UNIT TITLE: PUB016-6 PUBLIC HEALTH RESEARCH METHODS
ASSIGNMENT: RESEARCH PROPOSAL
TITLE: PREVENTING INFECTION RELATED VENTILATOR ASSOCIATED COMPLICATIONS
DATE:
STUDENT NAME:
STUDENT NUMBER:
Table of Contents
Describe and Critical evaluation of Key Background. 4
General Perspective on Key Background. 4
A specific and broad perspective on the same. 5
Probable implications of the study for public health. 6
Contribution of the study to existing knowledge. 6
Preventive measures of IVAC.. 7
Reflect on the probable results. 10
Abstract
This research proposal had provided an evaluation of the health care issue known as IVAC or Infection-related Ventilator-Associated Complication in terms of determining the proper research process by which knowing the preventive measure of the complication will be possible. In the introduction section, the researcher had proposed and discussed the research aim, objective and research question along with a piece of general and in-depth knowledge on the background of the research. It also had established a short literature review considering the research aim and objectives.
While developing the Gantt chart, the researcher had utilized software, Microsoft Excel, to develop in an effective manner and indulge every single activity under each stage. The researcher under the third stage had reflected on ethical considerations, which had instructed to disclose the ethical issues this research study could face and the importance of those issues to this study. Lastly, data analysis technique being suited to this study had also been discussed in the same stage. In the discussion stage, three major phases such as expected outcomes, limitations, and ideas to disseminate the research findings had been discussed. In the Conclusion section, the researcher had summarized the key points along with future research scope and also final thoughts through the development of a remark on the overall study. In the last stage, remarks and final thoughts had been disclosed under Final thought sub stage of the final stage, conclusion.
Infection-related Ventilator-Associated Complication is known as the infectious event that occurs in the respiratory function. It is mainly a subset of VAC and it occurs with the systemic inflammatory response (Barbier et al., 2018). It is essential to know about IVAC before proceeding to critically evaluate its key background. This particular research proposal is having the aim of critically carrying out the study from which knowing the preventive measures of Infection-related Ventilator-Associated Complication will be possible. It is going to be the study from which knowing the reason for the complications, its specific and broad perspective along with a general perspective can be obtained.
The research proposal is also going to discuss a proper research method in which the researcher will be determining the process, design and tools of research. The usage of the research method is essential to understand the carry out the research further for knowing about the key background of Infection-related Ventilator-Associated Complication and its preventive measures altogether. IVAC often happens with patients and knowing the reason for the occurrences is a proper way of determining proper prevention methods. Therefore, the research proposal is also going to generate a discussion on possible outcomes and a proper conclusion for determining the appropriateness of the whole research.
Patients often develop Infection-related Ventilator-Associated Complication when they obtain an inappropriate medical procedure conducted by a healthcare professional. It mostly happens when a healthcare staff or doctor performs a medical procedure through the usage of mechanical ventilation. Whenever a patient develops Infection-related Ventilator-Associated Complication, it increases the risk of having negative health outcomes such as peptic ulcer disease, pneumonia, gastrointestinal bleeding and also many other complications. Incubation and mechanical ventilation can sometimes be harmful and it is essential to process the invasive mechanical ventilation without any complications due to its life-threatening outcomes (Lopez et al., 2018). The infection-related ventilator-associated complications mostly occur when the vacuum-assisted closure coincides with several inflexions in the respiratory system. The occurrences of VAC and IVAC generate VAE which is known as Ventilator-Associated events (Kallet, 2019).
When a patient gets mechanically ventilated for breathing issues, sometimes, the healthcare professionals fail to incubate the patient properly and as the person gets mechanical ventilation machinery in their respiratory system, it generates complications and infections. As the possibility of the occurrence of IVAC is common in a healthcare setting, knowing the preventive measures are also essential in this regard as it can be helpful towards treating the infection of a patient and also the occurrences of the infection before it generates within the respiratory system.
After understanding the concept in a general term, it is essential to know about it from an in-depth perspective. The reason behind the occurrences of IVAC is related to the direct access of infectious bacteria to the lower respiratory tract through micro aspiration. It is possible at the time of incubation to get affected by the infection and complication. In this context, it is essential to prevent the complication with appropriate measures otherwise, it can generate difficulties in the respiratory system of the patient. Lower respiratory tract infection related to ventilation also happens when a critically ill patient obtains invasive mechanical ventilation.
It generates infections like ventilator-associated tracheobronchitis (VAT), and ventilator-associated pneumonia (VAP) (Rouzé et al., 2021). When a person gets affected through IVAC and develops VAP, it becomes essential for the healthcare professional to properly diagnose the infection before offering medical attention. VAP mostly generates symptoms of pulmonary infection such as purulent secretions, fever and leukocytosis in this regard (Othman and Abdelazim, 2017). Therefore, researching knowing the preventive measures of IVAC is essential and through the research, the researcher is going to obtain the information of those preventions.
