Identifying Research Methodologies

In this Assignment, you will identify clinical areas of interest (Ventilator-associated Pneumonia) and inquiry and practice searching for research in support of maintaining or changing the common and best practices. You will also analyze this research to compare the research methodologies employed.

Based on the clinical issue of interest (Ventilator-associated Pneumonia) and using keywords related to Ventilator-associated Pneumonia, search at least four different databases (CINAHL, ProQuest, MEDLINE, PubMed, ScienceDirect, or TRIP) to identify at least four relevant peer-reviewed articles related to Ventilator-associated Pneumonia. You should not be using systematic reviews for this assignment, select original research articles.

Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database (randomized controlled trials, cohort studies, or case studies) to search for peer-reviewed research.

Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

After reading each of the four peer-reviewed articles you selected, analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:

1. The full citation of each peer-reviewed article in APA format.
2. A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to Ventilator-associated Pneumonia, including a brief explanation of the ethics of research related to your clinical issue of interest (as a nurse working in a critical care unit for many years).
3. A brief (1-2 paragraph) description of the aims / purpose of the research of each peer-reviewed article.
4. A brief (1-2 paragraph) description of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.
5. A brief (1- to 2-paragraph) description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.

Be sure to include clear and comprehensive introduction, purpose of this assignment, and conclusion on this paper.

Use only references from years 2016 to 2021 but use and include two from the following references:
1. Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
2. Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26(2), 91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x
3. Hoare, Z., & Hoe, J. (2013). Understanding quantitative research: Part 2. Nursing Standard, 27(18), 48-55. doi:10.7748/ns2013.01.27.18.48.c9488
4. Hoe, J., & Hoare, Z. (2013). Understanding quantitative research: Part 1. Nursing Standard (through 2013), 27(15-17), 52-7. doi:10.7748/ns2012.12.27.15.52.c9485

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Solution

Introduction

The selection of this clinical inquiry was triggered by a dramatic increase in the rate of Ventilator-Associated Pneumonia (VAP) in the Intensive Care Units (ICUs). According to Villar et al (2016), the rate of Ventilator-associated pneumonia (VAP) is relatively high among critically ill patients in the Intensive Care Unit (ICU). Oral pathogens get into the lower respiratory system during aspiration causing Ventilator-Associated Pneumonia (VAP) among patients receiving this treatment therapy (Zand et al., 2017). According to Kocaçal Güler and Türk (2019), this infection is associated with adverse health outcomes, including a longer ICU stay, increased mechanical ventilation duration, and a higher mortality rate. Studies show that good oral hygiene care hinders the respiratory pathogens from colonizing the dental plaque, thus preventing the VAP (Hua et al., 2016). Thus, this evidence-based project assesses the efficacy of chlorhexidine oral rinse or chlorhexidine plus toothbrushing in preventing ventilator-associated pneumonia.

 

