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NUR 550 Discussion: Identification of Nursing Practice Problem

NUR 550 Discussion Identification of Nursing Practice Problem

Part 1

Catheter-Associated Urinary Tract Infections (CA-UTIs) is one of the most common healthcare-associated infections in the USA. CAUTIs can result in more adverse complications such as sepsis and endocarditis, and even death. According to Gomila et al. (2019), CA-UTIs account for more than 1 million cases annually in the US. They also account for more than 80% of UTIs originating in the healthcare setting. They are the most common causes of bacteremia in long-term care facilities and infection in patients with spinal cord injury. About 20% of hospitalized patients have a urinary catheter during admission, which increases the risk of CA-UTI by 3–7% daily (Gomila et al., 2019). The major risk factor for UTIs in hospital settings is the temporary insertion of an indwelling urinary catheter. CA-UTI develops due to the inoculation of microbes into the bladder by the urethral catheter, providing an environment for bacterial adhesion and causing mucosal irritation. The bacteria enter the bladder during insertion or manipulation of the catheter, the drainage system, and after removal.

CA-UTI is my topic of interest since it causes a significant burden on patients in terms of morbidity and mortality. In addition to the apparent harm posed to patients, governmental pressure has made hospitals across the country put more effort into reducing incidences of CA-UTI. According to Letica-Kriegel et al. (2019), CAUTI rates are included in both government quality ratings through the Centers for Medicaid and Medicare quality star ratings and financial penalties through the Hospital-Acquired Condition Reduction Penalty program. CA-UTI is relevant to advance nursing practice since advanced practice nurses (APRNs) have a responsibility of promoting better patient outcomes and improving patient safety by applying evidence-based research in clinical practice (Gomila et al., 2019). Nurses are the primary healthcare providers responsible for inserting and maintaining urinary catheters and promoting the desired outcomes. Consequently, they should have adequate knowledge about infection control in the use of urethral catheters, and their practice must adhere to healthcare setting’s guidelines on infection control (Gomila et al., 2019). Besides, PRNs are responsible for obtaining appropriate knowledge and practices of catheter care to prevent UTIs.

 

Part II: In the table below, describe the population and the intervention. (You will continue drafting the PICOT, completing the shaded areas in Topic 3.)

PICOT Question
P Population Hospitalized adult patients.

 

The population of interest is hospitalized adult patients because15–25% of hospitalized patients are catheterized at some point during their hospital stay. Catheter use is associated with most nosocomial UTIs. Patients with the highest risk of CA-UTI include those with extended periods of catheterization, errors in catheter care, microbe colonization of the drainage bag, catheterization late in the hospital course, and lack of antimicrobial therapy (Gomila et al., 2019).

In addition, females, diabetic patients, patients with diarrhea, renal insufficiency, and immunocompromised state have a high risk of developing CA-UTI.

 

I Intervention Meatal cleaning with using 0.1% chlorhexidine solution before urinary catheterization.

The most effective way of reducing incidences of CA-UTI is reducing catheter use. Nonetheless, catheter use is unavoidable in some patients since it is part of disease management.

The proposed intervention is to clean and disinfect the external urethral orifice using 0.1% chlorhexidine solution before urinary catheterization. According to Fasugba et al. (2019), cleaning and disinfecting the urethral meatus before inserting the urinary catheter is considered a potential solution to lowering the incidence of CA-UTI in patients.

The intervention seeks to decrease bacterial colonization around the meatal area, preventing the introduction of opportunistic bacteria into the urinary tract during catheterization (Fasugba et al., 2019).

Fasugba et al. (2019) conducted a study to evaluate the efficacy of 0·1% chlorhexidine solution for meatal cleaning before insertion of a urinary catheter in reducing the prevalence of catheter-associated asymptomatic bacteriuria and UTI.

The study showed that using 0.1% chlorhexidine solution led to a 74% decrease in catheter-associated asymptomatic bacteriuria and a 94% reduction in the incidence of catheter-associated UTI.

The study supports using chlorhexidine solution for meatal cleaning before insertion of catheter because it reduces catheter-associated asymptomatic bacteriuria and UTI and improves patient safety.

