Nursing response #3_sr

150 words 1 reference (nursing journals), this is a response to a peer. 

Article: 1  

Vianna, P. G., Jr Dale, C. R., Simmons, S., Stibich, M., & Licitra, C. M. (2016). Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital. American Journal of Infection Control, 44(3), 299-303. doi:10.1016/j.ajic.2015.10.009

            Hospital associated infections are attributed to extended hospital stays or death. Patients are at increased risk of acquiring infections after being admitted to rooms with previously contaminated MDRO-positive patients (Vianna, Jr Dale, Simmons, Stibich, & Licitra, 2016). Therefore, environmental personnel play a pivotal role in decontaminating infected rooms.  Problem arises when there are variation in cleaning methods.  The study published by the American Journal of Infection Control, reported that the use of xenon ultraviolet light technology in conjunction with standard cleaning measures greatly decreased hospital-wide and ICU infection rates.  Based on the Rating System of the Hierarchy of Evidence, this particular study is a  Level III, evidence obtained from well-designed controlled trail without randomization  (Melnyk & Fineout-Overholt, 2014).  Unlike, Level II there is a lack of randomization.   Level III is befitting as the study has a well-controlled trail, for instance: all ICU rooms have no touch cleaning before ultraviolet emission and non-ICU c. diff rooms were no touch cleaning before ultraviolet use. Although, one should note that results differ from ICU rooms and non-ICU rooms because of lack of control in cleaning procedures, hand washing compliance, and antimicrobial stewardship. 

Article 2:

Humphrey, J. (2015). Primary cesarean delivery results in emergency hysterectomy due to placenta accreta: A case study. AANA Journal, 83(1),28-34.

            High risk pregnancy complication such as placenta accreta has become more common as the rate of c-section increase (Humphrey, 2015). Placenta accreta is when the placenta remain attached to the uterine wall, which, can consequently result in severe bleeding and maternal morbidity and mortality. Humphrey (2015) described a scenario in which a 35 year old female with gravida 3, para 0 presented with ruptured membrane and breech presentation that required a primary  c-section. Her hospitalization was complicated by postpartum  hemorrhage  hours after delivery, which  eventually,  led to the patient receiving a hysterectomy  in order to control bleeding. Risk factors such as increase maternal age, history of placenta previa,  and primary c-section can potentially increase  postpartum hemorrhage. In summary, Humphrey expressed the importance of quickly recognizing and identifying those at risk of postpartum hemorrhage as a result of placenta accreta , in order, to control bleeding.  The article made  it a point, to express,  that these patient require close monitoring even if there vital signs are stable  because continued bleeding might me undetectable. The author recommended, initiating protocols that aides in identifying at risk mothers.  Institution of such protocol,  will alert staff of these life threatening situations in order to provide the appropriate intervention.  Upon review of this article, it is a Level VI on the Rating System of the Hierarchy of Evidence. This article was presented in a case study format that identified patients with primary c-section which resulted in placenta accreta. The author exposed the topic of interest and provided recommendation for practice.  In addition , Level VI evidence is good for addressing questions related to harm and can provide circumstantial evidence and not provide definitive proof of the causes of a disease. It is slightly reliable but there is a potential for bias when recalling information (Ingham-Broomfield,  2016).

            The advanced practice nurse evaluate evidence through research by critical appraisal.  This means assessing the validity and usefulness of evidence (Melnyk & Fineout-Overholt, 2014).  In addition, determining the type of method of research  such as quantitative or qualitative. The research methodology is also important for determining the appropriateness of the research, such as the use of systematic reviews or clinical trials. Rigor or the validity of the result is also crucial of evaluation of evidence (Melnyk & Fineout-Overholt, 2014).  For instance, this means determining if the research question is focused. Furthermore, the results of the research determine if there were any significant findings or data. Lastly,  the advanced practice nurse must determine the relevancy  of the research, meaning how applicable is it for practice (Melnyk & Fineout-Overholt, 2014).