Full citation of selected article	Article #1	Article #2	Article #3	Article #4
	Enwere, E. N., Elofson, K. A., Forbes, R. C., & Gerlach, A. T. (2016). Impact of chlorhexidine mouthwash prophylaxis on probable ventilator-associated pneumonia in a surgical intensive care unit. International journal of critical illness and injury science, 6(1), 3.	Veitz-Keenan, A., & Ferraiolo, D. M. (2017). Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia. Evidence-based dentistry, 18(4), 113-114.	de Lacerda Vidal, C. F., de Lacerda Vidal, A. K., de Moura Monteiro, J. G., Cavalcanti, A., da Costa Henriques, A. P., Oliveira, M., … & Lacerda, H. R. (2017). Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC infectious diseases, 17(1), 1-9.	Khan, M., Mohamed, Z., Ali, S., Saddki, N., & Sukminingrum, N. (2018). The effects of oral care with 0.2% chlorhexidine with toothbrushing to prevent ventilator associated pneumonia in adults’ intensive care units. European Respiratory Journal; 52 (62): 1-7. DOI: 10.1183/13993003.congress-2018.PA4697
Why you chose this article and/or how it relates to the clinical issue of interest (include a brief explanation of the ethics of research related to your clinical issue of interest)	This article was selected since it aligns with the clinical issue of study. The article is about the relationship between chlorhexidine mouthwash prophylaxis and probable ventilator-associated pneumonia. Similarly, the clinical issue of inquiry focuses on the use of chlorhexidine gluconate oral rinse and ventilator-associated pneumonia bundle in preventing ventilator-associated pneumonia. The ethics of research related to the clinical issue of inquiry involves obtaining written consent from the selected sample population as proof of their willingness to participate in the clinical trial involving chlorhexidine gluconate oral rinse and ventilator-associated pnuemonia bundle to prevent ventilator-associated pneumonia in a population at a high risk of developing this condition.	This article is about the efficacy of Oral care with chlorhexidine in reducing the incidence of ventilator-associated pneumonia. Hence, it was selected since it aligns with the clinical issue of inquiry that involves the use of chlorhexidine gluconate oral rinse and ventilator-associated pneumonia bundle in preventing ventilator-associated pneumonia. The ethics of research related to the clinical issue of inquiry involves affirming confidentiality. Participants are assured that the collected information will only be used for the purpose of the study and their personal information will not be disclosed.	The article was chosen since it related to the clinical issue of inquiry. It compares the efficacy of various forms of oral hygiene, including toothbrushing and chlorhexidine in preventing ventilator-associated pneumonia. Similarly, the clinical issue of inquiry focuses on the use of chlorhexidine gluconate oral rinse and ventilator-associated pneumonia bundle in preventing ventilator-associated pneumonia. The ethics of research related to the clinical issue of inquiry entails ensuring that study benefits overweigh the risks. Additionally, patients are not involved in clinical trials that might result in death of the participants.	This article was selected since it related with the clinical issue of inquiry. This article is about the impact of oral care with tooth brushing and 0.2% chlorhexidine on preventing ventilator associated pneumonia in adult patients in the intensive care units. Similarly, the clinical issue of inquiry focuses on the use of chlorhexidine gluconate oral rinse and ventilator-associated pnuemonia bundle in preventing ventilator-associated pneumonia. The ethics of research related to the clinical issue of inquiry involves obtaining informed consent from the participants before the study.
Brief description of the aims of the research of each peer-reviewed article	This study aims at evaluating the effect of implementing routine chlorhexidine mouthwash prophylaxis in reducing the pneumonia rate in mechanically-ventilated patients in the Surgical Intensive Care Unit (SICU).	The aim of this study is to evaluate the impact of oral care with chlorhexidine in lowering the incidence of ventilator-associated pneumonia. Specifically, the study focuses on assessing the effect of various forms of oral health care, including mouthwashes, tooth brushing or swabs or a combination of two of these forms in preventing ventilator-associated pneumonia in critically ill patients under mechanical ventilation.	This study aims at evaluating the efficacy of oral hygiene, including tooth brushing and chlorhexidine in gel at 0.12% in lowering the ventilator-associated pneumonia rate, mechanical ventilation duration, the length of stay, and death rates in the Intensive Care Units (ICUs).	The aim of this study is to compare the efficacy of oral chlorhexidine and the combination of chlorhexidine and tooth brushing in reducing the incidence of ventilator-associated pneumonia among mechanically ventilated patients in the ICU.
Brief description of the research methodology used Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.	The authors conducted a retrospective cohort study. The quantitative research methodology was used to collect data from 158 patients who met the inclusion criteria following the screening of mechanically ventilated patients with respiratory cultures.	The authors’ utilized quantitative methodology to collect data from the selected participants. The participants consisted of critically ill pneumonia patients receiving mechanical ventilation.	The researchers utilized a quantitative methodology to collect data during the study. Data was collected from 213 patients who met the inclusion criteria.	Quantitative research methodology was used to collect data during the study. The authors collected data from 63 patients who were mechanically ventilated at the ICU in the Hospital Universiti Sains Malaysia (USM). The participants were assigned to the study and control groups randomly. The control group had a total of 32 patients, receiving 0.2% chlorhexidine gluconate mouthrinse twice daily. On the other hand, the study group had 31 patients, practicing tooth brushing and receiving 0.2% chlorhexidine gluconate mouth rinse twice daily.
A brief description of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected.	The major strength of quantitative research methodology involves being relatively easy to analyze. Thus, data collected during study is easily analyzed using different statistical methodologies. This data collection methodology is highly reliability since it is consistent during data collection. Additionally, it is highly validity since it yielded accurate results during the study.	Quantitative research methodology is associated with various strengths. One of the greatest strengths involves having a clear grounding in theory. Variants are tested on established theories and models based on the developed hypotheses. Thus, theories are redefined based on the identified variables. This methodology is reliable since it provides consistent results throughout the study. Additionally, it is valid since it gives accurate results.	Quantitative research methodology is attributed to straightforward analysis of the collected data. Statistical tests to be used during data analysis are selected based on the collected data. Hence, this data collection methodology supports straightforward interpretation and presentation of the study findings with limited errors. This methodology is highly reliable since the collected data can be tested and checked. Data validity is also evident in this study since the methodology has given accurate results.	The major strength of this data collection methodology involves supporting a larger sample size, which allows for generalization of study findings. Furthermore, multiple data sets can be evaluated at once in quantitative research methodology. Quantitative method is highly reliable due to its consistency throughout data collection process. Additionally, this methodology has a high validity rate since it gives accurate results.
General Notes/Comments	The rate of ventilator-associated pneumonia reduces following the use of chlorhexidine mouthwash prophylaxis.	Oral hygiene care (OHC), such as chlorhexidine mouthwash lowers the risk of ventilator-associated pneumonia from approximately 25% to 19% in critically ill patients.	Oral hygiene care, including Tooth brushing plus 0.12% chlorhexidine gel reduces the rate of the ventilator-associated pneumonia. Additionally, tooth brushing reduces mechanical ventilation mean time in ICU patients.	Tooth brushing plus 0.2% chlorhexidine gluconate mouth rinse twice daily is more effective in preventing ventilator-associated pneumonia among critically ill patients being mechanically ventilated in the ICU.

