response to tow discussion

#1

For this week’s discussion post, I am choosing to use CAUTIs as my clinical quality problem and I believe the application of quasi-experimental design for quality improvement would be the best route to derive a solution. The main difference between a quasi-experimental design and a true experimental design is the randomization factor. In a quasi, we are strictly looking at the cause and effect of specific nursing interventions. This would be beneficial in decreasing the number of CAUTIs on a unit of a hospital because the quality improvement team will be able to look at each different nursing intervention and compare them to a predetermined comparison group. In the case of CAUTIs, there would be two group of patients picked out from each age level on the unit (adolescent, middle-age, etc.) who are about to receive a urinary catheter, one group would receive the nursing intervention and one would receive the same standard of care that has been performed on the unit prior to the study. The strength to this design method is that if the nursing intervention were to prove as successful in all age categories, then it would be safe to presume that the prior nursing intervention was unsuccessful; however, if the intervention was only successful in specific populations such as greater than 65 years old, then this would give the quality improvement team knowledge that another intervention may be better suited for the different age populations. The weakness to this design method is that there could be unique individuals that do not respond to the treatment, and for that reason no conclusion could be drawn on whether or not the intervention was unsuccessful due to the intervention itself or due to the uniqueness of the individual. When looking at a true experimental design, the randomization could be a great application because it would look at the overall rates of a specific nursing intervention. While it would be helpful, I ultimately believe that urinary catheters hold their own variations in problems depending on the individual that receives them, with age being a big factor. The quasi – experimental design can help narrow down definitive nursing interventions for each age group to prevent the occurence of CAUTIs.

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2#

The clinical quality problem I choose for a quality improvement project is the prevalence of Central Line-Associated Bloodstream Infections (CLABSI) in in-patient hospital settings. CLABSIs are a major life-threatening concern that can lead to an extended hospital stay, negative patient outcomes, and increased treatment costs. However, they can be prevented if advanced prevention measures are taken.

To address this quality problem, we will use a quasi-experimental study design. Quasi-experimental designs are helpful in this case in that they don’t require randomization of the participants but allow for including pre-existing individuals with their natural circumstances. This can help investigate individuals who are specifically at high risk for contracting CLABSI or who have already developed it and study the contributing variables.

Another reason for choosing this method is the practicality and validity of quasi-experimental study results. It is practical in that it doesn’t require modifying treatment variables around the patients to set a control group. This will help prevent causing any harm or unexpected outcomes for the patients participating in the study. Lastly, quasi-experimental designs may have more external validity in that the findings can be more applicable in other clinical settings because they reflect real-world conditions and a “normal” patient environment.

One weakness point of a quasi-experimental design is that it may be less effective at establishing causality. Due to the lack of randomization in the subjects, it would be challenging to attribute the results of the experiment to a certain intervention since there are many other factors that could have contributed to the results.

Overall, although experimental studies may provide very specific study findings, I still think that it’s difficult to implement randomization in a critical hospital setting. Therefore, I think that following a quasi-experimental approach will still allow for discovering nursing interventions that can help minimize the risk and occurrence of CLABSIs in a clinical setting.