The aforementioned discussion has reflected on the general and in-depth understanding of IVAC and also the reason for its occurrences. However, it is necessary to have a proper understanding of its importance and also the importance of its prevention methods. As ventilation related infections are possible to occur in clinical practices, the occurrences of the complications have been increasing the risk of death for severely ill patients in the healthcare setting (Phu et al., 2017). Therefore, the rationale of this study mainly directs to know the preventive methods and also the development of awareness and knowledge among healthcare professionals, nurses and hospital staff so that they can consider treating a patient and perform the medical procedure properly without creating any complications. There are many sets of risk factors related to IVAC which mainly increase the rationale of conducting the study as it will be generating information and prevention procedures that will be helping healthcare professionals and doctors to prevent the infection before its occurrences.
It is not often possible to diagnose ventilator-associated pneumonia as its criteria of diagnosis are very subjective (Neuville et al., 2017). Therefore, having a piece of proper knowledge about the infection that occurs through ventilation associated complications can help public health to gain better care and services. The overall research proposal thus also has the aim of generating the knowledge and idea of IVAC so that it can be implicated for the betterment of public health. Similar to the occurrences of health issues and diseases from the impact of the external environment, healthcare infections are also possible among patients any infection that a patient contracts after getting hospitalised is considered a healthcare-associated infection (Acelas et al., 2017). As this aspect indicates the occurrences of IVAC, the implication of the study will be effective for public health in this regard.
The most important risk factor that can occur through pneumonia associated with ventilation is the level of co-morbidity and also the severity of their illness (Papazian et al., 2020). It is essential to know about IVAC and have knowledge of its preventive measures so that it can reduce the occurrences of the situation in the healthcare setting. This particular research proposal thus holds the aim of identifying the preventive measures as the existing knowledge of preventing IVAC is less and does not offer much understanding on the aspect. Therefore, the overall research will be contributing to that area of knowledge and also will be filling the gap with the findings and information of preventive measures altogether.
RQ1: How can the complication based on IVAC be prevented?
The aim of this research is to obtain knowledge of IVAC and the appropriate measures of its prevention.
Considering the discussion of the IVAC along with its general and in-depth knowledge, it is essential to have a proper understanding of the possible preventive measures that can reduce the change of IVAC before its occurrence. There is always a possibility of IVAC happening within a patient’s respiratory system due to inappropriate incubating or usage of mechanical ventilation. Barriers have been occurring while adapting the surveillance process for ventilator-associated events as there is a lack of knowledge, information and quantifiable data and study that communicates about the preventive measures (Klompas, 2019). In this context, it is essential to know the process of preventing IVAC so that the health of a patient can be improved. Some research has addressed that in terms of preventing IVAC, there is a need of maintaining the flow of the oxygen and also the hygiene of the hardware that the patient is taking inside. However, there is less information related to the preventive measures for which, conducting the research is essential here.
This Gantt chart aims at making it clear to the reader when each of the stages associated with this research study is to be carried out. The Gantt chart always contains the list of activities that in OPM (Object Process Methodology) terms are processes (Sharon and Dori, 2017). Thus, here also, a list of activities is to be shown through the Gantt chart, which is to be carried out in this research study.
Figure 1: Gantt chart
(Source: Self-developed)
The above mentioned activities are parts of each stage, for instance the first stage includes selection of topic to literature review, second stage includes research method to data analysis technique, the third stage indulges activity discussion, and last stage includes conclusion only.
Significance of choosing the most appropriate research methodology including methods offers an insight into the importance of the ethical considerations around carrying out any research (Fleming and Zegwaard, 2018). Thus, while carrying out this research, the method section shows a considerable importance to ethical issues, which need to be discussed here in order to make this research study ethically valid, reliable, and confidential such as honesty, respect, integrity to each individual and literature indulged in this research. Thus, the researcher will maintain the ethical guidelines thoroughly while using the literatures or collecting the qualitative data from the respective respondents in order to avoid privacy issues.
This issue is important in this study because privacy is one of the ethical guidelines to make a study ethical enough. For instance, the researcher would be applying the Data Protection Act 1998, which would ensure the participants of the interview that whatever data they would be sharing with the researcher will be kept confidentially, privately, and securely. Every research participant must formally and voluntarily consent for participating in a research after being informed about the potential risks including benefits from the same study at any point of time (Clark-Kazak, 2017). Thus, voluntary participation and withdrawal is another issue, and is important because the participants will not claim any obligation that they are forcefully asked to participate in this research. Thus, the researcher will follow the informed-consent rules to invite the participants to participate in the interview session, further, the researcher will throughout the data collection respect the confidentiality, privacy, and even the emotions of the respondents.
Descriptive analysis method under data analysis technique is the most commonly used technique for analysing the collected data, yet, different other data analysis techniques are also used by a wide range of researchers on a frequent note (Fauzi and Pradipta, 2018). In this context, since the research will be following the primary qualitative pattern, thus the researcher would undertake an interview session involving the healthcare professionals belonging to different hospitals of the UK. Thus, the most suitable technique for data analysis with respect to this study is Narrative Analysis. This technique begins with a brief overview along with contextualization of the respective method before turning for analysing the data set itself (McAllum et al., 2019).
