Research Proposal: Cranberry Juice for UTI Reduction in Nursing Homes

This report investigates the effectiveness of cranberry juice in reducing urinary tract infections (UTIs) among elderly residents in nursing homes. It begins by identifying UTIs as a common and often overlooked problem in elderly care, leading to potential complications. The research employs the PICO framework to formulate a research question: "To evaluate whether cranberry juice can help in reducing urinary tract infections in elderly in Nursing homes?" A critical review of existing literature reveals mixed evidence, with some studies suggesting a positive effect of cranberry juice in preventing recurrent UTIs, while others highlight limitations and the need for unsweetened, pure juice. The report includes a short research proposal outlining a qualitative research approach using secondary data sources and thematic analysis. Ethical considerations and potential outcomes are addressed, ultimately concluding that while cranberry juice may offer some benefit in reducing UTIs, further research is needed to fully understand its effectiveness and optimal usage in elderly populations.

Research

Does cranberry juice help to reduce urinary tract infections in elderly in Nursing homes?
This brief paper will investigate an issue and use the PICO format to develop a
research question to discuss the use cranberry juice help to reduce urinary tract infections in
elderly in Nursing homes. The research question will be critically reviewed and a short
research proposal will be developed. Finally, a critical reflection will be done to determine
what was learnt through the development of this research project.
Identification of the problem
a. Description of problem
Urinary tract infections are one of the most common type of infection which is
commonly found in elderly people in nursing homes. Not only this it is one of the main
problems within nursing homes, but it can also be easily ignored. It is a serious problem
especially in elderly people because it directly degrades their overall quality of life.
b. Academic databases
Various studies have helped in explaining that urinary tract infection among elderly
people can be the result of bacterial inflammation in kidney, ureters, bladder and urethra.
This infection is most commonly found in elderly people who are above 85 years of age and
occurs especially among women (Jensen, H. D., & et. al. 2017). Various studies have clearly
stated in explaining that it is one of those infection which is mostly ignored in elderly people.
If this infection is treated quickly then it can be treated within 48 hours but if it is neglected
(which is mostly done in elderly people in nursing homes) then its consequences can be quite
severe such as blood poisoning, recurrent infection, permanent kidney damage etc. In elderly
people these consequences can be quite severe.
c. Gap in research evidence
As many as 25 percent of all infections in long-term care facility residents are urinary tract
infections (UTIs). Treatment to prevent UTI might lessen the severity of these consequences,
however, there are limited evidence-based techniques to minimize UTI in institutions. The
diagnostic uncertainties regarding UTI in the elderly population commonly lead to overuse of
antimicrobials which can be harmful and increases the risk of increasing antimicrobial
resistance (Leihof et al., 2021).

Research Question
For developing research question PICO framework is used. This framework has
been used for identification of problem as it helps in structuring clinical research questions in
connection with evidence syntheses.
PICO framework for identified problem have been explained below:
P- Population: Elderly people in Nursing Homes
I- Intervention: Use of cranberry Juice
C- Comparison: In comparison with antibiotics
O- Outcome Measured: Reducing urinary tract infections
From the above framework it has been identified that researcher will evaluate which
intervention out of cranberry juice and antibiotics is appropriate to be used for reducing
urinary tract infections among elderly people living in nursing homes.
Target research question developed from the above PICO framework for this project
is: To evaluate whether cranberry juice can help in reducing urinary tract infections in elderly
in Nursing homes?
Critical review of research evidence
Burleigh et al., 2013 stated that over 50 percent of women will get a urinary tract
infection (UTI) over their lives. Antibiotics can be used to prevent recurrent urinary tract
infections (UTIs), but they can also lead to the drug-resistant bacteria developing. To avoid
UTIs, it becomes sensitive to examine dietary methods. UTI prevention has been attempted
using cranberry juice and supplements, although with varying degrees of success. This
clinical study involved twenty women with recurrent urinary tract infections who ingested
one serving of SDC each day for two weeks. To evaluate the clinical effectiveness, two
criteria were used: a decrease in UTI rates at six months, pre-and post-consumption, and an
increase in time before the first UTI occurred since the research began.
Figure 1 level of Evidence

