- May 18, 2020
Transferring Central Line Care Evidence Article Critique
TransferringCentral Line Care Evidence: Article Critique
TransferringCentral Line Care Evidence: Article Critique
This report provides a theoretical critique of Marjorie S. McCaskeyarticle Transferring central line care evidence into practice onpediatric acute care units. Published in the Journal ofPediatric Nursing in 2013, the article explores the efficiency ofa scholastic strategy to integrate fundamental regulations forcentral line care. Thus, report appraises the accuracy of the journalarticle in presenting the research problem and outcomes in theabstract, background, methodology and design, results, discussion,and analysis.
Although thetitle describes the scope and nature of the study, it does notcomprehensively indicate the precise subject of the research. Thearticle evaluates the success of an approach in applying fundamentalrules venous catheter care. However, the title only highlights thetransfer of line care evidence into practice. The author should haveincluded the correlation between evidence-based regulations in linecare within pediatric units and educational intervention. Moreover,the author should have included the nurses working in pediatric units(participants) and the implementation of a multifaceted scholasticintervention. On the other hand, the abstract starts with theobjective of the study and then details how the study was conducted,and finally, illustrates the significance of the study. The abstractindicates that a statistically significant increase in compliance wasrealized after the application of the intervention. McCaskey showsthat the study reported a p-value of p < .001 meaning that theresearch was both significant and correlated well with thehypothesis. The researcher points out that the participants, but doesnot give the sample size or the setting of the study. It is criticalto note that the author provides the variables of the studyparticularly the main variable (intricate intervention) and thereliant factors (self-informed pre-intervention and post-interventionreview marks). However, the researcher has not highlighted thesecondary independent variable (feedback and audit). Furthermore,McCaskey fails to highlight extensively the results of the study onlyillustrating its significance and a general overview of theeffectiveness of the intervention. The failure to provide any data onthe results or the design employed to undertake the study shows acritical limitation of the abstract in giving readers a broadoverview of the research significance, outcomes, discussion, andconstraints. In this regards, the abstract is not a suggestivecomponent of the study since readers only gain a minor insight of theresearch problem, importance, and the correspondence between thedifferent variables.
The introductionproffers an intuitive assessment of the issue and the researchedundertaken prior to the current study. McCaskey defines theevidence-based practice and shows how the implementation of thedeveloped intervention can help tackle morbidity, costs, andmortality issues. The author postulates the purpose of the researchas “report the findings of a study on the impact of an educationalstrategy on the implementation of the evidence-based central linecare.” Additional, the researcher points out the setting (a Midwesthealth system) of the research and the unit where the participantsare surveyed. In this regards, it is easy for the reader tocomprehend that the research is a pre-intervention andpost-intervention experimental design. Besides, one notes that theresearcher will utilize a definitive measurement tool to analyze thedata obtained from the nurses’ feedback and audits. McCaskeycontends that the theoretical framework is grounded on Roger’stheory of Diffusion, which she describes and illustrates itsfoundations and application. The researcher delineates the theory asthe communication (audit and feedback represent communication in thepresent study) of innovation (application of the educationalintervention) or idea through specific channels. Moreover, McCaskeyillustrates the development of the identified contextual frameworkdiagrammatically, which points the relationship betweenevidence-based care, audit, education approach, and feedback and theenhanced compliance, audits, and decreased CLABSI (central lineassociated bloodstream infection). Consequently, the discussion ofthe theoretical framework helps to persuade the reader on thesignificance of the topic and the need to actualize a heuristicintervention.
Following theabstract, the researcher provides a scant discussion of the review ofthe literature. The researcher examines few studies and articles onthe development and definition of evidence-based practice. Most ofthe literature explored looks at the significance of the researchespecially the central line linked infections and the application ofbundled regulations. The significance part shows the utilization ofthese guidelines in the healthcare and the transfer of the practicesto pediatric units. Although McCaskey has sparingly reviewed theavailable literature, she indicates the costs, mortality, andmorbidity issues related to the central line. The researcher notesthat 80,000 CLABSI cases happen in critical areas among pediatric andhospitalized patients. The research’s effects for other populationshave been illustrated. However, the use of 1997 and 1999 articlesinhibits the credibility of the evidence on the implementation of theintervention and the efforts developed in the care setting. Thisshows that the researcher did not undertake in-depth research on themost applicable resources for the topic. The researcher should haveused more and current articles to successfully convince the readerson the development of the issue and any outcome associated with theintervention.
McCaskey definesthe research questions clearly by relating them to the contextualframework. Depicting the questions helps in refining the purpose ofthe study and allows the readers to note that the research problem istied to specific variables and the methodology. The author criticallydiscusses both the dependent and independent variables. In fact, sheties the theoretical framework effectively with the variables showingthe independent variables as the multifaceted intervention and thefeedbacks or audits and the dependent variables as thepre-intervention and post-intervention surveys. However, she has nothighlighted the hypothesis only presenting the purpose andsignificance of the study. The lack of a testable measurement andcomprehensive studies inhibits the review of literature greatly.
