The American Association of Critical Care Nurses’ Role

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Table of Contents

Background and Significance of the Problem
Statement of the Problem and Purpose of the Study
Literature Review
Methodology
References

Background and Significance of the Problem

Intensive Care Units (ICUs) play a critical role in the medication and treatment of acute conditions and diseases. While healthcare organizations follow standard rules and procedures to ensure patient safety in the ICUs, infections can be inevitable. Consequently, nurses and other involved stakeholders must adopt practices that reduce the chances of infections. The American Association of Critical-Care Nurses (AACN) is a 501(c)(3) nonprofit association that offers professional and personal support in pursuit of the best patient care. The overarching research will investigate the best evidence-best approach to controlling infection in the ICUs.

Infection is a common occurrence in the ICUs and can be detrimental to the patient’s well-being. Although the majority of infection cases are controlled, some lead to patients’ death. While infections in the ICUs have existed since time immemorial, insufficient studies have been conducted on national and international data on sepsis (Woodayagiri et al., 2022). The adoption of effective treatment and diagnostic options is important in reducing and controlling ICU infections. Evidence-based practice has been accepted as the most viable option for controlling sepsis in the ICUs (Gatti et al., 2022). Therefore, organizations such as the AACN can encourage member nurses to utilize evidence-based practice in controlling infections in the ICUs.

The problem of infections in the ICUs is crucial for various reasons. Firstly, the problem is significant since it allows medical stakeholders to predict and quantify the success rate of the patients admitted to ICUs. For instance, it is unlikely for the patient to survive in an ICU with high cases of infections. Secondly, the problem allows organizations to adopt practices for the wellness of their clients. Lastly, identifying the causes and the types of sepsis in the ICUs allow nursing organizations such as AACN to offer better professional and personal advice to nurses.

Statement of the Problem and Purpose of the Study

The U.S. is one of the countries with the most advanced healthcare systems and consequent low mortality rates. However, many Americans succumb to ICU infections due to poor disease and condition management. ICU infections are categorized as Healthcare-Associated Infections (HAI) by the Centers for Diseases Control and Prevention (CDC) (Woodayagiri et al., 2022). Although many American patients suffer from ICU infections, adopting evidence-based practice (EBP) can reduce and promote their well-being. Therefore, the overarching study aims to establish effective EBP intervention that AACN can promote among its nurse members.

Literature Review

Nurses play a significant role in ICUs and offer moral support to patients’ families. According to Abdul Halain et al. (2021), ICU patients’ families are likely to develop psychological conditions due to the critical condition of their loved ones. Penninx et al. (2022) further argue that depression and anxiety are the commonest forms of mental illnesses among individuals whose family members are under intensive care. The situation can be worsened if the members get ICU infections which increases their chances of dying (Gatti et al., 2022). Although family MSNs can help manage psychological conditions among ICU patients and their families, hospitals must reduce ICU infections.

There is no clear-cut trajectory on the definition of ICU infection since it manifests itself in various forms. However, according to Liu et al. (2022), the term means any infection that a patient can acquire during their stay in the ICU, and be critical if poorly managed. Lobo et al. (2022) add that ICU infections may result in absolute organ failure and death. According to Blot et al. (2022), the four common types of ICU-HAI are Central Line-associated Bloodstream Infection (CLABSI), Catheter-associated Urinary Tract Infections (CAUTI), Surgical Site Infection (SSI), and Ventilator-associated Pneumonia (VAP). The four types of ICU infections are a result of different causative agents.

While there is no sufficient data on the types of ICU infections nationally and internationally, various scholars have attempted to establish the most common ones. For instance, Izadi et al. (2021) tried to establish the national rate of intensive care unit-acquired infections in Iran. However, there are no studies that have tried to establish the same in the U.S. Managing ICU-HAI infections requires the adoption of sophisticated clinical techniques by nurses and other medical practitioners. A study by Cooley et al. (2022) concluded that EBP is the most appropriate for infections.

