Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene

Table of Contents

1.0 Introduction
1.1 Statement of Intent
1.2 Importance of Research in Nursing
1.3 Outline of the Critique and Definition of Key Terms Relevant to the Study
2.0 Believability
2.1 Writing Style
2.2 Research Title
2.3 Author Credentials
2.4 Abstract
3.0 Robustness
3.1 Research Problem, Purpose or Significance
3.2 Literature Review
3.3 Methodology (Research Design, Philosophical Underpinnings, Theoretical Framework and Aim or Hypothesis)
3.4 Sampling
3.5 Ethical Considerations
3.6 Data Collection Method
3.7 Validity and Reliability
3.8 Data Analysis
3.9 Findings
4.0 Conclusion
References

1.0 Introduction

1.1 Statement of Intent

The study that has been considered for critical introspection is based on the topic of health and hygiene. This particular study has been chosen for analysis and critiquing as it is considered that the outcomes of the topic will be useful for our learning process of nursing course. There have been ample studies on how health workers can become source of transmission of infectious bacterial pathogens. However, there are not many studies that are focused on how patients can be the cause of transmission of infections in hospitals. Therefore, it is expected that the research study will come up with some interesting outcomes that would help to enrich the nursing learning experience. So, this particular critiquing article will consider the research study and will come up with detailed analysis of research aspects like discussion of the key terms that are relevant to the study, the importance of the topic, research problem, literature review the design, methods philosophy, theoretical framework and conclusion drawn from the overall critiquing report “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

1.2 Importance of Research in Nursing

According to Rajasekar and Philominathan (2013) research in nursing is essential as it helps to make the discipline nursing all the more useful for the society. Nursing is a profession where an individual is required to serve patients with compassion and medical knowledge. In fact Kothari (2012) states that in nursing conducting research is all the more essential in nursing as nursing has to do more with applicability of knowledge in real life. Nurses basically learn about nursing when after training they actually start serving the patients in practical life. Thus research studies which mainly conduct experiments in practical applications of nursing, the outcomes are for sure to enhance the knowledge of nurses and the nursing community as a whole. For instance, as (Peffers, Tuunanen, Rothenberger, & Chatterjee, 2007) says, the fact that nurses will be able to deliver their best when they have good communication skills becomes evident when (Smith, 2012) conducted his research on Nursing and Communication.

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1.3 Outline of the Critique and Definition of Key Terms Relevant to the Study

The study that has been considered for critiquing is based on quantitative research methodology. In fact, this particular critiquing report will be analyzing the methods that have been developed in order to conduct the study. The design of the study has been based on the philosophy of positivism. Moreover, the design is identified to be deductive. Literature review has also been conducted in order to develop a strong literary understanding of the topic, which will eventually enable researchers to undertake primary data analysis. The quantitative data analysis is noted to be the form of data collection. The data is collected from samples taken from real life patients. The other form of primary research is qualitative study. However, in order to suit with the requirements of this particular study, the qualitative data collection has not been considered. According to Pedler (2012), qualitative analysis works best for research studies that are dependent of on in depth numerical analysis. Likewise, for this particular study, it has been found that to find the rate of transmissions of pathogens from the patients can best be determined with the aid of quantitative data collection. On the other hand, this particular study need not have to deal with much about in depth human psychological aspects. So, this particular study has been found to be not requiring the content centric qualitative data analysis. The following sections of the report will critique the research study by the process of identifying the strengths and limitations of the entire paper, especially in relation to believability and robustness. “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

2.0 Believability

2.1 Writing Style

According to Mahoney (2010) for any research paper irrespective of the topic, design and requirements of the research it is very essential to have a distinct writing style. For a literature based paper, it is recommended that researchers should cautious about the writing style as much of the success of the research depends on it. However, for studies that are based on scientific understandings like nursing, the nursing style should ideally be simple and straight forward (Blessing and Chakrabarti, 2009). The style of writing for this particular researcher paper has been identified to be engaging. This is mainly because of the fact that the style of writing has been found to be quite simple. Ranging from the usage of words and even the length of the sentence, the researchers have paid attention to keep the narration simple and easily comprehensible. The researchers have been identified that reveal information step by step so that the researchers can develop their understanding of the subject matter of the research in due course.

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2.2 Research Title

The topic of the study is “patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”. The title of study seems to be quite long however, the topic is not misleading. On reading the topic readers get an idea about the very need to conduct the study. The fact that apart from health care workers, the patients can themselves be responsible for transmission of health care associated infections comes to the light through the topic. Moreover, the topic also reveals the fact that hand hygiene can be one of the major sources of transmitting infectious diseases. The title also comes up with the idea that the contamination happens due to the presence of bacterial pathogens. Further, the readers get an idea that how far the patients are aware of the truth and in fact their attitude towards the entire issue will probably be considered during the process of conducting research.

