WEIGHING THE EVIDENCE 1

NURS 6052: Essentials of Evidence-Based Practice

Week 10 Discussion

Weighing the Evidence

INITIAL POST

For this discussion post, I chose an article that evaluates the management of ventilator-

associated pneumonia, as it is something that is relevant to working in the emergency department

and intensive care unit. It is common for patients to receive mechanical ventilation for

respiratory distress, but most patients do not realize that it can put them at an increased risk for

infection. As a result, ventilator-associated pneumonia (VAP) is the most common nosocomial

infection in the intensive care unit (Safdar et al., 2016).

The study aimed to identify barriers and facilitators of managing VAP from the

provider’s perspective via surveying two groups, one with physicians and one with other

personnel including nurses and respiratory therapists at two different hospitals. Data from the

survey was then entered into a database, and descriptive statistics were calculated to identify top-

ranked barriers and facilitators of VAP management. Statistical analysis was then performed to

compare the perceptions of participants from different professional groups and to examine the

impact of guidelines awareness on the perceptions of members. The team utilized a five-point

Likert scale. The study concluded that the barrier to VAP management was having multiple

physician groups managing the VAP while having the nurse, respiratory therapist, and

pharmacist present during rounds was viewed as most beneficial. However, the study did have

limitations as it was based on two separate facilities in Wisconsin, which may limit the

generalizability of their findings.

WEIGHING THE EVIDENCE 2

In conclusion, the research group could have reached an alternative result, such as the

nurses, respiratory therapist, and pharmacist being the top ranked barrier. Physicians, as least

ones that I have worked with, will sometimes do what they wish, despite the recommendations of

nurses, respiratory therapists, and pharmacists. Without recommendations from other providers,

this could ultimately cause the patient further harm, as some antibiotics that treat VAP are

nephrotoxic and should not be prescribed in patients with renal failure or at least give a renal

dose which is something that pharmacists assist with. Further research needs to be done on a

broader base, with similar facility size and prescribing techniques to improve the study. Some

institutions follow national guidelines to diagnose and treat VAP, whereas, others use institution-

specific guidelines, the two facilities would need to diagnose and treat based off the same

guidelines.

References

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating & assessing evidence for

nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Safdar, N., Musuuza, J. S., Xie, A., Hundt, A. S., Hall, M., Wood, K., & Carayon, P. (2016).

Management of ventilator-associated pneumonia in intensive care units: a mixed methods

study assessing barriers and facilitators to guideline adherence. BMC Infectious Diseases,

16(349). http://dx.doi.org/10.1186/s12879-016-1665-1