Sample Thesis On Ebp Project

Abstract

In this Evidenced-Based Project (EBP), the research seeks to evaluate the efficacy of cranberry in the prevention of UTIs and reoccurrence rate among females. Females are at an increased risk of contracting UTIs. Antibiotics are the common means of treatment, but due to increasing cases of antibiotic resistance, UTIs reoccurrence is high. Interventions that will prevent the prevalence and reoccurrences of UTIs are needed. The intervention will prevent the prevalence and reoccurrences of UTIs. Iowa EBP implementation model will be used. The application of the intervention will depend on the findings of the study. If the study proves that cranberry products reduce recurrence rate, a plan will be rolled out in the hospital to educate female patients on how to attain maximum results with the intervention.

Chapter I: Introduction

Background Information
Urinary tract infections can affect either the lower or upper part of the urinary tract system. The lower urinary tract infection is characterized by a bladder infection while the upper urinary tract infection causes a kidney infection in the form of pyelonephritis. Frequent urination or an increased urge to urinate and painful urination are the principal signs of a lower urinary tract infection. The symptoms of an upper urinary tract infection are same as those of the lower UTI, but flank pain and fever are also common. Generally, these infections are more common in females than males. Factors that influence a person’s susceptibility to these infections are sexual activity, female genitalia, and genetical factors. The nature of female genitalia makes it susceptible to UTI, and that is why they are common in women. Women have 1 or 2 chances of contacting UTIs in the course of their lifetime. These infections can be treated with short-term antibiotics. However, cases of antibiotic resistance are on the rise making the reoccurrence rate high. For that matter, there is a need for alternatives that would reduce the reoccurrence rate or boost prevention.
Different studies have been conducted to assess the medical benefits of cranberries. They report that cranberry consumption can help in the management of UTIs (Gupta et al., 2011). Specifically, it has been shown that cranberries have proanthocyanidins. These compounds are phenolic in nature and are antioxidants. Additionally, these compounds have been found to possess a solid anti-clinging property that accounts for their ability to limit bacterial adherence to the walls of the urinary tract (Gupta et al., 2011). In addition to limiting bacterial attachment, proanthocyanidins minimize bacteria from multiplying. It has been shown that consumption of cranberry juice reduces the reoccurrence of UTIs in pregnant and middle-aged women (Gupta et al., 2011). Furthermore, the same study showed that hospitalized females who take cranberry have a lower risk of developing UTIs (Gupta et al., 2011). It should, however, be noted that proanthocyanidins are not curative but preventative in nature.
For that matter, this research seeks to evaluate the efficacy of cranberry in the prevention of UTIs and recurrence rate among females.

Statement of the problem

Females are at an increased risk of contracting UTIs. Antibiotics are the common means of treatment, but due to increasing cases of antibiotic resistance, UTIs recurrence is high. Interventions that will prevent the prevalence and reoccurrences of UTIs are needed.

Significance Statement

The intervention will prevent the prevalence and reoccurrences of UTIs.
Purpose Statement
Proposed PICOT question: The consumption of cranberry products reduces prevalence and recurrence of urinary tract infections in females.
P: adult females.
I: cranberry products.
C: antibiotics
O: improved recovery rate and reduced re-occurrence rates (prevalence)
T: six months.
Female participants will be drawn from the population of female patients who visit local hospitals. They will be put on a cranberry program for six months. There will be two groups. The control group will not be put on cranberry but will be on a placebo. The outcomes in the two groups will be evaluated to assess the significance of cranberry consumption with respect to the reduction or UTI reoccurrence and enhancement of prevention.

