Research Question
Despite the significant advances made in the field of medical and surgical nursing and surgical techniques, surgical site infection remains a significant problem and a cause behind increasing morbidity and mortality among patients. Surgical site infections are also the third most common source of hospital acquired infection. The studies have also found that surgical site infection occur in all most 30% of the surgical procedures, therefore, also considered as most prevalent (Gillespie et al, 2015). Managing the surgical wound is also a significant aspect of post-operative care provided to the patients. Therefore, the nursing care is considered as the systematic and the scientific approach that can be very helpful in managing different patients (LeMone et al, 2015). Inappropriate medical-surgical nursing management can therefore, increase the risk of infections and can also increase the hospital stay that escalates the financial burden on the healthcare system. The study of Linton (2015) identifies that “medical surgical nursing focuses on the person’s response to the actual or potential alterations in the health and takes into account their history, community and social support network” (p. 3). Inappropriate surgical nursing care can led to the problem of surgical women infection that can negatively affect patient outcomes.
The aim of this research to focus on the significance of medical-surgical nursing management for preventing surgical site infections in healthcare setting. Therefore, the research question identified for this research is:
- How appropriate and quality medical-surgical nursing care can help in preventing surgical site infections?
Some of the sub questions are:
- What is medical-surgical nursing management?
- What are surgical wounds and how its is related to patient outcomes?
- How medical-surgical nursing care could be essential in identifying early signs and managing care and support for patient.
According to the evidences identified in the study of Worth et al (2015) the risk of infection in the patient underwent surgery is very high. The surgical wounds are often vulnerable to environmental pathogens that could cause surgical site, blood stream infections, as well as urinary tract infections. Therefore, this study is very relevant as it specifically focuses on the role of surgical nursing management for preventing infections. The studies have identified that the role of nurses is highly significant in surgical site infection prevention (Soule & Fshea, 2017). Surgical site infection can also have the short-term or the long-term impact on the patient’s health of the patient that can increase emotional and psychological problem. Therefore, it is significant to understand the role of surgical and post-operative nursing care in preventing surgical wound infections.
In this study the interpersonal nursing theory developed by Hildegarde E. Peplau (1991) will be used as the theoretical framework. The theory is based on explaining the interpersonal and intrapersonal process of providing nursing care to the patients. The main focus of the interpersonal theory lies on developing the therapeutic relationship with the patients and focusing on duty of care (Sitzman, 2017). The significance of the therapeutic nurse patient relationship has been acknowledged by many scholars and Fukuda et al (2015) has informed that for preventing the surgical site infection, the nursing care and treatment requires multimodal therapeutic approach. According to Forchuk (1993) “theory highlights one of the important principles in nursing, which is to “doing with” the clients instead of “doing to” (as cited by He, 2016, p. 16).
Relevance of the Study
Nurse client relationship sis the first significant aspects of the interpersonal theory. The nurse client relation ship is based on effective communication, providing health literacy to patient, including integrated and multidisciplinary approach in nursing care and developing therapeutic relationships (DeWit, Stromberg, & Dallred, 2016). Surgical site infection are mainly hospital acquired that can occur due to the lack of safe and quality nursing practices. According to Artinyan, et al (2015) competitive and quality nursing care is a very significant part of preventing long term complications among the patients underwent surgeries. Since, it has been identified that infection occur in all most 30% surgical procedure, therefore, the role of nurses become more significant. Therefore, interpersonal nurse client relations can be highly effective in preventing surgical site infections.
According to the study of Lewis et al (2016), medical-surgical nursing is an important part of the nursing practice and management in Australia. The main strength of this study is that it provides the information regarding the significance and important of appropriate medical-surgical nursing. Medical-surgical nursing is specifically is the branch of nursing practice, under which the nurses provide the nursing care to patients for overcoming wide variety of the medical issues as well as recovering from surgery or post-operative problems. Lewis et al (2016) also identifies that critical thinking, clinical judgement and clinical reasoning are the significant aspects of medical-surgical nursing. This helps the nurses to make appropriate care decisions, to adopt safety guidelines and protocols and make appropriate care plans for patient, who underwent surgeries. Since, the clinical care environment is increasingly becoming more complex, the significance of competent and quality nursing care is increasing (Teshager, Engeda, & Worku, 2015).
