NUR-550 Final Research Paper

NUR-550 Final Research Paper

NUR-550 Final Research Paper

The Healthcare sector and especially the patient care setting has faced various problems that threaten the safety and care of patients, from medical errors to patient falls; these problems have led to a call from various stakeholders for better strategies of handling them. One of such healthcare problems is catheter-associated urinary tract infections (CAUTI) (da Silva et al., 2018). Even though CAUTI is among the topmost prevalent conditions, they are largely preventable healthcare-associate infections among patients admitted in various hospital departments. Among the reasons why the occurrences of CAUTI have drawn much attention is that the condition has been connected to various problems such as increased length of stay in hospitals, higher healthcare spending, and exposure to other types of healthcare-associate infection (Letica-Kriegel et al., 2019). Even though deliberate efforts have been made to control the problem, the issue is still common in the care settings, particularly among the patients admitted to the intensive care units (Sampathkumar, 2017). Therefore, the purpose of this research paper is to present an evidence-based practice proposal that focuses on the incidences of CAUTI.

ORDER A PLAGIARISM-FREE PAPER HERE ON; NUR-550 Final Research Paper

The Problem Statement

Catheter-associated urinary tract infections are among the most prevalent healthcare-associated infections, even though there have been efforts to control and manage the problem. Besides, the problem is highly controllable, and recent research has shown that it can be reduced by up to 10% (da Silva et al., 2018). The problem is particularly common among patients admitted to the ICU due to the increased need for catheter use. Such infections have various adverse impacts on patients, hence needing more robust strategies to control them. One of the reasons why this topic is relevant to advanced nursing practice is that various nursing interventions can be explored and used to minimize infection rates.

The PICOT Question

In recent years, various strategies have been applied in efforts to prevent these infections. However, CAUTIs are still common in patient care settings, especially among patients admitted to the ICU. Such infections have various adverse impacts on patients, hence needing more robust strategies to control them (da Silva et al., 2018). One of the reasons why this topic is relevant to advanced nursing practice is that various nursing interventions can be explored and used to minimize infection rates. Therefore, a PICOT statement was formulated to guide the proposed study, which focuses on addressing catheter-associated urinary tract infections. The PICOT question formulated is: Among the patients admitted in the ICU, what is the efficacy of limited use of catheters and use of antibiotic-impregnated catheters as compared to the use of standardized insertion techniques in lowering the incidences of CAUTI within six weeks?

Population Demographics and Health Concerns.

In the past and in recent years, various researchers have explored strategies to address and manage CAUTI. However, CAUTIs are still common in-patient care settings, especially among patients admitted to the ICU (Sampathkumar, 2017). The main reason is that the patients admitted to the ICU are usually not able to move, making them more likely to use indwelling catheters. Annually, up to thirteen thousand death result from catheter-associated urinary tract infections (CAUTI) in the USA (Letica-Kriegel et al., 2019). Patients admitted in intensive care units are the most prone to CAUTI and are at more risk up to four times those in the general wards of getting CAUTI.

Proposed Evidence-Based Intervention

As earlier mentioned, CAUTI is prevalent in care settings and, therefore, a need to address the problem through various evidence-based strategies. The proposed evidence-based intervention is a double-pronged strategy involving limiting the use of indwelling catheters and using antibiotic-impregnated catheters. The limitation of the indwelling catheters entails avoiding the unnecessary use of the indwelling catheters and removing the catheters from patients as soon as an evaluation reveals that they no longer need the catheters. This intervention incorporates health policies and goals. For instance, one of the health policies and goal is health for all and sufficient healthcare access (Benjamin, 2020); the proposed evidence-based intervention incorporates the goal and the policy since it aims to reduce the rates of CAUTI for better health outcomes among the populations.

