(See attached Rubric)
Download and complete the Bare Bones Proposal Assignment. You will use content from your Problem Significance and Review of Literature and Methodology Assignments. Be sure to implement suggested faculty feedback from the assignments. Make sure you have responded to all portions of the grade rubric. You can simply combine these two assignments into one paper with revisions based on faculty feedback. This is a formal APA paper so you will need a title page and a reference page.
Bare Bones Proposal
Student’s Name
Institutional Affiliations
Bare Bones Proposal
Rising cases of catheter-associated urinary tract infections (CAUTIs) are among the factors that are affecting hospitals’ efforts to maximize patient safety today. According to Werneburg (2022), high CAUTI rates still remain a serious healthcare burden for hospitals despite the significant advancements that the industry has made to help diagnose, prevent, and treat these diseases. Farsi (2021) reported that 20.6% of 620 patients developed CAUTIs after undergoing colon and rectum surgery in an acute healthcare setting. Among the factors associated with the observed rates was the lack of training among nurses. According to Atkins et al. (2020), limited knowledge among healthcare professionals is among the barriers to successful CAUTI prevention in contemporary healthcare settings. Findings of a study conducted by Pokovik et al. (2019) revealed that CAUTIs lead to negative patient outcomes, increase patients’ length of stay, high patient mortality rates, negatively affect patient satisfaction, and increased healthcare costs. In this respect, healthcare organizations should implement evidence-based interventions to prevent CAUTIs.
Statement of the Problem
The clinical setting has been recording rising cases of CAUTIs among patients who have undergone colorectal surgery despite having employed adequate staff. Rates of CAUTIs among colorectal surgery patients in the facility have risen from 1% to 4% over the past one month. These rising cases are attributed to limited knowledge among the nurses regarding CAUTIs and their prevention strategies. For example, Farsi et al. (2021) linked high CAUTI rates in adult colorectal surgery patients with human-related factors attributed to limited knowledge among healthcare workers regarding CAUTI prevention strategies. Juanjuan et al. (2021) found that CAUTI rates were 66.67% in surgical patients where nurses replaced urine collection bags after 7 days and 13.33% in surgical patients whose urine collection bags were replaced between 2 and 4 days. Limited knowledge among nurses in relation to the risk factors for CAUTIs leads to delayed replacement of urine collection bags in post-surgical patients. Therefore, there is a need to implement strategies that will enhance nurses’ knowledge about the risk factors and prevention strategies for CAUTIs, particularly among colorectal surgery patients. Addressing high rates of CAUTIs in clinical settings is important to the public in that it will improve outcomes, reduce length of stay, prevent morbidity, reduce mortality rates, and enhance satisfaction.
Significance of the Study to Nursing
The proposed study has significant implications for nursing. Precisely, the study will provide evidence regarding the effects of educating nurses about CAUTI prevention on the rates of CAUTIs in colorectal surgery patients (Seyhan & Özbaş, 2018). Nurses in surgical units will use the evidence to improve the health outcomes of colorectal surgery patients. According to Schiessler et al. (2019) nurses who are adequately educated about how to implement evidence-based protocol regarding CAUTI identification, diagnosis, and prevention are encouraged to practice safety procedures autonomously which helps to reduce CAUTI incidences. Healthcare organizations will use study results to improve their practice policies and operating procedures for colorectal surgery patients. For example, medical facilities will use the results to evaluate whether they should include nurse training about CAUTI prevention in their onboarding and employee development practices (Mong et al., 2022; McIntosh, et al., 2021). Moreover, policymakers and healthcare regulatory agencies need evidence obtained from the proposed study to make decisions that are aimed at improving healthcare practice, improving health care policy for colorectal surgery patients, and improving nursing practice as a whole to promote patient safety in surgical departments.
