NU560-8D week 7 4Discussion2REPLY2
Foreveryng
NU560UNIT6DQ3EVIDENCEBASEDCHANGE-2.pptxEVIDENCE BASED/BEST PRACTICES
Student
Department of Nursing, Herzing University
NU 560-8D Research method and Evidence-Based Practice
Instructor
Date
OBJECTIVES
To describe CAUTI
To highlight the PICOT questions
To identify evidence-based articles
To summarize the search strategy used.
To discuss what changes could be made as a result of the findings
To describe strategies/resources needed to implement EBP
To describe areas of opportunity for future research
CATHETER ASSOCIATED URINARY TRACT INFECTION
Infection of the genitourinary tract system due to an indwelling urinary catheter (IUC).
Most common hospital acquired infection(HAIs) causing “1of 3 HAIs in patients in the hospitals” (Iowa Department of Public Health, 2021).
CAUTI “prolongs hospital stay, increases health care costs, morbidity, and mortality” (American Nurse Association, n.d).
CAUTI is an infection of the urinary system caused by the use on indwelling urinary catheter. It is one of the prevailing healthcare associated infection accounting for about “80% of all HAIs” (Parker etal. 2017). CAUTI compromises patients care and safety by “extending hospital stay, increasing morbidity and mortality as well as increasing financial burden of healthcare on patients and have an economic impact on healthcare system” (American Nurse Association, n.d).
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PICOT QUESTION
Does daily care with chlorhexidine wipes versus soap and water reduce the prevalence of CAUTI in Long Term Acute Care patients within 6 weeks of admission ?
P – Patients with an indwelling urinary catheter in a long-term acute care hospital
I – Daily use of Chlorhexidine gluconate (CHG) wipes for catheter care
C – Soap and water for catheter care
O – Decreases CAUTI
T –6 weeks of admission
Studies have had it that avoiding inappropriate and unnecessary insertion of an indwelling catheter is the only solution to CAUTI. However, in conditions where IUC is indicated proper management with antimicrobial chlorhexidine wipes and prompt discontinuation of an indwelling urinary catheter is necessary to prevent CAUTI.
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SUPPORTING ARTICLES
Article 1:
Title : “Implementing a CAUTI prevention program in an acute care hospital setting” by Ferguson, 2018.
Research design: qualitative design
Sampling/sample size: convenience sampling of 59 nurses
Settings: acute care hospital with 393-bed in the Southeastern part of the United States
Data collection/instrument: one-hour multifaceted, interactive program with pre/post questions survey.
Analysis: Statistical analysis using SPSS Version 22.0
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SUPPORTING ARTICLES
Article 2
Title: “enhancing nurses’ knowledge on Catheter-Associated Urinary Tract Infection (Cauti) prevention by Gesmundo (2016)
Research design: mixed research design
Sampling/sample size: convenience sampling of 13 nurses
Settings: two post-operative wards of a surgery center
Data collection/instrument: questionnaires implemented with a pre-test and post-test
Analysis: Statistical Package for the Social Sciences (SPSS)
Result: CAUTI education impact nurses’ knowledge of indwelling catheter management and CAUTI prevention”
SUPPORTING ARTICLES
Article 3
Title: “avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): A pre-post control intervention study by Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., OBrien, T., & Searles, A. (2017)
Research design: mixed research design
Sampling/sample size: cluster sampling of four acute care hospitals
Settings: purposefully selected 2 Health Districts in Australia.
Data collection/instrument: pre and post intervention questionnaire, audio recording interview
Analysis: Statistical analysis
Result: IUC reduced by 50%, reduced duration of use and CAUTI cases.
SEARCH STRATEGY
Search: Herzing university library/nursing databases
Databases: ProQuest Nursing and Allied Health Sources
Cumulative Index to Nursing and Allied Health (CINAHL Complete)
Key search terms/ filters: Nurses’ Knowledge
CAUTI
Chlorhexidine gluconate
Year of publication: 5year old article
Peer review
Indwelling urinary catheter
The search for literature review and selection of the articles was conducted using ProQuest Nursing and Allied Health Sources and Cumulative Index to Nursing and Allied Health (CINAHL Complete) on the Herzing university library/nursing databases to find the best research articles to support my EBP. The main terms of my EBP such as CAUTI, chlorohexidine wipes, and long-term care was typed on the search bar of the databases and refine/filter the related articles using customized features like the year of publication, peer review, and relevance to my topic of discussion and the best 3 that met my searching criteria were picked.
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CHANGE AS A RESULT OF STUDY FINDINGS
Increased nurses’ knowledge on proper assessment of patients for IUC
Increased nurses’ knowledge on proper insertion, management and care of an IUC
Decreased Inappropriate and unnecessary indwelling urinary catheter use
Reduce patient’s morbidity and mortality
Evidence based practice about IUC insertion, care and removal.