Organizational Culture and Readiness

Organizational culture is a substantial determinant of the possibility of the success of a particular project, such as an evidence-based practice project. Therefore, it is important to evaluate the organizational culture and determine its readiness in fostering the implementation of a quality improvement or an evidence-based practice project (Li et al., 2018). Organizational culture refers to various aspects like employee behavior, attitudes, norms, and organizational traditions that have defined the organization for a considerable time. Therefore, an evaluation was undertaken to determine how ready the organization was to accept and support the implementation of the proposed project. Upon carrying out the organization’s culture evaluation, various aspects were noted and therefore discussed here. One of the major traits or qualities noted in the organization was teamwork. Teamwork has been proven to support the implementation of EBP projects. The organization’s leaders were also noted to have opened active communication channels and displayed effective leadership. Therefore, from the evaluation, it was noted that the organization was ready for the implementation of the proposed project.

 

Literature Review

Implementing a proposed evidence-based practice project requires that the implementers carry out a comprehensive review of the literature to determine what exists in the literature and what kinds of gaps exist. Therefore, a peer-reviewed journal search was accomplished using various websites and databases for high-quality evidence. The databases used include CINAHL, PubMed, Dynamed, Cochrane Library, TRIP database, and Google Scholar. In searching the relevant articles from the databases, various keywords were used, including CAUTI, catheterization, reduced use, unnecessary use, and antibiotic-impregnated catheters were used. The search was then restricted to peer-reviewed articles and to those published in the last five years.

Da Silva et al., 2018, performed a systematic review and a meta-analysis to evaluate the impact of various interventions used in addressing CAUTI among neonates and children. From the analysis, the researchers revealed that the application of a multimodal approach to CAUT reduction among neonates and children is the most effective. From the article, it is conceivable that care providers can apply a combination of various strategies to address CAUTI incidences among various populations, neonates and children included (da Silva et al., 2018).

Not long ago, Letica-Kriegel et al., 2019, performed a study that focused on evaluating how the risk for CAUTIs change with time. The researchers were also interested in knowing whether the time from catheter insertion to CAUTI event was affected by comorbidities, patient type, and patient age, among other factors. With a sample of 47 926 participants and 61047 catheterizations in a retrospective cohort, the main finding was that the increased number of days that one spent in the hospital increased their risk for CAUTIs (Letica-Kriegel et al., 2019). In addition, this research also found out that individuals’ susceptibility to CAUTI attack substantially depends on various factors such as age and gender.

Another relevant piece of literature was authored by Omer et al., 2020 who studied CAUTI prevalence in a bid to gain more insight into the risks connected to the condition among patients in intensive care units and medical wards. The researchers used a retrospective study that involved two hundred participants. The researchers found out that the CAUTI cases were more prevalent in the wards as compared to the ICU settings. This study also explored the risk factors associated with CAUTI, where the researchers noted that length of stay in hospitals was a major determinant. In addition, females and individuals with other comorbidities were found to be at more risk.

Recently, Iqbal & Abbas (2021) conducted research that focused on the assessment of the nurse’s knowledge level on nosocomial infections. They identified a mix of nurses in terms of qualifications, designation, and experience to be part of the study. Upon analyzing the data collected, they found that only close to thirty-five percent of the nurses demonstrated excellent knowledge regarding healthcare-associated infection, with around sixty percent displaying average knowledge (Iqbal & Abbas, 2021). The importance of this source is that it shows the need to equip the nursing staff with more knowledge regarding healthcare-associated infections if the management of the condition in the care settings has to be better.

In one of the studies seeking to identify the best strategies for reducing CAUTI and the central-line associated bloodstream infection among adults admitted to the ICU care settings, Patel et al., 2017 indicated that it is key to understand when to apply a particular intervention. When used at the right time, some of the most effective strategies include avoiding unnecessary catheter use, using aseptic placement every time, and maintaining awareness. Therefore, this study demonstrates that identifying an intervention is not enough, as clinicians have to correctly identify when to use the interventions. Healthcare organizations and practitioners can then choose the best strategy to address the issue of increasing incidences of CAUTI.

