In “Bundles to Prevent Ventilator-Associated Pneumonia: How valuable are they?,” Charity Wip and Lena Napolitano present the results of a qualitative study to determine the value of different care bundles in preventing the occurrence of ventilator-associated pneumonia (VAP). In fact, the authors concede that VAP is often resultant of the ventilator care plan, and that the ventilator bundle would be critical in reducing the occurrence of VAPs among the intensive care unit (ICU) patients. Of important is the fact that a range of care bundles are present, each differing in its specific care process that focuses on VAP prevention and even mortality when VAP occurs. Using the information submitted in the research article, ICU medical personnel can refine their care plans for increased effectiveness in the reduction of VAP rates in the ICU. In addition, such an understanding would ensure better overall medical care outcomes in the ICU (Wip & Napolitano, 2009).
Therefore, the problem addressed by the article is the determination of the best care bundles for reducing the occurrence of VAP among ICU patients. It is clear that the articles intent is on identifying the best ventilator care bundle for reducing the incidence of ICU. In line with this problem statement, the authors acknowledge that there is a range of care plans being applied, each differentiated by the pharmacological, positional and physical strategies adopted. They assert that while VAP is preventable, it is still common owing to the fact that a range of differing guidelines are available to address it.
The same is also true for the bundles, acknowledging for principally used bundles that include head elevation to between 30o and 45o, sedation vacation and evaluation of readiness to extubate on a daily basis, prophylaxis for peptic ulcer disease, and prophylaxis for deep venous thrombosis. These strategies are also noted for producing different results (Wip & Napolitano, 2009). As a consequence, the article looks into how best to reduce VAP incidence, with particular emphasis on the available care bundles and guidelines effectiveness in addressing the problem. Purpose and Research Questions
As earlier indicated, this articles purposed is to identify the most effective ventilator care bundle that would reduce the incidence of VAP in the ICU. Although the article did not explicitly mention the research question, it is implied from the research. In this case, the research question can be concluded as: determining whether an effective care bundle exists with regards to reducing the incidence of VAP in the ICU. Answering this question allows the author/s to identify the most effective ventilator care bundle for application in the ICU, as well as recommend its application in medical facilities.
Besides that, the article also reviews the ventilator care guidelines as published by the different medical authorities such as the WHO and CDC. In this respect, the present research article answers the question of whether there exists one care bundle that would be more effective in reducing the incidence of VAP in the ICU. To respond to the presented question, the research compared the different care bundles based on other peer-reviewed publications opinions. As a result, answering the question involved comparing the results of other publications with the intention of noting outcome differences and similarities that existed between the various ventilator bundle components (Wip & Napolitano, 2009). Literature Review
The articles principal focus was on conducting a literature review that compared the results of the different ventilator care bundles. In fact, all the articles added to an understanding of that the Institute of Healthcare Improvement entailed. A total of 40 articles were used to prepare this article. All the articles were from journal publications, except for one that was from a website. This increases the authoritative nature of the article since journals are peer reviewed and authoritative, often being subjected to rigorous checks and confirmation of facts before publication. An examination of the literature sources publication dates shows that six had been published in 1999 or earlier while the remaining 34 had been published in the following years.
The relevance of the studies (considering that six were not current) was difficult to assess, although the fact that the study was of a qualitative nature shifts focus from their quantitative results and into their authoritative perceptions. Still, the use of quantitative findings from these publications could call into question their accuracy and how current they are since time is a factor that influences quantitative results. The fact that the authors did not indicate the weaknesses and strengths of the articles that were used is a negative against the research since readers are left to question the authentic nature of the studies and the authors objectively. This is because that authors could have only included what they deemed to support their opinions without regards to the research process thereby causing both Type I and Type II errors.
Despite the shortcomings identified with regards to the literature review, it must be accepted that it included adequate information to allow readers to build a logical conclusion that matched that of the authors. This is particular true when it is considered that quantitative evidence was presented as evidence to support the different ventilator bundles thereby allowing for conclusions to be drawn based on tangible referenced evidence (Burns & Grove, 2011; Wip & Napolitano, 2009). Therefore, the literature review was well researched and written to include pertinent information, although its value could have been increased by including the strengths and weaknesses of the different research articles that formed its basis. Conceptual/Theoretical Framework
The article critically reviewed the different ventilator care bundles. The concepts of theory and practice intersected to provide an overreaching conceptual framework intended for practice, whereby the focus was on reducing the incidence of VAP in the ICU as well as offering new understanding and presenting a new approach to VAP prevention. The qualitative design that was adopted for the research was based on medical practice framework that offered an advanced level of systemization while remaining grounded in reality that is supported by previous research evidence and authorities’ assertions.
In essence, the framework allows the article to capture the structure of VAP prevention in ICU settings, the challenges they bring about, as well as the best strategies for addressing the challenges in ways that empower stakeholders and medical practitioners to control ICU practice, in the same way that it allows researchers to evaluate the problem in a scientific setting. Besides that, an inductive approach has been applied in researching the material for the article with the focus being on developing a new VAP approach that combines the best practices thereby presenting a new understanding and new theory. Evidence of this is drawn from the conclusion that in as much as the ventilator bundles have been effective in some medical facilities, that is not a given. As such, there is a recommendation that the bundles be applied on a case by case basis, contrary to VAP prevention guidelines that call for the universal application of the bundles (Burns & Grove, 2011; Wip & Napolitano, 2009).
Burns, N., & Grove, S. K. (2011). Understanding Nursing Research: Building an evidence-based practice, 5th ed. Maryland Heights, MO: Elsevier Saunders. Wip, C. & Napolitano, L. (2009). Bundles to Prevent Ventilator-Associated Pneumonia: How valuable are they? Current Opinion in Infectious Diseases, 22, 159-166.