As per various non- experimental studies Prior and post-consumption rectal swabs
were also counted for intestinal E. coli numbers (Liska et al., 2016). During the six months of
SDC intake, more than half of the patients did not get a UTI, and the UTI rate per six-month
period fell dramatically. Comparing women who consumed SDC to patients in a prior control
group, Kaplan-Meier analysis revealed a substantial decrease in time before the first UTI
within six months. After cranberry ingestion, there were no significant differences in E. coli
strain heterogeneity, VF profiles, or prevalence. The results of this study show that eating
SDC can lower the number of UTIs in vulnerable women. Because there were no changes in
the mechanism of action of SDC in reducing UTIs must be determined through further study
of E. coli heterogeneity or VF profiles.
As per the view of Wan & et. al. (2016) instead of antibiotics cranberry juice can be
given to elderly people of nursing homes for treating urinary tract infections as an effective
alternative option. Asper the study of Jensen & et. al. (2017) cranberry juice can directly help
in reducing urinary tract infection. However, research in this field is still being carried out but
it is effective intervention that can be used for reducing urinary tract infections in elderly
people but its benefits are too small. There is no doubt that it is an effective intervention that
can be used as a treatment but it can only reduce this infection, it cannot completely cure it.
But there are certain limitations of this intervention such as if it is required to be used for
reducing urinary tract infections then it should be a pure and unsweetened juice. It should not
be mixed with other fruits. Only then it is can become effective and reduce this infection. For
elderly people it is effective and can be used for reducing urinary tract infections because
there are least number of side effects as per experimental studies.
However, explained by Nicolle, (2016) there are no proof that it is an effective
treatment but as per its study results it was identified that in elderly people of nursing home
who were suffering from urinary tract infections required less attention with time its
seriousness was reduced but it was not cured completely. But this study did help in
understanding that after starting daily usage of cranberry juice there was reduction in
occurrence of urinary tract infections among elderly people. As per the study results of
Luczak & Swanoski, (2018) it was identified that cranberry juice usage can help in
preventing urinary tract infection from occurring among elderly people and this intervention
can be easily adopted by nursing homes for providing protection to elderly people from this
infection.

Short Research ProposalType of research
There are many type through which the research can be conducted like qualitative
and quantitative. Quantitative research is also known as descriptive. This research will be
conducted using qualitative research method because this technique will be easy to analyse
that cranberry juice helps in reducing urinary tract infections among elder people (Newman
& Gough 2020). As qualitative research is the research which give deep analysis of any
subject. So that is this method will be helpful in doing deep analysis.Data source
It refers to the place from where data can be collected. There are two ways from
which data can be collected which are primary and secondary. This research will be
conducted using secondary data sources. So, for that online library will get referred.
Databases like Medline, CINHL and PubMed will be used. For collecting sources or
information various medical records are also evaluated. Secondary research will be used
because it is cost effective method and also saves time. For secondary qualitative data, some
articles will be reviewed.Method of data collection
It is the very important part of the research. For this research literature review will
be conducted in order to collect qualitative data in the form of words and feelings or not in
the form of numbers. Books and journals are also analysed in order to find out data or gather
information regarding urinary tract infections can be reduced using cranberry juice in elders
or not (Worthington & Bodie, (2017)).Mode of analysis
The next important thing after data collection is data analysis. It means extracting
important information from whole data. It can be done through two ways which is thematic
analysis or SPSS which is statistical analysis. This research will be conducted using thematic
analysis. As this technique helps in evaluating theoretical information. So that is why the
effect of cranberry juice in reducing urinary tract infections in elder people will be easily
addressed by using this technique. On the basis of already published secondary data
researcher will analyse survey data on either cranberry juice can reduce urinary tract infection
in elders by comparing data of elder or other people. It can help out in knowing effectiveness
of cranberry juice.Anticipated outcomes