C Comparison  
O Outcome  
T Timeframe  
PICOT  

 

 

Problem Statement  

 

 

 

 

References

Fasugba, O., Cheng, A. C., Gregory, V., Graves, N., Koerner, J., Collignon, P., Gardner, A., & Mitchell, B. G. (2019). Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomized controlled trial. The Lancet Infectious Diseases, 19(6), 611-619. https://doi.org/10.1016/S1473-3099(18)30736-9

Gomila, A., Carratalà, J., Eliakim-Raz, N., Shaw, E., Tebé, C., Wolkewitz, M., … & Pujol, M. (2019). Clinical outcomes of hospitalized patients with catheter-associated urinary tract infection in countries with a high rate of multidrug-resistance: the COMBACTE-MAGNET RESCUING study. Antimicrobial Resistance & Infection Control8(1), 1-8.

Letica-Kriegel, A. S., Salmasian, H., Vawdrey, D. K., Youngerman, B. E., Green, R. A., Furuya, E. Y., Calfee, D. P., & Perotte, R. (2019). Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals. BMJ Open9(2), e022137. https://doi.org/10.1136/bmjopen-2018-022137

Description:

Learners will select a valid nursing practice problem for an evidence-based practice project proposal. The project will be completed in

NUR 550 Discussion Identification of Nursing Practice Problem

NUR 550 Discussion Identification of Nursing Practice Problem

sections, beginning in NUR-550 and culminating in a final written paper detailing the evidence-based practice proposal in NUR-590.

The purpose of this assignment is to select a relevant nursing practice problem for your evidence-based practice project proposal. To identify a relevant problem, consider problems generally faced in nursing practice (coordination of health care, assessment, education, patient
support, trauma prevention, recovery, health screenings, etc.). Use the “PICOT Draft” template to complete this assignment.

Use a national, state or local population health care database to research indicators of disparity. Choose a mortality/morbidity indicator to identify a clinical problem or issue that you want to explore pertaining to a population of focus. Use this indicator to begin to formulate a PICOT statement.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

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

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.

You are not required to submit this assignment to LopesWrite.

 

Description

 

Objectives:

1. Identify the different levels of translational research.
2. Differentiate translational research from evidence-based practice.
3. Discuss the application of translational research to population health management.
4. Evaluate sources of translational research.
5. Select a valid nursing practice problem for an evidence-based practice project proposal

Advanced Practice Nursing: Essential Knowledge for the Profession

Description:

Read Chapters 22 and 23 in Advanced Practice Nursing: Essential Knowledge for the Profession.

Evidence-Based Practice in Nursing and Healthcare

Description:

Read Chapter 1 in Evidence-Based Practice in Nursing and Healthcare.

World Health Organization (WHO)

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Description:

Explore the World Health Organization (WHO) website.

Centers for Disease Control and Prevention (CDC)

Description:

Explore the Centers for Disease Control and Prevention (CDC) website.

State and County Departments of Health

Description:

Explore the websites of your state and county departments of health and access mortality and morbidity data. The link to the Arizona Department of Health Services website is provided, but students living in other states should access their county and state departments.

Non-Communicable Diseases (NCD) Burden of Disease

Description:

Read “Non-Communicable Diseases (NCD) Burden of Disease,” by the U.S. Department of Health and Human Services, located on the Centers for Disease Control and Prevention website.

GCU Library: Nursing and Health Sciences Research Guide

Description:

Review the “Nursing and Health Sciences” research guide, located on the GCU Library website.

The Electronic Health Record: A Friend or Foe of Translational Research and Evidence-Based Practice?
Description:

Read “The Electronic Health Record: A Friend or Foe of Translational Research and Evidence-Based Practice?” by Chipps et al., from Worldviews on Evidence-Based Nursing (2019).

Evidence-Based Practice

Description:

Read “Evidence-Based Practice” by Melnyk and Fineout-Overholt, from Encyclopedia of Nursing Research (2017).

Translation Research in Practice: An Introduction

Description:

Read “Translation Research in Practice: An Introduction,” by Titler, from Online Journal of Issues in Nursing (2018).

On Biostatistics and Clinical Trials: PICO, PICOTS, PICOTT Framework for Clinical Questions as a Way to Design Clinical Trials
Description:

Read “PICO, PICOTS, PICOTT Framework for Clinical Questions as a Way to Design Clinical Trials,” by Deng, from
On Biostatistics and Clinical Trials (2020).

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