NRS-433V PICOT and EBP Assignment: Finding the Research Evidence Paper

NRS-433V PICOT and EBP Assignment: Finding the Research Evidence Paper

NRS-433V PICOT and EBP Assignment: Finding the Research Evidence Paper

NRS-433V PICOT and EBP Assignment: Finding the Research Evidence Sample Paper

Nursing Practice Problem (200-250 words):

Hospitalized patients have increased risk of getting infected by catheter associated urinary tract infections (CAUTIs) compared to outpatients. Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent forms of hospital acquired infections (HAIs) with increased chances of mortality. The prevalence of CAUTIs across the healthcare sector is about 24% (Jones et al., 2022). Individuals in nursing homes who use Foley catheters have increased chances of getting CAUTIs because of the frequent use of these interventions. CAUTIs have adverse effects that include increased cost of patient care and facility, lengthens the hospital stay and leads to unnecessary exposure to more infections based on the number of more days that one should spend in the facility. Nurse-driven interventions, especially bladder bundle help, can reduce the incidences of CAUTIs for these patients and improve their outcomes. Having a proper plan to manage CAUTIs is essential to ensuring that nurses and healthcare facilities reduce the risks and susceptibility to infections. Effective protocols like assessment of catheter needs for each patient, having sufficient Foley catheter care using, and timely removal of catheters are some of the nurse-led activities that can reduce CAUTIs (Tyson et al., 2020). These activities mean that prompt removal of catheter as soon as possible without a physician’s intervention or order and their proper maintenance are critical to reducing CAUTIs across inpatient facilities and nursing homes. The purpose of this literature evaluation table is to explore literature support the developed PICOT question on CAUTIs and the use of nurse-driven protocol to reduce their susceptibility and prevalence.

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PICOT Question:

The PICOT model presents a framework for nurses and other healthcare providers to initiate interventions that focus on improving patient outcomes by using evidence-based interventions to address clinical and care issues arising from care provision. In this case the PICOT Question is;

Among patients at risk of CAUTIs in acute care setting (P), does having a nurse-driven bladder bundle (I) compared to no nurse-driven bundle (C) reduce and prevent the incidences of CAUTIs (O) within 6 months (T)?

