Diseases Prevention and Management. Nursing Research

Table of Contents

At the present stage of development of the healthcare system, socially significant nursing is undergoing several substantial changes. New approaches aimed at the prevention and management of chronic socially caused non-communicable human diseases are introduced. They have to apply the PICOT framework for specific clinical cases, such as doctor and nurse operative collaboration. A comprehensive strategy should identify risk factors and patient problems and also improve the processes of standardization and technologization of the professional activities of nurses and increasing their professional competence.

Comparison of Research Questions

The main objective of the PICOT statement paper is to identify the effect of surgery on germ cell tumor eradication in children compared with non-surgical treatments within three years. The article by Fukuda et al. examines an optimal solution for malnourished patients, who are prone to get surgical site infections. Al-Niaimi et al. show that quality improvement protocol can decrease SSI rates in surgical oncology. The article “Centers for disease control and prevention guideline for the prevention of surgical site infection” provides an updated evidence-based suggestion for SSI prevention (Berríos-Torres et al., 2017). Withal, Nishigori et al. study and outline critical risk factors that increase the SSI rate after laparoscopic total gastrectomy (LTG).

Also, the article by Shen et al. describes how negative-pressure wound therapy (NPWT) reduces the SSI occurrence rate. The main goal of the paper by Featherall et al. is to show that infection prevention bundles are associated with SSI reduction. However, McCullough et al. illustrate that prophylactic antibiotics do not reduce SSI. Finally, the key objective of the article “Consensus bundle on prevention of surgical site infections after major gynecologic surgery” is to show that patient safety bundles can prevent SSI in gynecologic surgeries (Pellegrini et al., 2017).

Comparison of Sample Populations

The population of the PICOT question for the topic problem was separated into groups depending on the kind of germ cell tumor. These groups included children with immature teratoma of the ovary, immature teratoma of the ovary and peritoneal gliomatosis, immature testicular teratomas, and gonadal tumors with different morphological structures and localization of the lesion. Three groups of 372 patients were also in the quantitative-correlational study of Al-Niaimi et al. 2015). 800 patients who underwent gastrectomy took part in the research of Fukuda et al. The quantitative-experimental study of Nishigori et al. analyzed 157 patients by eligibility. Besides, 265 patients with open resection intra-abdominal neoplasms were separated into three groups during the research of Shen et al.

The four other studies examined the duration of the surgical care episode (Featherall et al., 2016), 5759 article titles (Berríos-Torres et al., 2017), the database from 2005 to 2011 (McCullough et al., 2016), and cases of gynecological surgeries (Pellegrini et al., 2017). The populations of these eight studies differed from the population of the PICOT question in participants’ age (the population of the PICOT question consisted only of children), types of diseases, and performed surgeries.

Comparison of Limitations of Studies

The potential solution to the PICOT question is applying completely different approaches in the nursing practice on patients with common stages and relapses of the disease. Surgery follows chemotherapy, usually after reducing the size of the recurrent tumor and metastases and normalizing the level of tumor markers. The limitation is that the results of treating patients with disseminated carcinogenic tumors are significantly worse if, before surgery, chemotherapy fails to normalize levels of tumor markers. Also, the study of Fukuda et al. is limited since researchers chose a particular type of patients who underwent gastrectomy, and the rates were highly dependent on their condition. The work of Al-Naimi et al. had a small number of subjects and no reported difference between the study groups. Berríos-Torres et al. analyzed more than five thousand articles, some of which were not solid and factual.

The research of Nishigori et al. described only 157 patients without indicating selection criteria. Such a relatively small sample size may have insufficient statistical power to expose the studied effect. The study of NPWT should be learned by overviewing other risk factors since the given methodological tool did not fully cover the entire scope of instances of surgical site infections (Shen et al. 2017). Featherall et al. were limited with research location and needed to widen the scope of analysis by including more healthcare centers. The database of the study by McCullough et al. analyzed information received over several years, and some database sources were used with varying numbers of participants. Finally, the selection of individuals for the analysis of Pellegrini et al. was not randomized, and the cases of gynecological surgeries were collected-phenomenological.

Conclusion

Substantial changes in the healthcare system affect the significant and stressful profession of a nurse. Particularly, there are new approaches to the prevention and management of human diseases and applying the PICOT framework for doctor and nurse collaboration. Comparison of the PICOT statement paper and the eight modern studies shows differences in research questions, sample populations, and limitations complicating the determination of the reliability of the results. These data indicate trends and directions for further development and can be applied for improving the quality of medical care and nurses’ professional competence.

References

Al-Niaimi, A. N., Ahmed, M., Burish, N., Chackmakchy, S. A., Seo, S., Rose, S., Connor, J. (2015). Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients. Gynecologic Oncology, 136(1), 71-76.

Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., Dellinger, E. P. (2017). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surgery, 152(8), 784-791.

Featherall, J., Miller, J. A., Bennett, E. E., Lubelski, D., Wang, H., Khalaf, T., &Krishnaney, A. A. (2016). Implementation of an infection prevention bundle to reduce surgical site infections and cost following spine surgery. JAMA Surgery, 151(10), 988-990.

Fukuda, Y., Yamamoto, K., Hirao, M., Nishikawa, K., Maeda, S., Haraguchi, N.,… Nakamori, S. (2015). Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Annals of Surgical Oncology, 22(3), 778-785.

McCullough, M. C., Chu, C. K., Duggal, C. S., Losken, A., & Carlson, G. W. (2016). Antibiotic prophylaxis and resistance in surgical site infection after immediate tissue expander reconstruction of the breast. Annals of Plastic Surgery, 77(5), 501-505.

Nishigori, T., Tsunoda, S., Okabe, H., Tanaka, E., Hisamori, S., Hosogi, H., Sakai, Y. (2016). Impact of sarcopenic obesity on surgical site infection after laparoscopic total gastrectomy. Annals of Surgical Oncology, 23(4), 524-531.

Pellegrini, J. E., Toledo, P., Soper, D. E., Bradford, W. C., Cruz, D. A., Levy, B. S., & Lemieux, L. A. (2017). Consensus bundle on prevention of surgical site infections after major gynecologic surgery. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(1), 100-113.

Shen, P., Blackham, A. U., Lewis, S., Clark, C. J., Howerton, R., Mogal, H. D.,… Levine, E. A. (2017). Phase II randomized trial of negative-pressure wound therapy to decrease surgical site infection in patients undergoing laparotomy for gastrointestinal, pancreatic, and peritoneal surface malignancies. Journal of the American College of Surgeons, 224(4), 726-737.