative argument, displaying the ability to develop original ideas using the appropriate critique tools. Has developed a concise analysis of the evidence and displays the ability to apply this new knowledge to practice. Used the correct analysis tools either thematic or narrative analysis to build a strong argument. Engagement with theoretical and conceptual analysis. Wide range of appropriately supporting evidence provided, going beyond the recommended texts. Correctly referenced. Has included a high level of relevant articles with this being correctly cited, successfully supporting ideas, and referenced. An outstanding, well-structured, and appropriately referenced answer, demonstrating a high degree of understanding, critical analytic skills and application to practice. Upper Second 62. 65, 68 A very good attempt to address the objectives of the assessment task with an emphasis on the set structure of the assignment. Appropriate use of tools to show the review of the literature. A generally clear line of critical and evaluative argument is presented. Relationships between statements and sections are easy to follow, and there is a sound, coherent structure. Critical appraisal tool and analysis is clear and guides the writing. A very good range of relevant sources is used in a largely consistent way as supporting evidence. There is use of some sources beyond recommended texts. Correctly referenced in the main. The articles used apply to the question. The answer demonstrates a very good understanding of evidence and application to practice, with evidence of reading beyond the recommended minimum. Well organised and clearly written. Lower Second 52, 55, 58 Competently addresses objectives but may contain errors or omissions and clear demonstration of the review process, analysis and application may be superficial or limited in places. Although there is evidence of an appropriate set structure, the work is underdeveloped and lacks in-depth understanding. Some critical appraisal and analysis, but the argument is not convincing or applied to practice. The work is descriptive in most places, with a lack of evaluative and analytical writing. Critical appraisal tool and analysis is present but lacks clarity. A range of relevant sources is used. There is limited use of sources beyond the standard recommended materials. Referencing is not always correctly presented. The articles used apply to some aspects of the question. The answer demonstrates a good understanding of evidence and application to practice, but there are some errors and irrelevant material included. The ‘set structure’ lacks clarity. Third 42, 45, 48 Addresses some of the objectives of the assessment, with some notable omissions. The structure is unclear in parts, and there is limited in-depth understanding. The search strategy AND/OR analysis AND/OR application may not be clear or well discussed and there is limited evidence of in-depth understanding. The work is descriptive with little evaluative and analytical writing. Mention of critical appraisal and analysis, however this has not been applied well to practice. A limited range of relevant sources are used, without appropriate presentation as supporting or conflicting evidence, and very limited critical analysis. Referencing has some errors. The articles used do not apply clearly to the question and require further link. Some understanding is demonstrated but is incomplete, and there is little evidence and application to practice. Poor use of set structure with few and/or poorly presented references. Fail 35, 30, 20, 10, 0 Some deviation from the objectives of the assessment task. May not consistently address the assignment brief. At the lower end fails to answer the question set or address the learning outcomes. There is minimal evidence of search strategy, analysis, or application. A review of the literature process has not been followed correctly. Descriptive with no evidence of critical discussion or analysis. At the lower end displays a minimal level of understanding. Argument is not clear. Very limited use and application of relevant sources as supporting evidence. At the lower end demonstrates a lack of real understanding. Poor presentation of references. The articles used do not apply to the question and do not answer what is being asked. Whilst some relevant material is present, the level of understanding is poor with limited evidence of wider reading. The set structure was not used. At the lower end there is no evidence and application to practice, resulting in an assignment which is well below the required standard.

 

How influential are the nurses’ roles in controlling chest infections in the ICU to reduce the frequency and prevent their spread compared to nurse aids?

Student’s Name:

Institutional Affiliation:

Course Name:

Instructor’s Name:

Date:

 

Research Proposal: How influential are the nurses’ roles in controlling chest infections in the ICU to reduce the frequency and prevent their spread compared to nurse aids?

The following are the four papers

Al-Sayaghi, K. M. (2021). Critical care nurses’ compliance and barriers toward ventilator-associated pneumonia prevention guidelines: Cross-sectional survey. Journal of Taibah University Medical Sciences, 16(2), 274-282.