Gatti et al. (2022) established EBP approaches such as intravenous catheters to administer blood, measuring blood pressure noninvasively in children and infection control as important for ICU-HAI. A study by Zeb & Ali (2021) shows that keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions, and practicing correct handwashing can help control ICU-HAI. Therefore, MSNs need to consider the EBP approaches in controlling ICU-HAI.

The existing literature on ICU-HAI control presents various gaps that the current study will aim to fill. Firstly, the literature fails to account for numerical data on the rate of ICU-HAI in the U.S. Secondly, the majority of the literature is of non-U.S. context, making it problematic to associate the data with the occurrences in the country. Lastly, the existing literature generalizes EBP approaches to controlling ICU-HAI in the U.S. The overarching research will address the gaps identified, making it significant for academia and healthcare organizations.

Research Questions, Hypothesis, and Variables

Research questions will help in determining what the overarching study will examine. The current study will be guided by four research questions, focusing on the ICU-HAI in the U.S. context. The following are the research questions:

What is the common type of ICU-HAI infection in U.S. healthcare organizations?
How can U.S. healthcare organizations adopt the EBP approach to reduce ICU-HAI?
What is the role of family MSNs in reducing ICU-HAI in healthcare organizations?
Among general, internal, and surgical ICUs, which one has the highest cases of infections?

The hypothesis involves statements of expectation and predictions that research tests. The overarching research will use three hypotheses adopted from the existing literature. Firstly, the study hypothesizes that SSI and VAP are the most common types of ICU-HAI in U.S. hospitals (Blot et al.,2022Bl). Secondly, the research predicts that keeping the healthcare environment clean and wearing personal protective clothing are the most appropriate EBP approaches to controlling ICU-HAI (Lesan et al., 2021). Lastly, the research hypothesizes that ICU-HAI is the commonest cause of death among the patients in ICU (Wang et al., 2021). The study will use various variables to approve and disapprove the hypotheses.

The study will adopt various variables that will help in answering the research questions and achieving the objectives. The independent variables involve those that will not be changed by other variables measured in the study. The variables will be “type of ICU” which includes “general”, “internal”, and “surgical”. Additionally, the “type of ICU-HAI infection” will be measured, including “CLABSI”, “CAUTI”, “SSI”, and “VAP”. Meanwhile, the dependent variables will include those that will vary when measured. Some of the dependent variables for the study are “The EBP Measure”, “Mortality Rate”, “Number Of MSNs”, and “ Number of ICU-HAI infections”. The dependent and independent variables listed will be measured to approve and disapprove hypotheses.

Theoretical Framework

Overview and Guiding Propositions

The overarching study will utilize the Ecological Health Model (EHM) theory. The approach was developed by Urie Bronfenbrenner, who recognized the interaction of factors across all levels of a health problem (Tudge et al., 2022). The core guiding proposition of the theory is that behavior has multiple levels of influence: intrapersonal, interpersonal, organizational, community, physical environmental, and policy (Tudge et al., 2022). Moreover, the model proposes that population-level and individual-level determinants of health and interventions are crucial in solving a healthcare problem. The theory can be applied in addressing ICU-HAI infections among healthcare organizations in the U.S.

Application of Theory to Study Focus

The EHM theory is crucial in the development of more comprehensive interventions. The model is applicable in the current study since it will allow healthcare organizations to consider the environmental and policy contexts of healthcare behaviors. Consequently, through the theory, the MSNs and other medical stakeholders integrate intrapersonal, institutional, community, and public policy factors in addressing ICU-HAI infections. For instance, upon determination of the most effective EBP approach, AACN can develop a policy that promotes the intervention. Additionally, the model will allow family MSNs to consider community factors that exacerbate ICU-HAI. EHM is important in understanding ICU infections from diverse perspectives.

Methodology

Sample/ Setting

The study will involve participants who work in healthcare organizations. The participants will include family MSNs who are registered under AACN. The research setting will be those nurses who work in ICUs in American hospitals. A total of two hundred and fifty participants will be involved in the study. The research population will involve one hundred and twenty-five males and an equal number of female nurses. Additionally, the study will involve twenty healthcare organizations with clear records of ICU-HAI infections.

