Strategies to Prevent Ventilator- Associated Pneumonia (Vap) in Intensive Care Unit (Icu): an Experimental Study.

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CONTENT
Title………………………………………………………………………………..……….P.2 Research Question………………………………………………………………...……...P.2 Aims…………………………………………………………………………………………P.2 Introduction…………………………………………………………………..…………….P.3 Theoretical perspective…………………………………………………………...………P.4 Literature Review…………………………………………………………….……………P.5 Methodology…………………………………………………………………….………..P.11 Methods……………………………………………………………………..…………….P.12 Sample and Access to sample/ data…………………………………………………...P.13 Data collection…………………………………………………………….……………...P.16 Data analysis……………………………………………………………………………..P.19 Ethical issues……………………………………………………………….…………….P.19 Rigour…………………………………………………………………………..…………P.21 Limitations…………………………………………………………………..…………….P.23 Timeframe……………………………………………………………….………………..P.24 Dissemination………………………………………………………………….………...P.25 References……………………………………………………………….……………….P.26 Appendices…………………………………………………………….…………………P.33 Title

Strategies to prevent Ventilator- Associated Pneumonia (VAP) in Intensive Care Unit (ICU): An experimental study.

Question
What is the effect of adding mechanical oral care (toothbrushing) to the chemical oral care (usual oral care) on the prevention of VAP in ICU patients?

Aim
The aim of this experimental study is to examine the effectiveness of adding toothbrushing to the usual oral care on the prevention of VAP in ICU patients. Objectives are:
i. To explore the relationship between oral health status and the development of VAP in ICU patients. ii. To explore the relationship between oral care and the development of VAP in ICU patients. iii. To evaluate the effect of adding toothbrushng to the usual oral care on the prevention of VAP in ICU patients. iv. To identify a strategy for improving oral care so as to prevent VAP and to enhance quality of life of ICU patients.

Introduction
VAP is hospital-acquired pneumonia that develops in an intubated patient after 48 hours or more of mechanical ventilation, and that was not present before intubaton (Fields, 2008). The development of VAP is a concern and its prevention is essential because it is the most common nosocomial infection in mechanically ventilated patients and is a preventable consequence of intubation and mechanical ventilation (Barcaly & Vega, 2005). In addition, it results in high mortality and morbidity, prolonged length of hospitalization and ICU stay, and increased cost of care (Kleiman & Boody, 2009).

As bacterial colonisation of oral cavity is one of critical risk factors for VAP (Munro et al, 2006) and oral care plays a vital role in preventing VAP (Munro et al, 2004), nurses, therefore, have a responsibility to ensure oral care effectively supplement the other strategies used to prevent VAP.

Despite the importance of oral care in ICU has been noted, universal oral care standards do not exit and evidence-based oral care protocol for ICU have not been reported (Kleiman & Boody, 2009).

Thus, a better designed procedural approach for oral care for ICU patients is needed. In this experimental study, the specific aim is to determine the effect of adding toothbrushing to the usual oral care on the prevention VAP in ICU patients.

Theoretical perspective
Paradigm is “a set of assumptions on which the research question are based” (Bowling, 2009 p129) which guides the investigator in choice of method, ontological and epistemologically fundamental ways (Guba & Lincoln, 1994), so that this may help with the structure/ format of a research.

The assumptions of paradigm include ontology which means ‘what is the nature of reality’; epistemology which means the relationship between researchers and researched; and methodology which means the process of research (Hatch, 2000).

In this proposal, the author try to uncover the effect of adding toothbrushinge to the usual oral care on the prevention of VAP in ICU patients and try to prove the effect is truth. For the nature of this reality is a single objective and external truth exists out there,...
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