Bhalerao, J. D., & Tambey, R. (2021). Ventilator associated pneumonia in intensive care unit of a tertiary level hospital. Global Journal For Research Analysis, 21-24.

Bhandari, S., Sharma, M., & Shrestha, G. S. (2021). Knowledge of nurses working in critical care areas regarding ventilator associated pneumonia prevention bundles in a tertiary level cardiac centre. Journal of Institute of Medicine Nepal, 43(1), 36-42.

Yin, Y., Sun, M., Li, Z., Bu, J., Chen, Y., Zhang, K., & Hu, Z. (2022). Exploring the nursing factors related to ventilator-associated pneumonia in the intensive care unit. Frontiers in Public Health, 10.

How influential are the nurses’ roles in controlling chest infections in the ICU compared to nurse aids?

Student’s Name: Ayah Alhowaidi

Student ID: 10516416

Words count: 4130.

Table of Content Contents

 

Rationale for Question

One of the healthcare concerns affecting patients in the ICU is chest infections. Nurses are equipped to deal with chest infections to improve patient safety and health outcomes. Thus, it is essential to explore the role of nurses in treating chest infections by answering a research question. The research question under consideration is “How influential are the nurses’ roles in controlling chest infections in the ICU compared to nurse aids?” This question is essential in clinical practice because the incidence of ventilator-associated pneumonia has been increasing significantly, thus increasing the number of patients with complications of healthcare-related infections. In this regard, answering this question helps to understand the roles played by nurses in diagnosing chest infections. It also helps understand how nurses implement nursing interventions to prevent and reduce cases of chest infections such as ventilator-associated pneumonia (VAP). More importantly, it is essential to answer this question to understand the contribution of nurses in controlling chest infections, primarily for patients in the intensive care unit (ICU). 

The prevalence of VAP continues to increase in ICU. The incidence of chest infection is 5 to 40%, thus making it one of the most frequent ICU-acquired infections. It is also a significant health concern for patients with prolonged ICU stay when they are mechanically ventilated. Thus, answering this question will help reduce the incidence and prevalence of VAP in the ICU. The mortality rate associated with VAP in ICU is approximately 10%. Therefore, addressing the research question will help nurses to reduce deaths caused by a chest infection.

Additionally, the research question is essential in clinical practice because it explores evidence-based practices nurses need to implement to prevent and reduce VAP. Thus, nurses or midwifes should know the evidence-based answer to the question to minimise ventilator exposure. The information will improve clinical practice because nurses will provide excellent oral hygiene care as an evidence-based practice for controlling VAP. Answering this question via evidence-based practices also helps nurses to coordinate care for subglottic suctioning. Nurses will also learn how to maintain optimal positioning and encourage VAP patients’ mobility. 

Methodology

The method applied is the inclusion and exclusion criteria in the search strategy. The approach assisted in the critical analysis of keywords when applied together with each published source relevant to the research question. These search strategy helped to reduce the probability of accessing irrelevant articles that do not reflect an evidence-based answer. The search strategy also focused on using currently published sources not older than five years (Mohamed Shaffril et al., 2021). Thus, the sources used were published in 2019 upwards. This was the inclusion criteria for the published sources utilised to answer the research question. The exclusion criteria in the search strategy involved eliminating all the sources older than five years to ensure all the information used is updated to the current evidence-based practices for helping nurses control chest infections in the intensive care unit.

Another inclusion criterion in the search strategy is ensuring that all the published sources used are published in English to eliminate language barriers in answering the research question. More importantly, the search strategy mainly utilised asterisks that helped to highlight keywords (Mohamed Shaffril et al., 2021). Some keywords and subject headings used in the search strategy include nursing roles, intensive care unit, chest infections, ventilator-based pneumonia, controlling chest infections, and nurses’ impacts in reducing VAP.

