The impact of a clinical practice problem on the patient(s) and the organization it affects
The following PICO components of the clinical practice problem
The prevalence of catheter-acquired urinary tract infections (CAUTIs) in patients hospitalized in an acute care hospital setting is addressed. CAUTIs are urinary tract infections that arise in patients with indwelling catheters at the moment or one existing within the last 48 hours (Ferguson, 2018). In the US, CAUTIs are the fourth most prominent cause of healthcare-associated illnesses in care facilities (Ferguson, 2018). Patients admitted to the hospital, who have an indwelling catheter implanted, and who develop CAUTIs are the focus of this study. Generally, these patients will have more extended hospital stays, affecting their general well-being, work, and social lives. In addition, while in the facilities, they can contract other hospitals acquired infections (HAI), further deteriorating their health. On the other hand, organizations like Medicare and Medicaid will have to pay for the bills.
The greatest interventions to improve CAUTI rates in an inpatient hospital context include better, more precise teaching on proper insertion techniques and standardization of suitable indwelling catheter usage. In addition, the demonstration of optimum catheter management practices and guidelines for early removal can also reduce the infection rate. Education on CAUTI prevention measures must be reinforced among healthcare professionals (Ferguson, 2018). The training should be completed once a year or twice a year. Standardized teaching tools, detailed policies and procedures, and hands-on training for personnel certified to install indwelling catheters can all help with this response.
Many acute care hospitals now have policies on indwelling catheter care. However, these policies are either difficult to find or vague when identifying proper catheter insertion criteria, and many nursing staffs are unsure where to find this information. Several facilities provide only rudimentary training in indwelling catheter insertion, and just a few provide hands-on experience. Overall, healthcare workers have a limited understanding of evidence-based indwelling urinary catheter care procedures.
A decrease in the number of CAUTIs in the hospital setting would be the optimum outcome for this condition. A multimodal, participatory CAUTI prevention learning program has been proven to improve nurses’ understanding of proper indwelling catheter care and reduce CAUTI rates among inpatients (Ferguson, 2018). It would result in fewer unnecessary hospital expenses, improved patient safety, and uniform information for the insertion and care of indwelling catheters. Eventually, this could lead to higher patient satisfaction and better-informed employees.
An evidence-based practice (EBP) question based on the clinical practice problem
In the acute care setting, does provide education decrease CAUTI compared to no education?
A research-based article to conduct an evidence appraisal
The background or introduction (i.e., the purpose) of the research article
The article selected is “Examining instruments used to measure knowledge of catheter-associated urinary tract infection prevention in health care workers: A systematic review,” authored by Abubakar et al. and published in 2021. According to the authors, the purpose of the research is to “assess instruments used to assess knowledge of CAUTI prevention in health care workers to inform future research” (Abubakar et al., 2021, p. 255). Overall, it intends to create a collection of tools, resources, and devices utilized in various hospitals to educate staff about CAUTI and analyze their effectiveness.
The research methodology
For published research and instruments, five electronic databases were searched. The psychometric validity reporting of the items was assessed using the “Consensus-based Standards for the selection of health status Measurement Instruments checklist” (Abubakar et al., 2021). The article’s authors searched numerous databases for publications using specific search phrases. They further trimmed down the list of papers they discovered using their established criteria. The authors used another set of parameters in a framework to determine what parts of the catheter lifecycle model were included in each after narrowing down the articles to those corresponding with CAUTI prevention education based on the parameters set forth (Abubakar et al., 2021, p. 255). Eventually, they recorded their results in a spreadsheet for further analysis.
The level of evidence using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model
The level of evidence for this paper was a level III study based on the JHNEBP model. A systemic examination of materials used for CAUTI education is the type of research employed in this study. Level III entails a systematic review of RCTs and QE trials, or just QE studies, using or without meta-analysis (Oregon Health and Science University (OHSU), 2017).
Data analysis in the article
Empirical research involving quizzes or tests was conducted to measure healthcare personnel’s knowledge of CAUTI prevention in health care personnel. The search results were stored in RIS text and imported into Endnote version X8.2 reference manager. The headings of the remaining publications were checked after the duplicates were removed, and studies that were not relevant were discarded (Abubakar et al., 2021). One researcher (S.A.) conducted the selection procedure, which was separately cross-examined by two additional investigators (Abubakar et al., 2021). The retrieved data were plotted on a table using an Excel spreadsheet to aid in the narrative and synthesis of data from the included research. A narrative technique was adopted to synthesize information from the primary research. The data needed to achieve the goal was primarily textual and did not necessitate statistical analysis. Therefore, a framework synthesis was used to map the findings.
The ethical consideration(s) of the research-based article
There was no ethical consideration associated with the study. The research-based article did not include human subjects as part of the experimentation; instead, it comprises an analysis of CAUTI prevention measurement instruments. Furthermore, an analysis of databases and literature materials by other authors does not usually require moral guidelines.