All the 3 articles presented explained there is direct correlation between nurses; knowledge of an indwelling urinary catheter use and CAUTI prevalence. The studies explained that nurses are front runner for catheter insertion, care, and management. With efficient training and education nurses can provide patient with evidence-based practice care that decreased Inappropriate and unnecessary indwelling urinary catheter use, reduce patient’s morbidity and mortality, and improves patients’ care and safety.
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STRATEGIES TO IMPLEMENT EVIDENCE BASED CHANGE
Communication
Individual level
Organizational level
Interprofessional collaboration
Teamwork
When implementing an evidence-based change, communication is key. Effective and frequent communication to keep everyone abreast of the change is substantial at the individual and organizational level. Interprofessional collaboration should also be encouraged.
Effectiveness of evidence-based nursing practice and patient outcome largely depends on good collaboration within the health care team. Interdisciplinary health care collaboration is not just in writing or spoken words. O’Daniel and Rosenstein (2008) explain that “collaboration in health care is defined as health care professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patients’ care”. teamwork is important for the implementation of the EBP.
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STRATEGIES TO IMPLEMENT EVIDENCE BASED CHANGE
Anticipate barriers
Lack of motivation
Inadequate staffing
Increased workload and burnout
Unfavorable organizational cultures and values
Inadequate resources
Unavailability of professional and educational
advancement opportunities
Despite its importance, successful application of EBP in healthcare has been faced with many barriers such as lack of motivation among healthcare professionals and hostile organizational cultures and values. Motivation is crucial to implementation of EBP, as it “activates, guide and maintain goal directed behavior” (Basu and Bano, 2016). The actions of staffs are always a consequence of motivation, irrespective of how and where it is instigated. There are two types of motivation, intrinsic and extrinsic motivation.
Lack of motivation to implement EBP may be due to inadequate nursing staff which consequently causes increased workload and burnout. Also, lack of motivation may be due to inadequate or lack of incentives. Most times “financial rewards such as salary, bonuses, promotions, and benefits are offered to employee to reinforce efficiency and effectiveness of services rendered” (Singh, n.d). Another barrier to the implementation of EBP is an unfavorable organization cultures and values, such as inadequate resources, unavailability of professional and educational advancement opportunities, unapproachable administrative, etc. When these values and beliefs are hostile to employees it, it impedes a positive working culture that disallows successful outcomes and employee performances to full potential.
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STRATEGIES TO IMPLEMENT EVIDENCE BASED CHANGE
Stakeholder’s support
Internal stakeholders
Hospital administration and employees
Patients
External stakeholders
Suppliers
Financial organizations
Government
Health insurance providers
Evaluate
Formative
during EB program and implementation
Summative
done after EBP has been established
Determine “to what extent the EBP has achieved its goal” ” (Centers for Disease Control and Prevention, n.d).
Gives a detail report through “systematic data collection and analysis” (Torres, 2010).
Internal stakeholder’s support is necessary for the success of a change proposal, as that can influence “medical decisions or evidence from which the clinical decision is based upon” (Horev & Babad, 2005). Likewise external stakeholder that include suppliers, financial organizations, government, health insurance providers among others also play a major supportive role by providing “human, capital and material resources needed in the implementation of change in the facility” (Griffiths, Maggs & George, 2007). Also, as the recipient of health care services, patient’s support is critical in facilitating successful implementation of the evidence-based project therefore should not be left out as a key stakeholder.
To establish the effectiveness of the implemented evidence-based intervention, a detailed evaluation plan that described and identified the anticipated variables and outcomes of the intervention should be developed. There are two types of evaluation.
While formative evaluation should be conducted during the “program development and implementation to determine how best to achieve the EBP change goals, summative evaluation should be done once the EBP has been established and should highlight to what extent the EBP is achieving its goals”(Centers for Disease Control and Prevention, n.d). Summative evaluations would provide a detailed result through a systematic data collection and analysis on the “relevance, performance, efficiency, and impact (both expected and unexpected) of the project in relation to stated objectives” (Torres, 2010
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RESOURCES TO IMPLEMENT EVIDENCE BASED CHANGE
Human resources
adequate staffing
Materials and equipment
urinary catheter
chlorhexidine wipes
soaps and water
PPEs
bladder scanner, ultrasound transmission gel,
Financial/capital resource
Human resources: personnel are needed to implement the desired change. Healthcare professionals must be available to ensure efficient implementation of the indwelling urinary catheter assessment bundle (IUCAB). With an adequate staffing, nurses will be able to assess patients efficiently and critically for therapeutic indications of an indwelling urinary catheter (IUC). Having enough staff will reduce the number of patient’s nurses and doctors care for and hence the workload and prevent burnout are required to ensure the smooth implementation of the CAUTI prevention.