Sampling Strategy

The research will adopt a sampling strategy that will offer the participants equal chances while distinguishing their unique characteristics. Some of the characteristics to be observed during sampling will include age, gender, and years of experience. Therefore, a stratified sampling strategy will be appropriate for the study. The strategy will involve dividing the participants into subgroups that differ in important ways (Campbell et al., 2020). The strata will be based on gender and years of experience of individual MSN. The strategy will be advantageous since it will introduce extraneous variables which are crucial in adding more conclusions.

Research Design

The research design involves a framework of research methods that will be used in conducting the study. The current research will adopt a qualitative and quantitative research design since it will involve numerical and none numerical data. The entire study will be correlational to allow the researcher to establish the relationship between various variables under study. For instance, a relationship between “ EBP Measure” and “ Number of ICU-HAI infections”. Combining both qualitative and quantitative data will allow the researcher to describe the problem studied and provide a real-time number of projectors.

Extraneous Variables

The study will involve dependent and independent variables, as discussed above. However, some variables will be extraneous since they will not be investigated but can potentially affect the dependent variables under study. Some of the extraneous variables will include “years of experience”, “highest educational level”, and “gender”. The variables will affect the study’s dependent variable: “EBP Measure”. More experienced and highly educated MSNs are likely to adopt the most effective EBP measure and will suggest them.

Instruments

Various instruments will be used in the data collection and analysis. The researcher will use Google Forms to collect data from MSNs who cannot be reached physically. Meanwhile, questionnaires will be used to collect data from participants who can be reached physically. A voice recorder will be used for interviewing some of the participants. Meanwhile, Microsoft Excel will help in data recording and analysis.

Description of the Intervention

The intervention sought in the study is the EBP approach to ICU-HAI infections. The research questions will be formulated in a manner that focuses on the various EBP approaches to ICU infections. Therefore, the participants will be asked questions concerning healthcare environment cleanliness, and procedures adopted in measuring patients’ wellness, among others. The EBP approach involves the utilization of the most recent scientific evidence in diagnosing and controlling diseases and infections (Liu et al., 2022). Therefore, the EBP approach is regarded as the most appropriate intervention for ICU infections.

Data Collection Procedures

The data collection procedure will involve a series of steps that the researcher will follow. Firstly, the researcher will develop questionnaires and Google Forms that will be used in data collection. The questions will be constructed in a manner that answers the research question and helps measure variables. Secondly, Google Forms will be sent to participants via a unique link that does not allow multiple entries. Meanwhile, the questionnaires will be used in collecting data from participants who will be physically reachable. Lastly, the collected data will be recorded in MS Excel, awaiting analysis.

Data Analysis Plans

Data analysis will involve the use of two major software that allows the interpretation and presentation of collected information. MS Excel will be used to collect data and calculate statistical results including average, mode, and median. Meanwhile, IBM SPSS 28 will be used in analyzing the descriptive and numerical data. The researcher will code the collected data before entering it into the SPSS 28. The analysis will involve the use of graphs and other pictorial representations to present results.

Ethical Issues

During data collection, various ethical issues will be crucial for the researchers. Firstly, the researcher will ask for the participant’s consent before collecting data from them. Secondly, the researcher will ensure that personal information about the participants is concealed. For instance, name, organization of operation, employer, and other identifying information will not be shared. Lastly, the researcher will present the data as collected without tampering with the actual results.

Limitations of the Proposed Study

Although the study will help fill gaps in the existing literature and expand on the existing knowledge, it is limited in various ways. The study is focused on the U.S. context, failing to give a global perspective on the topic. Therefore, the study results will be more beneficial to Americans than other populations. Moreover, the study will be limited to time, leading to a possible inaccurate result due to hurriedly collected data. However, the study will remain significant to healthcare organizations.

