Problem Significance and Review of Literature Assignment
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Problem Significance and Review of Literature Assignment
Rising rates 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. A number of factors increase the risk of developing CAUTIs among patients with indwelling catheters. Some of these factors include prolonged urine bag replacement time (4 days and longer), patients aged 30 years and above, an extension of indwelling catheters, non-adherence to patient protocols, and poor hand hygiene during catheter placement and removal (Juanjuan et al., 2021). These risk factors, except the patient’s age, revolve around the involvement of the nurse in CAUTI rates. According to Atkins et al. (2020), limited knowledge among healthcare professionals is among the barriers to successful CAUTI prevention in contemporary healthcare settings. CAUTIs are associated with negative quality and performance outcomes in 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. Healthcare organizations should implement evidence-based interventions to prevent CAUTIs.
Problem Statement
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. CAUTIs have been identified to be among the common causes of morbidity in surgical wards, especially in colorectal surgery patients. 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. Nurses’ level of knowledge regarding CAUTI prevention affects their behaviors towards surgical patients. For instance, improper timing of urinary catheter replacement increases a patient’s risk of developing CAUTIs. For example, 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. In a study conducted by Ling et al. (2021), researchers discovered that patients who developed CAUTIs had 4 days extra length of stay. CAUTIs also increased morbidity and mortality in postoperative patients. Therefore, 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
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.
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?
References
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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
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.
Ling, R., Giles, M., & Searles, A. (2021). Administration of indwelling urinary catheters in four Australian Hospitals: cost-effectiveness analysis of a multifaceted nurse-led intervention. BMC Health Services Research, 21(1), 897. https://doi.org/10.1186/s12913-021-06871-w.
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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
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