Sample Answer for NRS 445 Rough Draft – Research Critiques and Evidence-Based Practice Proposal Included After Question
The purpose of this assignment is to synthesize a literature review that will be used to draw conclusions in order to propose an evidence-based practice change to address your identified nurse practice problem.
Using the “Literature Evaluation Table” assignment in Topic 1, and accompanying faculty feedback, you will synthesize the information created for your PICOT question into a literature review and evidence-based proposal.
In a 1,500-1,750-word paper, provide an overview that illustrates the research related to your particular PICOT question.
Use the following components from the “Literature Evaluation Table” to complete the assignment:
- Identified practice problem
- Two qualitative peer-reviewed research articles
- Two quantitative peer-reviewed research articles
Use the “Research Critiques and Evidence-Based Practice Proposal Guidelines” document to organize your paper.
You are required to cite a minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
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.
A Sample Answer For the Assignment: NRS 445 Rough Draft – Research Critiques and Evidence-Based Practice Proposal
Title: NRS 445 Rough Draft – Research Critiques and Evidence-Based Practice Proposal
Evidence-based practice in nursing is important for the provision of care that optimizes outcomes. Nurses utilize their experiences in the care process and leadership to identify issues that can be addressed and improved with evidence-based interventions. Organizations strive to create environments that support the use of best practices to enhance safety, quality, and efficiency outcomes.
Health problems such as catheter-associated urinary tract infections (CAUTIs) have considerable impacts on the patient’s health, health systems, and nursing care. Specific populations such as those with chronic conditions admitted in long-term care facilities have an increased risk of developing CAUTIs. Nurses should explore and adopt best practices to prevent CAUTIs among this population.
This paper reviews the literature on the use of best practices, including CAUTIs bundles for CAUTIs prevention and rates in long-term care settings. CAUTIs are among the most common healthcare-associated infections in health institutions. It develops among patients with indwelling catheters. CAUTIs develop due to factors such as prolonged catheterization, use of unsterile procedures in catheter insertion, and contamination from bowel movements (Shadle et al., 2021). CAUTIs act as a source of significant disease burden to patients, families, and health organizations.
CAUTIs contribute to about 9% of all hospital-acquired infections in health organizations. CAUTIs contribute to increased care costs due to prolonged hospitalization and the demand for complex care. CAUTIs also cause complications such as those affecting the bladder, septicemia, and premature mortalities. CAUTIs are preventable. Bundle interventions have demonstrated effectiveness in preventing and reducing CAUTIs in healthcare (Decker et al., 2021). However, their effectiveness has not been explored in the practice site, hence, the focus of the project.
In the dilapidated patients admitted to long-term care units and using indwelling catheters, how does the use of CAUTI bundles compared to securing and positioning of catheters affect CAUTI rates within eight weeks?
Quantitative Studies: Methods
Two quantitative studies were used in this literature review. They include the studies by Decker et al. (2021) and Shadle et al. (2021). The study by Shadle et al. (2021) investigated the effectiveness of a bundle-based approach in preventing CAUTIs in the intensive care unit. The increase in the number of CAUTIs above the benchmark data informed this study. Accordingly, the institution reported 13 CAUTIs against the hospital benchmark of 4 or fewer CAUTIs annually. The project targeted a 30% reduction in CAUTIs, a 20% reduction in urinary catheter days, and a 75% compliance rating in catheter-related documentation in the intensive care unit.
The methods used in the research by Shadle et al. (2021) were appropriate. The researchers adopted a pre-post design over 2 consecutive 4-month periods. The intervention targeted critically ill patients aged 18 years and above and admitted to the intensive care unit and catheterized. The bundle interventions included staff education, nurse-driven removal protocol for indwelling urinary catheters, and an electronic daily checklist.
The obtained data was analyzed using mixed statistics such as Fisher exact tests and independent sample t-tests. The use of methods such as a pre-post design is appropriate for the project aim because it shows the impact of the bundle interventions on the rate. The selected bundled interventions also support the use of best practices to address CAUTIs.