Central to the control and prevention of CAUTI are knowledgeable nurses and adherence to the standards of practice regarding healthcare-associated infections. Therefore, Menegueti et al., 2019 performed a study to explore the impact of using a healthcare worker educational program and a daily checklist regarding the use of indwelling urinary catheters among critical patients. The researchers employed a quasi-experimental design while performing this research and found out that applying education and daily evaluation of the indication to use indwelling urinary catheters led to a substantial decrease in CAUTI incidences (Menegueti et al., 2019). They also found out that there was a considerable reduction in the use of indwelling catheters, which eventually had a positive outcome on patients. The importance of this source is that it indicates the need to evaluate if a patient needs to use indwelling catheters or not, and if the use of these catheters can be lowered, then the cases of CAUTI can be lowered too.

Soundaram et al., 2020 explored the possibility of using a catheter care bundle to lower the incidences of CAUTI. The care bundle consisted of various strategies geared towards lowering the incidences of CAUTI in a healthcare facility. The researchers used a prospective interventional study that lasted for a period of nine months. Upon the use of the bundle, the researchers noted that there was a substantial decrease in the cases of CAUTI among the selected population. The researchers assert that the reduction of the rates of infections emanated from a better device use ratio and average catheter days for each patient (Soundaram et al., 2020). This article similarly supports the EBP project as it shows the need to implement better interventions to reduce CAUTIs in different care settings, especially critical care.

Using a systematic review, Durant, 2017 reported on the nurse-driven protocols that can be used in preventing CAUTIs. This systematic review evaluated the use of various interventions based on particular established guidelines applied in preventing CAUTIs. The analysis revealed that the nurse-driven protocols positively impacted the prevalence of CAUTIs and CAUTI clinical predictors. Therefore, it is evident from the study that nurses play a key role in controlling, preventing, and managing CAUTI. The implication is that more nurse-driven protocols should be formulated to help address the issue.

It is worth noting that all the reviewed articles presented sufficient evidence supporting the proposed project. However, various differences and similarities were observed in the articles, such as relating to conclusions methods and design. Out of the articles reviewed, three of them were systematic reviews, hence secondary data sources. The rest were primary sources based on various research designs as such as quasi-experimental and cohort designs. One of the major underlying messages in all the articles is that CAUTI negatively impacts patients and should be controlled at all costs. One of the most reliable strategies is eliminating unnecessary catheterization. The articles are also similar in that apart from giving conclusions, they also offered recommendations. For example, da Silva and the group recommended the application of a multimodal approach to the prevention of CAUTIs in different care settings (da Silva et al., 2018).

The synthesis and analysis of the research articles revealed various gaps that can be filled in future research. For instance, only one article had a substantially large sample size among the primary articles. Hence there is a need for more studies with such sample sizes to improve the credibility of the results. In addition, more studies should be conducted as multi-site to increase the generalizability of the findings. Randomized controlled trials can give stronger levels of evidence. Therefore, there is also a need to conduct more research using the design for better control and management of CAUTI.

The Change Model

The success of implementing an evidence-based practice project or a quality improvement project requires various important aspects and steps. One of such important aspects is a model or a framework for change. Models or frameworks for change are important since they form the basis for theoretical underpinnings for the implementation of a proposed project. As such, this section addresses a model for change that will be applied in implementing the proposed project.

Kurt Lewin’s change model has been identified as the guiding model for this project. Since its formulation, Lewin’s change model has been used in many projects as it is versatile (White, 2019). The relevance comes from the fact that this project proposes a change in practice concerning the prevention and management of CAUTI. Since the project is proposing a change in practice, it implies that the project will have to be implemented through various stages for successful and complete completion. Lewin’s change model has three phases which makes it relevant. The three stages are the unfreezing stage, the change stage, and the refreezing stage.

Lewin argued that two kinds of forces, the driving forces, and restraining forces operate in the opposite directions and influences behavior. The change is eventually accomplished when the driving forces exceed the restraining forces (Hussain et al., 2018). In the first phase, the problem is recognized, and there are also increased driving forces to make a change. During this phase, the stakeholders are made to have a sense of change and the need to make the change.

