Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it NRS 493

Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it NRS 493

Briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it NRS 493

Topic 6 DQ 2

Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction?

Sharia Jones

Posted Date

May 29, 2022, 7:57 AM

Replies to Sharia Jones

My initial capstone topic started out as CAUTI (Catheter Associated Urinary Tract Infection) associated with foley utilization rates. Although there are several evidence-based practices that have been shown to reduce CAUTI including reducing the use of urinary catheters, incorporating interventions to help avoid the use of urinary catheters when they are not indicated including nurse-driven protocols for the removal of urinary catheters as soon as no longer required (Centers for Disease Control and Prevention, 2019).

This is quite different than the current focus of my change proposal. I decided to shift to a more narrowed focus that is a direct reflection of a current need at the rehabilitation hospital. One influential moment for the change came when I was asked by a staff nurse, “Do I really have to change the foley out before I get a specimen?” I thought that she was just joking, considering her experience and longevity with the company. Either way I assumed that she would know the proper procedure to collect from a catheterized patient. After going over the policy of urine specimen collection in catheterized patients, it dawned on me that perhaps she actually didn’t know, which may result in improper collection and false positive readings. After discussing this situation with my preceptor, she shared with me that that hospital just got their second CAUTI of the year, due to urine cultures being ordered without proper clinical indication. After considering these factors, my focus shifted to urine culture collection and how they can increase CAUTI rates.

My capstone change proposal project involves the initiation of a Urine culture stewardship initiative focused on addressing the issue of increased rates in CUATI associated with improper testing of urine cultures for reason that do not indicate the need for culture testing, as well as addresses the significance of proper specimen collection practices and in reducing the overtreatment with antibiotics and other associated treatment costs. Specific studies have shown that urine culture stewardship initiatives aimed at reducing UC overutilization and were correlated with a decrease in CAUTIs, and the addition of urine-culture stewardship to standard best practices could reduce CAUTI in various care settings (Al-Bizri,  Vahia, Rizvi,  Bardossy, Robinson, et al., 2021).




Al-Bizri, L., Vahia, A., Rizvi, K., Bardossy, A., Robinson, P., Shelters, R., Alangaden, G. (2021). Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units. Infection Control & Hospital Epidemiology, 1-4. doi:10.1017/ice.2021.273

CDC (Centers for Disease Control and Prevention). (2019). Survey Practices and Outcomes. Urine Culture Stewardship. HAI.

Esther Obiyaa

replied toSharia Jones

May 29, 2022, 5:57 PM

Replies to Sharia Jones

Hello Sharia,

Thank you for sharing your project with the class. In addition to what you elaborated on the interventions that are mostly carried out by health professionals to prevent CAUTI are external catheters such as condom catheters for male patients and pure wick for females. These external catheters are used in my unit a lot on patients on incontinent patients with impaired movement and also on patients who are on diuretics and on strict intake and output.

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Replies to Esther Obiyaa

Hello Ester,

Thank you for responding to my post. The alternatives to foley catheters are many, but I agree are greatly under utilized. Evidence-based alternatives to indwelling catheterization include intermittent catheterization, bedside bladder ultrasound, external condom catheters, and suprapubic catheters. In addition, adherence to general infection control principles is important (eg, hand hygiene, surveillance and feedback, aseptic insertion, proper maintenance, education). Other CAUTI prevention strategies include aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation (Meddings, Rogers, Krein, Fakih, Olmsted, & Saint, 2014).




Meddings, J., Rogers, M. A. M., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual. Saf., 23(4), 277–289. doi: 10.1136/bmjqs-2012-001774


  • Lydia Kwofie

replied toSharia Jones

May 29, 2022, 7:02 PM

Replies to Sharia Jones

Hi Sharia,

I am interested in the topic you are working on because we had the same issues about collecting urine specimens from indwelling catheters in the hospital where I work. Before, we were doing urine cultures on all patients admitted with an indwelling catheter even when they did not have any symptoms. But by doing that, all CAUTIs were recorded against the hospital. So, we do not do that anymore. We only collect urine cultures when patients present with symptoms of UTI. According to CHI Health, collecting urine specimens from an indwelling catheter follows the following steps; Using a 70% alcohol swab, clean the catheter collecting port. Puncture the collecting port with a needle linked to a syringe using sterile procedures. Take a syringe and a sterile container and aspirate the urine. Using urine from a collection bag is not recommended.


CHI Health. (2020).


  • Sharia Jones

replied toLydia Kwofie

May 29, 2022, 9:17 PM

    • Replies to Lydia Kwofie

Hi Lydia.

Thank you for your response and sharing your experience with urine culture collection and its impact on CAUTI rates. Urine culture testing is often performed without proper clinical indications, According to the CDC, some of these reasons that do not warrant testing include odorous, cloudy, or discolored urine in the absence of other localizing signs/symptoms,

reflex urine cultures based on urinalysis results, such as pyuria, in the absence of other indications (Absence of pyuria suggests diagnosis other than CAUTI) and urine culture to document response to therapy unless symptoms are fail to resolve.




CDC (2021). Strategize Initiatives | Urine Culture Stewardship | HAI.


Stacy Moore

Posted Date

May 28, 2022, 3:51 PM

Replies to Sharia Jones

The issue I am focusing on for the Capstone Project is an unmet educational need specific to prenatal/postpartum women and newborns. The educational need is in regard to a specific audit tool used when hospitals and/or clinics are working toward the Baby Friendly Hospital Initiative (BFHI). The Ten Steps to Successful Breastfeeding are the broad framework that guide the Baby-Friendly Hospital Initiative. In a recent audit, the scores identified that there were not enough mothers who could list 4-5 benefits of breastfeeding for both mothers and babies. The topic and intervention will target mothers during the prenatal and postpartum period and education will be done at the OB/GYN clinic with their provider. The overall goal is to council and educate mothers of all ages and gravidas on the benefits of breastfeeding to both mom and baby and have them verbalize 4 benefits during an audit.

Education on benefits of breastfeeding is the intervention strategy in this case, as it helps create awareness on the impact. Education could be in through groups or individual visits. Additionally, it can take the form of written materials, videos or orally through talks and demonstrations (Lumbiganon, 2011). Lack of or insufficient knowledge about the necessity of breastfeeding has been demonstrated to be detrimental to an infant’s general growth and development. Preterm newborns cannot be placed under exclusive breastfeeding, according to current clinical or nursing practice. As a result, it focuses on the best time to advise the mother about starting exclusive breastfeeding (Maastrup 2014). In this example, the intervention technique is education on the benefits of breastfeeding, which serves to raise knowledge about the impact. Individual or group visits could be used to educate. It can also take the shape of textual materials, videos, or spoken presentations and demonstrations (Lumbiganon, 2011). The plan has not really changed much since I first envisioned it. I created a plan and am happy I was able to stick with it and gather more information as I move forward.



Lumbiganon, P., Martis, R., Laopaiboon, M., Festin, M. R., Ho, J. J., & Hakimi, M. (2017). Antenatal breastfeeding education for increasing breastfeeding duration. The Cochrane Database of Systematic Reviews, (11), CD006425. Advance online publication.


Maastrup, R., Hansen, B. M., Kronborg, H., Bojesen, S. N., Hallum, K., Frandsen, A., … Hallström, I. (2014). Breastfeeding Progression in Preterm Infants Is Influenced by Factors in Infants, Mothers and Clinical Practice: The Results of a National Cohort Study with High Breastfeeding Initiation Rates. PLoS ONE, 9(9), e108208.