The data extraction process was also applied to obtain evidence-based published literature via a SRDR (Systematic Review Data Repository) as data extraction tool (Saldanha et al., 2019). Data been extracted by screening the abstract and full text of sources to determine whether they were published sources. The following eligibility criteria were used during the data extraction process. First, full-text publications showing the NLP strategy for data extraction related to publish sources to answer the research question were used. Data extraction also involves using scholarly articles published from 2019 until the present day to ensure the information used to address the research question is updated. All the sources were written in English, but it was possible to translate non-English publications to extract data. Overall, the data extraction process ensured that data contained in the published sources contained texts from randomised controlled trials, meta-analyses, comparative cross-sectional studies, control studies, and comparative cohort studies to provide different levels of evidence. The approach used in data extraction ensures the information from published sources is aligned to the high accuracy to demonstrate the roles and impacts of nurses in controlling chest infections in the ICU. 

The sources used in the research were obtained from databases via an inclusion criterion that made sure the four papers are published sources. For example, published scholarly sources were searched from various databases to obtain evidence-based information for answering the questions. The method also used the PICO tool to set the research question.

The search strategy incorporates various databases to obtain published scholarly sources that provide an evidence-based answer to the research question (Al-Sayaghi, 2021). As a researcher of a healthcare topic, it is essential to search for published literature from several healthcare and social care databases. First, it involves using different databases because no single database provides a complete and comprehensive search from published scholarly sources to answer the research question. Thus, it is essential to rely on multiple databases to obtain evidence-based published literature that captures the research from a broad collection of sources. Data presented in the paper helped distinguish reviews from published sources since published paper contains author’s ideas, research, and present new data from author’s experiment. It also used multiple databases to distinguish systematic reviews from traditional literature reviews, thus reducing bias as much as possible. Based on that, the following databases were used in search strategy. 

First, Medline Database was used because it provides information relating to biomedical information, life sciences, wellness issues, and health conditions. Medline Database was used because of its distinctive feature of indexing records with NLM’s controlled vocabulary to make it easy to find relevant published literature. Medline Database was also viable and feasible as a search strategy because it contains Medical Subject Headings (MESH) to provide relevant published sources (Mohamed Shaffril et al., 2021). Medline Database was used as a search strategy because it is freely available through PubMed. The second database used is Embase. This database was essential in providing published scholarly sources related to the topic. It is also highly used when looking for biomedical information. The third database used was Cochrane Library, which provided a high level of evidence of published literature on randomised control trials to address the research question in an evidence-based manner. Another database used to search for published literature is Web of Science-Clarivate Analytics (Mohamed Shaffril et al., 2021). It helped to search for highly cited articles related to the research question. The current research also applied Google Scholar and PubMed as search engines for obtaining published literature on nurses’ impacts in reducing or controlling ventilator-associated pneumonia. Google Scholar helped to locate more superior published sources related to the research question than those obtained through PubMed.

Nonetheless, the priority of the database will be presented as a PRISMA diagram. PubMed Database is prioritised in the search strategy because it focuses on nursing information, topics, and insights relating to the research question. Thus, the following PRISMA diagram demonstrates the priority of databases used in the search strategy. 

Apart from using the databases, the search strategy also relied on critical concepts and terms to obtain published literature for the research question. When using keywords to research information relating to the research question, the keywords were restricted to subject headings and to the key terms related to healthcare concerns. The search strategy helped reduce bias when connecting to the desired published scholarly sources and expanding the scope of the topic to provide an evidence-based answer. 

Critical Appraisal

The critical appraisal will focus on the four published papers presented to address the research question on the roles of nurses in controlling VAP. The critical appraisal also summarises the relevance and quality of the paper used to review and answer the research question (Mohamed Shaffril et al., 2021). The critical appraisal used to select the four papers involved five steps. The first step involved asking the research question. The critical appraisal then involved obtaining published papers that would provide the best research literature. The third step involved critically appraising the published papers. The fourth step involved integrating the evidence from the research papers into the research question. Lastly, the outcomes were evaluated to determine whether the published papers thoroughly answered the research question.