On other hand, QCA (Qualitative Content Analysis) is also found to be a famous research approach for describing and interpreting the textual data utilizing the systematic process regarding coding (Assarroudi et al., 2018). However, since it would be interview through which data will be collected, where voice or narration would be involved instead of text, thus QCA is not applicable to this research study. The selected analysis technique, narrative, is all about listening to the respondents or healthcare professionals indulged in the interview session sharing their relevant experience in the form of telling stories and then analysing the same what actually those stories mean. There seems to be a growing interest in using narrative analysis technique in a nursing research for understanding, from the perspective of patient or healthcare professionals, the experience of living with illness (Meraz et al., 2019).
The expected outcomes would direct the researcher to understand the best possible measures that the healthcare professionals apply in order to prevent the complications based on IVAC. In addition, the researcher is expecting to grasp in-depth knowledge about the concept of IVAC, what complications are offered by the same concept, how these complications are cured. After conducting this research, it is also expected to deliver such results, which could majorly focus on those preventive measures, which the interviewee or participants would have applied and those measures would definitely cure the infections spread due to IVAC. Before grabbing knowledge about preventive measures and since this is a nursing research, thus it would be expected to get in-depth and clear understanding about VAC as well.
VAC can be defined as worsening oxygenation whenever on mechanical ventilation after a specific period of stability or improvement based on the changes in daily minimum FiO2 (Fraction of Inspired Oxygen) or PEEP (Positive End Respiratory Pressure) (Cocoros et al., 2017). Reflecting on the possible results reveal that importance proper ventilation in a hospital, air temperature, impacts of indoor comfort, and many other factors, which lead to infections regarding lower respiratory tract. It is also expected that the researcher could gain outcome regarding the ventilation strategies applied by the healthcare professionals. The pattern of air distribution and the ventilation strategy in a hospital building are found to be correlated with the airborne-transmissions of infectious agents (Shajahan et al., 2019).
The implications of the expected findings for the public health practice and policy reflect that once the preventive measures applied by the top hospitals of the UK would be known to other hospitals having comparatively small size and less advanced infrastructure, then at least the percentage of encountering this infection could be lessened. Hence, the probability of this infection due to ventilation could be reduced by applying the most suitable ventilation strategy, however in an effective manner. Hence, an improved public healthcare facility and quality of care could be delivered to the patients having such critical condition, which makes them prone to this infection. Its implication for public health could help the healthcare professional to have a control over the length of stay and duration of mechanical ventilation, which are usually identified higher in the patients having pVAC, VAC, and IVAC (Pouly et al., 2020). The implications could come up as strength and contributor to reduce the occurrence of peptic ulcer, pneumonia, venous thromboembolic events, aspiration, gastrointestinal, and sepsis due to IVAC.
Thus, as a result, the rate of death due to these diseased led by IVAC could also be reduced, hence the overall mortality and morbidity could also be lessened by making every possible hospitals and nursing known about the factors and ineffectiveness in ventilation strategy leading to the encounter of IVAC. Thus, the implication to public health policy would direct the policymakers to make such strict rules and regulations that if any healthcare professional fails to apply effective ventilation strategy then strict actions would be taken against his/her professionalism. Furthermore, education and training need to be a mandatory subject in the public health policy under IVAC, ventilation strategies, its cases, and related infections.
There are some limitations regarding this proposed study, which could be encountered while carrying out the third stage, research method. For instance, due to limited budget, the researcher would be bounded to apply only qualitative research method instead of mixed research method that is qualitative and quantitative both. Thus, indulging only qualitative method would restrict the researcher to obtain limited amount of data and information, although this method would offer a scope to the researcher to get in-depth and evidence-based practical data without getting restricted in closed-ended format. However, if the researcher would undertake quantitative research method as well, then the expected outcomes would get a huge scope to provide variations, clarity, different perspectives, and extended responses to meet the research objectives. Furthermore, validity and reliability of an interview session in a research study could be a limitation (Queirós et al., 2017).
Thus, in this context, reliability and validity of the information shared by the healthcare professionals could be a limitation this study. Apart from these limitations, while gathering secondary data for accomplishing the first stage, the researcher would have experienced limitation based on availability and accessibility of relevant data. It is due to that there is les number of secondary sources being available over the internet regarding the preventive measures of IVAC, as the researcher aims at grabbing this information conceptually or theoretically. The limitations have implications to this study that the overall credibility of this study would be lessened a bit, however not a major effect could be imposed on the expected outcomes. However, a slight transition or difference could be obtained when the researcher expects the possible findings from the first stage specifically. Furthermore, the implications of method based limitations would reduce the scope of getting the reliable and valid data and information from the respondents if the researcher involves less experienced healthcare professionals.
The process of research dissemination seems to be critical aspect of a study, specifically research, which directly indulges the community (Hagan et al., 2017). Thus, own ideas for dissemination direct the researcher for publishing this research study or finings of this study in any national journal or state-wide publications. Furthermore, the researcher could disseminate the ideas by presenting the research findings at the meetings or conferences with the tutor or higher authority indulging professional associations. At the same time, for improving the current situation of public health, the dissemination of ideas could also be carried out by organizing programs or initiatives indulging the local community groups or hospitals including the healthcare professionals to inform them about the respective findings and outcomes.