2.3 Author Credentials

The authors of the research study are Nacy Istenes, Susan Hazelett RN, Eileen Fleming of the Summa Health System and James Bingham, Jane Kirk of GOJO Industries, Inc, Akron, Oh. The authors of the study are noted to be extremely educated and on acknowledging their positions and associations with prestigious institutions enables the readers to develop trust on the authenticity and effectiveness on the research study. It is expected that the researchers have used their professional knowledge in depth in order to ensure success of the study in meeting its objectives.

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2.4 Abstract

As per the study of Gioia, Corley, and Hamilton (2012) a good abstract must always show a clear overall view of the research paper. The over view should include the research problems, sample, methodology, the findings of the paper followed by recommendations (Noor, 2008). The abstract of this particular study has been found to be quite exhaustive. For instance, the abstract of the research has categorically segregated the overall views of each sections of the study. The abstract contains segregated background of the study where the current scenario of HAIs or transmission of infections associated to health care has been dealt. The abstract also has a separate section for describing the methodology adopted in brief. Moreover, the results have also be mentioned followed by the conclusive ideas. In other words, the abstract of the study seems quite complete. However, the abstract does not have a clear set of references to the research problems and objectives. However, the background to some extent throws some light. On the other hand, one vital aspect of the abstract is identified to be missing. The abstract should have a brief account of the recommendations provided towards the end of the study. Thus, on analyzing the writing style, credentials of the authors, title of the study and also its abstract, the research paper can be considered to be believable as a true research paper on nursing with well identified to rationale behind conducting the study and its usability or applicability in current nursing practices in order to enhance the quality and standard of nursing profession. “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

3.0 Robustness

3.1 Research Problem, Purpose or Significance

As stated by Dul & Hak (2008), a research study becomes all the more effective when it has well identified research problem. The research problem will in turn help to identify the purpose or significance of conducting the study. In this particular research study, although there is no specific content that states directly the problem or purpose for conducting the research study, However, on reading the first half of the study where the researcher has informed about the current health and hygiene scenario in hospitals, the researchers have clearly been able to establish the significance of the study. For instance, the introductory paragraphs of the study mentions how millions of death occur due to diseases associated to HAI. Moreover, the strategies taken to identify the real cause and billions of dollars spent on enhancing hygiene among health care workers have also be notified. However, the significance of the study is attained when it is explained that not much attention has been given patients, who to a great extent are also responsible for HAI induced diseases and consequent deaths. The purpose of the research study thus becomes clear when it focuses on to the fact this study will prove how frequent is the chance of the spread of HAI sourced from hospital patients, who otherwise are often not counted as major cause behind the transmission of harmful bacteria pathogens. “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

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3.2 Literature Review

According to (Ellingsen, Størksen, & Stephens, 2010) literature review is essential for a research study as it enables the researchers to understand the various theoretical concepts relevant to the subject matter. The literature review of this particular research is not well defined as the study is mainly focused on conducting the research based on primary study, especially the quantitative study. However, the researchers to an extent have consulted secondary literature sources in order to establish the significance for conducting the research study. The literature has mentioned few secondary studies like the one conducted by Larson where a comparison was made between hand flora of a sample of homemakers and some inpatients of non-intensive care units. There is another reference of secondary literary source of Sanderson and Weissler that focused on examining the extent of hand contamination of nurses and patients in an orthopedic hospital. The results showed that the hands of the patients were contaminated. However, the research study is mainly restricted to checking the presence of coliforms. Another secondary source of information mentioned in the study is the one conducted by Lemmon.

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The research study mainly investigated into the presence of multi-drug resistance organisms in the hands patients who are being treated under general or intensive care patients. The study also revealed that there is substantial contamination in their hands. However, the patients targeted for this research were the ones who actually suffering from these specific bacterial infections. The last study that has been mentioned in the literature review is of the study of Byan where the study showed that the incidence of mastitis in the hands of new mothers can significantly be reduced by the process of maintenance of hand hygiene. “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

The literature review of the study is therefore identified to be short but precise. The researchers have clearly been able to identify the outcomes of relevant studies done till date on the subject matter and according have been able to identify what they are required to take up for the current study. They have been able to come up with clear objectives. So, the literature review has effectively been able to provide the researchers good guidance to progress with the study in order to meet objectives like systematic determination of contamination of hands of inpatients and then examine the relationship with the various infection diagnosis and attitudes.

