student – 1
Evaluating a clinical outcome in patients with a chronic disease is not always able to be defined by solely numerical data. All interventions come with a change to the patient’s quality of life. Weighing the clinical benefit of the outcome with the positive or negative effect on quality of life is an important part of research. Evaluating both types of data is called Mixed method evidence and provides a comprehensive understanding of the outcome of your question (Melnyk & Fineout-Overholt, 2023).
With my PICOT question, I will need not only numerical data but also patient experiences to fully evaluate the evidence and how my intervention holistically affects the patient. After our last discussion post, I added peritoneal dialysis to the control group. I want to compare how home hemodialysis is beneficial to all dialysis patients not just patients undergoing in-center hemodialysis. My PICOT question is:
In end-stage renal disease patients, how does treating kidney failure with home hemodialysis compared with treating kidney failure with incenter hemodialysis or peritoneal dialysis affect clinical outcomes and quality of life over 5 years?
Home hemodialysis allows patients with end-stage renal disease to treat their kidney disease at home (Corbett, 2023). To fully evaluate how this benefits these patients, I will need not only numerical data to evaluate the clinical outcomes, but I will also need qualitative data to assess quality of life. Dealing with end-stage renal disease is life-altering and time-consuming, especially when completing incenter hemodialysis because patients have virtually no control. They are committed to three times per week treatments, at a specific time with works for their dialysis center, and often spend a minimum of 4 hours at the dialysis center to complete treatment. Many of these incenter dialysis patients arrive for the first time at a dialysis center thinking the end of life is near and that within weeks they will pass away. Populations with a chronic illness including end-stage renal disease patients often battle depression (Ginieri-Coccossis et al., 2008). In dialysis patients, this depression is made worse by a lack of knowledge and the negative impression every medical show paints of dialysis. Not every patient who ends up on dialysis knows they have kidney disease before they crash a burn into the emergency room and are told they need to start dialysis. They are thrown into the grieving process because they are grieving how their life was. The power of negative thinking or being in denial is often detrimental to dialysis patients. I have seen many times depression in a dialysis patient leading to non-compliance and the patient not dedicating the time needed to make the required life-altering changes needed for incenter dialysis or committing to starting home hemodialysis. Home Hemodialysis is underutilized in America and the biggest identified barrier is the lack of patient and care partner motivation to complete treatments individually (Wilson et al., 2023). An improved quality of life leads to reduced depression. Reduced depression leads to less non-compliance, and ultimately improved clinical outcomes. Dialysis when completed as prescribed helps regulate many lab values including potassium, phosphorus, calcium, and bicarbonate levels. In addition, the teachings by the dialysis staff help reduce hospital readmissions. Evaluating how all of this is improved by an intervention is the only way to fully understand my outcome.
student -2
In conducting research there are many questions that can arise and finding the answers to those questions may require a type of research design to ensure one is receiving the most accurate information. There are different types of research, for instance qualitative and quantitative. Typically researchers used quantitative designs, this was a controlled scientific process and the data would then be resulted in statistical analysis. Through time it was discovered that the human experience/condition could not be gathered via numbers and statistical analysis, this is where qualitative research comes into play. It was found that when certain phenomenon were unable to be explained or understood the use of qualitative research would aid in describing the phenomena. Furthermore this would then lead to more questions that could be studied via quantitative research (Melnyk & Fineout-Overholt, 2023). This is why it is important to have different types of research methods in studies as they can aid in determining all aspects of the question being asked. At times one might think that they are asking the right questions but with the different type of research designs one might realize more is needed or the question may need to be adjusted.
The variety of research methods aids in evidence-based practice by ensuring that the research findings result in optimal patient outcomes and lead to ideal practice and innovation. As mentioned before the use of different research methods aids in more questions being asked and more research being conducted to answer those questions. Even those quantitative was once seen as the research method with the utmost scientific rigor, it has been found that qualitative and other research methods can also aid in research findings and having scientific rigor. As Melnyk and Fineout-Overholt (2023) state, “Corroboration of findings across levels of evidence can provide the most comprehensive understanding of what the literature can offer to guide clinical practice” (p.163).
PICOT Question: For inpatient adults how does the use of a standardized central line care bundle compared to noncompliance of the central line care bundle affect CLABSI rates during hospital admission?
The research method I would initially use to best support my PICOT question is a quantitative research study. Using this method would provide me with information of what works and have the ability to incorporate what hundreds of hospitals across the nation are doing to prevent CLABSIs. For instance the study by Patel et al., 2019a, CLABSI rates over a 1.5-year period in 387 hospitals in 23 states. At times it is difficult to pinpoint what if any behavioral aspects are a factor in the contribution of developing a CLABSI. In the study that a qualitative research method is used to review literature “to develop a conceptual model focus on stages of catheter dwell and decision-making, and incorporate elements of the Behavior Change Wheel model, which emphasized motivation, capability, and opportunity to change behavior” (Patel et al., 2019b, p. S16). Ensuring that medical professionals are inserting and removing central lines are just as important as the steps and practices in place when keeping the area clean.
