Ventilator-Associated-Pneumonia and a Higher Nurse-Patient Ratio

The last thing patients would want when seeking medication in the hospital is the Hospital acquired infections. It means therefore that the hospital and the nurse have to be very vigilant to ensure that patients remain healthy and don’t acquire any other disease apart from the one diagnosed on arrival in the hospital. This , therefore, is one of the nurse primary evidenced-based practices in the hospital. The nurses are thus required to ensure that the acquired illnesses in the hospital environment are prevented before they affect the clients. This is done by nurses adhering to the evidence-based infection control practices. 

PICOT Question 

The central PICOT question is that is there a correlation between the decrease of ventilator-associated-Pneumonia and a higher nurse-patient ratio? The ventilation associated Pneumonia is a common kind of disease which is associated with the patients in the intensive care unit. The main problems as presented by the PICOT question are the decrease of related pneumonia while its implication as stated by the Picot question is the increase nurse-patient ratio. This PICOT question is fundamental is very important in the nursing intervention (Polit & Beck, 2017). First, it provides evidence that there is a need for more nurses in the hospital to ensure that the bulk of work is reduced . This is very important as it will aid the nurses in ensuring that their work for instance prevention of the ventilator associated pneumonia is done perfectly well. Secondly, the considerable ration of the nurses to patients is very critical in reducing the rate of stress in the hospital. Nursing practice is one of the stressful occupation and with increasing patents every time, nurses need to be in good number to balance their work and avoid stress which may lead to less quality work (Marschall, Mermel LA, Classen, Arias, Podgorny et al., 2008). 

Summary of Systematic Review in Week 4 

The presentation in week four has indicated that there exists a relationship between the number of nurses providing care to patients and reduction of new infections in the intensive care unit. It was noted that nurses tend to be overwhelmed especially when dealing with emergency situations in a scenario where the number of nurses are limited in number. The period that patients remain in hospitals is highly dependent on the quality of care that they receive from such facilities. The review during week four pointed at the need to enhance the relationship between patients and the nurses. As a result, patient satisfaction with work and retention rate increases. Enhanced hygiene among the patients enhances the overall level of their performance. 

Summary of Findings Week 8 

Polit and Beck (2017) document some examples of the nursing evidenced practice. One of the dominant examples of the healing evidenced based infection control. According to Mallory, nurses need to ensure that hospital is free from Acquired diseases. The article “has it that hospital patient’s contract an infection at a rate of 4.5 out of 1,000. A patient who develops an infection is at risk for a prolonged hospital stay, serious illness or death.” According to this article, this is a justification for the need of the evidenced-based nursing practices. It further states that hand hygiene, decontamination, antibiotic stewardship and much more are some of the infection control methods which nurses should ensure that they give consideration. Shivnan (2011) also indicates that due to the importance of the EBP, the healthcare managers and any other bodies concerned should ensure that the medical practitioners, especially nurses are helped to ensure that they are in line with the EBP. According to this article, the staff needs support from the management and many other people surrounding them regarding training to enhance their practices in this field (Mayhall, 2012). 

Evidence-Based Practice 

Infection control is the example of the EBP which will be given attention in this article. The last thing the patients would like to have after seeking medication in the hospital is the hospital-acquired infections. Hospital-acquired infections are those disease which the patient contact within the facility (Coffin, Klompas, Classen, & Arias, 2008). The rate of the acquired infectious disease has been on the rise with data from the Centre for Disease and Control indicating that almost 32% of the patients who are admitted to the varicose healthcare institutions are a risk of getting the acquired disease. The nurses “play a key role in helping to prevent illness before it happens by adhering to evidence-based infection-control policies” (Mayhall, 2012). "This includes keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions and practising correct hand washing." it should be noted that there is no impotence of treating the patients as they acquire another kind of infections in the hospital. It, therefore, means that the strategies put in places for the control of the received infection in the by the nurses is not a wasted effort. 

With hospital-acquired diseases under control, the hospital will reduce the number of bed occupancy most of the patients who stay for long in the wards, their situations often even elongated due to acquired infections. Furthermore, with such diseases under control, the level of the confidence among the staff will be elevated, and this improves quality (Rosenthal et al., 2011). The patients' faith and trust will also increase when hygiene and cleanliness within the hospital environments are enhanced. However, in case the infection control practice is not given attention, the will be adverse consequences within the facility. First, the risk of infection within the hospital will increase. This will hurt the confidence of the staff. The image of the institution also will be affected. Lastly, the institution risk facing legal consequences since some of the patients who suffer from their acquired disease may prefer legal solutions, and this will be much cost full for the organization (Cimiotti, Haas, & Saiman, 2006). 