Criteria	Article 1	Article 2	Article 3
APA-formatted article citation with permalink	Minor, L., VanDerSlik, A. L., Lapsley, C. E., & Albers, C. E. (2022). Implementation of a Nurse-Driven Foley Removal Protocol and Urine Specimen Algorithm in a CCU at a Level 1 Trauma Center. American Journal of Infection Control, 50(7), S33-S34. https://doi.org/10.1016/j.ajic.2022.03.055	Schiessler, M. M., Darwin, L. M., Phipps, A. R., Hegemann, L. R., Heybrock, B. S., & Macfadyen, A. J. (2019). Don’t have a doubt, get the catheter out: a nurse-driven CAUTI prevention protocol. Pediatric Quality & Safety, 4(4), e183. DOI: 10.1097/pq9.0000000000000183	DePuccio, M. J., Gaughan, A. A., Sova, L. N., MacEwan, S. R., Walker, D. M., Gregory, M. E., … & McAlearney, A. S. (2020). An examination of the barriers to and facilitators of implementing nurse-driven protocols to remove indwelling urinary catheters in acute care hospitals. The Joint Commission Journal on Quality and Patient Safety, 46(12), 691-698.
How does the article relate to the PICOT question?	The article is related to the PICOT as it demonstrates the efficacy of nurse-led protocols to reduce and prevent CAUTIs in critical care units (CCU). This means that even the setting relates to the PICOT question	The article relates to the PICOT as it shows how nurse-led protocols can reduce CAUTIs among pediatric patients.	The article relates to the PICOT as it demonstrates that despite the efficacy of nurse-led protocols to remove indwelling catheters, there are barriers that may impact these interventions. However, there are also facilitators that are critical to overall implementation
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Qualitative methods The article uses an evaluation study design meaning that it gets views and opinions about the implementation of the suggested interventions.	Qualitative The article used the Plan, Do, Check, Act methodology which is more theoretical and focuses on the effectiveness of the different interventions deployed.	Qualitative They used semi-structured interviews and collected experiences of managers, executives and frontline staff including nurses and physicians.
Purpose statement	The study aimed at creating a urine specimen algorithm to reduce unnecessary utilization of urine cultures together with a nurse-driven Foley removal protocol.	The purpose of the study was to reduce the incidence of CAUTI in a pediatric intensive care unit at a free-standing pediatric facility	The purpose of the study was to evaluate the barriers and facilitators of implementing urinary catheter nurse-based protocols in removing indwelling urinary catheters.
Research question(s)	Does a combination of urine algorithm and nurse-driven catheter removal reduce CAUTI in CCU?	Does the use of a nurse-driven CAUTI prevention protocol reduce the incidence of CAUTI in a pediatric ICU?	What are the barriers and facilitators of urinary catheter nurse-driven protocols (UCNDPs) in removal of indwelling urinary catheters?
Outcome(s)	The number of CAUTIs reduced after the implementation of these interventions to only five with a standardizes infection ratio of 1.63.	The use of indwelling urinary catheter device days reduced by 28% in six months of the implementation.	The outcomes show that hospitals and providers had similar barriers and facilitators.
Setting (Where did the study take place?)	Critical care units (CCU)	Pediatric intensive care unit of a free standing pediatric hospital	The study occurred in 17 U.S. hospitals
Sample	Patients in the critical care unit during the study	Included children in the unit who had been hospitalized.	The sample comprised of 449 frontline staff.
Method	Evaluation design to determine effects of nurse-led Foley removal protocol and urine specimen algorithm	Plan, Do, Check, Act (PDCA)	Semi-structured interview
Key findings of the study and implications for nursing practice	The researcher found that these two interventions reduce CAUTIs greatly and improve patient outcomes. The implication for nursing practice is that these interventions can reduce CAUTIs.	The researchers found that the protocol led to a reduction in the number of PICU CAUTI from 4.8 (per 1,000 device days) to 0.8 a year later after implementing the protocol. The implication is that nurses need skills and competence to implement these protocols to reduce CAUTIs.	The key findings included the identified barriers like miscommunication, nurse deference to physicians, and physician push-back. The facilitators entailed training of care team members to use the protocol, discussion of the necessity of the interventions during rounds and reminders. The implication is that nurses and other providers should understand barriers and factors that can help them implement these protocols in their settings
Recommendations of the researcher	The article recommends need for medical professionals inserting indwelling urinary catheters to get training and develop competency as we as be confident in their skills.	The researchers recommend prompt removal of indwelling urinary catheter to reduce catheter days and incidence of CAUTIs.	Hospitals should support the implementation of these protocols and use through developing relevant skills among their team members. They should improve their awareness about their value and importance in reducing CAUTIs

 

Criteria	Article 4	Article 5	Article 6
APA-formatted article citation with permalink	Implementation of a Nurse-Driven Protocol for Catheter Removal to Decrease Catheter-Associated Urinary Tract Infection Rate in a Surgical Trauma ICU	Krocová, J., & Prokešová, R. (2022, January). Aspects of prevention of urinary tract infections associated with urinary bladder catheterization and their implementation in nursing practice. In Healthcare, 10(1): 152. https://doi.org/10.3390/healthcare10010152	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
How does the article relate to the PICOT question?	The article relates to the PICOT question as demonstrates the use of nurse-led protocols like early removal of urinary catheter to prevent CAUTIs.	The article relates to the PICOT question as it is categorical that having diverse interventions reduces the susceptibility of patients to CAUTIs, especially preventive measures led by nurses.	The article relates to the PICOT question by demonstrating that bundled approach can help reduce the prevalence of catheters in intensive care units, like acute care.
Is the article qualitative, quantitative, or mixed methods? Justify your selection.	Quantitative The researchers carried out retrospective cohort approach. They also analyzed the outcomes using regression analysis and incident rate ratio as well as confidence intervals	Quantitative The researchers conducted a quantitative study to determine the efficacy of steps of CAUTI prevention, especially those leading to better care in urinary infections.	Quantitative/ Mixed The researchers rely on a mixed method approach based on the interventions that they have and the use of pre-post design
Purpose statement	The purpose of this study was to demonstrate that nurse-directed catheter removal protocol reduces catheter use and CAUTI rates.	The purpose of the study was to determine the effectiveness of implementing steps of CAUTI prevention and the measures that led to better quality of care in urinary infections.	The objective of the project was to lower catheter-associated urinary tract infections by 30% and reduce urinary catheter days by 20% as well as attain a compliance rate of 75% in catheter-associated documentation in an ICU.
Research question(s)	Does the use of nurse-driven catheter removal protocol result in reduced catheter utilization and CAUTI rates in a surgical trauma intensive care unit (STICU)?	Does the use of CAUTI steps prevent occurrence of catheter infections and improve quality of care?	What are the negative effects of CAUTIs and can a bundled approach reduce the prevalence of these infections?
Outcome(s)	Catheter utilization declined through the implementation of the protocol. The infections also reduced significantly per 1000 catheter days.	The outcomes from the study were mixed and demonstrated deficiencies in monitoring of CAUTI outcomes and process indicators.	The outcomes show that the bundled approach was effective in reducing all the components of the study, from catheter days to reported CAUTIs.
Setting (Where did the study take place?)	Surgical trauma intensive care Unit	The setting was acute bed care in Czech Republic	The setting was an intensive care unit
Sample	Sample included patients in the ICU during the period based on 1000 catheter days	The sample comprised of 186 respondents from 34 hospitals.	Patients admitted to the ICU in the setting where the study occurred.
Method	Retrospective cohort	The researchers used three sets of Questionnaires	The project used a pre-post design of over 2 consecutive 4-month duration.
Key findings of the study and implications for nursing practice	The key findings include a reduction in the use of catheters and a decline in CAUTI rates per 1000 catheter days based on before and after the implementation period. Nurses should implement interventions to reduce CAUTIs and improve patient outcomes.	The results show that not all respondents monitored CAUTI outcomes in their facilities. The lack of monitoring means that they could not prove the effectiveness of the preventive measures. The implication is that nurses must implement these protocols to enhance outcomes and reduce CAUTIs in their settings	The findings show that a bundled approach reduces the rates of CAUTIs in ICU and allows nurses to attain better knowledge on the most effective interventions based on their circumstance.
Recommendations of the researcher	The researchers recommend the use of nurse-based protocol for early urinary catheter removal as a component of CAUTI prevention strategy that can lead to significant reduction of CAUTI rates and even utilization.	The researchers recommend regular CAUTI training for nurses to improve implementation of these interventions. Hospitals should also have HAI teams to prevent CAUTIs based on the interventions that they implement	The authors recommend the adaptation of the approach in other facilities to reduce CAUTIs and HAIs.