Literature Review and Synthesis
The effectiveness of a nurse educational program in reducing rates of healthcare-associated infections in surgical patients is supported by published research. Published evidence identifies limited knowledge among healthcare professionals as a risk factor for CAUTIs in healthcare settings. For example, Farsi (2021) conducted a study to investigate the risk factors associated with postoperative CAUTI rates among colorectal surgery patients. Using a retrospective cohort design, the researcher assessed rates of postoperative CAUTIs in 620 colorectal surgery patients. The study found that nursing procedures that are performed during pre- and post-operations such as speedy interventions increased patients’ risks of developing CAUTIs. 20.6% of 620 patients developed CAUTIs after undergoing colon and rectum surgery. In a study conducted to examine the barriers and facilitators of CAUTI reduction in healthcare settings, Atkins et al. (2020) employed a mixed-methods approach conducted in three phases to gather evidence. From the study, it was evident that the nurse’s knowledge, memory, level of attention, and decision processes were among the major barriers to CAUTI-prevention behaviors. The researchers identified frequent nurse education training, education, and enablement as the key facilitators of CAUTI-prevention behaviors. Based on these findings, the recommended approach to address limited nursing knowledge in relation to CAUTI prevention is to provide frequent education, training, and enablement for nurses.
Nursing education and training are associated with a reduction in rates of CAUTIs in surgical patients. According to Schiessler et al. (2019), appropriate catheter removal and insertion prevent infections at the catheter site in patients with indwelling catheters. A qualitative study conducted by Schiessler et al. (2019) examined the effectiveness of a nurse-driven protocol for CAUTI prevention, primarily focusing on catheter removal, in reducing the rates of CAUTIs. The protocol primarily focused on the removal of catheters using the Plan, Do, Check, Act methodology. Within a period of 6 months, the facility recorded a 28% reduction in CAUTI rates. Guiding nurses through catheter removal increased their practice autonomy and safety attitudes. In a similar study, Barnum et al. (2020) analyzes changes in CAUTI rates after medical students in the operating room were taken through a simulation-based curriculum that primarily focused on urinary catheter insertion. From this study, the implementation of urinary catheter insertion simulation-based curriculum completely eliminated CAUTIs in the operating room. Educating nurses on how to appropriately insert and remove catheters provides nurses with the skills that they need to safely manage surgical patients thereby enabling them to prevent CAUTIs and improve patient outcomes.
The implementation of an educational program is widely recognized as a long-term prevention strategy for CAUTIs in patients with indwelling urinary catheters. Menegueti et al. (2019) conducted a quasi-experimental study with nurses and healthcare workers (HCWs) deployed in a general intensive care unit to investigate how the implementation of a daily checklist and an educational program on rates of CAUTIs among critically-ill patients. The researchers implemented routine training on CAUTI prevention coupled with the use of a daily checklist in IV phases. During the four phases, the incidence density of CAUTIs reduced from 14.9, 7.3, 3.8, to 1.1 per 1000 catheter days, respectively. In a semi-experimental study conducted by Seyhan and Özbaş (2018), the researchers found that nurse education increased the mean post-education knowledge score to 95.13 ± 6.27 from 68.05 ± 10.69 in pre-education. There was a decrease in the mean catheter duration from 1.06 ± 6.34 days-3.83 ± 0.95 days following nurse education. CAUTI rates were reduced by 9.37 per thousand. The effectiveness of HCWs’ education in reducing CAUTIs among surgical patients is further supported by Krocová et al. (2019) who assert that education of healthcare workers regarding CAUTI prevention is among the multifactorial measures utilized by healthcare organizations to prevent CAUTIs in patients with urinary catheters. Healthcare organizations need to evaluate the impacts of each of these factors independently to determine their effectiveness.
Numerous studies have confirmed the positive correlation between nurses’ knowledge regarding CAUTI prevention and a reduction in CAUTI rates. Haza’a et al. (2021) revealed that CAUTI rates remained low at public hospitals in Amran City in Yemen because nurses had some level of knowledge regarding CAUTI prevention. The researchers recommended that hospitals should increase nurses’ knowledge of CAUTI prevention through workshops, continued training, and improved curriculum. Using a cross-sectional study design, Mong et al. (2022) assessed the effects of nurses’ attitudes and knowledge on CAUTI rates in medical-surgical inpatient wards at a Malaysia-based tertiary teaching hospital. Nurses with good knowledge about CAUTI prevention had positive attitudes towards engaging in CAUTI prevention interventions. Van Decker et al. (2021) recommend the use of a bundled care model that includes the implementation of nurse educational programs to help reduce rates of CAUTIs in healthcare settings. An educational program that aims to teach nurses about CAUTI prevention helps to reduce infection rates among at-risk patients.