The research question is answered by four papers found in the databases. Each paper has unique information to demonstrate the nurses’ impacts in controlling or preventing VAP. Thus, it is essential to present the findings of each paper in line with the research question. 

The first paper was written by Al-Sayaghi (2021). The overview of this paper is that Ventilator-associated pneumonia affects many patients in various healthcare units. Therefore, the author researches how critical care nurses contribute to preventing VAP. Critical care nurses must comply with prevention guidelines for controlling VAP to improve health outcomes in the ICU and other critical areas. The articles also focused on the limitations and barriers encountered by nurses as they integrate and implement clinical guidelines for preventing VAP. The author performed the study in the Kingdom of Saudi Arabia, where the main participants were nurses. The author invited 283 nurses to participate in the study. The clinical setting involved in this paper was the ICUs, where critical care nurses and eight ICUs in five public hospitals were involved in determining their contribution to implementing guidelines for preventing VAP.

The second paper used in the research was written by Bhalerao & Tambey (2021). The overview of this paper is that ICU patients are at higher risk of developing VAP, one of the most common nosocomial infections. The paper focused on exploring the case facility rate, risk factors, and incidence of VAP to allow nurses in the intensive care unit to reduce the incidence and prevalence. The study was conducted in a tertiary-level hospital in the United States to understand how nurses can reduce risk factors leading to VAP in ICUs. 

The third paper was written by Bhandari et al. (2021). The overview of this paper is that their clinical knowledge highly influences the role of nurses in preventing VAP. It is also determined by the nursing practices applied to deal with nosocomial and chest infections. This paper mainly focused on assessing ICU nursing knowledge to prevent VAP in a tertiary-level cardiac center. The study was conducted in Nepal, and the clinical setting used was the tertiary-level cardiac center. 

The fourth paper used in the research was written by Yin et al. (2022). The overview of this paper is that nurses have great influence in the ICU because they undertake different activities to prevent, reduce, and control VAP.

Findings

Al-Sayaghi (2021) used a cross-sectional study. For example, the author conducted a cross-sectional descriptive survey utilising a self-administered questionnaire to determine the best strategies for controlling and preventing VAP. Although a cross-sectional study falls at the lowest level of evidence, the article by Al-Sayaghi (2021) was relevant to the research question because it recommended strategies that nurses in the ICU should implement to prevent VAP. It also presented some barriers nurses need to overcome when preventing VAP. The quality of a cross-sectional study used in the article as a critical appraisal tool meets the criteria for addressing the research question because the survey was conducted on critical care nurses at eight ICUs from five public hospitals. This shows that high-quality information was obtained since it involved evidence-based practices used by nurses in ICU to prevent VAP.

Bhalerao & Tambey (2021) used observational study. The authors conducted a prospective observational study to determine the incidence of VAP in ICU. Thus, this article is relevant to the research question because it eludes that nurses play a critical role in preventing chest infections through regular surveillance of antibiotic susceptibility patterns that help eliminate Acinetobacter, which is mainly responsible for VAP. The level of evidence for this article is level 3 since it is an observational study. Thus, the article is of low strength/quality. 

Bhandari et al. (2021) used a descriptive study. The authors used the descriptive study to evaluate the knowledge of nurses working in the intensive care unit to address and prevent VAP. This article is relevant to the research question. According to Bhandari et al. (2021), nurses effectively and successfully participate in preventing VAP due to their high level of knowledge and practices in the clinical environment. The article assessed nurses’ knowledge in critical care and concluded that nurses are highly skilled and knowledgeable in preventing VAP. This article falls under level 6 in the hierarchy of evidence. However, it contains quality information since it recommends additional training for nurses on how to deal with chest infections and prevent VAP. 

