Pneumonia: causes, symptoms, and treatment

Pneumonia: Analysis, Evaluation & Critique pneumonia your purchase.99

PNEUMONIA

Analysis, Evaluation & Critique: Tolentino-Delosreyes, Et Al (2007): "Evidence -- Based Practice: Use of the Ventilator Bundle to Prevent Ventilator-Associated Pneumonia" (American Jounral of Critical Care -- January, 2007)

The objective of this work in writing is to analyze and critique the work of Tolentino-DelosReyes, et al. (2007) entitled: "Evidence-Based Practice: Use of the Ventilator Bundle to Prevent Ventilator-Associated Pneumonia" published in the American Journal of Critical Care in January 2007. The stated purpose of Tolentino-DelosReyes, et al. In their work is the examination of the knowledge possessed by critical care nurses concerning the use of the ventilator bundle in the prevention of pneumonia associated with use of a ventilator. Ventilator-associated pneumonia (VAP) is held by Tolentino-DelosReyes, et al. To be a safety issue that is of vital importance in treating patients who are critically ill and who are also receiving mechanical ventilation as part of their treatment regimen. Specific recommended steps of the American Association of Critical Care Nurses (AACN) for reduction of the incidence of ventilator associated pneumonia are those stated as follows: (1) elevation of patient's head at 30 to 45 degrees unless there is medical contradiction stating otherwise; (2) there should be ongoing removal of subglottic secretions; (3) the ventilator circuit should be changed no more often than forty-eight hours; and (4) the nurse should make sure to wash their hands both before and following contact with each patient. (Tolentino-DelosReyes, et al., 2007) Stated as inclusive in the limitations in the study reported in this specific work on reduction of ventilator associated pneumonia is the fact that "not all the nurses in the CCU and SICU were able to participate in the live education sessions; for those who could not attend, the information was provided through an educational poster that was posted in the unit. In some cases, nurses who attended the sessions shared the information with those who did not attend. Because of the nature of the project and the scheduling of staff, no comparisons were made between nurses who attended the sessions and those who did not." (Tolentino-DelosReyes, et al., 2007)

The first point that will be noted in support of the soundness of the work of Tolentino-DelosReyes, et al. (2007) is that the guidelines developed for reduction of ventilator-associated pneumonia is that these guidelines are stated by the Centers for Disease Control and Prevention (CDC) as best practice in the prevention of nosocomial pneumonia." (Tolentino-DelosReyes, et al., 2007) There is a great deal of current evidence in this area of study that supports HOB elevation at approximately thirty to forty degrees. Previous research is inclusive of 18 randomized controlled trials, an inception cohort design, and comparison studies, surveillance of patients, and data collection as well as a study that was longitudinal and descriptive in nature and another study that was prospective with a descriptive design. Previous research was also conducted in the areas of oral care and specifically oral aspiration and its effects on goal of reducing ventilator-associated pneumonia in critically ill patients. These factors were examined in the work of Tolentino-DelosReyes, et al. (2007) who report themselves having conducted a study and in the form of the administration of a test containing ten items which was developed for the purpose of scoring the nurse on knowledge related to VAP. These questions were comprised by a Powerpoint presentation utilized by the project director in the education sessions in the CCU and SICU. The test specifically were related to "best-practice guidelines, microorganisms that cause VAP, hand washing, supine positioning, enteral feeding, factors related to VAP, definition of VAP, and diagnosis of pneumonia." (Tolentino-DelosReyes, et al., 2007) Stated as participants in the reported study were 14 nurses on day shift and another 14 night shift nurses along with 15 day shift and 18 night shift nurses from the CCU comprising a stated "65% to 70% of all the nurses in each unit." (Tolentino-DelosReyes, et al., 2007) it is reported that both pretests and posttests were administered immediately before and after the in-service education sessions." (Tolentino-DelosReyes, et al., 2007) Observational methods are also reported to have been used in the month before and the month following the learning sessions. It is reported that the patterns of practice of these nurses was assessed prior to and following the education sessions through observation of the care rendered to 30 patients in the SICU and 69 patients in the CCU, all of whom were receiving mechanical ventilation. HOB elevation was measured by checking the beds that were equipped with angle measurement to specify the degrees of elevation." (Tolentino-DelosReyes, et al., 2007) Also assessed were factors relating to: (1) nurse hand-washing practice (including factors such as artificial nails, nail polish and wearing of rings and even number of rings worn on hands during patient contact; (2) auditing of patient charts for: (1) HOB elevation; (2) frequency of oral care; and (3) frequency of nasogastric tube checking in the preceding 12 hours." (Tolentino-DelosReyes, et al., 2007) it is reported that data collection and analysis was conducted through 2 critical care nursing experts making a review of project team members over a six-month time period. Findings in the work of Tolentino-DelosReyes, et al. (2007) state that examination of the charts "showed significant improvement in HOB elevation (from 51% to 69%) with oral care frequency significantly increasing following the education sessions. Furthermore, the nasogastric tube was further monitored more frequency rising from 3% to 18% following the education sessions. These education sessions increased the knowledge of nursing staff and in turn increased nurse testing scores and the quality of treatment provided to patients by nursing staff. In addition the hand-washing practices of nurses prior to patient contact improved and there was a reduction in the use of nail polish, artificial nails and wearing of rings during patient contact. It is important to note the statement of: "The ultimate goal of evidence-based practice is high-quality healthcare with beneficial outcomes. Reinforcement of education can help ensure that the education improves nursing practices in a sustained manner. Consistent and accurate documentation of OB elevation at 30° or higher, oral care, and checking of residual volume in the nasogastric tube, along with surveillance of proper hand-washing practice among nurses, should be recommended." (Tolentino-DelosReyes, et al., 2007)