Purpose
The purpose of the study is to examine the effects of implementing a nurse educational program on rates of CAUTIs among adult patients who have undergone colorectal surgery. A nurse educational program is the independent variable and CAUTI rate is the dependent variable. The intended population is a team of operating room nurses who are working with adult colorectal surgery patients.
Research Question/PICOT
The intervention template was used to develop a PICO question assessing the effects of a nurse educational program on rates of CAUTIs among colorectal surgery patients in the clinical setting. In adult patients who have undergone colorectal surgery, how does the implementation of a nurse educational program compared to the lack of education for nurses affect rates of CAUTIs?
Methodology
Research Design
Type of Design
A quasi-experimental study will be conducted to examine the effects of a nurse educational program on rates of CAUTIs among adult patients who have undergone colorectal surgery. A quasi-experimental research design is a type of design that almost resembles an experimental research design but the independent variable is manipulated (LoBiondo-Wood & Haber, 2019). It is the most appropriate design for studies that are aimed at establishing a cause-and-effect relationship among variables but where participants cannot be selected at random, the intervention cannot be assigned randomly to study participants, and a control group cannot be created to help monitor the impacts of the intervention (LoBiondo-Wood & Haber, 2019). The chosen research design is appropriate for the proposed study because the study entails the implementation of an educational program for a group of nurses to establish its effects on the rates of CAUTIs among adult colorectal surgery patients.
Control for Extraneous Variables
The principal investigator will put in place appropriate measures to control extraneous variables. Cobzaru et al. (2021) define an extraneous variable as that type of variable that is not being investigated but that which might have an effect on the dependent variable. The extraneous variables in the proposed study include noise within the environment where the study will be conducted and the participants’ awareness of the intended goal of the study. For instance, noise within the study environment might prevent nurses from understanding the concepts being taught. As a result, there would be no difference in patient outcomes before and after the implementation of the educational program. Additionally, nurses might care for patients differently even without acquiring new knowledge from the training program when they learn about the goal of the planned study in advance (Cobzaru et al., 2021). The investigator will control for these extraneous variables by implementing the educational intervention in a quiet room and by using external trainers to make it appear like nurses are receiving normal training.
Sampling Plan
Type of Sampling Plan
The specific sampling plan that will be used for the study is convenience sampling. Andrade (2021) defines convenience sampling as the type of non-probability sampling plan where the researcher utilizes the sample that is conveniently available. Convenience sampling is appropriate for the study because the study will use operating room nurses who are working with adult colorectal surgery patients. These nurses are conveniently accessible in the practice setting.
Target Population
The target population for the study is a team of operating room nurses who are working with adult colorectal surgery patients. Since the investigator will use a convenience sampling technique, all nurses who will be on duty at the time of the study will be included in the sample. The use of the convenience sampling technique in the recruitment of nurses will enable the investigator to eliminate bias and increase internal validity, especially when the data is collected appropriately (Andrade, 2021). Additionally, in order to control for extraneous variables, the investigator will implement the educational intervention in a quiet room and use external trainers to make it appear like nurses are receiving normal training.
Method for Selection of Sample
The sample will be obtained from the duty roster of the facility. The roster will be reviewed to identify nurses who meet the inclusion criteria. Only those who meet the set criteria will be included in the study. Nurses deployed in the operating room to provide care to adult colorectal surgery patients will be sampled for training.
Inclusion and Exclusion Criteria
Inclusion and exclusion criteria will be used to recruit the right participants for the study. The three inclusion criteria that will be used include; operating room nurses, must be caring for adult colorectal surgery patients, and must have worked at the facility for at least 6 months by the start of the study. The exclusion criteria will include; nurses not deployed in the operating room, operating room nurses who are not providing care to adult colorectal surgery patients, and nurses who have stayed in the facility for less than 6 months by the start of the study.