According to Bull et al (2017), evidence-based practice in nursing is very vital. Evidence based practice allows nurses to enhance their skills and competence for providing quality care to the patient. The strength of the study conducted by Bull et al (2017) in its emphasis on enhancing the patient safety, which is the core element of nursing practice. This study also focuses on the duty of care toward patient to ensure that safe nursing practice is adopted in order t prevent any kind of infections. Reducing the risk to patient’s health and well-being is the main aspect of nursing care, which can be improved by applying evidence-based knowledge to nursing practice (Bull et al, 2017). Evidence based approach is found to be a significant approach in collecting and reporting the high-quality data related to nursing practice. This can also help in promoting quality improvement and to drive a change in nursing practice (Tao, Marshall, & Bucknill, 2015). The analysis of the WHO guidelines conducted by Humphreys (2017) and Meyhoff et al (2017) have found that evidence-based practice has been considered as the main aspect of improving nursing care and preventing surgical site infections. These two studies have been included in this research, as they are significantly focused on providing the information regarding WHO guidelines that are very important to be followed for safe and quality nursing practice.
Theoretical Framework
Tao, Marshall & Bucknill, (2015) have asserted that a “bundle of care” approach is highly significant evidence-based approach that can be used for preventing various common risk factors that can increase the chances of surgical site infections (p. 39). Therefore, this study is very important to understand the technique of care required in order to answer the research question and to throw light on research problem. Study conducted by Tartari et al (2017) has also identified that patient engagement is necessary for preventing surgical site infection, which can be achieves through therapeutic nurse patient relationship and by developing an integrative nursing approach. Study of Tartari et al (2017) is identified as very significant as it provides current evidences regarding the role of nurses for enhancing patient participation and empowering patient to actively involving in the process of surgical site infection prevention.
Tartari et al (2017) informs that quality nursing care can play a vital role in preventing surgical site infection. By following the national quality and safety standards, providing patient centred care and by ensuring medical safety, surgical site infections can be prevented. According to the ethical principle of nursing preventing any harm to the patient is the most significant approach in providing post-operative care (Lewis et al, 2016). Focusing on the post-operative care is very significant for the aim and objectives of this study. The strength of the study conducted by Lewis et al, (2016) lies in the information and evidences that it provides regarding ethical care offered to patients. Therefore, medical and surgical nursing is considered as a collaborative and multidisciplinary endeavour. The role of the nurse in preventing surgical site infections is very comprehensive and requires the continuum of care. The role of nurse in preventing surgical site infections is also significant because nurses are in the most appropriate position to execute or implement the evidence-based practices. For example, as identified in the interpersonal theory of nursing care informs about developing therapeutic relations and enhancing communication with patient, so that patient could share their concerns, feelings and problems. Such communication is very important for identifying the early on-set of infection (He, 2016). Effective communication and observational skills are also identified as important approaches for providing quality medical and surgical nursing care. They are also important for conducting the holistic assessment of the patient of the patient’s needs ad for identifying the potential signs of infection (Adekhera, 2016).
The research methodology adopted for this study is the qualitative research methodology. The study aims towards providing a systematic review of literature that could be helpful in identifying the problem of surgical site infection among patients and significance of nursing practice in early detection of infection and prevention. The qualitative review of literature has been identified as the most appropriate research methodology, because it can help in identifying and analysing the various evidences associated with the study problem (Creswell, & Creswell, 2017). Qualitative research methodology also helps in understanding different perspectives related to problem and identify the appropriate answers to research questions. This methodology has also found to be appropriate for developing an integrative review of literature that can significantly contribute in reducing the gap in literature regarding the significant role of medical-surgical nurse in reducing or preventing surgical site infections (Gillespie et al, 2015).
Literature Review
The validity of the qualitative research, which has been selected as the methodological instrument of this study lies in the fact that it is the most appropriate approach for finding the correct evidences and locating them appropriately for developing a comprehensive review of literature. The reliability of the research lies in the fact that data collected for the purpose of he literature review are collected from the original source and analysed by the researcher for validating accuracy and quality (Silverman, 2016).
