Appraisal of a piece of published research evidence and a discussion of the factors affecting its application to professional practice
Search Strategy in Locating Research Evidence
In the electronic age, a wide array of information is available through different channels of data networking, particularly online libraries together with academic and professional sites allowing interested to gain access to information important in informed decision-making especially salient in the medical and other life-dependent professions. This means that most information needs are accessible through these electronic channels However, the wide array of information makes it difficult to locate particular studies pertinent to the quest for information needed in decision-making as much as it is difficult to locate a book in a huge library. Thus, locating research evidence necessitates the use of keywords to narrow down the search area enabling the researcher to focus on the targeted evidence. Moreover, the integrity and reliability of the information derived is reflected in part by the reliability of the online source so that it is important to choose the source of information by mainly considering academic and professional information sources.
Required research evidence focuses on the issue of nosocomial infections caused by the poor compliance of health care workers with hand decontamination protocol after every contact with different patients. This issue revolves around the acceptability of hand decontamination procedures to healthcare workers due to problems in skin tolerance from frequent washing despite recognition of the need to ensure proper hygiene at work. The article chosen for review studies the daily hand hygiene practices of hospital nurses based on the premise that the extent of utilisation of hand decontamination procedures is linked to antimicrobial effectiveness and skin tolerance so that minimizing nosocomial infection depends upon these two determinants of hand decontamination methods. The study then aims to evaluate the antimicrobial effectiveness as well as skin tolerance of two commonly accepted hand decontamination methods to give light to this issue. ( 2000)
Description & Appraisal of Research Approach & Methods
The research approach used by (2000) in studying the response of nurses to two hand decontamination procedures is the experimental research approach. According to and (1993), the experimental approach comprises the fully compelling tool able to establish causation through the conduct of diligently planned experiment from which the effects of one or more variables to other variables are derived and studied. The study subject of review utilises the experimental research design because it seeks to determine and study the causal relationship between hand decontamination compliance and the variables of antimicrobial effectiveness and skin tolerance, with compliance as the effect and the two variables as the causes, for two commonly accepted hand decontamination procedures.
The experimental research approach has two unique features. One is the ability of the researcher to manipulate certain variables, particularly the independent variable, in order to derive controlled results. The other is the ability of this research design to allow empirical observations that provide strong arguments for the cause-and-effect relationships arising in the course of the study. (2006) In the study being reviewed, the research design is expressed in the design below. The independent variable is comprised of the two hand decontamination methods utilised by nurses in the different health care facilities. This variable is manipulated in the research through the randomised exclusive use of either of these decontamination methods by the research participants to determine the exclusive effects of these methods. The manipulation of the independent variable is expected to determine the similarities and differences in the nature and extent of antimicrobial effectiveness of the hand decontamination methods as well as the skin tolerance of the nurses to these methods. The variables of antimicrobial effectiveness and skin tolerance are then expected to determine in turn the characteristics of the compliance of nurses to either hand decontaminations techniques. An aspect of evidence-based practice is drawing learning and understanding from the experiences of healthcare workers themselves necessitating the eliciting of knowledge and practice-based opinions from healthcare workers involved in the research study.
Choosing the appropriate research design is imperative to the overall success of the research. This is because research disasters is determined more by the failure of the research design more than the analysis made of the data derived from the design. This means that it is futile to focus on analysis of data when the research design is inappropriate or flawed. (2000) This further implies that evaluating research design involves the determination of both design appropriateness and flaw. In the research subject to review, the research method is appropriate to the achievement of the aims of the study. This is because the study aims to find links between the variables hand decontamination techniques, and antimicrobial effectiveness and skin tolerance to determine and explain compliance with these decontamination techniques. The experimental design characterised by its ability to draw cause-and-effect relationships between variables best suits the design needs of the study. In relation to the flaws in the application of the research design relative to the aims of the study, the application of the experimental research design creates a limitation in the study, which is the derivation of qualitative data on the perceptions of nurses on the effectiveness of the hand decontamination techniques based on their experience and recommendations on the manner of improving or changing these techniques to achieve both antimicrobial effectiveness and skin tolerance leading to greater degrees of compliance.
To obtain research participants for the study, the research utilised convenience sampling by drawing volunteers from the nurses and nursing assistances who were contacted, working in twelve medical and four surgical departments at the Assistance Publique HoÃpitaux de Marseille. Out of the 78 nurses and nursing assistants contacted, 52 volunteered to participate in the experiment so this number also comprised the population sample. Convenience sampling involves the selection of a research sample based on the availability and accessibility of participants, which in the study being reviewed is comprised of contacted people willing to participate in the experiment. This type of sampling works effectively in instances where it is difficult to obtain a research sample such as in exploratory research but its drawbacks include the probability of high non-representation of different population characteristics. (2000) In the study subject to review, the use of convenience sampling carries both advantage and disadvantage. If the population being represented is the total number of nurses and nursing assistants in the hospital then the sample may be representative of the population but if the population being considered is the entire number of nurses and nursing assistance of different hospital in a geographic location then the sample may not be representative. One implication of this is that in analysing and generalising data, the conclusion only applies to the hospital nurses and nursing assistants in the given case or non-encompassing of the entire nurses and nursing assistants in the given population. In the first instance, generalisations can be made but limited only to the hospital while in the latter case generalisations cannot be validly made for the entire population. The study carries this sampling dilemma in using convenience sampling.
