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NURS 4220A Leadership Competencies In Nursing And Healthcare

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NURS 4220A Leadership Competencies In Nursing And Healthcare

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NURS 4220A Leadership Competencies In Nursing And Healthcare

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Course Code: NURS4220A
University: Walden University

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Country: United States

Question:
Catheter associated urinary tract infection as a nursing practice problem.
State the practice problem in measurable terms and that reflect quality indicators.
Synthesize the purpose, methods, and findings from at least five peer-reviewed, evidence-based practice articles that support your practice problem.Describe the quality improvement process and the tool that will be used as a basis for the practice problem. (The Quality Improvement Process to be used is PDSA.) Plan-Do-Study-Act (PDSA) CycleExplain why the specific process was selected and document your explanation with references
Answer:

Introduction
Catheter-associated urinary tract infection is regarded to be among the most common hospital-acquired infection. This is a major problem since there was an increase from one infection last year to five infections this year. It is a preventable problem since nurses can assess the need of inserting an indwelling catheter, use of an aseptic technique and aftercare of an indwelling catheter. According to (International Federation of Infection Control,2016) use of indwelling catheters increases the risk of bacteriuria at a daily rate of 5% and by 100% by four weeks. In an untreated infection progresses to septicemia, cystitis, and pyelonephritis. A patient who has an indwelling catheter in place for an entire day on recognition of urinary tract infection and at least fever, suprapubic pain, costovertebral pain, urgency, dysuria, and a positive urine culture qualifies to be a catheter-associated urinary tract infection (Bucci,2016).
There is need to address rise in catheter-associated urinary tract infection. (Scott,2009) states complications such as endocarditis and meningitis cause discomfort to the patient, prolonged hospital stays and increased mortality. This superimposes more unnecessary conditions to the patient and resistance to antibiotics if managed inappropriately. It is important to address the rise of such infections to avoid unnecessary costs in treatment and to advocate for the patient against unnecessary catheter insertion. The purpose of this paper is to address indication of indwelling catheters and reduce the rate of infections from five to zero which occurred in the hospital by proper nursing care and quality improvement process.
Literature review
(Dogra,2015) undertook a research to determine knowledge of doctors and nurses regarding indication for catheterization and preventing catheter-associated urinary tract infection in a hospital. The data was collected via questionnaires given to 54 doctors and 105 nurses. The findings indicated that only 57% could identify steps to prevent catheter-associated urinary tract infection. The doctors were had better knowledge on indication for inserting a catheter compared to their counterparts in nursing. This indicates need for imparting knowledge on catheter use among healthcare professionals.
(Drekonja,2014) engaged a research to ascertain nurses’ attitudes and knowledge regarding indications for using a catheter and how to prevent associated infections in Minnesota. This was done via an internet survey containing scale questions on the indications for catheter insertion and measures to prevent catheter-associated infections. The results indicated high level of knowledge on need to remove foley catheter to prevent infection. However, there was concern on other aspect of catheter knowledge. This information if imparted would make a difference in catheter care in hospitals
(Park,2018) conducted a study on factors associated with hospital-acquired catheter urinary tract infections. The methods used in identification of such factors are decision trees. The results identified were nurses with specialty certifications working under such clients reduced occurrence of catheter-associated urinary tract infections. Also, if a catheter is left in situ for more than 48 hours there are higher chances of infections. The findings also suggest more nursing hours with patient results to positive outcomes.
(Nicolle,2014) investigated antimicrobial resistance and infection control in regard to catheter-associated urinary tract infections. Methods used was cohort studies across Quebec. The findings regarding the study was use of an indwelling catheter was associated with an increased occurrence of urinary tract infection and morbidity from noninfectious causes. There was evidence limiting use of catheters and removal of catheters while not in use would go a long way in prevention of infections. Asymptomatic urinary infections would require biofilm resistant catheters.
(Givens,2014) conducted a research to investigate the excess morbidity and costs related to catheter-associated urinary infections in surgical patients. This was conducted via case matched and controlled study. The findings were the patient’s stay was increased by three days and hospital costs by 558 dollars per patient. The recommendations included removal of the catheter as soon as the patient was able to ambulate.
Quality improvement process and tool used for basis in cauti
Quality improvement process refers to the act of improving the needs and healthcare of targeted patients groups in a manner that can be evaluated. According to (Batalden,2014) quality improvement involves combined efforts of healthcare workers, patients, and their families, researchers to yield better outcomes and care. This process involves forming a team that looks into the desired change, whether it is measurable, whether the staff is able to undertake the changes and the models that will be used. The use of data is a guideline in the need of quality improvement process. The formation of quality improvement team is important as it spearheads the whole process with the main focus being the patient. The team establishes the changes to be met according to the data, sets the objectives to be met, implements the objectives via teamwork from all the healthcare providers and evaluates if there is any difference. In addressing catheter-associated urinary tract infections quality improvement process would be applied right from handwashing, insertion of catheter, daily assessment, and cleaning and prompt removal of the catheter.
The quality improvement tool that will be used is the plan-do-study-act cycle in catheter-associated urinary tract infections. Plan-do-Study-Act cycle is a quality improvement tool which involves determining needed improvement and changes required, implementing changes, analyzing data to note any improvement and finally evaluating the changes(Spath,2013).There is deeper insight after every repetition of the cycle and there easy assessment of mistakes by the team.(Spath,2013).According to(Bell,2014) science improvement draws conclusions from tools such as plan-do-study-act. This would involve implementing changes at each step of catheter insertion, drawing of urine samples and removal of the catheter. This will be monitored to assess if there is a reduction in the occurrence of the catheter-associated urinary tract infections. If there is an improvement the actions can then be implemented at a large-scale level by repeating the cycle
During my clinical rotation, the third week mainly involved taking actions according to the Plan-do-study-act cycle to reduce the number of catheter-associated urinary tract infections. A performance improvement team was formed to review data, establish areas of improvement and monitor improvement. Another action was nurse-driven protocol to remove foley, for example, the nurse had the autonomy to remove a catheter in a surgical patient who was ambulatory. Nurse performed perineal care aseptically. There was continuing medical education regarding the handling of the catheters. Nurses were taught that catheters should be below the bladder level, the urine bag should not be on the flow, change of catheter before obtaining a urine culture if it has been in place more than five days. The nurses were challenged to engage the doctors on the indications of indwelling catheter.
References
Batalden, P. B., & Davidoff, F. (2014). What is “quality improvement” and how can it transform healthcare?.
Bucci M. (2016). Understanding outcome measures: catheter-associated urinary tract infections and CDI.
Drekonja DM, Kuswoski MA, Johnson JR. (2014). Internet survey of foley catheter practices and knowledge among Minnesota nurses.
Givens, C. D., & Wenzel, R. P. (2014). Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs. The Journal of urology, 124(5), 646-648.
International federation of infection control (2016).Catheter associated urinary tract infections. Retrieved from www.who.int>CAUTI_student-handbook.
Jain, M., Dogra, V., Mishra, B., Thakur, A., & Loomba, P. S. (2015). Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(2), 76.
Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial resistance and infection control, 3(1), 23.
Park JI, Bliss DZ, Chi CL, Delaney CW, Westra BL. (2018). Factors associated with healthcare-acquired catheter-associated urinary tract infections
Scott, R. D. (2015). The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention.
Spath, P. (2013). Introduction to healthcare quality management (3rd ed.). Chicago IL:Health Administration Press.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf, 23(4), 290-298.

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