PICOT Proposal Formative

PICOT: Nurse driven interventions to reduce hospital acquired infections in Oral care
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P-population- Elderly people in nursing care with no prior history of pneumonia before admission to nursing homes.
I-intervention- oral care
C-Comparison- non oral care patients
O-outcome- reduced infection
T-Time frame- yearly assessment
Hospital acquired infections refer to new infections that occur in a health care facility or hospital for patients admitted for other infections or diseases. Even though, there has been improvement in public health over the years, hospital acquired infections pose a challenge to nurse who need to reduce the frequency of these infections. Similarly, lack of proper oral care is a public health concern, as it often leads to increased cases of infections in hospital settings when not handled properly Pneumonia is the leading cause of death for residents in nursing homes, and hence oral hygiene is vital in preventing pneumonia (El- Sohl, 2011). Thus, the relevance of nursing interventions in improving health care is relevant to reduce mortality from hospital associated infections.
The background of the problem is that a large number of the patients are admitted in the hospital as a result of diseases and infections. The situation is such that patients acquire other infections when they get admitted to the hospital. Poor oral care serves as the main cause of increased infection in hospitals. Pneumonia is the leading causes of death in nursing home which necessitates the maintenance of good oral hygiene in order to prevent pneumonia.
What role do the nurses have in ensuring a hygienic environment in hospital?
What precautions should nurses take when handling patients with infections?
How does poor oral health contribute to infections?
In nursing homes which patients are at risk for pneumonia, what are the risks associated with getting pneumonia as a result of poor oral hygiene as compared to maintaining good oral hygiene and getting infected with pneumonia?
Nurses have the responsibility to facilitate a safe and clean environment in hospital settings and in nursing homes. In essence, practicing nurses follow standards in carrying out their duties, while also adhering to ethics in the profession. Similarly, nurses are expected to take precautions when taking care of patients and surgery patients are at a high risk of pneumonia infection if there is an ineffective oral care system in place. Essentially, good oral care prevents occurrence of infections, and these practices include tooth brushing and oral hygiene. However, most nurses are aware of the importance of oral hygiene, but few see tooth brushing as a viable option in oral care (Soh et al., 2012). In the case of mechanically ventilated and intubated patients, oral care is crucial among nurses as pneumonia is a high risk infection for such patients. However patient uncooperativeness in oral care is the biggest challenge facing implementation of proper oral care programs (El- Sohl, 2011).
Increased risk of pneumonia among patients occurs because they typically stay with their mouths open under mechanical ventilation. Furthermore, secretions also occur in a state where they are less conscious about their surroundings. Consequently, prevention of ventilator associated pneumonia also involves oral care besides frequent neurological checks and head elevation during bed rest. In combination with VAP bundle, oral care provides a better management strategy. This, intervention will look into hospitalized elderly patients under critical care in nursing homes. At the same time, the patients chosen will not have suffered pneumonia before hospitalization. The preferred sample size is 50 patients for a period covering one year, with non oral care group being the control group for the study. Assessment will occur when comparing results between oral care group and non oral care group.
Another way through which to improve oral care among the patients is through training of nurses and adherence to protocols. Even though, it is assumed that most nurses are competent, it is important to highlight on the role of training in hospital settings when handling patients. In essence, the role of the protocol is to establish a standard of practice which helps in training nurses. With a common protocol for assessment and training, nurses are likely to show standard of care to patients before they are mechanically ventilated, as opposed to when there is no emphasis on the role of handling patients in their training.
Even before performing assessment of patients, nurses need to understand that saliva is a critical component in determining the immunity of patients. Thus, periodic cleaning of the tongue is an essential step towards achieving better oral care. After doing this, then nurses need to conduct assessment of patient’s oral health. This process enables nurses to categorize patients on the basis of oral health, and top priority is given to patients with previous history of oral hygiene problems. Through mechanical ventilation, patients suffer from lower immunity as the tubes used in the process blocks the secretion system. Thus, an initial assessment of oral hygiene prioritizes the likely complications of oral care related to tracheal response to tubes and inability to secrete properly.
Evidence suggests that oral care is a significant factor in manage...