Data Collection Procedures
Process for IRB Approval and Informed Consent
The study will begin by obtaining ethical approval from the Institutional Review Board (IRB). This is important because the study will utilize human subjects whose rights must be protected throughout the study. Informed consent will be obtained from participants who meet the inclusion criteria. Operating room nurses who meet the inclusion criteria will be required to read and sign a form that describes details of the planned study, including its associated risks and benefits.
Intervention
The intervention, which also acts as the independent variable, will be a nurse education program. The intervention will be administered during the second phase of the study. Nurses who meet the inclusion criteria will be offered an educational program explaining the best practice protocols to maintain quality care and safety of post-surgery patients. They will also be taught how to identify and manage risk factors for CAUTIs.
Procedure for Data Collection
The current place of work will be the venue for the study. The study will be conducted for a period of 6 weeks. It will be divided into 3 phases comprising of 2 weeks each. The three phases include a pre-test, an intervention phase, and a post-test phase. Data related to rates of CAUTIs will be collected in each phase from the electronic health records. During the pre-test, the project team will record rates of CAUTIs among adult colorectal surgery patients without administering the intervention. In phase two, the team will implement a nurse educational program while also recording changes in CAUTI rates. In the third and last phase or post-test, rates of CAUTIs will be recorded and no intervention will be implemented. The rationale for the post-test is to assess changes in CAUTI rates after the implementation of a nurse educational program. Data from the charts will be accessed with the help of the nurse manager.
Measurement of Variables and Outcomes
The study will measure one primary outcome variable. The primary outcome variable will be CAUTI rates among colorectal surgery patients. It is anticipated that rates of CAUTIs at the facility will reduce following the implementation of the nurse educational program.
Measures or Data Collection Tools
Data Collection Tool
Changes in CAUTI rates will be recorded in a computer as part of the facility’s electronic health records. The specific data to be collected will include; the total number of adult colorectal surgery patients at the time of study (N), the number of episodes of CAUTIs during the three phases of the study, and the mean incidence rates of CAUTIs during the pre-test, intervention phase, and post-test. The investigator will also collect data related to the patient’s age, gender, time of hospitalization, and presence or absence of comorbidities. In order to establish whether patients have developed CAUTIs or not, the investigator will perform a Urine Re and CS test (a urine routine examination and urine culture sensitivity test) (Morado & Wong, 2022). Changes in rates of CAUTIs will be evaluated using the criteria recommended by the Centers for Disease Control and Prevention (Centers for Disease Control and Prevention, 2022). These criteria have been adequately tested and thus will give reliable, valid, and consistent data.
Reliability, Validity, and Ensuring Consistency
The Urine Re and CS test is a highly valid are reliable exam for determining rates of CAUTIs in at-risk patients. The test combines urinalysis and urine culture to detect urine components and pathogens that are used to confirm the presence of urinary tract infections in patients with indwelling catheters. The Urine Re and CS test is reliable in that it provides accurate and consistent results across patients. The validity of the test is confirmed by its ability to provide acceptable results that adequately match the outcomes that are being measured (Morado & Wong, 2022). The investigator will work with the same participants and implement the intervention under similar conditions throughout the study period to ensure consistency in data collection among all participants. Table 1 shows the data collection sheet that will be used to record changes in CAUTI rates.
Table 1: Data Collection Sheet
The total number of adult colorectal surgery patients at the time of the study (N=?)
| Patient Demographics
Age: Gender: M=?; F=?: Time of hospitalization: Presence or absence of comorbidities |
| Baseline/Pretest | Intervention phase | Post-test | |
| The number of episodes of CAUTIs | |||
| The mean incidence rates of CAUTIs |
References
Andrade C. (2021). The inconvenient truth about convenience and purposive samples. Indian Journal of Psychological Medicine, 43(1), 86–88. https://doi.org/10.1177/0253717620977000.
Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., Bunten, A., Michie, S., & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science: IS, 15(1), 44. https://doi.org/10.1186/s13012-020-01001-2.