After selecting the sample research participants, the research utilised randomised control trial to determine the research participants employing one or the other hand decontamination method. The first hand decontamination method is the use of non-antiseptic liquid soap and the second method involves the use of an alcohol-based antiseptic hand rinse. The research participants exclusively used their random designated hand decontamination technique continuously for eight days. The primary difference between the two techniques is that while the substance used in the non-antiseptic method contains moisturizer implying close proximity to skin tolerance the substance used in the antiseptic method contains disinfectant indicating close alignment with antibacterial effectiveness. The experiment provided a controlling element for the two hand decontamination methods through the common type of washing facilities for all nursing and nursing assistants. The controlling element for the respective techniques is the standard 10-second rubbing for the non-antiseptic method and the 3-5 ml spreading on both hands of the antiseptic substance. The number of hand decontamination depended upon the caseload of the research participants logged into a journal.
The randomised control trial (RCT) comprises one of the commonly utilised methods for evaluating the effectiveness of treatments. The significant characteristic of RCT is its ability to provide a comparison between two groups. Depending upon the rigorousness of the controls used in the experiment determines the reliability of the derived conclusions. The central value of RCT is the elimination of cognitive bias through randomisation. (2006) The characteristics of RCT implies that evaluating the effectiveness of this method in a particular research involves the consideration of the ability of the study to provide sufficient criteria for comparison and the provision of sufficient controls to manipulate the flow of the experiments towards the intended results. In the study subject of review, two hand decontamination methods are being tested as utilised by two different groups. This means that it would be difficult to establish criteria for comparing two different hand decontamination systems for two different groups. In the study, the criteria established for comparing the two hand decontamination systems is antibacterial effectiveness measured through microbiological results and skin tolerance determined through Larson's Skin Assessment Rating Scale. These criteria suffice, for the purpose of the study, to provide uniformity in the experiment. In the study, the common washing areas and uniform systems of performing the two techniques also comprise sufficient controls for the study. However, the fact that hand decontamination of the research participants depends upon their varying case loads, this could significantly affect the results of the study.
To analyse results the study applied the quantitative research method to determine the statistical implications of the microbiological and skin assessment tests conducted after the eight-day experiment period. The study used the Mann-Whitney U-test in comparing distributions in the occurrence of the general characteristics of the two experimental groups, the x2-test determines differences between the results, and the Pearson’s correlation was used to determine the links between the variables. Quantitative research is geared towards deduction since it tests theory. This means that this type of research method leads to generalised results. Apart from this, quantitative research method also involves the treatment of measurable or quantifiable data. Quantitative research allows the achievement of precise results from the statistical tools as derived in the study. However, the study, in using quantitative analysis also assumes the innate disadvantage of quantitative method of determining the existence of relationships without necessarily providing the reasons for the nature and extent of the relationship. (1999)
Main Findings & Applicability of Evidence to Professional Practice
Based on the quantitative data, the study determined that the skin condition and extent of skin damage of participants using the non-disinfectant substance significantly worsened relative to the participants using disinfectant. This is expressed in the 20 out of 50 hand washes using non-disinfectant substance resulting to bacterial contamination in the hands. The result came about because the alcohol-based hand washing substance was more effective in removing transient microorganisms contaminating the hands resulting to a lower incidence of bacterial skin conditions. This means that using antiseptic wash works better in maintaining the skin condition as well as minimizing bacterial infection in the hands of nurses and nursing assistants contributing to a lower incidence of nosocomial infections. As the experiment period concluded, the tests showed that bacterial count in the hands of the participants using non-disinfectant hand wash increased together with an escalation in skin damage relative to the participants using disinfectant wash. The study concluded with the greater effectiveness of disinfectant techniques in the healthcare setting but the frequency and quality of hand decontamination using disinfectant is greatly influenced by skin comfort. This implies that even with the proven effectiveness of using alcohol-based hand wash, compliance with quality hand decontamination after every contact with a patient subjectively depends upon the skin comfort or tolerance of the healthcare worker.
Despite the positive and negative assessments of the methodological foundation of the study, research results and conclusions still provides important implications in evidence-based practice in terms of both research and practical value. In terms of research value, the study was able to show that in the case of the sample population, using alcohol-based hand washes is more effective than non-disinfectants in minimizing hand bacterial contamination. Due to the minimization of bacterial contamination, the skin condition of the participants did not relatively worsen. However, the methods used in the research also indicates the need to expand the research in order to arrive at valid generalisations for the healthcare industry in support of policy changes in hygiene practices of healthcare workers. This is important in evidence-based practice because not only should healthcare practitioners be informed of possible areas of change but they should also be informed accurately and comprehensively before making critical decisions with practical implication (1998). In terms of practical value, the research indicates enhanced bacterial effectiveness and skin tolerance with disinfectant hand washes. However, the research also shows that there is room for improvement since the frequency of compliance with quality hand decontamination subjectively depends upon the tolerance of practitioners indicating a problem in praxis. This opens several alternatives. One is the formulation of skin sensitive alcohol-based hand washes to target not only bacterial effectiveness but also skin tolerance on an equivalent level. This addresses both frequency and quality of hand decontamination. Another is the evaluation of the hand washing process to determine if there are ways of improving the process to enhance skin tolerance together with bacterial effectiveness. These aspects of practical value are important in evidence-based practice because research results should be consistent with the experiences of practitioners and recommendations should be workable or doable to be viable in actual practice (1998).
Conclusion
Overall, the study provides research and practical value for evidence-based practice. The study offers information on the relative effectiveness of two hand decontamination methods in terms of bacterial effectiveness and skin tolerance. Results showed that alcohol-based hand decontamination wash is more effective in minimizing bacterial contamination in the hands lessening the development of skin conditions by healthcare workers. It also provides practical value in encouraging the critical use by healthcare workers of disinfectant wash instead of non-disinfectant wash and opens areas for improvement in the frequency and quality of hand decontamination compliance. However, it also has methodological limitations indicating the need for further research to encompass wider scope such as the technique of combining both hand decontamination techniques and increasing the research sample to include healthcare workers in other facilities.
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