McCaskey uses aquasi-experimental study design in Riley Hospital with a 275-bedcapacity. A pre-intervention and post-intervention design areemployed in six acute units with three units labeled as surgical andthe remaining as medical. The sample size (n = 187) is well indicatedand connected to the variables identified. The participants includedare full-time nurses only to ensure that the researcher identifiedthe effectiveness of an intervention approach on participants withadequate exposure to central care. The researcher clearly shows thedata she obtained: demographic, gender, and age. Moreover, sheindicates the care bundle module (see table 1) relevant for theresearch and the scale (six-point scale) utilized to score the15-question survey. The prevalence of CLABSI was reported over a4-month period in 2010 and 2011 for both the pre andpost-intervention study. It is important to note that author has notindicated the separate sample size for the pre or post interventionstrategies, only pointing out that different sample sizes in theresults section. Given that the education approach only took 2months, the research’s outcomes should not be taken as extensivelyconclusive. Moreover, the sample size utilized is not enoughrepresentative for exploring the effectiveness of an edifyingintervention. It is also important to note that the researchersourced all the participants from a single hospital, which shows thatthe study is not feasible since the level of admission is probablylow. However, the sample size is sufficient to answer the questionsand provided the required results. Nurses in the pediatric sectionwere invited to partake in the research and those who completed thesurvey were seen as consenting to participate. However, part-time andresource nurses were excluded since McCaskey deemed them as having alow experience in central line cares. Although the researcherspecifies she collected and compiled the data using Microsoft Excel,she has not demonstrated how she analyzed the data.
Thesetting of the study design is suitable for this nature of theresearch given that it is a care facility offering focused servicesto children. Nonetheless, the overall design is not applicable inexploring the effectiveness of an educational strategy, as it limitsvalidity and credibility of the study (Miller & Maragakis, 2012Viswanathan, 2012). Viswanathan et al. (2012) opine that utilizing awide range of setting is critical in ensuring that a research tacklesthe patients’ awareness and complexity, as well, as examines allthe variables effectively. The use of one setting enhances the riskof external validity (selection influence) and internal validity(selection bias). Moreover, using a sample size from one unit onlymay promote bias or force the readers to question the necessity ofrepeating the intervention elsewhere (Miller & Maragakis, 2012).The researcher does not indicate whether random sampling was utilizedonly positing that the participants “were invited to participate,”showing that she reached to “all full-time nurses working in themedical and surgical units.” McCaskey measured the independentvariable (intricate educational intervention) on three fronts:electronic educational sessions, small group discussions, andhands-on demonstration. The second independent variable: feedback andaudit, took place only in the surgical units because of the highnumber of central venous catheter usage while the dependent variablesincluded mean survey scores, results of the audit, and incidence ofCLABSI in 4-month periods for both pre and post intervention studies.The nurses were supposed to complete the electronic care bundleeducation within four weeks. On the other hand, the discussioncomprised eight participants, took 1 hour, and allowed the nurses toask explicatory questions while the demonstration and looked ataccessing central line, assessment of line dressings, a cap change,and dry time. The study had a Cronbach’s alpha of .67, which showsthat it had a reasonable internal consistency. The author audited theresults using excel and compiled them in a broad-minded bar graph.This shows that there was efficient constancy of data increasing thevalidity of the research. However, the daily inconsistency instaffing patterns may have inhibited the capacity to equal reviewsprior to or after the interpolation. McCaskey asserts that theresearch was assessed and sanctioned as exempt by Purdue Universitiesand the Institutional Review Board at Indiana. She has also includedthe inclusion and exclusion criteria but has not indicated theconfidentiality or consent components that nurses were made aware of.However, she indicates that nurses who completed the surveys wereviewed as assenting to the study. Perhaps, the lack of comprehensivedescription of the consent process comprehensively may have beenbecause of the perception that the intervention approach should be aroutine. In fact, the electronic maintenance care bundle stayedaccessible to all the workers once the 4-week closing date and ispresently a prerequisite for new employees.
McCaskey hashighlighted the results of the study in a table format (see table 2)and provided a thoughtful discussion. Table two (independent samplest-test) offers comprehensive results of the comparison betweenpre-intervention and post-intervention surveys. The table indicatesthe statistical findings of the 15 questions. The table iseffectively organized hence, it offers clarity and allows the readerto comprehend the findings well. She analyzed the data using SPSS andtested the reliability using the Cronbach’s alpha. A two-way ANOVAwas assessed contrasting the self-multiple marks of bothinterventions and for the nurses who operated on a division that waspart (or not a segment) of the UNIT (audit and feedbackintervention). McCaskey found a t-value [t (145)] of -8.06 anda p-value of p < .001 for the pre against post interventionsurvey. It is also imperative to note that the research exposed anoteworthy variation concerning the averages of pre-interventionparticipants (M = 67.33, SD = 4.16) andafter-intervention surveys (M = 71.81, SD = 2.45).Moreover, the mean scores reveal the same thing: post-interventionsurveys (M= 4.812, SE = .022) show a higher score thanbefore the strategy surveys (M = 4.527, SE = .023)while a main impact for pre and post approaches marks was revealed [F(1,1980 = 78.67]. However, the research shows that the main effectfor UNIT (F = .327, p = .568) and the correlation for theself-described reviews and element (F = .404, p = .526) werenot significant.