Yin et al. (2022) elude that nurses in the ICU perform their roles differently in VAP prevention because they have different levels of seniority, staffing, education, working shifts, and nursing specialisation. These factors determine the quality of care offered by critical care nurses in preventing chest infections. However, this paper recommends that healthcare organisations increase nurses’ allocation in the ICU to reduce the incidence of VAP. The study was conducted in Hebei Province in China. The clinical setting used for the research was the ICU. Yin et al. (2022) used a quantitative study to investigating the factors influencing nursing roles in preventing VAP. This article is relevant to the research question because it presents the contribution of nurses in critical care and the nursing factors that determine nurses’ impacts in preventing VAP. This article is of high quality because it uses questionnaires to collect information from nurses regarding preventing VAP. Yin et al. (2022) argue that all nurses, both experienced and less experienced, play a fundamental role in preventing and reducing VAP as long as the ratio of nurses to patients is adequate to improve the quality of care in the ICU and other critical care areas. 

Themes

The four papers present themes that help address the research question and provide an evidence-based answer.

Common findings in the research

The first theme is common findings in the research. This theme is illustrated through nursing roles in critical care areas. This theme is captured by Al-Sayaghi (2021), stating that nurses in the critical care unit embrace compliance guidelines that help in preventing VAP. Nurses’ key roles include invasive mechanical ventilation and tracheal intubation to control VAP. The nurse applies these procedures and guidelines to help intensive care patients who are critically ill. The finding of nursing roles in the critical care areas has been presented by Bhalerao & Tambey (2021) by assessing how nurses help address the incidence and risk factors of VAP. Therefore, adequate nursing staffing is a critical factor that explains the low incidence of VAP in the ICU. Thus, it is essential to ensure nurse to patient ratio is 1:1 to improve strategies for preventing chest infections in the ICU. This theme relates to nursing roles in critical care areas and is effectively captured by Bhandari et al. (2021). This paper presents this theme by demonstrating how practices and knowledge of nursing influence their roles in preventing VAP. Thus, nurses with higher knowledge perform their roles better than those with lower knowledge, thus influencing the healthcare outcome of nosocomial infection patients in critical care areas. Lastly, the nursing roles in the critical care areas have been captured by Yin et al. (2022) by demonstrating how nursing qualifications influence their roles in preventing VAP. Therefore, the roles of nurses are determined by their level of education, staffing, seniority, work shifts, and experience to determine the outcome of addressing nosocomial infections in the ICU. 

The second illustration for the theme of common findings in the research that appears across the four papers is VAP prevention. Each paper presents this theme by focusing on the nursing requirements for preventing chest infections. For example, the theme of VAP prevention has been captured by Al-Sayaghi (2021) stating that nurses should implement prevention guidelines and eliminate barriers that may undermine the prevention process. Some of the guidelines for prevention include mechanical ventilation, incubation, and providing respiratory care to patients in the ICU. Bhalerao & Tambey (2021) demonstrate the theme of preventing VAP by identifying the risk factors that should be addressed to reduce the high incidence and prevalence of the infection. Bhandari et al. (2021) addressed this theme by recommending an increase in the nursing staff and improving their skills and knowledge through adequate training on nosocomial infections and prevention. Lastly, the aspect of preventing chest infection has been captured by Yin et al. (2022) by resolving the shortage of nurses in the ICU. Prevention can also be achieved through other interventions such as mechanical ventilation, but nurses should address complications associated with this intervention when treating ICU patients with chest infections. 

Common methodological approaches in the research

The second theme is common methodological approaches in the research. For example, the research by Al-Sayaghi (2021) and Bhandari et al. (2021) used a descriptive study that involved collecting information via a questionnaire. For example, Al-Sayaghi (2021) applied a cross-sectional descriptive survey. The author also administered questionnaires to allow 283 critical care nurses to present their recommendations on the most suitable strategies for preventing VAP. The questionnaire also invited critical care nurses to identify key barriers undermining the prevention of chest infections. Based on the findings obtained from the questionnaires, critical care nurses argued that hospital cost control policies, forgetfulness, and shortage of nursing staff undermine the prevention of VAP. On the other hand, questionnaires were used by Bhandari et al. (2021) in a descriptive study to allow 57 critical care nurses to present their knowledge in addressing VAP. The findings of the descriptive study by Bhandari et al. (2021) reveal that nursing in the intensive care unit has sufficient knowledge and experience in preventing chest infections. 