This could help them to know a bit more about the ventilation strategies, preventive measures, and how this infection could be avoided. Specifically the researcher would aim to target The BMJ, European Heart Journal, SAGE, and Clinical Nurse Specialist: The Journal for Advanced Nursing. Apart from these, the researcher further aims at publishing the research or disseminating the research findings at the Conferences, specifically at RCN (Royal College of Nursing) International Nursing Research Conference and Global Experts Meeting on Frontiers in Nursing Education. For instance, the Conference as event would be hosted over the world leading all-in one virtual Conference Platform Hopin that enables a highly interactive with engaging experience for the delegates (The Royal College of Nursing, 2021).
Based on the overall discussion of the research proposal, some primary aspects that can be synthesised from the study are that it is important to research as it is related to a serious and severe health issue. The aim of knowing the preventive measures of Infection-related Ventilator-Associated Complication is going to be generating information so that filling the gap of the literature will be possible. Moreover, the study also has focused on using different research methods and also has proposed techniques and tools by which conducting the research further will be possible for the researcher. In the study, the researcher also has discussed the findings and implications that are more likely related to the gap of the literature about preventive measures of IVAC. The researcher also has discussed the limitations in the methodological aspects as it will be helping the researcher and the reader to obtain the information on preventions. Therefore, the proposed study has generated the importance of it and also the necessity of it through the overall discussion.
As the researcher will be conducting this research further, it will be generating information and ideas for other potential future studies. Through the determination of preventive measures for IVAC, the determination of using the preventive measures and also knowing the risks related to preventing measures will be some other areas of research. In this context, the overall research proposal has presented the possibility of conducting future research on other aspects related to IVAC and its related aspects in this regard.
The concluding thoughts reflect that conducting this research proposal seemed to be a challenging task, however provided a few key insights into IVAC, VAP, VAC and much other ventilation in nursing related knowledge. The remarks for this study say that the overall credibility and efforts of this researcher seemed to be of a higher level, which seek for a considerable attention by the assessor.
Assarroudi, A., Heshmati Nabavi, F., Armat, M.R., Ebadi, A. and Vaismoradi, M., 2018. Directed qualitative content analysis: the description and elaboration of its underpinning methods and data analysis process. Journal of Research in Nursing, 23(1), pp.42-55.
Barbier, F., Bailly, S., Schwebel, C., Papazian, L., Azoulay, É., Kallel, H., Siami, S., Argaud, L., Marcotte, G., Misset, B. and Reignier, J., 2018. Infection-related ventilator-associated complications in ICU patients colonised with extended-spectrum β-lactamase-producing Enterobacteriaceae. Intensive care medicine, 44(5), pp.616-626.
Clark-Kazak, C., 2017. Ethical considerations: Research with people in situations of forced migration. Refuge: Canada’s Journal on Refugees/Refuge: revue canadienne sur les réfugiés, 33(2), pp.11-17.
Cocoros, N.M., Priebe, G.P., Logan, L.K., Coffin, S., Larsen, G., Toltzis, P., Sandora, T.J., Harper, M., Sammons, J.S., Gray, J.E. and Goldmann, D., 2017. A pediatric approach to ventilator-associated events surveillance. infection control & hospital epidemiology, 38(3), pp.327-333.
Fauzi, A. and Pradipta, I.W., 2018. Research methods and data analysis techniques in education articles published by Indonesian biology educational journals. JPBI (Jurnal Pendidikan Biologi Indonesia), 4(2), pp.123-134.
Fleming, J. and Zegwaard, K.E., 2018. Methodologies, Methods and Ethical Considerations for Conducting Research in Work-Integrated Learning. International Journal of Work-Integrated Learning, 19(3), pp.205-213.
Hagan, T.L., Schmidt, K., Ackison, G.R., Murphy, M. and Jones, J.R., 2017. Not the last word: dissemination strategies for patient-centred research in nursing. Journal of Research in Nursing, 22(5), pp.388-402.
Kallet, R.H., 2019. Ventilator bundles in transition: from prevention of ventilator-associated pneumonia to prevention of ventilator-associated events. Respiratory care, 64(8), pp.994-1006.
Klompas, M., 2019. Barriers to the adoption of ventilator-associated events surveillance and prevention. Clinical Microbiology and Infection, 25(10), pp.1180-1185.
McAllum, K., Fox, S., Simpson, M. and Unson, C., 2019. A comparative tale of two methods: how thematic and narrative analyses author the data story differently. Communication Research and Practice, 5(4), pp.358-375.
Meraz, R.L., Osteen, K. and McGee, J., 2019. Applying Multiple Methods of Systematic Evaluation in Narrative Analysis for Greater Validity and Deeper Meaning. International Journal of Qualitative Methods, 18, p.1609406919892472.