The quality rating of the research-based article according to the JHNEBP model
The article can be categorized as high quality according to the JHNEBP. The paper is reasonably consistent with the findings, well structured, has decisive conclusions, and generally reliable recommendations based on a fairly extensive literature assessment (OHSU, 2017). Only 59 nurses completed the test, which is not a good number to qualify it as high quality. In addition, the choice of systematic analysis means the authors did thorough research before starting to write. Finally, it was published recently, meaning it is up to date with the emerging issues in healthcare settings.
The results or conclusions of the research-based article
According to the authors, the emphasis on education in disease control and prevention must be viewed from the perspective of the larger literature on learning as a behavior modification intervention, which suggests that its influence on change may be limited (Abubakar et al., 2021). The article backs up the EBP question by demonstrating that providing education with the right tools decreases CAUTI compared to no education in the acute care setting. Essentially, if CAUTI awareness cannot be effectively achieved through training, it may negatively impact clinical treatment and intervention. Therefore, a standardized method is needed so that focused treatments can tackle knowledge gaps and reduce CAUTI.
A non-research article from a peer-reviewed journal
The background or introduction (i.e., the purpose) of the non-research article
The article titled “Implementing a CAUTI prevention program in an acute care hospital setting” by Ferguson can be beneficial in answering the BEP. The goal of this study was to improve CAUTI preventive education in two hospital units in an acute care setting with the highest CAUTI prevalence (Ferguson, 2018). Generally, the objective of this initiative was to improve nurses’ understanding of proper indwelling urinary catheter care and lower the rate of CAUTIs in the facilities.
The type of evidence (e.g., case study, quality improvement project, clinical practice guideline)
The type of evidence in this article was a quality improvement project (QIP). The goal of this QI project was to deploy an active CAUTI prevention training program in two acute care hospital units that were chosen because they had the most significant CAUTI incidence of all the care units (Ferguson, 2018). Hence, the objective of this QI initiative was to improve nurses’ understanding of proper indwelling urinary catheter care and reduce the rate of CAUTIs in the facility.
The level of evidence using the JHNEBP model
Level V is recognized as the level of evidence based on the JHNEBP approach because it was a non-research-based QI project article.
The quality rating of the non-research-based article according to the JHNEBP model
Based on the JHNEBP model, this article has a high-quality rating. It encompasses a clear set of goals, consistent results across numerous contexts, systematic quality improvement, and extensive use of scientific evidence (OHSU, 2017). In addition, it has an explicit purpose, recommendations, and conclusions.
The author’s recommendation(s) in the article
The authors suggested that assessing staff training standards for professional or organizational development is critical to lowering CAUTI. It validates my EBP concern since there is currently no standardized tool for use in the hospital context, making it challenging to educate nurses in CAUTI prevention effectively. Therefore, better, more efficient teaching should be put forth if a comprehensive approach is established to make it easier to inform nurses of CAUTI control on a more regular basis, reducing the overall occurrence of CAUTIs.
A practice change that addresses the EBP question
My recommended practice change is to implement education to reduce CAUTI. According to Abubakar et al. (2021), if CAUTI awareness cannot be effectively examined using an efficient method, it may negatively impact clinical treatment and intervention. Essentially, providing education with the right tools decreases CAUTI compared to an ineffective framework in an acute care setting. In addition, research by Ferguson (2018) demonstrated that after evidence-based training of nurses, their knowledge significantly increased while CAUTI rates reduced.
Three key stakeholders in supporting the practice change recommendation
I would recommend nurse educators and nurse managers to help implement the policy and a sponsor to finance the changes. The nurse educators will provide education to all staff on the new practice change. The nurse manager is tasked with ensuring that all the evidence-based training received is implemented or reflected in actual care for patients. Finally, I will engage a philanthropist sponsor to donate the money needed to fund the project.
Barriers when implementing the practice change recommendation
Nurses may be hesitant to change, which could be a challenge to overcome throughout implementation. It might be tough since it can be difficult to break habits or modify how care is delivered if things have been done a certain way for a long time. Sometimes nursing staff may be resistant to the change since it will require them to relearn procedures in a new way and “unlearn” negative habits established through time with care. Some caregivers may find it challenging to transition from the “ideal setting” in the classroom to the actual world.
A strategy to overcome the barriers
Encouraging nurses to express their particular concerns about changing practices and directly addressing these issues is a critical strategy for overcoming the problem of resisting change. The education team must fully present the significant reasons for changing the rules clearly and concisely and provide time for nurses to ask specific questions or express concerns. It will be vital that the nurses feel heard and that their problems are addressed to enact the adjustments gradually.
Outcome to measure the recommended practice change
The decrease in CAUTI rates within each unit over six months would be vital in quantifying the practice improvement. The reduction in CAUTI infections indicates that the education was successful.
Abubakar, S., Boehnke, J. R., Burnett, E., & Smith, K. (2021). Examining instruments used to measure knowledge of catheter-associated urinary tract infection prevention in health care workers: A systematic review. American Journal of Infection Control, 49(2), 255-264. Web.
Ferguson, A. (2018). Implementing a CAUTI prevention program in an acute care hospital setting. Urologic Nursing, 38(6), 273. Web.
Oregon Health and Science University (OHSU). (2017). Johns Hopkins Nursing Evidence-Based Practice. Web.