The first stage is followed by the second stage, which is the change stage. During this stage, the proposed change is turned into a reality as an action plan is created, and the stakeholders are made to see the proposed change’s potential benefits (White, 2019). Central to the success of this stage is the recognition of the existence of the restraining forces which could derail the process. Therefore, a comprehensive plan has to be formulated, which can help in minimizing the impacts (Hussain et al., 2018). The last stage discussed in this model is the refreezing stage. During the phase, the change implementers make the implemented change part of the normal practice, and the staff is required to follow the recommendation of the project. Upon becoming comfortable with the implemented change, the change becomes part of the organization’s culture.

This model is relevant in that its stages can be used in implementing various stages of this project. The first stage, which is the unfreezing stage, entails the investigators identifying the increasing cases of CAUTI when compared to the acceptable benchmark and the in comparison to the cases observed in other similar centers, triggering a need for immediate change. The evidence is then presented to various staff and stakeholders, including a proposed solution and potential benefits (Hussain et al., 2018). During the second phase, which is the change phase, the team formulate relevant and detailed plans and strive to obtain buy-in from the organization’s leadership. It is worth noting that staff education is key during this phase. In addition, increased staff involvement and effective communication during this stage are important as they will ensure a more successful implementation of the project. In the final stage, which is the refreezing, the proposed interventions for the prevention of CAUTIs are made to be part and parcel of the standard practice in the organization. The use of antibiotic-impregnated catheters and limiting the use of indwelling catheters form part of the daily activities used in the facility to address the CAUTI problem.

The Implementation Plan

The implementation plan is one of the most vital documents needed for a successful implementation of an evidence-based practice project. A good implementation plan supports the effective implementation of various phases of the project and allows the implementers to view the parts or the phases of the project as a unified whole (Melnyk & Fineout-Overholt, 2019). The implication is that the set goals and objectives are more effectively fulfilled. The implementation plan should include various aspects such as potential barriers, stakeholders, intervention delivery methods, instruments and methods, and the potential subjects.

The setting that has been selected for this project is the intensive care units at the facility. Since the project focuses on reducing the incidences of CAUTI, ICUs have been chosen as the ideal setting since patients admitted to these units are more likely to use indwelling catheters. Therefore, a change in the use of catheters will be effected in these units, where the use of indwelling catheters will be minimized. In addition, in cases catheters will have to be used, then the antibiotic-impregnated catheters will be used. The potential research subjects will be accessed by recruiting every patient admitted into the ICU. The proposed timeline for implementing the project is six months. Relevant activities will be accomplished during this time, including project implementation, monitoring, evaluation, and stakeholder feedback. In addition, necessary corrective measures will be taken to help the project be a success.

The successful implementation of any project heavily hinges on the financial plan put in place in terms of the budget and the resource list (Melnyk & Fineout-Overholt, 2019). Therefore, such a plan is key in showing what financial needs are required and possibly how to get them. As earlier indicated, the project seeks a change in practice targeting minimal use of indwelling catheters and using antibiotic-impregnated catheters. The implication is that the nurses will need to be trained; hence the financial resources for training are needed. Human resources will also be a key part of the project. As part of the project, the trainers, nurses, the management, and other hospital staff connected to the facility’s ICU will be key as part of the human resources. The estimated budget for the project is $60,000. The proposed design for the project is the quantitative design. Quantitative data collection methods will be used to obtain the appropriate data for testing the efficacy of the project, as baseline data will be compared with the number of CAUTIs developed upon the implementation of the proposed solution. In addition, the data obtained for the control group will also be compared with that of the intervention group (Melnyk & Fineout-Overholt, 2019). The quantitative design will allow easier use of statistical analysis to obtain results to determine how effective the project is.