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3.3 Methodology (Research Design, Philosophical Underpinnings, Theoretical Framework and Aim or Hypothesis)

As stated by (Sminia, 2009), for any research study, the methodology is indeed an essential aspect as it helps to determined how actually the research study will be conducted. As stated by (Boso, 2006), for a research study, researchers are required to identify the design, methods of data collection, the various philosophical underpinnings including the theoretical frameworks, hypothesis and aim. From philosophy of the research study has been found to be positivism. According to Yin (2009), positivism philosophy is basically the science that supports the point of view that information can be derived from mathematical or logical treatments and sensory experience. The philosophy therefore seems to fit with this particular research study as the researchers have been able to obtain certain valid knowledge while conducting quantitative data collection process. In fact, the results of the study have been based on the survey data considering them to be true. “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

The design of the study seems to be explorative. The researcher has based his understandings based on the way the collected data has been handled. The researchers have actually collected samples from real patients and analyzed the results. The findings and also the conclusion has been drawn by exploring the various data that they have acquired on the process of data collected. According to (DuBois, Doolittle, Yates, Silverthorn, & Tebes, 2006), a research study that is based on positivism, will shape up accurately in case an explorative research design is followed. Thus, the explorative design of this particular study is also followed as there is an underpinning of positivism philosophy. Hence, the aim of the study will best be met with the aid of a positivism philosophy and explorative form of research design.

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3.4 Sampling

According to (Uy, Foo, & Aguinis, 2010), sampling is indeed an important part of data collection. Often while conducting research studies that involve large population for data collection, it becomes difficult for researchers to handle the complex and laborious data collection method (Tight, 2013). In that case, the researchers opt for sampling process. Likewise, for this particular study as well the researchers have conducted a sampling process. The target population for sampling process was patients from every surgical floor of a hospital named, Summa Health System’s Akron City Hospital. Each of the patients was identified based on unit census from lists prepared by unit managers and were able to take part only for once. An exclusion criterion was utilized for the process of sampling. About 8 samples of patients used to be produced for each day. The right hand was considered to be dominant.

3.5 Ethical Considerations

Friedrichs & Kratochwil (2009) opined ethical considerations actually enable researchers to conduct the study with decent sense of morality. This study has also been conducted ethically. As it is found, that approval for conducting the survey was obtained from Summa Health System’s Institutional Review Board. Moreover, the researchers were also found to be cautious about the health and comfort of patients. Patients suffering from psychiatric illness, having allergy to components like sodium thiosulfate, polysorbate or lecithin were excluded from the study. Also, patients having AIDs, skin diseases or intravenous injections in the dominant hands or the ones undergoing chemo or radiotherapy, admitted in maternity or ICU are also not involved. Nurses were in fact instructed to obtain consent from the patients as well even if they patients fitted under the inclusion criterion. “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

3.6 Data Collection Method

According to Anthony & Jack (2009), the quality of data collected determines the standard of research study. For this particular research as well, the researchers have been found to have prepared a detailed data collection process. The researchers have clearly defined source from where the data is to be collected. The process of data collection has in face been demonstrated well involving the kind of standard testing methods of samples for collection. Also, the various bacterial pathogens that are to be looked out for are also specifically mentioned. The data collection has mainly been quantitative as numerical data has been collected for analysis.

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3.7 Validity and Reliability

According to Friedrichs & Kratochwil (2009), validity can be described as the very ability of the instruments to measure what is expected to be measured. On the other hand according to (), reliability is basically the ability of the instrument to accurately and consistently measure the particular concept that has been considered under the study. On identifying the instruments or the methods that has been used for measuring and assessing data for this particular study it becomes evident that the study is conceptually planned. Furthermore, the reliability of the study has been well ensured by undertaking clear and logical steps of data collection and data analysis.

3.8 Data Analysis

According to Anthony & Jack (2009) the data analysis of a quantitative research study is considered to be a daunting process. One of the most labourious tasks is associated to complex statistical tasks. One of the most important aspects of results of data analysis is the percentage of the original sample that has ultimately been considered. Usually, at least fifty percent of the original sample is required for participation in order to avoid any kind of biased responses. In this particular research the researchers have used the entire 100 samples and so, the results are expected to be authentic and accurate.

3.9 Findings

The findings of the study have been found to be flowing logically from the data analysis and results for instance based on statistical inferences that patients are also a source of transmission of pathogens. Also, those patients have been found to have higher preference for using alcohol based sanitizers are found to have lower hand contamination rates. The probability calculations have in fact enabled the researchers to come up with findings that can be discussed and concluded with definite outcomes. From the discussions of the study it has been identified that the researchers have been able to determine the significance of the findings which are then considered with respect to the strengths and limitations of the research. One of the major strengths of the study is that the outcomes of the study has exhibited evident that is now instigating the patients to be included in efforts to bring improvement in hygiene. On the other hand, the study requires understanding the relationship between hand contamination of patients and acquisition of HAIs and also the roles that can be played by patients to reduce HAIs. “Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene”.

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4.0 Conclusion: Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene

The critiquing report of the study has considered all possible aspects of the research study as per the standard tools of critiquing. The study has been found to have all important components of a standard research study. The methodology has been developed as per the aims and objectives of the study. Especially, the data collection process, sampling and data analysis have been conducted based on the purpose for which the research study has been initiated.

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