Conclusion

The evaluation table’s articles show that CAUTIs are a common issue that impacts healthcare delivery and there is need for stakeholders to develop interventions to address the issue. The articles all show that having nurse-driven protocols, especially on removal of catheters and use of catheters, are essential and have better outcomes. The evaluation table demonstrates that most of the articles align with the PICOT question and make recommendations based on their findings about the need for providers and organizations to implement these components to reduce hospital acquired infections (HAIs) like CAUTIs.

References

Jones, A. E., Nagle, C., Ahern, T., & Smyth, W. (2022). Evidence for a nurse-led protocol for removing urinary catheters: A scoping

review. Collegian, 30(1): 190-197. https://doi.org/10.1016/j.colegn.2022.08.008

Tyson, A. F., Campbell, E. F., Spangler, L. R., Ross, S. W., Reinke, C. E., Passaretti, C. L., & Sing, R. F. (2020). Implementation of a

nurse-driven protocol for catheter removal to decrease catheter-associated urinary tract infection rate in a surgical trauma ICU. Journal of intensive care medicine, 35(8), 738-744. https://doi.org/10.1177/0885066618781304

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The first step of the evidence-based practice process is to evaluate a nursing practice environment to identify a nursing problem in the clinical area. When a nursing problem is discovered, the nurse researcher develops a clinical guiding question to address that nursing practice problem.

For this assignment, you will create a clinical guiding question know as a PICOT question. The PICOT question must be relevant to a nursing practice problem.

Use the “Literature Evaluation Table” to complete this assignment. Prior to starting the “Literature Evaluation Table,” complete the following:

Select a nursing practice problem of interest to use as the focus of your research. Start with the patient population and identify a clinical problem or issue that arises from the patient population.
Following the PICOT format, write a PICOT question in your selected area of interest. The PICOT question should be applicable to your proposed capstone project (the project students must complete during their final course in the RN-BSN program of study).
Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. Note: This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem. A mixed methods article can qualify towards meeting a qualitative or quantitative methodology.
Articles must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments. The PICOT question will also provide a framework for your capstone project.

Note: To assist in your search, remove the words qualitative and quantitative and include words that narrow or broaden your main topic. For example: Search for diabetes and pediatric and dialysis. To determine what research design was used in the articles the search produced, review the abstract and the methods section of the article. The author will provide a description of data collection using qualitative or quantitative methods. Systematic reviews, literature reviews, and metanalysis articles are good resources and provide a strong level of evidence but are not considered primary research articles. Therefore, they should not be included in this assignment.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be 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.