It is also vital to have a plan in place regarding how the intervention will be delivered as it enhances the chances of the success of the project. As such, the intervention has been planned to be delivered in various phases. One of the most vital phases is the needs assessment (Melnyk & Fineout-Overholt, 2019). Needs assessment entails an evaluation of the nurses’ levels of awareness and knowledge regarding CAUTI in terms of causes, impacts, prevention, management, and treatment. This step will be key in determining what kind of education should be offered to nurses regarding the proposed solution. In addition, the needs assessment will be key in refining the project’s strategy.

The needs assessment will be followed by appropriate education and training of the nurses regarding the use of impregnated catheters and when to remove the catheters. This education and training will be offered by qualified and certified personnel. The project proposes a change in practice from the use of normal catheters to the utilization of antibiotic-impregnated catheters and limited use of catheters. Therefore there will be a need to train and educate the nurses working in the ICU. Upon the completion of education and training, the nursing staff will be ready for the implementation of the proposed protocol of antibiotic-impregnated catheters and limited use of catheters. This is one of the most vital steps as it determines the continuity and longevity of the intervention (Melnyk & Fineout-Overholt, 2019). Therefore, there will be a need to ensure that the ICU nurses are following the new standards of practice and applying them appropriately. In addition, this phase will be a vital part since important data for evaluating the efficacy of the project will be obtained.

Stakeholders

Stakeholders form a vital part of any project as they are usually involved in the projects and are also affected by the project’s outcomes (Melnyk & Fineout-Overholt, 2019). While some of them are directly involved in the project, others are indirectly involved. As such, this section identifies various stakeholders.

 

• One of the most important stakeholders are patients who will form part of the study as the impact of the new intervention on the development of CAUTI will be studied through them.
• The nursing staff and other staff involved in the care of patients at the ICU also form part of the stakeholder team. They will be involved in the project’s direct implementation; hence they need to understand the goals of the project and buy into the ideas of the project.
• Doctors and other providers will also be key stakeholders. They need to buy into the project’s ideas and participate at some point in the implementation of the project.
• The other groups which will be vital among the stakeholders are policymakers, representatives, facility leaders, and administrators. This group of stakeholders will be expected to support the project and influence the policy processes to accommodate new proposals.

Potential Barriers and Strategies of Overcoming them

In most cases, the implementation of change projects implies that an organization’s normal or day-to-day practice has to be interfered with and changed to an extent. The implication is that the implementation process may encounter various barriers, be it organizational, stakeholders, or the project team members, hence threatening the successful implementation of the project (Melnyk & Fineout-Overholt, 2019). Therefore, it is prudent to be proactive and formulate a comprehensive plan to help in addressing the challenges when they eventually arrive. Among the most common barriers is a potential failure from the organization’s leaders and administrators to offer the needed support to the proposed change project. Since this is one of the biggest and most challenging barriers, it is vital to mitigate it. One way of mitigating the problem is that the goals and objectives enacted for the project should be aligned to the organization’s goals, mission, and vision. This will make the leadership and administrators support the project.

In most cases, people like the status quo and tend to oppose changes. Therefore, another potential barrier is the resistance by nurses and other staff working in the ICU department. It is also vital to ensure that such resistance is timeously addressed as the nursing staff is expected to play a critical role in the project. In addressing potential resistance, various strategies can be used, including encouraging effective and open communication (Melnyk & Fineout-Overholt, 2019). Effective and open communication gives everyone a chance to contribute their thoughts and speak out their concerns. The end result will be increased involvement of the staff and a substantial reduction of possible resistance.

Evaluation Plan

One of the most important phases of an evidence-based practice project process is the evaluation phase. Therefore, it is important that a comprehensive evaluation plan is created in time. The evaluation phase draws its importance from the fact that it offers valuable information concerning how well the project has achieved the targeted outcomes (Galiano et al., 2020). Besides, the evaluation phase also helps in assessing the effectiveness of the methods applied in the project in terms of how well they operated to achieve the targeted outcomes. As such,  evaluation data should be communicated in time among the project implementer as it allows every member to gain a deeper understanding of relevant strategies to be applied in ensuring that the project is a success.