The other quantitative study selected for the literature review is the research by Decker et al. (2021). Decker et al. (2021) investigated the effect of bundle interventions on CAUTIs in critical care units. Decker et al. (2021) study was conducted in Boston Medical Center to decrease CAUTI rates in the intensive care units using five bundles. The bundles included new processes for catheter insertion and maintenance, indications for catheter insertion, appropriate testing for CAUTIs, alternatives to indwelling devices, and sterilization techniques. Unit nursing supervisors performed daily rounds to determine appropriate catheter use in the unit. The interventions by Decker et al. (2021) are appropriate since they demonstrate the effectiveness of nurse-led bundle interventions in addressing CAUTIs.
Qualitative Studies: Methods
Qualitative studies by Quinn et al. (2020) and Parker et al. (2020) were included in the literature review. The study by Quinn et al. (2020) explored persistent barriers to detecting and removing unnecessary catheters in healthcare settings. The authors adopted a multimethod qualitative study design that included in-person interviews and observations of clinicians working in a large hospital. The observations entailed shadowing nurses during shift changes and when admitting patients and observing doctors during morning rounds. Unstructured field notes were used to gather observational data.
Semistructured interviews were conducted, audiotaped, and transcribed. Qualitative content analysis was used to identify the main themes. The methods used in this study were appropriate for the project’s aim. For example, the use of multimethod qualitative approaches enriched the data obtained on the barriers to detecting and removing unnecessary catheters. Unstructured field notes and semistructured interviews ensure the relevance and accuracy of the obtained data.
The study by Parker et al. (2020) provided insights into clinicians’ experiences in implementing multifaceted bundled urinary catheter care interventions in four acute care hospitals in New South Wales, Australia. The researchers adopted a pre and post-intervention study design to implement the catheter care bundle. The intervention was implemented in all adult inpatient wards, operating theatres, inpatient wards, and emergency departments in the four hospitals.
The bundle interventions focused on improving clinician’s decision-making on catheter insertion, care, and removal practices. Focus groups were conducted in the four hospitals to understand the implementation process from the clinicians’ perspective, and identify barriers and enablers to successful implementation. The adopted interventions in this study answer the project focus. For example, the use of bundle interventions provides insights into the effectiveness of the proposed project change.
Summary of Findings
The study by Parker et al. (2020) found that the main complexity and challenges associated with the implementation of bundle intervention could be understood from varied themes. They included early and sustained engagement with key stakeholders, good planning but remaining flexible, managing the burden of practice change, and adopting and sustaining practice change.
The study by Quinn et al. (2020) found themes that relate to barriers to detecting and removing unnecessary catheters. They include catheters being hard to find, not accurate, or not available, catheter removal is not a priority, confusion about who has the authority to remove catheters, and lack of agreement on and awareness of standard protocols and indications for removal and communication barriers.
The study by Shadle et al. (2021) found that the implementation of the bundle interventions led to no CAUTIs during the intervention period and reduced the rate by 1.33 per 1000 catheter days. There was also a statistically insignificant increase in catheter days by 10.5%. Documentation compliance increased significantly from 50.0% before to 83.3% during the intervention.
The study by Decker et al. (2021) found that bundle interventions reduced CAUTIs from 53 in 2013 to 9 in 2017 and a 33.8% reduction in the utilization of indwelling catheters. CAUTIs awareness education, insertion, and removal protocols, and implementation of PureWick female incontinence devices had significant and clear effects on reducing CAUTIs rates.
Anticipated Outcomes for PICOT Question
The PICOT question is associated with some anticipated outcomes. Firstly, the use of bundle interventions is expected to reduce CAUTI rates in long-term care facilities. Evidence obtained from the included studies demonstrates a decrease in CAUTI rate with the use of bundle interventions (Quinn et al., 2020; Shadle et al., 2021). The other anticipated outcome is the increase in the provider’s knowledge about indications, contraindications of indwelling catheters, and indwelling urinary catheter care.
Bundle interventions such as education and training increase the provider’s knowledge about the safe use of indwelling urinary catheters. The third anticipated outcome is the reduction in hospital stay and hospitalization costs for patients with indwelling urinary catheters. CAUTIs increase the length of hospital stay and costs incurred in treating hospitalized patients (Ling et al., 2022; Smith et al., 2019). The proposed bundle interventions will reduce and prevent CAUTIs, hence, efficiency in long-term facilities.