Dissemination, Communication and Implementation 

The hospital newsletter is an excellent medium for dissemination. In this case, the hospital newsletter will be used to disseminate the EBP. The management will ensure that the entire practices and strategies to implements it in the respective places or departments printed in the newsletter and distributed to those concerns (McHugh & Barlow, 2010). Posters will also be used in case necessary. The posters will be placed strategically for instances in the wards, the nursing bay , the nursing offices and many other accessible places within the hospital to ensure that they are available to all the nurses and other professionals. The EBP will be communicated through many channels (Daud-Gallotti, Lorenzi, & Eluf-Neto, 2005). The first one is the meeting organized between the administrations with people concerned for instances nurses. In this session, the importance of the infection control will be emphasized . Moreover, best practices will be discussed to enhance proper infection control practices within the hospital. 

After communications, the strategies to implements the infection control practice will in place. Three Cs implementation strategies can be appropriate. In this case, the first C is a clarification of the infection control practices to the nurses; the second C is the communication of the entire strategy to the nurses, and the last one is Cascading. In this case, the implementing team seeks the support of those who can object the plan and win them to influence the entire process and avoid resistance (Frith, Anderson, & Caspers, 2010). 

Dealing with Opposition 

The project team will be willing to compromise in case the opposition view makes sense and is very strong. Through compromising, resistance to this change will be reduced significantly. Moreover, the opposing view will be understood, and any positive view from their perspective which will be more beneficial on the change will be incorporated in the EBP to reduce any conflict. Lastly, the opponents will be supplied with enough information on the benefits of the infections control in the hospital (Portny, 2017). This will serve as answers to their question, and the team will also be willing to answer any extra questions they will air. 

Importance of EBP 

People tend to protect the status quo to avoid the new change. Lack of knowledge on the adoption of EBP has also emerged as a challenge in its adoption. In spite of this, adoption of EBP results to the enhanced level of efficiency in health facilities. It also aids in the elimination of human errors that limits efficiency in treatment. In the past, human errors have emerged as key culprits in health facilities. EBP have also enhanced the rate of continuous improvement in health facilities (Berger, 2015). 

Conclusion 

The study has found out that with the current trend of insufficient nurses in the hospital and decreased employee satisfaction for them, the risk of patients acquiring infections from health facilities is relatively high. However, this would be mitigated if necessary measures were taken to ensure that nurses across hospitals are sufficient and with the necessary equipment, skills and capabilities as well as being ethically responsible. Similarly, the management in health care should ensure that there is a fair nurse to patient ration and that the welfare o f the nurses is observed to avoid overworked and fatigued nurses whose performance will consequently be negatively affected. Evidence-Based Practice (EBP) is one of the measures that have been found to be effective in improving healthcare EBP is very important in the current nursing care. The infection control is an example of the EBP which should be enhanced within the healthcare institution. Nurses are obliged to ensure that the patients are protected , and they are free from the hospital-acquired infections. This will be beneficial in enhancing patient health outcomes. From the above presentation, it is evident that health outcomes are enhanced through an increase in the level of staff in a health facility. 

References 

Cimiotti, P. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, Volume 40, Issue 6, Pages 486–490. 

Cimiotti, P., Haas, J. & Saiman, L. (2006). Impact of staffing on bloodstream infections in the neonatal intensive care unit. Arch Pediatric Adolescent Medicine. 2006; 160:832–6. 

Coffin, SE., Klompas, M., Classen, D. & Arias, KM. (2008) Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infection Control Hospital Epidemiology 29: S31–S40. 

Daud-Gallotti, R., Lorenzi, C., & Eluf-Neto, J. 2005) Adverse events and death in stroke patients admitted to the emergency department of a tertiary university hospital. European Journal of Emergency Medicine, 12: 63–71 

Frith, K., Anderson, E., & Caspers, B. (2010). Effects of nurse staffing on hospital-acquired conditions and length of stay in community hospitals. Quality Management Health Care. 2010; 19:147–55. 

Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, et al. (2008) Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control Hosp Epidemiology 29: S22–S30. 

McHugh, MD., Kutney-Lee, A., Cimiotti, JP. & Sloane, D. (2011). Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood) 2011; 30:202–10 

Rello, J. (2013). A care bundle approach for prevention of ventilator-associated pneumonia. Clinical Microbiology and Infection Volume 19, Issue 4, April 2013, Pages 363-369 

Stone, P. Mooney-Kane, K., & Larson, E. (2007). Nurse working conditions and patient safety outcomes. Med Care. 2007; 45:571–8. 

