Surgical Site Infections (SSI) are defined as infections related to operative procedures and occurring within thirty days of such procedures at surgical incisions or near them. According to Yuki and Shibamura-Fujiogi (2021), SSIs are the most common among all nosocomial infections affecting surgical patients, accounting for around 20% of the appraised two million such infections in the United States. Additionally, SSIs tend to be associated with high rates of morbidity and mortality, as well as with enhanced readmission rates and hospital stay length. Moreover, SSIs and responsible for the cumulative annual cost of $3,5-10 billion, which exacts a toll on the national budget (Yuki & Shibamura-Fujiogi, 2021). All of that points to SSIs being a problem that needs to be addressed on several levels.
The significance of this issue in regard to nursing lies in the fact that Surgical Site Infections emerge in operating rooms. Consequently, at least in some cases, they occur due to medical specialists, nurses included, not being attentive or careful enough during the operating process. The purpose of the study is to reduce the exposure of surgical patients to SSIs and improve the quality of their lives. The objective is to search for ways to do that with the help of evidence-based nursing care. The research question is: how can operating room nurses use evidence-based care in the prevention of Surgical Site Infections and reduce patient exposure to them?
This research critique will be focused on two articles from peer-reviewed journals. The first one is called The Persistent Breach between Evidence and Practice in the Prevention of Surgical Site Infection and examines the intra-operative prevention of SSIs by operating room nurses. The relevance of this study in regard to my PICOT question is that it provides an example of the SSI prevention system constructed by the article’s authors and being legitimate enough to be implemented. Moreover, Qvistgaard et al. (2019) ensure that every aspect of intra-operative care is analyzed so that only the most appropriate practices are used. The second article is called Intraoperative Prevention of Surgical Site Infections as Experienced by Operating Room Nurses, and it sets the goal of examining what prevents theoretical measures of SSI prevention from being properly implemented. This study’s relevance in relation to my PICOT question is in the necessity to explore all the obstacles on the way to translating evidence into practice. Badia et al. (2020) consider it essential before actually applying the theoretical measures – and rightfully so. Otherwise, the resources and efforts expended might not lead to the desired result.
When it comes to Qvistgaard et al. (2019), their intervention was interviewing participants, each of whom was either an experienced or a currently practicing operating nurse. Comparison groups were patterns in the interviewees’ answers that were used to build clusters of meaning. These clusters of meaning served as a determinant of a core meaning, which constituted a phenomenon’s essence. Badia et al. (2020) used a Web-based questionnaire as their intervention method: it was distributed among members of various nursing and surgical associations across the nation. Their answers were compared to the most recent recommendation from guidelines of clinical practice from the most distinguished organizations. This looks not dissimilar to my PICOT questions interventions and comparisons: interventions intend inquiring qualified professionals having experience with the issue, while comparison groups are universally accepted in the field guidelines.
The first study’s method is the one based on phenomenology – the Reflective Lifeworld Research, or RLR. Qvistgaard et al. (2019) state that, in accordance with the method’s approach, a researcher should seek to be open to both the phenomenon’s particularities and generalities as best as they can. Therefore, RLR’s methodological principles are openness, discernment, and contemplation – principles that aim at grasping the phenomenon’s essential nature and its variations. The authors of the second study did not denote the methods, in the same manner the first article’s authors did. Badia et al. (2020) only stated that their project was put on record in the United States clinical trials registry and reported in accordance with the criteria for Reporting Qualitative Research. Additionally, the responses to the questionnaire were admitted to an electronic database which was analyzed using a statistical software suite. Therefore, the methods described in the studies vary significantly: Qvistgaard et al. (2019) focus on their own openness and unbiasedness, whereas Badia et al. (2020) pay attention to the technical side of the question.
In terms of Reflective Lifeworld Research, its benefits are evident: by employing it, researchers commit to being open to any result they arrive at and any consequent conclusions. Even if these do not coincide with the researchers’ expectations, they still accept it and do their best to learn as much as possible about the phenomenon they chose to explore. Its possible limitation is that, by trying to consider every valuable opinion on the subject and viewing it from every possible angle, researchers might not come to any definite conclusion. In such cases, additional tools to lean on are necessary – for instance, as with Qvistgaard et al. (2019), comparison groups. The approach of Badia et al. (2020) is beneficial in terms of its visual clarity: the transferring of data gathered into the database allowed them to quickly and accurately create a dozen of various diagrams. However, by choosing to focus on the technical side only, researchers might lose sight of more important issues, such as integrity and representativeness.
In reviewing the results of both studies, one can see that the researchers have come to some peculiar conclusions. For instance, Qvistgaard et al. (2019) discovered that SSI prevention is not only dependent on the team’s function but also on an individual’s personal and organizational legitimacy. Moreover, in such a complex caring environment as an operating room, personal and organizational legitimacy depend on one another. Seeing how everything is interconnected, a nursing specialist is to take into consideration that in order to be of use and do no harm in an operating room, they have to be prepared. Badia et al. (2020), in their turn, found that among the most widely used SSI preventive measures are those that surgeons and nurses have gotten used to resorting to in their practice. Other measures – as strongly recommended by the guidelines – tend to be ignored. Moreover, remarkable differences were detected between the specialists’ beliefs of what has to be done and their actual practice.
The implications of both studies lead one to the same conclusion: the practice of SSI prevention in the operating room needs to be taken more seriously. A nursing specialist must rely not only on the work of their team but also on their specific actions. It is essential that these actions correspond with one’s beliefs: while most professionals tend to be trained properly, it does not mean much unless it makes a difference in their working environment. Additionally, a nursing specialists must be aware of the responsibility they have every time they enter the operating room — especially to the patient, who might be harmed by any careless movement. Moreover, there must be consistency in regard to the practices recommended to implement in order to ensure SSI prevention. If there is no consistency, there seems to be no point in complying with the precautions at all – any practice applied can be made useless if due to the non-applied ones infecting occurs.
Finally, researchers are to resort to particular ethical considerations when conducting their studies. According to Artal and Rubenfeld (2017), one of the most important considerations is the process of consent. Volunteers have to know exactly what they agree to and have an opportunity to withdraw from further participation at any stage of the process. Moreover, the studies have to correspond to the criteria of ethical conduct established by the codes of ethics (Artal & Rubenfeld, 2017). Qvistgaard et al. (2019) state that their study was approved by the ethical committee of the country they conducted it in (Sweden) and that all ethical considerations met the guidelines of the Declaration of Helsinki. In addition to that, all the interviewees received information about the research in verbal and written form and signed confidential written consents prior to interviewing. Badia et al. (2020) report that if a person with relevant qualifications expressed no desire to be questioned or wished to refuse during the process, they faced no obstacles or repercussions. Furthermore, the study’s report meeting the criteria for Reporting Qualitative Research automatically means that it meets the criteria of codes of ethics.
Artal, R., & Rubenfeld, S. (2017). Ethical issues in research. Best Practice & Research Clinical Obstetrics & Gynaecology, 43, 107-114. Web.
Badia, J. M., Rubio-Pérez, I., López-Menéndez, J., Diez, C., Bolaños, B. A. R., Ocaña-Guaita, J.,… & Balibrea, J. M. (2020). The persistent breach between evidence and practice in the prevention of Surgical Site Infection. Qualitative study. International Journal of Surgery, 82, 231-239. Web.
Qvistgaard, M., Lovebo, J., & Almerud-Österberg, S. (2019). Intraoperative prevention of Surgical Site Infections as experienced by operating room nurses. International Journal of Qualitative Studies on Health and Well-Being, 14(1), 1632109. Web.