Research Critiques and PICOT Statement Final Draft Assignment Paper

Research Critiques and PICOT Statement Final Draft Assignment Paper

Research Critiques and PICOT Statement Final Draft Assignment Paper

As they study, engage in routine practice, and interact with different populations, nurses encounter many problems affecting health outcomes. They include diseases, unhealthy lifestyles, and unsafe work environments. Using their professional knowledge and experience, nurses explore the causes of such problems, manifestations, and other characteristics and develop evidence-based interventions. Evidence-based solutions rely heavily on quantitative and qualitative research. The purpose of this paper is to analyze the four studies used to answer the PICOT question and how the findings can be used to guide practice change.


Nursing Practice Problem and PICOT Question

Surgical site infections (SSIs) are typical hospital-acquired infections (HAIs) that adversely affect health outcomes in patients undergoing surgical procedures. They extend hospital stays and readmission rates and degenerate the patient’s overall health (Nthumba, 2020). Such outcomes increase health care costs and demonstrate patient care that does not meet the desired quality level. In response, health care practitioners must devise appropriate mechanisms to prevent SSIs. Khairnar et al. (2020) argued that hands are a typical medium for initiating and spreading infections in health care settings. Accordingly, effective hand hygiene practices can be a practical response to HAIs, pivotal in enhancing patient safety and reducing the overall health care costs.

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PICOT Question: Among patients who undergo surgical procedures (P), how effective is hand rubbing with alcohol (I) use of the waterless, alcohol-based solution in addition (C) compared to handwashing with soap and water (O) in reducing the incidence of surgical site infections (T) over a three-month period?


The quantitative studies’ principle argument is that hospital-acquired infections hamper patient care and hand hygiene is a practical, simple procedure for nurses to prevent infections. Khairnar et al. (2020) compared the efficacy of alcohol-based sanitizer, liquid soap, and their combination. The study is significant to nursing practice since it guides health care professionals in choosing the most effective hand hygiene method. It answered the question of whether there is a significant difference between the three hand-hygiene methods. In the other study, Nasution et al. (2019) theorized that hand hygiene effectively reduces hospital-acquired infections (HAIs), but different practices have different outcomes. The study is significant to nursing since selecting the most appropriate hand hygiene method would lead to better outcomes as far as HAIs control is concerned. The study determined the effectiveness of handwashing with soap compared to alcohol-based hand rub. The objective was to explore their suitability and answer the research question of whether the two methods are significantly different.

The qualitative studies’ primary tenet is that hand rubbing with alcohol can improve standards and practice for hospital care by minimizing the transmission of pathogens. Alsagher et al. (2018) sought to uncover whether there is a significant difference between handwashing soap and alcohol-based solutions. The study is significant in nursing since it guides nurses on using the best handwashing solution by determining their effectiveness in eliminating microorganisms on hands. The research question was whether alcohol-based solutions and soap handwash differ in their efficacy in eliminating microorganisms. Kingston et al. (2018) established their study on the premise that cleanliness and constant disinfection are the primary solutions to surgical-site infections in health care settings. As a result, the study compared hand hygiene practices using alcohol-based hand rubs among Irish nursing and medical students. The study is significant to nursing since it proposes evidence-based solutions for reducing SSIs in health care settings. It aimed to provide insight into nursing and medical students; hand hygiene and hand rubbing practices while answering the question of whether different hand hygiene practices cause a significant difference in the required hygiene.

How the Articles Support the Nurse Practice Issue

As hypothesized in the PICOT, handwashing with soap and hand rubbing with an alcohol-based solution differs in their effectiveness in reducing the incidence of SSIs. Nasution et al. (2019) and Khairnar et al. (2020) articles illustrate the difference between the two hand hygiene methods. In the qualitative studies, Alsagher et al. (2018) and Kingston et al. (2018) answer the PICOT question by demonstrating the importance of alcohol-based solutions and handwashing practices in reducing infections in nursing. Overall, the four articles support the nurse practice issue by affirming that strong sanitization has an increased positive effect on reducing SSIs.