Chapter II: Critical Appraisal of the Evidence

As indicated earlier, this Evidence-Based Project seeks to assess whether the consumption of cranberry products reduces prevalence and reoccurrence of urinary tract infections in females. In this section, different literatures that have evaluated this concept before are analyzed. PuMed search engine will be used as the main database because it is easily accessible and has reputable peer-reviewed literatures. The search will dwell on two factors: the medical properties of cranberries and their mechanism of action in the prevention of UTIs. Secondly, literatures that have studied the association between cranberry consumption and UTIs in females will be evaluated. Review articles, qualitative, and quantitative studies will be examined. However, all must be peer-reviewed and must have been published in the past 10 years (2005-2015). A total of ten scholarly articles will be selected.
In the first article, Hisano et al. (2012) review the key methods that are employed in the reduction of recurrent UTIs using cranberries. These authors review mechanisms through which cranberries are believed to reduce UTIs both in vitro and in vivo. They note that E.coli must adhere on the host cells for it to survive. The bacteria has an adhesion protein that help it cling on host cells. The adhesion protein could be either fimbriae or pili (Hisano et al., 2012). The lectins expressed on either pili or fimbriae bind on the glycoproteins of host cells. Fructose found in cranberries is believed to inhibit fimbriae adhesion on the urothelium. But the pili is mannose-sensitive and thus helps pili bind on the urothelium.
In patients with recurrent UTIs, there has been an extraction of other forms of fimbriae (p-fimbriae) that bind to the double lipid b-layer of renal epithelial cells via glycosphingolipids (Hisano et al., 2012). Current studies that postulate the role of cranberries in UTI management point to the inhibition of p-1 and p-fimbriae adherence (Hisano et al., 2012). In essence, if the adhesion is inhibited, the bacteria is incapable of infecting the host cell. In vitro, the adhesion inhibition is accomplished by fructose and proanthocyanidins. Another study has pointed to the possibility that fructose and proanthocyanidins inhibit the expression of p-fimbriae. Other studies have reduced adherence in other forms of bacteria other than E.coli (Hisano et al., 2012).
Hisano et al., (2012) have also reviewed different clinical studies that examined the role of cranberries in the management of UTIs. It is evident that different studies have produced different results. In one study, cranberries were found to be less effective in the cure of UTIs. On the other hand, another study evaluated the prophylactic effect of cranberries in women. It was revealed that cranberries reduce UTI symptoms in women with recurrent forms of UTIs (Gupta et al., 2011).
There are also three randomized trials that have been conducted in young women that experience recurrent UTI. In the first study, Walker et al. (2000) found that the incidence rate was 2.4 subjects/year in the group that took cranberry while in the placebo group, the incidence rate was 6.0 subjects/year; (p<0.0005) (Walker et al., 2000). The researchers had sought evaluate the rate of infection per year in the two groups. On the other hand, the study conducted by Stothers (2002) employed both cranberry tablets and juice in one group and a placebo in another group. The researchers used females participants aged 21 to 72 years. They sought to find out the recurrent rate of UTI in the selected group. With respect to the contraction of UTIs, the results were as follows: 18 % (cranberry tablets group), 20% (in the cranberry juice group), and 32% (in the placebo group) (Stothers, 2002).
In the third, Barbosa et al. (2011) used a double-blind study. The researchers sought to evaluate the reoccurrence rate in individuals who were put cranberry juice and oz. In that study, the researchers found that the recurrence rate in the group that took oz was 19.2 percent while that of the cranberry group was 27 percent. In the placebo group, the recurrence rate stood at 16.6 percent (Barbosa et al., 2011). Furthermore, Kontiokari et al. (2001) also employed a double-blind study to assess recurrence rate. The first group received cranberry-lingonberry. The second group was put on lactobacillus CG. The third group had no treatment. The study was conducted for a year. In the cranberry group, the reduction was reported to be 24 percent. On the other hand, the lactobacillus group and no treatment group registered recurrence rates of 43 and 38 percent respectively (Kontiokari et al., 2001).
Wang et al. (2012) conducted a study to evaluate the role of cranberry in the prevention of UTIs in at-risk populations. The researchers employed systematic review, as well as the meta-analysis of randomized trials. The findings of their study indicated that cranberry products possess a protective power against UTIs. However, they did not account for the mechanism of action. In a similar study, Goldman (2012) assessed if cranberry can be used to reduce UTIs in children. This study is essential because it allows for comparison of finds in different target groups. The study found a positive correlation between the use of cranberry and the reduction in UTIs among children. Similarly, another randomized trial was conducted by Stapleton et al. (2012). The researchers sought to evaluate the effectiveness of cranberry in the prevention of UTIs and E.coli infections among women who consumed cranberry on a daily basis. The results of this study were consistent with those of previous studies. Cranberry had a protective effect, and it led to a reduction in p. fimbriae of E.coli. Moreover, a review conducted by Raz, Chazan, and Dan (2005) sought to non-antibiotic alternatives for UTIs treatment, and they found that cranberry is one of the alternatives that can be used.
In this review, it is evident that not all studies have registered positive results. Some have found that cranberry does not prevent a recurrence or treat UTIs. However, most of the studies suggest that the use of cranberry products helps in the reduction of recurrence, as well as minimizes symptoms of UTIs. Fructose and proanthocyanidins are the current compounds that are believed to execute the cranberry UTIs management role. The differences in the findings can be accounted for by the differences in the approach of the studies that were conducted. Three review articles and seven randomized trial studies have been included in the review. One study was conducted in children, and it helps to highlight insights of a different group other than that of females. However, the studies do not give a clear picture on the dosage of cranberry that provides effective results.