Neuville, M., Mourvillier, B., Bouadma, L. and Timsit, J.F., 2017. Bundle of care decreased ventilator-associated events—implications for ventilator-associated pneumonia prevention. Journal of thoracic disease, 9(3), p.430.
Othman, A.A. and Abdelazim, M.S., 2017. Ventilator-associated pneumonia in adult intensive care unit prevalence and complications. The Egyptian Journal of Critical Care Medicine, 5(2), pp.61-63.
Papazian, L., Klompas, M. and Luyt, C.E., 2020. Ventilator-associated pneumonia in adults: a narrative review. Intensive care medicine, 46(5), pp.888-906.
Pena-Lopez, Y., Ramirez-Estrada, S., Eshwara, V.K. and Rello, J., 2018. Limiting ventilator-associated complications in ICU intubated subjects: strategies to prevent ventilator-associated events and improve outcomes. Expert review of respiratory medicine, 12(12), pp.1037-1050.
Phu, V.D., Nadjm, B., Duy, N.H.A., Mai, N.T.H., Trinh, D.T., Campbell, J., Khiem, D.P., Quang, T.N., Loan, H.T., Binh, H.S. and Dinh, Q.D., 2017. Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology. Journal of intensive care, 5(1), pp.1-9.
Pouly, O., Lecailtel, S., Six, S., Préau, S., Wallet, F., Nseir, S. and Rouzé, A., 2020. Accuracy of ventilator-associated events for the diagnosis of ventilator-associated lower respiratory tract infections. Annals of intensive care, 10(1), pp.1-8.
Queirós, A., Faria, D. and Almeida, F., 2017. Strengths and limitations of qualitative and quantitative research methods. European Journal of Education Studies.
Rodríguez-Acelas, A.L., de Abreu Almeida, M., Engelman, B. and Cañon-Montañez, W., 2017. Risk factors for health care–associated infection in hospitalized adults: systematic review and meta-analysis. American journal of infection control, 45(12), pp.e149-e156.
Rouzé, A., Martin-Loeches, I., Povoa, P., Makris, D., Artigas, A., Bouchereau, M., Lambiotte, F., Metzelard, M., Cuchet, P., Geronimi, C.B. and Labruyere, M., 2021. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive care medicine, 47(2), pp.188-198.
Shajahan, A., Culp, C.H. and Williamson, B., 2019. Effects of indoor environmental parameters related to building heating, ventilation, and air conditioning systems on patients’ medical outcomes: A review of scientific research on hospital buildings. Indoor Air, 29(2), pp.161-176.
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The Royal College of Nursing. 2021. RCN International Nursing Research Conference | Events | Royal College of Nursing. Available at: <https://www.rcn.org.uk/news-and-events/events/uk-international-nursing-research-conference-070921> [Accessed on 13 May 2021].
UNIT TITLE: PUB016-6 PUBLIC HEALTH RESEARCH METHODS
ASSIGNMENT: RESEARCH PROPOSAL
TITLE: PREVENTING INFECTION RELATED VENTILATOR ASSOCIATED COMPLICATIONS
DATE:
STUDENT NAME:
STUDENT NUMBER:
Table of Contents
Describe and Critical evaluation of Key Background. 4
General Perspective on Key Background. 4
A specific and broad perspective on the same. 5
Probable implications of the study for public health. 6
Contribution of the study to existing knowledge. 6
Preventive measures of IVAC.. 7
Reflect on the probable results. 10
Abstract
This research proposal had provided an evaluation of the health care issue known as IVAC or Infection-related Ventilator-Associated Complication in terms of determining the proper research process by which knowing the preventive measure of the complication will be possible. In the introduction section, the researcher had proposed and discussed the research aim, objective and research question along with a piece of general and in-depth knowledge on the background of the research. It also had established a short literature review considering the research aim and objectives.
While developing the Gantt chart, the researcher had utilized software, Microsoft Excel, to develop in an effective manner and indulge every single activity under each stage. The researcher under the third stage had reflected on ethical considerations, which had instructed to disclose the ethical issues this research study could face and the importance of those issues to this study. Lastly, data analysis technique being suited to this study had also been discussed in the same stage. In the discussion stage, three major phases such as expected outcomes, limitations, and ideas to disseminate the research findings had been discussed. In the Conclusion section, the researcher had summarized the key points along with future research scope and also final thoughts through the development of a remark on the overall study. In the last stage, remarks and final thoughts had been disclosed under Final thought sub stage of the final stage, conclusion.
Infection-related Ventilator-Associated Complication is known as the infectious event that occurs in the respiratory function. It is mainly a subset of VAC and it occurs with the systemic inflammatory response (Barbier et al., 2018). It is essential to know about IVAC before proceeding to critically evaluate its key background. This particular research proposal is having the aim of critically carrying out the study from which knowing the preventive measures of Infection-related Ventilator-Associated Complication will be possible. It is going to be the study from which knowing the reason for the complications, its specific and broad perspective along with a general perspective can be obtained.