Barnum, T., Tatebe, L. C., Halverson, A. L., Helenowski, I. B., Yang, A. D., & Odell, D. D. (2020). Outcomes associated with insertion of indwelling urinary catheters by medical students in the operating room following implementation of a simulation-based curriculum. Academic Medicine: Journal of the Association of American Medical Colleges, 95(3), 435–441. https://doi.org/10.1097/ACM.0000000000003052
Centers for Disease Control and Prevention. (2022). Catheter-associated urinary tract infections (CAUTI). https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html
Cobzaru, R., Jiang, S., Ng, K., Finkelstein, S., Welsch, R., & Shahn, Z. (2021, n.d.). State of the art causal inference in the presence of extraneous covariates: A simulation study. American Medical Informatics Association Annual Symposium Proceedings, 1(1), 334–342.
Farsi A. H. (2021). Risk factors and outcomes of postoperative catheter-associated urinary tract infection in colorectal surgery patients: a retrospective cohort study. Cureus, 13(5), e15111. https://doi.org/10.7759/cureus.15111.
Haza’a, A., Al-Jaradi, A., & Odhah, M. (2021). Knowledge of nurses toward prevention for catheter-associated urinary tract infection in public hospitals at Amran City, Yemen. Open Journal of Nursing, 11, 933-946. doi: 10.4236/ojn.2021.1111076.
Juanjuan, D., TianTian, Z., Yue, D., Lili, W., Ping, X., & Xu, H. (2021). Analysis of etiology and risk factors of catheter-associated urinary tract infection in critically ill patients and research on corresponding prevention and nursing measures. Applied Bionics and Biomechanics, 2021, 8436344. https://doi.org/10.1155/2021/8436344.
Krocová, J., Prokešová, R. & Horová, J. (2019). The prevention of healthcare associated urinary tract infections from the point of view of nursing care. Journal of Nursing and Social Sciences Related to Health and Illness, 21(2), 135–143. doi: 10.32725/kont.2019.008.
LoBiondo-Wood, G. & Haber, J. (2019). Nursing research: methods and critical appraisal for evidence-based practice. Mosby.
Menegueti, M. G., Ciol, M. A., Bellissimo-Rodrigues, F., Auxiliadora-Martins, M., Gaspar, G. G., Canini, S., Basile-Filho, A., & 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), e14417. https://doi.org/10.1097/MD.0000000000014417.
McIntosh, S., Hunter, R., Scrimgeour, D., Bekheit, M., Stevenson, L., & Ramsay, G. (2021). Timing of urinary catheter removal after colorectal surgery with pelvic dissection: A systematic review and meta-analysis. Annals of Medicine and Surgery (2012), 73, 103148. https://doi.org/10.1016/j.amsu.2021.103148.
Mong, I., Ramoo, V., Ponnampalavanar, S., Chong, M. C., Wan, N. W. (2022). Knowledge, attitude and practice in relation to catheter-associated urinary tract infection (CAUTI) prevention: A cross-sectional study. Journal of Clinical Nursing, 31(1-2):209-219. doi: 10.1111/jocn.15899.
Morado, F., & Wong, D. W. (2022). Applying diagnostic stewardship to proactively optimize the management of urinary tract infections. Antibiotics, 11(3), 308. https://doi.org/10.3390/antibiotics11030308.
Podkovik, S., Toor, H., Gattupalli, M., Kashyap, S., Brazdzionis, J., Patchana, T., Bonda, S., Wong, S., Kang, C., Mo, K., Wacker, M. R., Miulli, D. E., & Wang, S. (2019). Prevalence of catheter-associated urinary tract infections in neurosurgical intensive care patients-The overdiagnosis of urinary tract infections. Cureus, 11(8), e5494. https://doi.org/10.7759/cureus.5494.
Seyhan, A. E & Özbaş, A. (2018). The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. Journal of Clinical Nursing, 27(5-6):e1078-e1088. doi: 10.1111/jocn.14160.
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. https://doi.org/10.1097/pq9.0000000000000183.
Van Decker, S. G., Bosch, N., & Murphy, J. (2021). Catheter-associated urinary tract infection reduction in critical care units: a bundled care model. BMJ Open Quality, 10(4), e001534. https://doi.org/10.1136/bmjoq-2021-001534
Werneburg G. T. (2022). Catheter-associated urinary tract infections: current challenges and future prospects. Research and Reports in Urology, 14, 109–133. https://doi.org/10.2147/RRU.S273663.