Chapter III: Theoretical & Operational Review of Concept(s) PICOT Question.

The literatures that have been reviewed provide the scientific basis for the proposed integration. First, the literature review has provided the mechanism of action of cranberries in their protective role against. In essence, this review has shown that cranberries have proanthocyanidins. These compounds are phenolic in nature and are antioxidants. Additionally, these compounds have been found to possess a solid anti-clinging property that accounts for their ability to limit bacterial adherence on the walls of the urinary tract. In addition to limiting bacterial attachment, proanthocyanidins minimize bacteria from multiplying. Additionally, fructose and proanthocyanidins limit the expression p-fimbriae.
Secondly, the randomized trial studies that have been reviewed have registered positive outcomes. They support the hypothesis that cranberries are helpful in preventing recurrence of UTIs in women. There no doubt that UTIs are higher in females than in males and that cases of recurrence are on the rise. For that matter, this review provides insights in the use alternatives to antibiotics in the reduction of UTI recurrence in females. The use of cranberry would be a safer alternative than antibiotics because it does not have side effects or if there are there, they are very minimal.
In that case, the proposed intervention will help in the reduction of recurrence of UTIs among females. Nursing practice can play a significant role in the reduction realization of this goal. Nurses can execute this goal by training female patients to adopt a routine of taking cranberry products. This paper proposes that since the anticipated change must be evidence-based, the current research must be organized and conducted for six months. In the said period, two groups of participants will be formed whereby one group will be given a placebo while the other one will be given cranberry. The dosage of cranberry should be recorded. After the study, if the results support the hypothesis, it will be important to execute a change in policy.
Here, stakeholders will be advised on the quantity and type of cranberry product that ought to be consumed by the target group if positive results are to be observed. After that, a training program will be initiated. Nurses will be educated on how the new policy and how they are expected to inform the new findings to the patients.
Alternatively, government officials in the ministry of health will be contacted and informed about the new developments. They will be informed about the significance of the new findings and the cost that will be expected in rolling out the program. The officials will be requested to come up with a national program to educate the public on the relevance of consuming cranberry products. Caution should be taken so that only authentic products of cranberry are introduced in the market. The products must be approved by the Food and Drug Agency.
In summary, this paper proposes to conduct the study for six months. The findings of the study will determine the next phase of the plan. Should the results prove to be positive, a program will be rolled out at the hospital to whereby all at-risk female patients will be put on cranberry diet. Secondly, relevant government officials will be informed about the new findings. They will be advised to initiate a national program that would encourage females to consume cranberry products as a UTIs preventative measure. In addition, a single cranberry brand with all the composition needed to offer the protective role will be registered and approved by the FDA.

Chapter III – Model Methodology and Implementation, Results, Implications

This Evidence-Based Project seeks to whether the consumption of cranberry products reduces prevalence and reoccurrence of urinary tract infections in females. In this section, model methodology and implications are evaluated.

Methodology

The Iowa model will employed in this research. This model requires the ANP to take into consideration the entire healthcare system beginning from the patient, provider, and infrastructure. For that matter, care has been taken to ensure that the intervention meets this criterion. Females in the reproductive age (18 years and above) will be chosen. Secondly, a hospital (provider) that will act as a basis for this research has been identified. Thirdly, the management of the hospital and the nursing department (system) will be informed about the intervention. The involvement of these parties is essential for the attainment of the anticipated outcomes.