The research proposal is also going to discuss a proper research method in which the researcher will be determining the process, design and tools of research. The usage of the research method is essential to understand the carry out the research further for knowing about the key background of Infection-related Ventilator-Associated Complication and its preventive measures altogether. IVAC often happens with patients and knowing the reason for the occurrences is a proper way of determining proper prevention methods. Therefore, the research proposal is also going to generate a discussion on possible outcomes and a proper conclusion for determining the appropriateness of the whole research.
Patients often develop Infection-related Ventilator-Associated Complication when they obtain an inappropriate medical procedure conducted by a healthcare professional. It mostly happens when a healthcare staff or doctor performs a medical procedure through the usage of mechanical ventilation. Whenever a patient develops Infection-related Ventilator-Associated Complication, it increases the risk of having negative health outcomes such as peptic ulcer disease, pneumonia, gastrointestinal bleeding and also many other complications. Incubation and mechanical ventilation can sometimes be harmful and it is essential to process the invasive mechanical ventilation without any complications due to its life-threatening outcomes (Lopez et al., 2018). The infection-related ventilator-associated complications mostly occur when the vacuum-assisted closure coincides with several inflexions in the respiratory system. The occurrences of VAC and IVAC generate VAE which is known as Ventilator-Associated events (Kallet, 2019).
When a patient gets mechanically ventilated for breathing issues, sometimes, the healthcare professionals fail to incubate the patient properly and as the person gets mechanical ventilation machinery in their respiratory system, it generates complications and infections. As the possibility of the occurrence of IVAC is common in a healthcare setting, knowing the preventive measures are also essential in this regard as it can be helpful towards treating the infection of a patient and also the occurrences of the infection before it generates within the respiratory system.
After understanding the concept in a general term, it is essential to know about it from an in-depth perspective. The reason behind the occurrences of IVAC is related to the direct access of infectious bacteria to the lower respiratory tract through micro aspiration. It is possible at the time of incubation to get affected by the infection and complication. In this context, it is essential to prevent the complication with appropriate measures otherwise, it can generate difficulties in the respiratory system of the patient. Lower respiratory tract infection related to ventilation also happens when a critically ill patient obtains invasive mechanical ventilation.
It generates infections like ventilator-associated tracheobronchitis (VAT), and ventilator-associated pneumonia (VAP) (Rouzé et al., 2021). When a person gets affected through IVAC and develops VAP, it becomes essential for the healthcare professional to properly diagnose the infection before offering medical attention. VAP mostly generates symptoms of pulmonary infection such as purulent secretions, fever and leukocytosis in this regard (Othman and Abdelazim, 2017). Therefore, researching knowing the preventive measures of IVAC is essential and through the research, the researcher is going to obtain the information of those preventions.
The aforementioned discussion has reflected on the general and in-depth understanding of IVAC and also the reason for its occurrences. However, it is necessary to have a proper understanding of its importance and also the importance of its prevention methods. As ventilation related infections are possible to occur in clinical practices, the occurrences of the complications have been increasing the risk of death for severely ill patients in the healthcare setting (Phu et al., 2017). Therefore, the rationale of this study mainly directs to know the preventive methods and also the development of awareness and knowledge among healthcare professionals, nurses and hospital staff so that they can consider treating a patient and perform the medical procedure properly without creating any complications. There are many sets of risk factors related to IVAC which mainly increase the rationale of conducting the study as it will be generating information and prevention procedures that will be helping healthcare professionals and doctors to prevent the infection before its occurrences.
It is not often possible to diagnose ventilator-associated pneumonia as its criteria of diagnosis are very subjective (Neuville et al., 2017). Therefore, having a piece of proper knowledge about the infection that occurs through ventilation associated complications can help public health to gain better care and services. The overall research proposal thus also has the aim of generating the knowledge and idea of IVAC so that it can be implicated for the betterment of public health. Similar to the occurrences of health issues and diseases from the impact of the external environment, healthcare infections are also possible among patients any infection that a patient contracts after getting hospitalised is considered a healthcare-associated infection (Acelas et al., 2017). As this aspect indicates the occurrences of IVAC, the implication of the study will be effective for public health in this regard.
The most important risk factor that can occur through pneumonia associated with ventilation is the level of co-morbidity and also the severity of their illness (Papazian et al., 2020). It is essential to know about IVAC and have knowledge of its preventive measures so that it can reduce the occurrences of the situation in the healthcare setting. This particular research proposal thus holds the aim of identifying the preventive measures as the existing knowledge of preventing IVAC is less and does not offer much understanding on the aspect. Therefore, the overall research will be contributing to that area of knowledge and also will be filling the gap with the findings and information of preventive measures altogether.
RQ1: How can the complication based on IVAC be prevented?
The aim of this research is to obtain knowledge of IVAC and the appropriate measures of its prevention.