Weinstein, A. & Marc, J. (2004). Risk Factors for Ventilator-Associated Pneumonia: From Epidemiology to Patient Management. Clinical Infectious Diseases, Volume 38, Issue 8, 15 April 2004, Pages 1141–1149, https://doi.org/10.1086/383039 

Appendix 

Source	General claim	Synthesis	Comments
Cimiotti (2012)	ventilator-associated-Pneumonia increased in the health institutions with fewer nurses but decreased with the increase in the number of staff.	From the research findings, there is a correlation between the number of staff and the reduction of infections among the ICU patients. With the increased number of staff, patients receive quality care as the nurses do not suffer from fatigue.	The researcher conducted a survey of doctors and patients in a healthcare facility. The observation focused on how the interaction between nurses and patients increased the chances of infections. The research is credible as it is consistent with other studies.
Cimiotti, Haas, & Saiman (2006)	A correlation exists between staffing and blood infections of children in intensive care units	The researchers found that nurses tended to be overwhelmed when working under pressure. As a result, they failed to maintain high standards of hygiene and compliance to the nurses’ patient care plans (NPC). However, an increase in the number of nurses led to a general improvement health.	The results are based on a quantitative research design. The results are based on scientific research, which increases the validity and reliability. The study is also consistent with other previous studies, which is a major strength for this research.
Coffin, Klompas, Classen, & Arias (2008)	Factors such as compliance with the compliance to the nurses’ patient care plans and staffing led to a decrease in ventilator-associated pneumonia	When nurses adhere to the policies of healthcare, there is a significant reduction of infections among the intensive care unit patients. However, the compliance with policies is largely associated with the nurses’ emotional and physical status. When the question of fatigue is addressed , nurses become more efficient and compliant with the policies.	The study is relevant to the research question. The population of the study were nurses and patients, which helped in getting reliable information. However, the main weakness is the sample, which is too small to warrant the general claim.
Daud-Gallotti, Lorenzi, & Eluf-Neto (2005)	Understaffing is perceived to be a major risk factor to the wellbeing of patients in the healthcare facilities. The number of infections and deaths increase with the low number of nurses.	Patients in the intensive care unit require special care. Issues of hygiene are imperative in minimizing ventilator-associated pneumonia and deaths. Staffing allows nurses to pay more attention to the patient’s health, thereby reducing the frequency of infections.	The research findings are backed by a scientific study . The research findings are relevant to the study question and consistent with previous studies.
Frith, Anderson, & Caspers (2010)	There is a relationship between staffing and the length of time patients in intensive care units stayed in hospitals	What the length of the time patients stay in the hospital is determined by the quality of healthcare . As the number of nurses increased, quality of health care also improved. This on the other hand led to a decrease in the number of days patients stayed in the hospital.	The main weakness is that there is an assumption that staffing led to a decrease in the day's patients stayed in hospitals. While this could be true, other factors that could have been addressed as well. However, the study is reliable and consistent with the previous studies
Marschall, Mermel, Classen, Arias & Podgorny (2008)	The study claimed that staffing, hygiene, and improved relationship between nurses and patients could minimized the central line-associated bloodstream infections	The findings emphasized the need for staffing and improving the relationship between nurses and patient. Excellent communication with patients leads to improved healthcare. The reduction of fatigue ensures that nurses provide quality healthcare.	The main strength of the study is that it focuses, not just on staffing, but on other factors, such as communication and hygiene. The study is also valid and reliable as it is research-based.
McHugh, Kutney-Lee, Cimiotti, & Sloane (2011)	There was a correlation between burnout, job satisfaction, healthcare benefits, and quality of healthcare	Burnout is mostly as a result of understaffing, which leads to a low job satisfaction and high retention rate. Health benefits are aimed at motivation nurses. Their absence leads to low job satisfaction. The unsatisfied nurses are likely to increase infections among patients.	The main strength is that the study focuses on the problem from a wider perspective. Staffing is not the only challenge. Healthcare benefits and other forms of motivation will also determine the ability of the nurses to perform. This on the other hand will affect the health of the patients.
Rello, (2013)	A care bundle approach led to the reduction in ventilator-associated pneumonia	Hygiene, which included the oral care and handwashing led to a significant reduction of infections. Sedation protocols and intracuff pressure control also led to a general reduction in infections. As a result, the patient took little time to recover.	The study is relevant to the research question. It is evidence-based study, which focuses on more variable that together leads to a general welfare of the patients.
Stone, Mooney-Kane, & Larson (2007).	A correlation between the nurse working conditions and the patient’s health existed	The study findings indicated that improved working conditions, including access to health benefits, improved salaries, and paid leave led to high job satisfaction and high retention. The motivated nurses were more likely to adhere to the health policies that improved the health of the patient. This lead to a general reduction in infections	The study is evidence-based, and it is consistent with previous studies. Its main strength was the focus on multiple sources that may have helped in reducing the infections
Weinstein & Marc (2004).	The study claimed that hygiene among the nurses was a major risk factor for factors for ventilator-associated pneumonia	More emphasis is placed on hygiene, especially that of handwashing before handling the patient. This reduces the infections significantly.	The main weakness is that the study assumed that hygiene was the only major risk factor for factor for Ventilator-Associated Pneumonia. Other factors, including the working conditions and the availability of technology, could also help in preventing the infections. Nevertheless, the study is relevant to the research question and consistent with the previous studies.