Regarding interventions and comparison groups, Nasution et al. (2019) used three groups: liquid hand-wash, alcohol-based sanitizer, and the combination group. On the other hand, Khairnar et al. (2020) had two groups involved: the first group used handwashing with soap, and the second group used hand rub. In each study, handwashing and hand rubbing using an alcohol-based solution are compared as described in the PICOT question, where outcomes in two groups are compared. The interventions and comparison groups included in the qualitative articles are more related to the effective discussion and solution of SSI issues in nursing. Alsagher et al. (2018) compared the difference in bacterial counts when using conventional hand washing and after applying an alcohol-based gel. Kingston et al. (2018) compared nursing students’ and medical students’ hand hygiene practices. Like other studies, the objective was to compare the effectiveness of different solutions.

Method of Study

Nasution et al. (2019) conducted a single-blinded randomized controlled trial. The dominant feature of such a study is participants not knowing the treatment or intervention until the study is complete. The main advantage is randomization, eliminating treatment bias (Lim & In, 2019). However, trials require large samples. Khairnar et al. (2020) conducted an experimental analytic study with pre-test and post-test designs. Researchers study the effects of an intervention in different groups in such studies. Experimental studies are usually randomized, grouping the subjects by chance. Randomization reduces the experimenter’s bias, although the study’s findings are not immune to subjectivity. No theoretical frameworks have been mentioned in the articles.

In the qualitative studies, Alsagher et al. (2018) conducted a prospective microbiological evaluation of volunteers, while Kingston et al. (2018) conducted an observational study via a cross-sectional, self-reported design. In a prospective evaluation, outcomes of interest occur after the study commences. In an observational study, researchers examine the effect of an intervention without manipulating the subjects (Kingston et al., 2018). Prospective studies can be conducted with a small sample size, making them less time-consuming. However, small samples limit the accuracy level. Observational studies are more insightful since the subjects are observed in a natural setting. However, they are time-consuming and tedious. Like the quantitative studies, the qualitative studies do not apply any theoretical frameworks.

Result of Study

Nasution et al. (2019) found that combining handwashing and hand rubbing was the most effective method, with a median percentage reduction of 100%. Alcohol-based sanitizer followed at 94.29%, and handwashing liquid soap was the last at 92.31%. All the methods effectively reduce microbial colonies on hands; their difference is clinically significant but not statistically significant. Khairnar et al. (2020) found no significant difference between handwashing with soap and hand rubbing with alcohol-based solutions (p = 0.088). As a result, nurses can use the solution available as situations necessitate. Alsagher et al. (2018) found that both antiseptic and non-antiseptic soaps did not reduce bacterial counts effectively, but the results significantly improved after applying alcohol gel. This implied that alcohol-based solution has better results compared to antiseptic and non-antiseptic soaps. In the last study, Kingston et al. (2018) found that more medical students (46%) than nursing students (22%) used alcohol-based hand rubs over other solutions. Attitude and knowledge on when to use soap/alcohol determine outcomes.

These findings affirm the effectiveness of alcohol-based solutions in hand hygiene to control infections. Considering that health care professionals are mandated to reduce surgical site infections, they should prioritize hand hygiene as an effective method of reducing bacterial contamination. Alcohol-based hand rub should dominate other methods since all the studies have confirmed its effectiveness. Care providers’ training is also crucial to change their attitude and improve hygiene compliance.

Ethical Considerations

Ethics is critical in research involving human subjects. One ethical research consideration dominating health practice is the need for respondents’ informed consent. The consent allows the researcher to include only the participants willing to participate in the study (Matsui et al., 2021). Another ethical research practice is the confidentiality of information given by the participants. Researchers must protect the confidential information provided by the participants. Ethical considerations dominating the quantitative studies include study approval by an institutional ethical committee, informed consent, and involving adults of sound mind. Subjects who were unwilling to participate, with any fresh injury or history of allergy to soap or alcohol solutions, were excluded from the studies (Nasution et al., 2019; Khairnar et al., 2020). In the qualitative studies, Kingston et al. (2018) ensured that the participants signed consent forms before participating in the research. Alsagher et al. (2018) also used informed consent to allow the students to participate in the trials voluntarily and ensured all data remained confidential.