The article by Yin et al. (2022) also applied questionnaires in the methodology section. The authors administered questionnaires to collect data from nurses in the intensive care unit. Thirty-two tertiary hospitals in Hebei Province, China, were involved in the questionnaire. Nurses who participated in the questionnaires provided data about the incidence of VAP in the intensive care unit and how nursing staff contributes towards the prevention. The nursing factors influencing the prevention of chest infections were correlated with the incidence of VAP. The findings indicate that cases of chest infections in the intensive care unit increase when the number of nurses assigned to the patients is low. Thus, the questionnaire revealed that increasing the number of nurses in critical care areas is a fundamental milestone in preventing chest infections. 

Mathematical description

Mathematical description has been used in the four papers to present the findings. The mathematical description in the article by Al-Sayaghi (2021) is that the mean compliance score for nursing using prevention guidelines for VAP was 85.9%. Also, over 54% of the nurses exhibited acceptable compliance levels. Mathematical description as a conceptual framework was also used by Bhandari et al. (2021) when the authors stated that 75.4% of nurses involved in the prevention of VAP in the ICU had completed their Bachelor’s degree, thus demonstrating their knowledge. Also, 91.3% of the nurses have over one year of experience in the critical care areas, thus making them qualified and eligible to prevent chest infections. The mathematical description was used as a conceptual framework by Yin et al. (2022) because the mathematical ratio compared the outcome of nurses to patient ratio in preventing VAP. The patient-to-nurse ratio of 2:1 was ineffective in preventing chest infections. Thus, this paper recommended an adequate patient-to-nurse ratio to reduce their risk of chest infections. Lastly, mathematical description as a conceptual framework was used by Bhalerao & Tambey (2021) by recommending a nurse-to-patient ratio of 1:1 to lower the incidence of chest infections in the ICU. 

Application to Practice

The evidence obtained in answering the research question impacts nursing practice as a future nurse in several ways. First, the evidence demonstrated that nurses play critical roles in controlling nosocomial infections in the ICU. As a future nurse, infection control measures and interventions are essential in controlling and preventing chest infections. Therefore, extensive training of nurses is paramount in ensuring the incidence of chest infections in the ICU reduces significantly. The evidence also demonstrated that nurses should embrace safety measures when offering care to ICU patients to reduce and prevent VAP and other nosocomial infections (Bhalerao & Tambey, 2021). The evidence will impact nursing practice for future nurses because it is essential to observe infection control measures in the ICU, such as using personal protective equipment. In other words, it is essential for nurses to prevent chest infections by wearing protective gear such as gowns, masks, and gloves. The evidence also impacts future nursing practice because it demonstrates that nurses should be involved in patient monitoring, patient education, and guiding patients’ family on how to behave when visiting patients in the ICU to reduce and prevent nosocomial infections. As a future nurse, the evidence has emphasized the importance of observing hand hygiene to prevent infections in the ICU. Thus, the papers used to answer the research question provided evidence-based practices that assist future nurses in delivering patient-centered standards of care in critical care areas such as ICUs. 

Another piece of evidence obtained from the papers to answer the research question is that the most fundamental element in controlling ICU infections is ensuring ICU patients are free from chest infections or VAP. The evidence shows that the chest is highly vulnerable to infections, especially in ICU patients. As a future nurse practitioner, this evidence impacts nursing practice because it informs critical care nurses to take full responsibility and utilise every opportunity to perform clinical examination and diagnosis in patients in the ICU. For example, a nurse should assess chest pain to control and reduce chest infections (Bhandari et al., 2021). Chest pain assessment will help future nurses to rule out chest infections from other health problems. As a future nurse, the evidence guides nurses in managing patients in critical care areas to reduce chest infections. The evidence also shows that nurses should follow strict infection control protocols. Thus, the evidence will impact nursing practice for future nurses. Nurses should avoid using contaminated medical devices like suction devices and endotracheal tubes when treating patients with Ventilator-associated pneumonia. Nurses should also observe and practice meticulous hand hygiene prior to using medical devices to assist ICU patients. 