Considering the discussion of the IVAC along with its general and in-depth knowledge, it is essential to have a proper understanding of the possible preventive measures that can reduce the change of IVAC before its occurrence. There is always a possibility of IVAC happening within a patient’s respiratory system due to inappropriate incubating or usage of mechanical ventilation. Barriers have been occurring while adapting the surveillance process for ventilator-associated events as there is a lack of knowledge, information and quantifiable data and study that communicates about the preventive measures (Klompas, 2019). In this context, it is essential to know the process of preventing IVAC so that the health of a patient can be improved. Some research has addressed that in terms of preventing IVAC, there is a need of maintaining the flow of the oxygen and also the hygiene of the hardware that the patient is taking inside. However, there is less information related to the preventive measures for which, conducting the research is essential here.
This Gantt chart aims at making it clear to the reader when each of the stages associated with this research study is to be carried out. The Gantt chart always contains the list of activities that in OPM (Object Process Methodology) terms are processes (Sharon and Dori, 2017). Thus, here also, a list of activities is to be shown through the Gantt chart, which is to be carried out in this research study.
Figure 1: Gantt chart
(Source: Self-developed)
The above mentioned activities are parts of each stage, for instance the first stage includes selection of topic to literature review, second stage includes research method to data analysis technique, the third stage indulges activity discussion, and last stage includes conclusion only.
Significance of choosing the most appropriate research methodology including methods offers an insight into the importance of the ethical considerations around carrying out any research (Fleming and Zegwaard, 2018). Thus, while carrying out this research, the method section shows a considerable importance to ethical issues, which need to be discussed here in order to make this research study ethically valid, reliable, and confidential such as honesty, respect, integrity to each individual and literature indulged in this research. Thus, the researcher will maintain the ethical guidelines thoroughly while using the literatures or collecting the qualitative data from the respective respondents in order to avoid privacy issues.
This issue is important in this study because privacy is one of the ethical guidelines to make a study ethical enough. For instance, the researcher would be applying the Data Protection Act 1998, which would ensure the participants of the interview that whatever data they would be sharing with the researcher will be kept confidentially, privately, and securely. Every research participant must formally and voluntarily consent for participating in a research after being informed about the potential risks including benefits from the same study at any point of time (Clark-Kazak, 2017). Thus, voluntary participation and withdrawal is another issue, and is important because the participants will not claim any obligation that they are forcefully asked to participate in this research. Thus, the researcher will follow the informed-consent rules to invite the participants to participate in the interview session, further, the researcher will throughout the data collection respect the confidentiality, privacy, and even the emotions of the respondents.
Descriptive analysis method under data analysis technique is the most commonly used technique for analysing the collected data, yet, different other data analysis techniques are also used by a wide range of researchers on a frequent note (Fauzi and Pradipta, 2018). In this context, since the research will be following the primary qualitative pattern, thus the researcher would undertake an interview session involving the healthcare professionals belonging to different hospitals of the UK. Thus, the most suitable technique for data analysis with respect to this study is Narrative Analysis. This technique begins with a brief overview along with contextualization of the respective method before turning for analysing the data set itself (McAllum et al., 2019).
On other hand, QCA (Qualitative Content Analysis) is also found to be a famous research approach for describing and interpreting the textual data utilizing the systematic process regarding coding (Assarroudi et al., 2018). However, since it would be interview through which data will be collected, where voice or narration would be involved instead of text, thus QCA is not applicable to this research study. The selected analysis technique, narrative, is all about listening to the respondents or healthcare professionals indulged in the interview session sharing their relevant experience in the form of telling stories and then analysing the same what actually those stories mean. There seems to be a growing interest in using narrative analysis technique in a nursing research for understanding, from the perspective of patient or healthcare professionals, the experience of living with illness (Meraz et al., 2019).
The expected outcomes would direct the researcher to understand the best possible measures that the healthcare professionals apply in order to prevent the complications based on IVAC. In addition, the researcher is expecting to grasp in-depth knowledge about the concept of IVAC, what complications are offered by the same concept, how these complications are cured. After conducting this research, it is also expected to deliver such results, which could majorly focus on those preventive measures, which the interviewee or participants would have applied and those measures would definitely cure the infections spread due to IVAC. Before grabbing knowledge about preventive measures and since this is a nursing research, thus it would be expected to get in-depth and clear understanding about VAC as well.
VAC can be defined as worsening oxygenation whenever on mechanical ventilation after a specific period of stability or improvement based on the changes in daily minimum FiO2 (Fraction of Inspired Oxygen) or PEEP (Positive End Respiratory Pressure) (Cocoros et al., 2017). Reflecting on the possible results reveal that importance proper ventilation in a hospital, air temperature, impacts of indoor comfort, and many other factors, which lead to infections regarding lower respiratory tract. It is also expected that the researcher could gain outcome regarding the ventilation strategies applied by the healthcare professionals. The pattern of air distribution and the ventilation strategy in a hospital building are found to be correlated with the airborne-transmissions of infectious agents (Shajahan et al., 2019).