Time: this is an important resource needed to implement the EB change proposal. Time is needed to train and educate nurses in catheter care.
Materials and equipment: materials such as urinary catheter, chlorhexidine wipes, soaps, sterile gloves, bladder scanner, ultrasound transmission gel, disposable apron, non-sterile disposable gloves, paper tissue, disposal bag amongst other things are needed for the efficient implementation of EB change.
Financial/capital resource: For an efficient implementation of this, money is required in the procurement of necessary materials listed above and hiring of additional employees.
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AREAS OF OPPORTUNITY FOR FUTURE RESEARCH AND EBP FOR CAUTI
Regular in-service and continuous education
Complete and accurate documentation of catheter care
Restrictive use of IUCs as part of the hospital culture
Ways in which EBP in utilized in catheter insertion, management, and removal
Further studies are needed to ensure a regular and continuous education of nurses and other healthcare professionals involved in urinary catheter management. Also, studies must be done to assess the way and extent to which proper documentation about catheter use is done, to track its usage and care. not only that but further research is needed in incorporating IUCs use restrictively as an integral part of all hospital culture and identify extent to which EBP has been used in catheter insertion, management, and removal.
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CONCLUSION
Nurses plays crucial role in insertion, management, and removal of an IUC.
CAUTI “compromises patient’s care and safety” (Ferguson, 2018).
Education on all aspect of catheter care is imperative for all healthcare worker.
Use of EBP such as “chlorhexidine wipes in catheter care is essential for the prevention of CAUTI” (Schmudde, Olson-Sitki, Bond & Chamberlain, 2019).
REFERENCES
American Nurses Association. (n.d). ANA CAUTI prevention tool. https://www.nursingworld.org/practice- policy/work environment/ healthsafety / infectionprevention /ana- cauti -prevention-tool/
Basu, S., & Bano, S. (2016). Intrinsic extrinsic motivation and positive- negative affect of
correctional home inmates. Journal of psychosocial research, 11(2), 497-505. Retrieved from https://eds-a-ebscohost- com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=3&sid=36b1b9bf- 3d90-4a0f-adb5- 4b4c85b2f9cb%40sessionmgr4008
Centers for Disease Control and Prevention. (n.d). Building Our Understanding: Key Concepts
of Evaluation What is it and how do you do it? https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/eval_plannin g.pdf
Ferguson, A. (2018). Implementing a CAUTI prevention program in an acute care hospital setting. Urologic Nursing, 38(6), 273. doi:http://dx.doi.org/10.7257/1053816X.2018.38.6.273
REFERENCES
Gesmundo, M. (2016). Enhancing nurses’ knowledge on Catheter-Associated Urinary Tract Infection (Cauti) prevention. Kai Tiaki Nursing Research, 7(1), 32–40.
Griffiths, J., Maggs, H., & George, E. (2007). Stakeholder involvement: Background paper prepared for the WHO/WEF joint event on preventing noncommunicable diseases in the workplace. http://www.who.int/dietphysicalactivity/griffiths-stakeholder-i nvolvement.pdf
Horev, T., & Babad, Y. (2005). Healthcare reform implementation: Stakeholders and their roles- the Israeli experience. Health Policy, 71(1):1 26 https://doi.org/10.1016/j.healthpol.2004.05.001
Iowa Department of Public Health. (2020). CAUTI information. What is CAUTI?
Retrieved from https://idph.iowa.gov/hai-prevention/information/cauti
REFERENCES
O’Daniel, M. and Rosenstein A. H. (2008). Professional communication and team collaboration. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2637/
Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., OBrien, T., & Searles, A. ( 2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): A pre-post control intervention study. BMC Health Services Research, 17 doi:http://dx.doi.org/10.1186/s12913-017-2268-2
Schmudde, Y., Olson-Sitki, K., Bond, J., & Chamberlain, J. (2019). Navel to Knees With
Chlorhexidine Gluconate: Preventing Catheter-Associated Urinary Tract Infections. Dimensions of critical care nursing : DCCN, 38(5), 236–240. https://doi.org/10.1097/DCC.0000000000000371
Singh, R. (n.d). The Impact of Intrinsic and Extrinsic Motivators on Employee Engagement in Information Organizations. Retrieved from https://files.eric.ed.gov/fulltext/EJ1096700.pdf
Torres, R., T. (2010). Evaluation reporting and communication. International encyclopedia of education. 3(746-756). https://doi.org/10.1016/B978-0-08-044894-7.01616-X