Implications for Practice

The study results will impact various healthcare stakeholders including hospitals and family MSNs. The findings will allow AACN to adopt effective mechanisms to prevent ICU infections. Additionally, the study may lead to the formulation of policies and regulations that guide the conduct of nurses in the ICU. Furthermore, healthcare organizations can develop ethical codes and conduct regulations for their practitioners working in the ICUs. Therefore, the study results will lead to the adoption of new practice techniques.

References

Abdul Halain, A., Tang, L. Y., Chong, M. C., Ibrahim, N. A., & Abdullah, K. L. (2021). Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review. Journal of Clinical Nursing. Web.

Blot, S., Ruppé, E., Harbarth, S., Asehnoune, K., Poulakou, G., Luyt, C.-E., Rello, J., Klompas, M., Depuydt, P., Eckmann, C., Martin-Loeches, I., Povoa, P., Bouadma, L., Timsit, J.-F., & Zahar, J.-R. (2022). Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention, and contributions of new technologies. Intensive and Critical Care Nursing, 103227. Web.

Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? Research case examples. Journal of Research in Nursing, 25(8), 652–661. Web.

Cooley, M. E., Biedrzycki, B., Brant, J. M., Hammer, M. J., Lally, R. M., Tucker, S., & Ginex, P. K. (2022). Translation of evidence-based interventions into oncology care settings. Cancer Nursing, Publish Ahead of Print. Web.

Gatti, M., Viaggi, B., Rossolini, G. M., Pea, F., & Viale, P. (2022). An Evidence-Based multidisciplinary approach focused on creating algorithms for targeted therapy of infection-related ventilator-associated complications (IVACs) caused by Pseudomonas aeruginosa and Acinetobacter baumannii in critically ill adult patients. Antibiotics, 11(1), 33. Web.

Izadi, N., Eshrati, B., Mehrabi, Y., Etemad, K., & Hashemi-Nazari, S.-S. (2021). The national rate of intensive care unit-acquired infections, one-year retrospective study in Iran. BMC Public Health, 21(1). Web.

Lesan, M., Khozaei, F., Kim, M.-J., & Shahidi Nejad, M. (2021). Identifying healthcare environment contradictions in terms of infection control during a pandemic with a focus on health workers’ experience. Sustainability, 13(17), 9964. Web.

Liu, Z.-Y., Wei, L., Ye, R.-C., Chen, J., Nie, D., Zhang, G., & Zhang, X.-P. (2022). Reducing the incidence of stroke-associated pneumonia: an evidence-based practice. BMC Neurology, 22(1). Web.

Lobo, B. B. P., Marba, S. T. M., Machado, H. C., & Caldas, J. P. S. (2022). Neonatal Sequential Organ Failure Assessment as a late-onset sepsis mortality predictor in very low birth weight newborns: a Brazilian cohort study. European Journal of Pediatrics, 181(10), 3767–3774. Web.

Penninx, B. W. J. H., Benros, M. E., Klein, R. S., & Vinkers, C. H. (2022). How COVID-19 shaped mental health: from infection to pandemic effects. Nature Medicine, 1–11. Web.

Tudge, J. R. H., Merçon-Vargas, E. A., & Payir, A. (2022). Urie Bronfenbrenner’s bioecological theory: Its development, core concepts, and critical issues. Sourcebook of Family Theories and Methodologies, 235–254. Web.

Wang, W., He, Q., Zhu, S., Wang, M., Kang, Y., Zhang, R., Ji, P., Zou, K., Zong, Z., & Sun, X. (2021). Association between blood transfusion and ventilator-associated events: a nested case-control study. Infection Control & Hospital Epidemiology, 43(5), 597–602. Web.

Woodayagiri, S., Moorthy, S., BHASKAR, E., & Marappa, L. (2022). Bedside Scoring System for Predicting Adverse Outcomes Among Patients Suffering From SARS-CoV-2 Infection. Cureus. Web.

Zeb, S., & Ali, T. (2021). Factors associated with the compliance of standard precaution; Review article. JPMA. The Journal of the Pakistan Medical Association, 71(2(B)), 713–717. Web.

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