PICOT STATEMENT-INFLUENZA INFECTION CONTROL IN LTCF

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper (see attachment) and Literature Evaluation Table (see attachments) assignments to develop a 750-1,000 max (please do not exceed word count limit) word review that includes the following sections:

1. Title page

2. Introduction section

3. A comparison of research questions

4. A comparison of sample populations

5. A comparison of the limitations of the study

6. A conclusion section, incorporating recommendations for further research

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Please use the Literature review template (see attachment) when completing this assignment to ensure all points are included. The Literature review template is written from the assignment guidelines and it is imperative that you use them as I grade from them.

Please include in-text citations for all factual information, and references used must be within the last 5 years. Please include DOI in references.

PICOT STATEMENT-INFLUENZA INFECTION CONTROL IN LTCF

7

Student Name:

Course:

Due Date:

1

Instructor:

PICOT Statement Comment by Ellen Pavela: This page label should NOT be in bold.

Controlling of Influenza infections among elderly long-term resident of long-term care facilities (LTCFs) in New York using oseltamivir antiviral prophylaxis (Ishikane et al., 2016). It is important to control the rates of infection of influenza among the elderly patients in LTCFs so that the effects of the outbreak of the disease and the cost of treating and controlling it are lowered. This is a very important aspect in the nursing fraternity, which aims at ensuring management of all health conditions below adverse threshold level and improving the wellbeing of the elderly patients in LTCFs.

PICOT Question

In the patients in LTCFs, how does the use of antiviral prophylaxis approach control the infection and outbreak of influenza in the older patients in various LTCFs within the first 3 years of the reception of influenza outbreak report? In this question, P stands for the elderly patients that are long-term care residents of the LTCFs due to various neurological and neurocognitive medical conditions. The people who shall be recruited in the controlling of influenza infections using antiviral prophylaxis approach. The ellipsis I represent the oseltamivir prophylaxis intervention or treatment that shall be administered on the long-term care elderly residents in the LTCFs in New York. The acronym C refers to the comparison aspects, which identifies the control or reference group upon which the results of the administered intervention will be compared to. In this case, the elderly residents subjected to standard and drop precautions approaches will be the control group. The O on the other hand denotes that outcome which shall be measured in order to achieve the objective of examining the effectiveness of antiviral prophylaxis intervention on the subjects under study. Lastly, T is the Time or duration during which the intervention is effective. In this study, antiviral prophylaxis shall be administered for a period of three years. Comment by Ellen Pavela: What is the nursing intervention in this PICOT question? The use of a medication is a medical intervention. What does the nurse do that improves the nursing practice of patient care? How can this question be reworded so that it is still supported by the researched studies in the literature review? The comparison nursing intervention, the measurable outcome and the time frame need to be added. See me on the private forum with this question so that it can be reworded to meet the PICOT standard. Dr Pavela Comment by Ellen Pavela: This PICOT question supports a research project that will be performed during this class. You cannot have a project that lasts longer than the duration of the class which only lasts for 10-weeks.

Evidence-Based Solution

The use of antiviral prophylaxis approach has been reported to decrease the occurrence of influenza infections among long-term care residents in LTCFs. The use of oseltamivir neuraminidase inhibitor shortens the clinical disease, lowers viral load and inhibits nasopharyngeal virus shedding and transmission among members of a household (Ishikane et al., 2016). In order to improve the situation for future nursing practices, efficient assessment and monitoring of etiological and epidemiological factors of influenza will be important in planning of the oseltamivir prophylaxis program. It is vital for the prophylaxis intervention to be administered during the onset of the infections months and 1 day after the report of influenza outbreak (Miksić et al., 2015).

Nursing Intervention

In order to control the outbreaks and spread of influenza disease, timely vaccination with oseltamivir is recommended at the onset of every influenza outbreak seasons. Long term care elderly residents with neurological and neurocognitive medical conditions will be vaccinated with oseltamivir at the onset of winter and summer seasons. Studies show that influenza infections are most likely to occur in December, rising to January and early February. Studies reveal that antiviral prophylaxis increases protection for about three months, which lowers in summer. This implies that summer experiences high outbreaks between June and August. Accurate prediction and administering of oseltamivir prophylaxis may improve the management and control of influenza infections in the peak seasons. Compared to use of standard and drop precautions measures, antiviral prophylaxis lowers the nasopharyngeal viral shedding, transmission and load among patients in constricted settings like LTCFs. The intervention offers 25% lower influenza outbreaks in peak seasons compared to standards and drop precaution measures. Comment by Ellen Pavela: Missing citation for this section.

Patient Care

Administering antiviral prophylaxis in elderly long-term care residents of LTCFs will reduce their exposure to and resistance to influenza virus. This will reduce the influenza outbreak incidences and thus reduces adverse effects and mortality rates among elderly long-term care residents in LCTFs. Influenza is reported to cause severe illness in over three million people and 250, 000 deaths annually in the world (Andrew et al., 2017). The highest percentage of the affected are people aged 65 years and above. Reducing influenza outbreaks will lower the medical burden on the patients and existing healthcare system, will reduce mortality, morbidity rates and lower hospitalization cases (Merritt et al., 2016).