In reviewing the maintenance care package, McCaskey used a chi-squaretest, which shows that a significant correlation between early andlate acquiescence for the surgical entities (p = .253) did not occur.The results show that CLABSI reported after the implementation of aneducational intervention decreased [six (three in medical and threein surgical) CLABSI in the pre-intervention study and four in thesubsequent strategy entirely in the surgical unit]. However, thechi-square showed a lack of significance between the correlation ofeducational intervention and the frequency of CLABSI between surgicaland medical units (p = .822). The presentation of the findings in atable format helps to outline the p-values and mean scores withoutcluttering the measures. The illustration of the standard errorshelps to show assess the accuracy of the study. Furthermore, throughp-values, McCaskey shows that the implementation of an educationalapproach is statistically significantly in lowering the incidence ofCLABSI in both surgical and medical units.
The researchersystematically indicates the limitations of the study. She contendsthat unmeasured impenetrable elements, such as, prior or personalexperience with the care, undertaking the study in a small and singlehospital, introduction of other unit-based practices, the variabilityof patient complexity, and increased attention on the units may haveimpacted the study. In the surgical units, nurses realized that theirdressings were visually evaluated early on, which means thatcompliance was high. Nonetheless, these limitations are included in aseparate part following the discussion. The Hawthorne effect was amajor intervening factor throughout the study. Furthermore, shediscusses the behaviors (tubing change, hand hygiene, and alcoholscrub) that were not affected by the application. She concludes thatthe application of an educational strategy was linked with anincrease in nurses’ compliance. Moreover, she referred to East andJacoby (2005) and Semelsberger (2009) studies on the diminishingCLABSI incidences after the implementation of an educationalintervention. East and Jacoby (2005) study is particularly importantsince it is a primary article published in the Pediatric Nursingjournal. Semelsberger (2009) study is a systematic review ofother studies hence, it reveals results from numerous articles onthe effectiveness of an educational intervention. However, the authordoes not attempt to make any other reference to literature resources.The failure to include other articles affects the accuracy andvalidity of the study. It is critical to point out that the authordoes not attempt to comprehensively analyze or discuss the presenteddata in the results section and only concludes the important bits ofthe research. This makes it hard for the readers to have a betterunderstanding of the study’s elements. In concluding the discussionpart, the researcher says that the occurrence of CLABSI wasdocumented and compiled during the same 4-month period in bothinterventions to diminish the risk of cyclical inconsistency. Theconclusion and suggestion part include significant aspects of futurestudies and recommendations on enhancing the application of thestrategy. As attested by other studies (East & Jacoby, 2005Humphrey, 2015), McCaskey (2013) asserts that the effective adoptionof venous catheter package can enhance the successful application offundamental practices. Moreover, she considers the study helpful forother authors or policymakers comprehend the significance ofcompliance and standardization within clinical settings.
As a registerednurse with a doctorate in nursing practice, Marjorie McCaskey is anexpert in the field of central line care and pediatric care areas.She is chief coordinator of quality at Riley Hospital where she alsoundertook the research thus, she is extensively involved in SPSoutcomes and the advancement of sustainable process improvementsthrough compliance, adoption, and evidence-based packagedevelopments. Her work was received in 2012 and published in 2013 inthe Journal of Pediatric Nursing. Given that Christian (2012) inillustrating the interplay between study and nursing practice hascited her work, it is critical to note that the paper iswell-researched and a significant study in understanding theapplication of educational intervention in medical and surgicalunits. Scholars and policymakers can use the results of this study toimprove clinical settings, promote consistency, and comprehend thesignificance of compliance and normalization with a central linecare. In fact, all hospitals should adopt central line care todecrease the risk of infections, healthcare costs, and prolonged stay
Christian, B. J. (2012). Translational research: the interplaybetween research and nursing practice. Journal of PediatricNursing, 28(6), 613-615.
McCaskey, M. S. (2013). Transferring central line care evidence intopractice on pediatric acute care units. Journal of PediatricNursing, 28(6), e57-e63.
East, D., & Jacoby, K. (2005). The effect of a nursing staffeducation program on compliance with central line care policy in thecardiac intensive care unit. Pediatric Nursing, 31(3),182.
Humphrey, J. S. (2015). Improving registered nurses` knowledge ofevidence-based practice guidelines to decrease the incidence ofcentral line-associated bloodstream infections: an educationalintervention. Journal of the Association for VascularAccess, 3(20), 143-149.
Miller, S. E., & Maragakis, L. L. (2012). Central line-associatedbloodstream infection prevention. Current opinion ininfectious diseases, 25(4), 412-422.
Semelsberger, C. (2009). Educational interventions to reduce the rateof central catheter–related bloodstream infections in the NICU: AReview of the Research Literature. Neonatal Network, 28(6),391-395.
Viswanathan, M., Ansari, M. T., Berkman, N. D., Chang, S., Hartling,L., McPheeters, M., … & Treadwell, J. R. (2012). Assessingthe risk of bias of individual studies in systematic reviews ofhealth care interventions. Agency for Healthcare Research andQuality