The theme of common findings in research implies that nurses contribute to preventing chest infections through various control strategies. Some common findings in reducing and preventing VAP via nursing interventions are; reducing ventilator exposure, offering excellent oral and hand hygiene, care coordination for subglottic suctioning, increasing staffing of nurses, and maintaining optimal position. The finding to minimise mechanical ventilator exposure to the patients provides evidence-based practice for reducing and preventing VAP. The theme implies that nurses should use other safer alternatives, such as noninvasive ventilation approaches to reduce complications caused by mechanical ventilators (Bhandari et al., 2021). However, some circumstances require mechanical ventilation, thus making it inevitable in the ICU. It implies that nurses should reduce the duration of using mechanical ventilators via evidence-based care bundles and Ventilator weaning protocols (Bhandari et al., 2021). The common findings indicate that oral hygiene should be prioritised during intubation procedures to minimise the risk of chest infections. The common finding of increasing the staffing of nurses in the ICU implies that hospitals should hire more nurses to reduce the shortage of nurses. A nurse-to-patient ratio of 1:1 is fundamental in minimising the risk of infections, especially in mechanically ventilated patients.

From a person-centered practice, it is essential to recommend healthcare organizations to improve nurses’ working environment and promote interprofessional collaboration to reduce the risk of chest infections in the ICU. In this regard, local and national priorities in health and social care include increasing the number of nurses and allocating adequate resources to equip nurses to treat ICU patients, thus reducing and preventing chest infections. Also, further research on how nurses can work closely with other healthcare providers, such as doctors, therapists, and other health professionals, to control chest infections in clinical units other than the ICU should be embraced. Further study should be conducted to determine the incidence of chest infection in hospitals after nurses have implemented nursing strategies and interventions to control VAP. The study will help assess the effectiveness of infection control measures and protocols in the ICU (Bhandari et al., 2021). Overall, the literature review experienced some limitations. For example, very few sources focused on chest infections, even after using filters and asterisks. Most sources were showing VAP rather than chest infections. Therefore, VAP represents chest infections because it is what most of the published sources displaced in the databases. The search for published sources to answer the question also followed all ethical considerations to eliminate conflict of interests that would undermine the research.

 

References

Al-Sayaghi, K. M. (2021). Critical care nurses’ compliance and barriers toward ventilator-associated pneumonia prevention guidelines: Cross-sectional survey. Journal of Taibah University Medical Sciences, 16(2), 274-282.

Bhalerao, J. D., & Tambey, R. (2021). Ventilator associated pneumonia in intensive care unit of a tertiary level hospital. Global Journal for Research Analysis, 21-24.

Bhandari, S., Sharma, M., & Shrestha, G. S. (2021). Knowledge of nurses working in critical care areas regarding ventilator associated pneumonia prevention bundles in a tertiary level cardiac centre. Journal of Institute of Medicine Nepal, 43(1), 36-42.

Mohamed Shaffril, H. A., Samsuddin, S. F., & Abu Samah, A. (2021). The ABC of systematic literature review: the basic methodological guidance for beginners. Quality & Quantity, 55, 1319-1346.

Saldanha, I. J., Smith, B. T., Ntzani, E., Jap, J., Balk, E. M., & Lau, J. (2019). The Systematic Review Data Repository (SRDR): descriptive characteristics of publicly available data and opportunities for research. Systematic reviews, 8(1), 1-12.

Yin, Y., Sun, M., Li, Z., Bu, J., Chen, Y., Zhang, K., & Hu, Z. (2022). Exploring the nursing factors related to ventilator-associated pneumonia in the intensive care unit. Frontiers in Public Health, 10.

 

Appendix

Appendix 1: Data Extraction Table

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