Health Care Agency

The outcome of the study will be presented to the health service staff in the LTCF facilities in New York. The LTCF facilities in New York have short-term residents and long-term residents of the facility suffering from chronic diseases like cardiovascular, diabetes mellitus, dementia, neurological and neurocognitive diseases among others. Other occupants of the facilities include medical staff that comprise of physicians, various categories of health workers, nurses and practitioners, visitors and family members (Najafi et al., 2017). These occupants should be informed on the importance of controlling influenza. Other important agencies that need to be informed on the importance of controlling influenza include New York Communicable Disease or Management organization, the Ney York CDC and LTCF management, Centers for Medicare and Medicaid Services (CMS) among other funders and healthcare researchers (Ishikane et al., 2016).

Nursing Practice

Improving on the strategies of managing and controlling influenza infection in New York LTCFs is important in controlling influenza outbreaks in the state (Ishikane et al., 2016). This impact on the daily activities of nursing fraternity in that their health wellbeing will be improved and shall be protected from influenza infection. This will improve their health status and thus increase their productivity (Andrew et al., 2017). Daly activities will include assessing and monitoring influenza outbreak aspects, management and control measure implementation, daily assessment of the patients’ wellbeing, pain and other health condition adverse impacts and quarantine enforcements in the event of outbreak. The nursing fraternity will also be involved in information acquisition and sharing which is reported to increase the effectiveness of controlling risks of Influenza outbreaks in LTCFs by one-third. Information sharing increases outbreak awareness and antiviral programming, which play a big role in timely interventions (Cheng et al., 2018).

Conclusion

Influenza infection in the LTCFs in New York is on the rise given the dramatic change in the environmental aspects and therefore means to control the disease before becoming a pandemic is necessary. Although many approaches exist, oseltamivir antiviral prophylaxis approach proves to be the most effective in controlling the infection among long-term care residents of LTCFs. The approach reduces the adverse effects of the disease on both the patients and government spending, and also alleviates mortality, morbidity and hospitalization cases of the long-term care residents of LTCFs. Controlling influenza is beneficial to the government, families and other financial sponsors of health care systems. The knowledge of the effective approaches for influenza control transforms the daily activities of the healthcare professions and nurses by increasing their monitoring and evaluation of the aspects of influenza infections and control. (word count-1116. This count is 366 words OVER the maximum word limit of 750 words. Please adhere to the word limit for full points in the future assignments.)

References Comment by Ellen Pavela: The page label should NOT be in bold.

Andrew, M. K., Shinde, V., Hatchette, T., Ambrose, A., Boivin, G., Bowie, W., & Haguinet, F. (2017). Influenza vaccine effectiveness against influenza-related hospitalization during a season with mixed outbreaks of four influenza viruses: a test-negative case-control study in adults in Canada. BMC infectious diseases17(1), 805. Comment by Ellen Pavela: The first letters of the major words of the journal name should be capitalized. The DOI number or web link is missing.

Cheng, H. Y., Chen, W. C., Chou, Y. J., Huang, A. S. E., & Huang, W. T. (2018). Containing influenza outbreaks with antiviral use in long‐term care facilities in Taiwan, 2008‐2014. Influenza and other respiratory viruses12(2), 287-292. Comment by Ellen Pavela: See comment above- same errors.

Ishikane, M., Kamiya, H., Kawabata, K., Higashihara, M., Sugihara, M., Tabuchi, A., & Sugiki, Y. (2016). Seasonal influenza vaccine (A/New York/39/2012) effectiveness against influenza a virus of health care workers in a long term care facility attached with the hospital, Japan, 2014/15: A cohort study. Journal of Infection and Chemotherapy22(11), 777-779. Comment by Ellen Pavela: Missing DOI number.

Merritt, T., Hope, K., Butler, M., Durrheim, D., Gupta, L., Najjar, Z., & Fletcher, S. (2016). Effect of antiviral prophylaxis on influenza outbreaks in aged care facilities in three local health districts in New South Wales, Australia, 2014. Western Pacific surveillance and response journal : WPSAR7(1), 14. Comment by Ellen Pavela: The major words in the journal name should have the first letter capitalized. The DOI number is missing.

Miksić, N. G., Uršič, T., Simonović, Z., Lusa, L., Rojko, P. L., Petrovec, M., & Strle, F. (2015). Oseltamivir prophylaxis in controlling influenza outbreak in nursing homes: a comparison between three different approaches. Infection43(1), 73-81. Comment by Ellen Pavela: DOI number is missing.

X Comment by Ellen Pavela: Page label is missing.

Najafi, M., Laskowski, M., de Boer, P. T., Williams, E., Chit, A., & Moghadas, S. M. (2017). The effect of individual movements and interventions on the spread of influenza in long-term care facilities. Medical Decision Making37(8), 871-881. Comment by Ellen Pavela: Missing DOI or web link.

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