A systematic search was conducted using the electronic databases such as Medline (PubMed), Allied Health Literature (CINAHL), Medical Journal of Australia, EBSCO, BMC, Elsevier and Google Scholar. The above-mentioned journals are used to identify the research articles and peer reviewed studies that are published within the period of 2014 to 2018. This time frame ha been applied in the search strategy in order to provide the most current evidences related to the role of nursing practice in preventing surgical site infections. During the period of five years various initiative have been taken in he healthcare sector of Australia. The evidences inform that significant focus is being placed on improving nursing practice and enhancing the skills and competence of nurses in Australia (Bull et al, 2017). Some of the important search terms (Keywords) related to the study problem and to answer the research question were selected in order to identify the studies.
The articles that will be considered to be appropriate to be include in this study for the review and analysis will be those that reported the results of the case studies, the cohort studies, cross-sectional studies, randomized control trials and systematic literature reviews. The books published by the significant scholars in the field of medical and surgical nursing have also been included in the research, in order to collect some important evidences regarding prevention of surgical site infections. The exclusion criteria also include selection of the research studies that are published during the period of 2014 to 2018 in order to maintain the quality of evidences. The exclusion criteria for the study has also determined, according to which the grey-literature, and non-peer reviewed studies have been excluded. Another limitation is that the literature published in only English language has been included in the study.
Study of Mitchell et al (2017), during the period of last five years some significant state and national initiative being taken in Australia are “the national hand hygiene initiative, development of National Health and Medical Research Council guidelines, revision of hospital accreditation standards, surveillance initiatives and public reporting of some infection data” (p. 118). The databases will be independently access and the duplicate records will be removed from the study selection criteria (Morse, 2015). The title and abstract of the studies that will be identified from the research databases will be closely examined and assessed for finding the appropriateness and relevance to the study questions by the reviewer (Anderson, et al 2014). The articles or the studies that will provide the complete access to full text will be eligible to be selected. Then the full text review of the selected articles will be conducted in order to access the eligibility of the studies.
For the purpose of this research study, qualitative inducive content analysis approach will be applied. According to the various studies, it has been identified that content analysis is the most common and appropriate qualitative research method, which can be applied for analysing the text. Inductive content analysis can be used for content for qualitative research and also allows the researchers to text the hypothesis (He, 2016). According to Hsieh, (2005) “provide knowledge, new understandings, a reconstruction of facts and a practical guide to future clinical studies” (as cited by He, 2016). Selecting the correct analysis approach is depends on the purpose of the study. Therefore, inductive analysis approach is considered as suitable, when there is very limited research available related to the study area. The inducive content analysis will be significantly helpful in identifying the appropriate evidences and also for finding the answers to the research questions.
This study mainly presents the review of the existing literature. Therefore, research do not pose any harm to anyone. Therefore, the ethical approval from the participants is not applicable in this research study. However, the author of the research will specifically focus on the ethical principles of writing the review of literature and attempts to use critical thinking while collecting and analysing the data. Inclusion criteria for the study articles have been mentioned in the above section, which do not require the ethical approval. However, no direct contact was made with any author in case of unclear or incomplete information. The data collected will be reviewed and stored by the researcher. No involvement of the any person or study participants n the study informs that no safety issues or risk to participants are applicable for this research. The study do not have any competing interests and need of ethical approval is not applicable.
Conclusion
There are some important limitations to the study that must be considered, while reading the research paper. The first limitation to the study is that, this study will be a qualitative study that mainly relies on the evidences that have been identified in the literature. The study will not make any personal assumptions. Secondly this study will only include the studies that have been published during the last five years, which could have resulted in avoiding any important study or evidence that have been published in earlier period. Third limitation to the study is that it will only include the studies that are published in English language and excludes all other studies.
The study will not have any negative impact on the wider community, due to exclusion of human participants. Therefore, do not pose any safety or any other risk. However, study can positively impact the wider community, as it will provide the most recent evidences related to the significance of appropriate and quality medical-surgical nursing care and its impact in preventing surgical site infections. The role of medical-surgical nurses has not been broadly explored in the literature, nr there are wide array of evidences regarding the effective role of medical and surgical nursing management in preventing surgical site infection.
The main emphasis of the study is on improving the knowledge regarding the problem of surgical site infection and to contribute to the wide array of literature towards the significant role of medical-surgical nurses. The study will emphasize on the significance of the role of nurses in enhancing and promoting interpersonal and therapeutic relationship with patient to enhance patient engagement in preventing surgical site infections.
References
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