Organization/system/stakeholders where EBP will be implemented

In order to implement this model, a hospital will be needed. The hospital will provide access to the participants who will take part in the study. The hospital will also play a crucial role in the implementation of the proposed intervention. In essence, it will act as the place for data collection, as well as the actual implementation. The findings that will be registered here will help in coming up with the conclusion of the research.

APN coordinates personnel/staff responsible for implementation

Advanced practitioner Nurse (APN) will help in collecting data in the clinical setting, and defining roles for junior members and supervising the overall process of data collection. In essence, they will ensure that the procedures of the research are followed to the later to ensure that the data collection process is done appropriately. In addition, the APN will help in the training participants of the study about what is expected of them.

Implementation

As indicated earlier, the application of the intervention will depend on the findings of the study. If the study proves that cranberry reduces a recurrence rate, a plan will be rolled out in the hospital to educate female patients on how to attain maximum results with the intervention. There will be a need to print educational materials that would educate the targeted group. The materials will be placed at strategic places in the hospital for easy access. Secondly, there will be monthly or weekly seminars that will guide the target group on how to attain maximum results. Again, this will depend on how the hospital’s organization entrenches the plan into their policy. For that matter, the top management and the nursing department will need to work hand in hand.

Data collection, analysis, interpretation, applicability and recommendations specific to your area of practice, policy or nursing in general

Data collection and analysis will be conducted at the hospital, and recommendations made according to the findings. The top management and nursing departments will need to provide the go ahead of conducting the research.

Identify facilitating factors to implementation

Support from the top management and hospital department will be very important. Access to study participants and support from other nurses will help make the process easy.

Identify barriers to implementation

Lack of support from the hospital’s management and the nursing management is the biggest barrier. In addition, if the access to participants will be hard, it will make the entire process difficult. Again, there will be need to budget for the implementation process, and this is another area where the hospital’s management comes in. Therefore, a budget for implementation ought to be provided. If a budget for the implementation of the intervention is not provided, the whole process will collapse.

References

Barbosa, S., Brown, M., Buxton, M., Zhang, M., Debussscher, J., and Foxman, B. (2011). Cranberry Juice Fails to Prevent Recurrent Urinary Tract Infection: Results From a Randomized Placebo-Controlled Trial. Clin Infect Dis. 52 (1): 23-30. doi: 10.1093/cid/ciq073.
Goldman, R. (2012). Cranberry juice for urinary tract infection in children. Can Fam Physician, 58(4): 398–401.
Gupta, A., Dwivedi, M., Mahdi, A.A., Nagana,K., Gowda, G.A., Khetrapal, C.L., Bhandari, M. (2011). Inhibition of adherence of multi-drug resistant E. coli by proanthocyanidin. Urol Res., 1-10.
Hisano, M., Bruschini, S., Nicodemo, A., and Srougi, M. (2012). Cranberries and lower urinary tract infection prevention. Clinics 67(6), 661–667. doi:  10.6061/clinics/2012(06)18.
Kontiokari, T., Sundqvist, K., Nuutinen, M., Pokka, T., Koskela, M., and Uhari, M. (2001). Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ, 322(7302), 1571.
Raz, S., Chazan, B., Dan, M., (2005). Cranberry Juice and Urinary Tract Infection. Clin Infect Dis., (10): 1413-1419. doi: 10.1086/386328.
Stapleton, A., Dzuira, J., Hooton, M., Cox, M., Yarova, Y., Chen, S., and Gupta, K. (2012). Recurrent Urinary Tract Infection and Urinary Escherichia coli in Women Ingesting Cranberry Juice Daily: A Randomized Controlled Trial. Mayo Clin Proc., 87(2): 143– 150. doi:  10.1016/j.mayocp.2011.10.006
Stothers, L. (2002). A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol., 9(3), 1558–62.
Walker, E.B., Barney, D.P., Mickelsen, J.N., Walton. R.J., and Mickelsen, R.A., Jr. (2000). Cranberry concentrate: UTI prophylaxis. J Fam Pract., 45(2), 167–8
Wang, C., Fang, C., Chuan, N., Liu, S., Yu, P., et al. (2012). Cranberry-Containing Products for Prevention of Urinary Tract Infections in Susceptible PopulationsA Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Intern Med., 172(13), 988- 996. doi:10.1001/archinternmed.2012.3004.