The implications of the expected findings for the public health practice and policy reflect that once the preventive measures applied by the top hospitals of the UK would be known to other hospitals having comparatively small size and less advanced infrastructure, then at least the percentage of encountering this infection could be lessened. Hence, the probability of this infection due to ventilation could be reduced by applying the most suitable ventilation strategy, however in an effective manner. Hence, an improved public healthcare facility and quality of care could be delivered to the patients having such critical condition, which makes them prone to this infection. Its implication for public health could help the healthcare professional to have a control over the length of stay and duration of mechanical ventilation, which are usually identified higher in the patients having pVAC, VAC, and IVAC (Pouly et al., 2020). The implications could come up as strength and contributor to reduce the occurrence of peptic ulcer, pneumonia, venous thromboembolic events, aspiration, gastrointestinal, and sepsis due to IVAC.
Thus, as a result, the rate of death due to these diseased led by IVAC could also be reduced, hence the overall mortality and morbidity could also be lessened by making every possible hospitals and nursing known about the factors and ineffectiveness in ventilation strategy leading to the encounter of IVAC. Thus, the implication to public health policy would direct the policymakers to make such strict rules and regulations that if any healthcare professional fails to apply effective ventilation strategy then strict actions would be taken against his/her professionalism. Furthermore, education and training need to be a mandatory subject in the public health policy under IVAC, ventilation strategies, its cases, and related infections.
There are some limitations regarding this proposed study, which could be encountered while carrying out the third stage, research method. For instance, due to limited budget, the researcher would be bounded to apply only qualitative research method instead of mixed research method that is qualitative and quantitative both. Thus, indulging only qualitative method would restrict the researcher to obtain limited amount of data and information, although this method would offer a scope to the researcher to get in-depth and evidence-based practical data without getting restricted in closed-ended format. However, if the researcher would undertake quantitative research method as well, then the expected outcomes would get a huge scope to provide variations, clarity, different perspectives, and extended responses to meet the research objectives. Furthermore, validity and reliability of an interview session in a research study could be a limitation (Queirós et al., 2017).
Thus, in this context, reliability and validity of the information shared by the healthcare professionals could be a limitation this study. Apart from these limitations, while gathering secondary data for accomplishing the first stage, the researcher would have experienced limitation based on availability and accessibility of relevant data. It is due to that there is les number of secondary sources being available over the internet regarding the preventive measures of IVAC, as the researcher aims at grabbing this information conceptually or theoretically. The limitations have implications to this study that the overall credibility of this study would be lessened a bit, however not a major effect could be imposed on the expected outcomes. However, a slight transition or difference could be obtained when the researcher expects the possible findings from the first stage specifically. Furthermore, the implications of method based limitations would reduce the scope of getting the reliable and valid data and information from the respondents if the researcher involves less experienced healthcare professionals.
The process of research dissemination seems to be critical aspect of a study, specifically research, which directly indulges the community (Hagan et al., 2017). Thus, own ideas for dissemination direct the researcher for publishing this research study or finings of this study in any national journal or state-wide publications. Furthermore, the researcher could disseminate the ideas by presenting the research findings at the meetings or conferences with the tutor or higher authority indulging professional associations. At the same time, for improving the current situation of public health, the dissemination of ideas could also be carried out by organizing programs or initiatives indulging the local community groups or hospitals including the healthcare professionals to inform them about the respective findings and outcomes.
This could help them to know a bit more about the ventilation strategies, preventive measures, and how this infection could be avoided. Specifically the researcher would aim to target The BMJ, European Heart Journal, SAGE, and Clinical Nurse Specialist: The Journal for Advanced Nursing. Apart from these, the researcher further aims at publishing the research or disseminating the research findings at the Conferences, specifically at RCN (Royal College of Nursing) International Nursing Research Conference and Global Experts Meeting on Frontiers in Nursing Education. For instance, the Conference as event would be hosted over the world leading all-in one virtual Conference Platform Hopin that enables a highly interactive with engaging experience for the delegates (The Royal College of Nursing, 2021).
Based on the overall discussion of the research proposal, some primary aspects that can be synthesised from the study are that it is important to research as it is related to a serious and severe health issue. The aim of knowing the preventive measures of Infection-related Ventilator-Associated Complication is going to be generating information so that filling the gap of the literature will be possible. Moreover, the study also has focused on using different research methods and also has proposed techniques and tools by which conducting the research further will be possible for the researcher. In the study, the researcher also has discussed the findings and implications that are more likely related to the gap of the literature about preventive measures of IVAC. The researcher also has discussed the limitations in the methodological aspects as it will be helping the researcher and the reader to obtain the information on preventions. Therefore, the proposed study has generated the importance of it and also the necessity of it through the overall discussion.
As the researcher will be conducting this research further, it will be generating information and ideas for other potential future studies. Through the determination of preventive measures for IVAC, the determination of using the preventive measures and also knowing the risks related to preventing measures will be some other areas of research. In this context, the overall research proposal has presented the possibility of conducting future research on other aspects related to IVAC and its related aspects in this regard.
The concluding thoughts reflect that conducting this research proposal seemed to be a challenging task, however provided a few key insights into IVAC, VAP, VAC and much other ventilation in nursing related knowledge. The remarks for this study say that the overall credibility and efforts of this researcher seemed to be of a higher level, which seek for a considerable attention by the assessor.
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