As part of the evaluation process, various expected outcomes have been noted. The primary outcome is diminished cases of catheter-associated urinary tract infections. Therefore, it is hoped that the main interventions, the application of limited use of catheters, and the use of antibiotic-impregnated catheters, will have a positive impact on CAUTI outcomes (Clarke et al., 2020). As earlier indicated, education and training of nurses will be undertaken to ensure that the nurses have sufficient knowledge regarding the project and CAUTI prevention and management. Therefore, the other targeted outcome is increased nurse knowledge and competence on limiting the use of catheters and knowing the right time to take off the catheters. The nurses will also be more competent through continuous use of the intervention. The other expected outcome is a possible adoption of the proposed intervention in the whole organization to be used as a standard practice. However, the adoption of the new solution in the whole facility may depend on the magnitude of the impact of the intervention in reducing the cases of catheter-associated urinary tract infections.

Data Collection Tools

Data collection is essential for obtaining the needed data that can be used in supporting the project. Therefore, it is important to identify the necessary data collection tools. Among the vital data collection tools to be applied during the project are questionnaires. As earlier indicated in the implementation phase, one of the main activities included assessment of the nurses’ level of knowledge concerning catheter use to evaluate what kind of training to offer. Therefore, questionnaires will be key in capturing such data. Questionnaires are usually easier to administer and also enhance accurate data collection and better analysis (Hopp & Rittenmeyer, 2021). The patient health records will also form an important part of the data source on the catheter-associated urinary tract infection rates before and after the intervention. The importance of these tools is that they are more accurate data collection points since they will contain the exact number of CAUTI cases in the clinical setting.

Statistical Test

As earlier indicated, the major focus of this project is to lower the occurrences of catheter-associated urinary tract infections. As such, one of the major activities will be determining the impact or effectiveness of the implemented intervention, and this is where statistical tests come in. Relevant statistical tests will be applied to evaluate the efficacy of the intervention. One of the tests that will be applied is the paired t-test. The paired t-test will be applied in comparing the scores obtained before the intervention and the ones obtained after the implementation of the intervention (Grove & Cipher, 2019). Mean scores will also be key in determining the impact of the proposed intervention. Mean as a statistical tool has been shown to have a minimal bias.

Data Collection Methods

The project data is useful in determining the efficacy of the implemented intervention. Therefore, it is important to use effective data collection strategies that will lead to reliable and accurate data. To ensure that the data is more reliable and accurate, two independent individuals will be tasked with checking the collected data for completeness and to help eliminate any kind of bias (Khare et al., 2017). The data to be checked for completeness will be obtained from questionnaires. Besides, the data check will also ensure that only the completed questionnaires are used during the data analysis phase. Again, data curation will be performed to ensure that there is improved accuracy. As part of determining the efficacy of the program, data analysis will have to be done. Both the outcome and process measures of the project are key and, therefore, will both be explored. Process measures will entail finding out if the intervention has been effective. On the other hand, the outcome measures will help the implementing team have an idea of the extent of achievement of the expected results.

Strategies to Consider if the Results are not as Expected or if the Outcomes are not Positive

The expectation of the outcome of the intervention is that the intervention will lead to positive results. However, this is research, and anything is expected; therefore, strategies should be put in place in case the outcomes are not positive. One of the most relevant strategies is a re-examination of the intervention. A careful analysis of the intervention and the implementation process will help reveal any areas of weaknesses and what can be done to implement intervention to improve outcomes (Linsley et al., 2019). Another strategy is to extend the timeline for accomplishing the project. The increased time will enable the implementing team to seek various corrective measures for improved outcomes. In addition, the additional time will also help in monitoring the new strategy.