It is true that taking dosage around 240-300 ml of cranberry juice cocktail is helpful
in reducing urinary tract infections in elder generation or elderly people in nursing homes.
But cranberry juice dosage should be only taking as per prescribed by healthcare providers
and should not be taking as per the wish (Rosskam, 2018).Evidence to improve practice and patient outcomes
Although there is buzz about cranberry juice in curing UTI but the question arise here
is that these berries actually helpful in providing medication to elder people so that they get
rid from UTI infection (Jensen, H. D., & et. al. 2017). Many researches are done and
outcomes is drawn that taking cranberry juice can actually prevent UTI especially in women
case which are prone with these kinds of infections. But it is also true that cranberry will not
be effective with every elderly or people as it depends on individual to individual. It is also
said that the cranberry juice which is unsweetened helps a lot in fighting with urinary tracts
infections but is also not clearly defined that how much it has to be taken or the exact
quantity is unspecified. On the other hand, sweetened juice have few effectiveness as
compared to unsweetened juice.Research findings
This research will be conducted using secondary source. As books and articles are
evaluated which is relevant to the research topic. Online library and databases like Medline
and CINHL are also used (Shahar et al., 2019). The current investigation will be conducted
using thematic analysis because the topic is about reduction in urinary tract infections by in
taking cranberry juice can be discussed through secondary data that is published already. The
research will be done using qualitative method because it will be helpful in understanding
topic more effectively because it will present deep analysis.
Ethical issues
The research design incorporates ethical considerations. Ethical approval will be
obtained from the ethics committee before commencing the research project. All individuals
and participating organizations were asked for their permission. A standardized consent form
and information sheet will be employed. Subjects had the right to withdraw from the study at
any moment, as well as refuse to answer any questions, according to the instruction page. The
key approach to address the reliability and validity of qualitative research will be the
formulation of a clearly defined research protocol making sure that the author’s approach was
consistent, well documented and methodical. Confidentiality and anonymity will be other
topics of discussion. Data which is taken from internet or on online website is reliable or

relevant or not. So, to solve this issue copyright and patented sources are only considered to
extract information. It is the duty of the researcher who is doing the secondary analysis to
make sure that the analysis of the data is done appropriately.
REFLECTION
Drafting the study proposal assisted me in establishing the research's goals and has helped me
in building my research skills. As earlier I had limited knowledge about qualitative research
method but after I conducted this research I got to know about this technique and also how to
use it. This investigation has also raised my confidence level. Further, it allowed me to
consider each stage of the research process to create a clear and precise plan. I learned about
evidence-based practice, developing research questions, evaluate the evidence and assess
outcomes. In addition, I also learnt about the significance of ethical considerations in research
and the incorporation of the same in the research plan. Anonymity, informed consent and
confidentiality are three essential considerations in qualitative research. Any potential
intrusion into the autonomy of the study must be kept to a bare minimum by the researcher.
Informed consent has been recognized as a key part of research ethics. I also understood that
following problems must be clarified: the nature of study, the participant’s potential role, the
researcher’s protocols, the objectives of the research and how the outcomes will be publicized
and used.
REFERENCES
Books and Journals
Devi, P. S. (2017). Research methodology: A handbook for beginners. Notion Press.

Jensen, H. D., & et. al. (2017). Cranberry juice and combinations of its organic acids are
effective against experimental urinary tract infection. Frontiers in microbiology, 8,
542.
Luczak, T., & Swanoski, M. (2018). A review of cranberry use for preventing urinary tract
infections in older adults. The Consultant Pharmacist®, 33(8), 450-453.
Maki, K. C., & et. al. (2016). Consumption of a cranberry juice beverage lowered the number
of clinical urinary tract infection episodes in women with a recent history of urinary
tract infection. The American journal of clinical nutrition, 103(6), 1434-1442.
Newman, M., & Gough, D. (2020). Systematic reviews in educational research:
Methodology, perspectives and application. Systematic reviews in educational
research. 3-22.
Nicolle, L. E. (2016). Cranberry for prevention of urinary tract infection?: time to move
on. Jama, 316(18), 1873-1874.
Rosskam, E. (2018). Using participatory action research methodology to improve worker
health. In Unhealthy Work(pp. 211-228). Routledge.
Shahar, S. M. & et.al (2019, September). Research Methodology Trending in Evolutionary
Computing. In International Conference on Computational Collective
Intelligence (pp. 474-485). Springer, Cham.
Wan, K. S., & et. al. (2016). Cranberries for Preventing Recurrent Urinary Tract Infections in
Uncircumcised Boys. Alternative Therapies in Health & Medicine, 22(6).
Worthington, D. L., & Bodie, G. D. (Eds.). (2017). The sourcebook of listening research:
Methodology and measures. John Wiley & Sons.