Comparison of Outcomes of the Selected Studies to the Anticipated PICOT Outcome
The outcomes of the selected studies align with the anticipated PICOT outcomes. For example, Shadle et al. (2021) found that bundle interventions eliminated CAUTIs, which support the PICOT outcomes. Similarly, Decker et al. (2021) revealed that bundle interventions reduce CAUTIs and increase healthcare provider’s knowledge of the appropriate use of indwelling urinary catheters. Parker et al., (2020) and Quinn et al. (2020) provide insights into the potential barriers that might be experienced when implementing the proposed bundle interventions. Therefore, the outcomes of the selected studies align with those of the PICOT statement.
The Link between the PICOT Question, Research Articles, and Identified Nursing Problem
The identified nursing problem is CAUTI. The existing evidence shows the increased risk of CAUTIs among hospitalized patients with indwelling catheters. CAUTIs have adverse outcomes such as prolonging the length of hospital stay, increasing care costs, predisposing patients to other complications, and premature deaths (Carter et al., 2016; Shadle et al., 2021; Smith et al., 2019). Nurses should adopt best practices to prevent and reduce CAUTIs.
The selected research articles provide insights into the effectiveness of bundle interventions in preventing and reducing CAUTIs. They also inform about the barriers that might be encountered in implementing the proposed change in the project. The PICOT question seeks to determine the effectiveness of bundle interventions in reducing and preventing CAUTIs. Therefore, the PICOT question, research articles, and the identified nursing problem are interrelated.
Proposed Evidence-Based Practice Change
The proposed evidence-based practice change based on the reviewed evidence is the implementation of bundle interventions to prevent and reduce CAUTIs in long-term care facility. The bundle interventions include educating nurses on indications, contraindications, evaluation, care, and removal of urinary catheters, the introduction of a daily checklist for indwelling urinary catheters, and nurse-driven protocol for catheter removal. The practice change will address CAUTIs by strengthening the consistent use of best practices in catheter insertion, care, and removal. Staff training will equip them with the required competencies in assessing the need, caring for, and removing indwelling urinary catheters. The proposed change is evidence-based as seen from the evidence from the included studies in this review.
In summary, the reviewed articles support the use of bundle interventions to address CAUTIs in long-term care facilities. Bundle interventions reduce and prevent CAUTIs. The anticipated PICOT outcomes for the project include reduction and prevention of CAUTIs, increase in provider’s knowledge about CAUTIs prevention and reduction, and reduction in the length of hospital stay and costs for patients with indwelling urinary catheters. Therefore, the evidence informs the proposed change, which entails the use of bundle interventions in the project.
Carter, E. J., Pallin, D. J., Mandel, L., Sinnette, C., & Schuur, J. D. (2016). A Qualitative Study of Factors Facilitating Clinical Nurse Engagement in Emergency Department Catheter-Associated Urinary Tract Infection Prevention. The Journal of Nursing Administration, 46(10), 495–500.
Decker, S. G. V., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection reduction in critical care units: A bundled care model. BMJ Open Quality, 10(4), e001534. https://doi.org/10.1136/bmjoq-2021-001534
Ling, R., Giles, M., & Searles, A. (2022). Budget impact analysis of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use in New South Wales Hospitals. BMC Health Services Research, 22(1), 1000. https://doi.org/10.1186/s12913-022-08313-7
Parker, V., Giles, M., King, J., & Bantawa, K. (2020). Barriers and facilitators to implementation of a multifaceted nurse-led intervention in acute care hospitals aimed at reducing indwelling urinary catheter use: A qualitative study. Journal of Clinical Nursing, 29(15–16), 3042–3053. https://doi.org/10.1111/jocn.15337
Quinn, M., Ameling, J. M., Forman, J., Krein, S. L., Manojlovich, M., Fowler, K. E., King, E. A., & Meddings, J. (2020). Persistent Barriers to Timely Catheter Removal Identified from Clinical Observations and Interviews. Joint Commission Journal on Quality and Patient Safety, 46(2), 99–108. https://doi.org/10.1016/j.jcjq.2019.10.004
Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A Bundle-Based Approach to Prevent Catheter-Associated Urinary Tract Infections in the Intensive Care Unit. Critical Care Nurse, 41(2), 62–71. https://doi.org/10.4037/ccn2021934
Smith, D. R. M., Pouwels, K. B., Hopkins, S., Naylor, N. R., Smieszek, T., & Robotham, J. V. (2019). Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: A probabilistic modelling study. Journal of Hospital Infection, 103(1), 44–54. https://doi.org/10.1016/j.jhin.2019.04.010