Maintaining, Extending, Revising, and Discontinuing the Solution

            Project outcomes are an important part of an evidence-based practice project as they dictate whether the project will be maintained, extended, revised, or discontinued. As such, depending on the observed outcomes, various steps will be followed. The maintenance of the project will be the option picked in the case where the results prove to be positive, and the clinical practice, systems, and processes are positively impacted. The cost-effectiveness of the implemented solution will also dictate the action to be taken after the implementation (Melnyk & Fineout-Overholt, 2019). For example, if the project is cost-effective, then the project will be maintained. However, if the project is not cost-effective, discontinuation may have to follow. Extension of the project will be considered in the case where the outcomes arrived at are inconclusive. As such, during the extended period, more data will be obtained to help come to better conclusions and determine the efficacy of the project.

Project revision will also be considered in a situation where the strategies are not aligned to the outcomes. During the revision, relevant modifications will be performed on the intervention to help in improving the chances of the success of the project. Again, discontinuation of the intervention will be pursued if the interventions cause harm to the nursing staff using the intervention and the patients.

Conclusion

In conclusion, catheter-associated urinary tract infections form part of the most common health-associated infections and lead to various adverse impacts. Therefore, there is always a need to explore better strategies for addressing the problem. Annually, up to thirteen thousand deaths result from (CAUTI) in the USA, indicating the need for more robust methods to control and prevent the condition. Therefore, this proposal focuses on the use of antibiotic-impregnated catheters and the reduction of catheter use as a way of reducing the incidences of CAUTI. For this project, Kurt Lewin’s change model has been identified as the model to lead the implementation. As such, the three stages of unfreezing, movement, and refreezing will be key in the implementation process.

References

Benjamin, G. C. (2021). Becoming the Healthiest Nation: The Role of Healthy People 2030. Journal of Public Health Management and Practice, 27(6), S218. https://dx.doi.org/10.1097%2FPHH.0000000000001417

Clarke, K., Hall, C. L., Wiley, Z., Tejedor, S. C., Kim, J. S., Reif, L., … & Jacob, J. T. (2020). Catheter‐Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention. Journal of hospital medicine, 15(9), 552-556. https://doi.org/10.12788/jhm.3292

da Silva, A. A., Marques, A. F., di Biase, C. B., Zingg, W., Dramowski, A., & Sharland, M. (2018). Interventions to prevent urinary catheter-associated infections in children and neonates: a systematic review. Journal of pediatric urology, 14(6), 556-e1. https://doi.org/10.1016/j.jpurol.2018.07.011.

Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: a systematic review. American journal of infection control, 45(12), 1331-1341. https://doi.org/10.1016/j.ajic.2017.07.020.

Galiano, A., Simonetti, M., Quiroga, N., & Larrain, A. (2020). Development, implementation, and evaluation of an evidence‐based practice model in a new hospital in Chile. Journal of Nursing Management, 28(7), 1748-1757. https://doi.org/10.1111/jonm.13134.

Grove, S. K., & Cipher, D. J. (2019). Statistics for nursing research-e-book: A workbook for evidence-based practice. Elsevier Health Sciences.

Hopp, L., & Rittenmeyer, L. (2021). Introduction to evidence-based practice: A practical guide for nursing. FA Davis.

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002.

Iqbal, A., & Abbas, F. (2021). Assessing the knowledge among nurses regarding nosocomial/healthcare-associated infections. International journal of allied health sciences, 5(2), 2201-2205.

Khare, R., Utidjian, L., Ruth, B. J., Kahn, M. G., Burrows, E., Marsolo, K., … & Bailey, L. C. (2017). A longitudinal analysis of data quality in a large pediatric data research network. Journal of the American Medical Informatics Association, 24(6), 1072-1079. https://doi.org/10.1093/jamia/ocx033

Letica-Kriegel, A. S., Salmasian, H., Vawdrey, D. K., Youngerman, B. E., Green, R. A., Furuya, E. Y., … & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ open, 9(2), e022137. https://doi.org/10.1136/bmjopen-2018-022137.

Li, S. A., Jeffs, L., Barwick, M., & Stevens, B. (2018). Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review. Systematic reviews, 7(1), 1-19. https://doi.org/10.1186/s13643-018-0734-5,

Linsley, P., Kane, R., & Barker, J. H. (2019). Evidence-based practice for nurses and healthcare professionals. Sage.