Outcomes Comparison

As described in the PICOT, a significant difference was expected between hand rubbing with alcohol and handwashing with soap and water. Hand rubbing with alcohol was expected to be more effective. The four articles favor the anticipated outcome since they confirm the effectiveness of hand rubbing with alcohol over handwashing with soap and water, albeit Khairnar et al. (2020) found no statistically significant difference between the methods. Nasution et al. (2019) even went further to confirm that a combination of the two solutions is the most effective. Kingston et al. (2018) and Alsagher et al. (2018)  revealed that hand rubbing with alcohol-based solutions proved more effective than handwashing with soap in controlling infections, albeit relying heavily on students’ perceptions. Overall, the outcomes match PICOT’s anticipation.

Proposed Evidence-Based Practice Change

The link between the PICOT question, the research articles, and the nursing practice problem is that the research articles prove the PICOT’s conjecture to provide evidence-based information to address the nursing practice problem. The research articles describe how the nursing problem (incidence of surgical site infections) can be addressed using evidence-based practices (hand rub with alcohol-based solutions). Based on this information, an effective evidence-based practice change for the setting is shifting to alcohol-based hand rub as the dominant hand hygiene practice to reduce SSIs among patients undergoing surgical procedures. Since alcohol-based hand rub has been proved highly effective in killing microbes, the anticipated change could be realized within three months. As Alsagher et al. (2018) suggested, educating nurses on this shift is crucial to changing their perception, essential in reducing resistance to change.


Surgical sites are critical treatment areas where patients should be handled with maximum care, and evidence-based interventions are always used. Nurses should be ready to adopt the most current and scientific practices to enhance patient safety. As described in this paper, hand rubbing with alcohol-based solutions can achieve better results than handwashing with soap and water. Adopting the practice in surgical sites will help to minimize SSIs, leading to a proportional decline in hospital stays, readmissions, and health costs, among other adverse outcomes.


Alsagher, M. R., Soudah, S. A., Khsheba, A. E., Fadel, S. M., Dadiesh, M. A., Houme, M. A., … & Almsalaty, S. M. (2018). Hand washing before and after applying different hand hygiene techniques in places of public concern in Tripoli-Libya. The Open Microbiology Journal, 12(1), 364-375. 10.2174/1874285801812010364

Khairnar, M. R., G, A., Dalvi, T. M., Kalghatgi, S., Datar, U. V., Wadgave, U., Shah, S., & Preet, L. (2020). Comparative efficacy of hand disinfection potential of hand sanitizer and liquid soap among dental students: A randomized controlled trial. Indian journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(5), 336–339.

Kingston, L. M., O’Connell, N. H., & Dunne, C. P. (2018). A comparative study of hand hygiene and alcohol-based hand rub use among Irish nursing and medical students. Nurse Education Today, 63, 112-118.

Lim, C. Y., & In, J. (2019). Randomization in clinical studies. Korean journal of anesthesiology, 72(3), 221–232.

Matsui, K., Ibuki, T., Tashiro, S., Nakamura, H., & Study Group on Regulatory Science for Early Clinical Application of Pediatric Pharmaceuticals. (2021). Principles of ethical consideration required for clinical research involving children. Pediatrics International, 63(3), 248-259.

Nasution, T. A., Yunita, R., Pasaribu, A. P., & Ardinata, F. M. (2019). Effectiveness hand washing and hand rub method in reducing total bacteria colony from nurses in Medan. Open Access Macedonian Journal of Medical Sciences, 7(20), 3380.

Nthumba, P. M. (2020). Effective hand preparation for surgical procedures in low-and middle-income countries. Surgical Infections, 21(6), 495-500.


Requires Lopeswrite
Assessment Description
Prepare this assignment as a 1,500-1,750 word paper using the instructor’s feedback from the previous course assignments and the guidelines below.
PICOT Question
Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor. TOPIC 1 IS THE LITERATURE EVALUATION TABLE ORDER #236368
The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study).
Research Critiques
In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.
The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.
Refer to “Research Critiques and PICOT Guidelines – Final Draft.” Questions under each heading should be addressed as a narrative in the structure of a formal paper.
Use this document to organize the content from your four studies into your final draft. TWO Qualitative and TWO Quantitative Studies are discussed in order 236416 and 23604 RESPECTIVELY

Proposed Evidence-Based Practice Change
Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanations and use that information to propose evidence-based practice changes.
General Requirements
You are required to cite a minimum of FOUR peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

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