Conclusion

The rate of ventilator-associated pneumonia among critically ill patients receiving mechanical ventilation is relatively high. This issue can be addressed through evidence-based practices (EBP) specifically oral hygiene care (OHC), including chlorhexidine oral wash or chlorhexidine plus tooth brushing twice daily. These interventions are effective in reducing the high rate of ventilator-associated pneumonia and mechanical ventilation duration among critically ill patients in the ICU.

 References

De Lacerda Vidal, C. F., de Lacerda Vidal, A. K., de Moura Monteiro, J. G., Cavalcanti, A., da Costa Henriques, A. P., Oliveira, M., … & Lacerda, H. R. (2017). Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: a randomized study. BMC infectious diseases, 17(1), 1-9.

Enwere, E. N., Elofson, K. A., Forbes, R. C., & Gerlach, A. T. (2016). Impact of chlorhexidine mouthwash prophylaxis on probable ventilator-associated pneumonia in a surgical intensive care unit. International journal of critical illness and injury science, 6(1), 3.

Hua, F, Xie, H, & Worthington, HV, et al. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev; 10:Cd008367.

Khan, M., Mohamed, Z., Ali, S., Saddki, N., & Sukminingrum, N. (2018). The effects of oral care with 0.2% chlorhexidine with toothbrushing to prevent ventilator associated pneumonia in adults’ intensive care units. European Respiratory Journal; 52 (62): 1-7. DOI: 10.1183/13993003.congress-2018.PA4697

Kocaçal Güler, E., & Türk, G. (2019). Oral chlorhexidine against ventilator-associated pneumonia and microbial colonization in intensive care patients. Western journal of nursing research, 41(6), 901-919.

Veitz-Keenan, A., & Ferraiolo, D. M. (2017). Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia. Evidence-based dentistry, 18(4), 113-114.

Villar, C. C., Pannuti, C. M., Nery, D. M., Morillo, C. M., Carmona, M. J. C., & Romito, G. A. (2016). Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilator-associated pneumonia: meta-analysis and systematic review. Respiratory care, 61(9), 1245-1259.

Zand, F. Zahed L, & Mansouri P, et al. (2017). The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults’ intensive care units. J Crit Care; 40: 318–322.