 

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Wolters Kluwer.

Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., da Silva Canini, S. R. M., … & Laus, A. M. (2019). Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: a quasi-experimental study. Medicine, 98(8). Doi: 10.1097/MD.0000000000014417

Omer, S. A., Zahran, F. E., Ibrahim, A., Sidahmed, L. A., Karam, G., & Almulhim, F. (2020). Risk Factors for Catheter-Associated Urinary Tract Infections (CAUTI) in Medical Wards and Intensive Care Units (ICU). Journal of Microbiology Research, 10(1), 1-5. Doi: 10.5923/j.microbiology.20201001.01.

Patel, P. K., Gupta, A., Vaughn, V. M., Mann, J. D., Ameling, J. M., & Meddings, J. (2017). Review of strategies to reduce central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) in adult ICUs. Journal of hospital medicine, 13(2), 105-116. https://doi.org/10.12788/jhm.2856.

Sampathkumar, P. (2017). Reducing catheter-associated urinary tract infections in the ICU. Current opinion in critical care, 23(5), 372-377. https://doi.org/10.1097/MCC.0000000000000441

Soundaram, G. V., Sundaramurthy, R., Jeyashree, K., Ganesan, V., Arunagiri, R., & Charles, J. (2020). Impact of Care Bundle Implementation on Incidence of Catheter-associated Urinary Tract Infection: A Comparative Study in intensive care Units of a Tertiary Care Teaching Hospital in South India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(7), 544

White, K. M. (2019). Change theory and models: Framework for translation. Translation of Evidence Into Nursing and Healthcare, 59.

BUY A CUSTOM-PAPER HERE ON;NUR-550 Final Research Paper

Appendices

   Appendix A: PICOT table

PICOT Question
P	Population	Patients admitted to the ICU
I	Intervention	Limited use of catheters and the use of antibiotic-impregnated catheters
C	Comparison	Standardized catheter insertion techniques
O	Outcome	Lower incidences of CAUTI
T	Timeframe	Six weeks
PICOT	Among the patients admitted in the ICU, what is the efficacy of limited use of catheters and use of antibiotic-impregnated catheters as compared to the use of standardized insertion techniques in lowering the incidences of CAUTI within six weeks?

Appendix B: APA Checklist Summarized

Page numbering- flush right	Yes
Title of document appears at the top of the first page of text	Yes
The introductory paragraph or section should not be labeled	Yes
Double line spacing	Yes
Margins- 1 inch	Yes
Paragraph formatting- indented and left-aligned	Yes
Punctuations after quotations	None
Section headings- level 1 headings centered and in bold, and in title case	Yes
References- in a new page. The word references centered.	Yes

 

Appendix C: Concept Map

For this assignment, you will synthesize the independent evidence-based practice project proposal assignments from NUR-550 and NUR-590 into a 4,500-5,000-word professional paper.

Final Paper

The final paper should:

Incorporate all necessary revisions and corrections suggested by your instructors.
Synthesize the different elements of the overall project into one paper. The synthesis should reflect the main concepts for each section, connect ideas or overreaching concepts, and be rewritten to include the critical aspects (do not copy and paste the assignments).
Contain supporting research for the evidence-based practice project proposal.
Main Body of the Paper

The main body of your paper should include the following sections:

Problem Statement
Organizational Culture and Readiness
Literature Review
Change Model, or Framework
Implementation Plan
Evaluation Plan
Appendices

The appendices at the end of your paper should include the following:

All final changes or revisions for the drafts that will be included in the appendices of your paper.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as the final appendix at the end of your paper. In each preceding course you have been directed to the Student Success Center for assistance with APA style, and have submitted the APA Writing Checklist to help illustrate your adherence to APA style. This final paper should demonstrate a clear ability to communicate your project in a professional and accurately formatted paper using APA style.
General Requirements

You are required to cite 10-12 peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

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.