Translational Research – Use Of Indwelling Urinary Catheters

Indwelling urinary catheters are extensively utilized in hospitalized patients and can be suitable ways for therapeutic management under particular situations. Nevertheless, a number of indwelling urinary catheters are utilized with no clear indications, therefore subjecting patients at an unnecessary complications risk in their hospitalization. Among the catheter associated complications include psychological and physical discomfort to the patient, renal inflammation, bladder calculi, and catheter-related urinary tract infections (CAUTI). CAUTI development in older adults can yield into immobility, fall and delirium (Bernard et al., 2012). Most healthcare organizations are experiencing increased in the rate of mortality and morbidity as a result of CAUTI. In this regard, more and more research are being carried out to establish evidence based practices that would reduce the risk of CAUTI among hospitalized individuals, particularly elderly and those in the intensive care unit.

Current Nursing Practice

Nurses in our healthcare organization have been using indwelling urinary catheters to assist critically ill patients to remove urine from their body. This practice has for long been recognized as the best practice to assist elderly and critically ill patients who cannot manage to toilet. Normally, patients with indwelling urinary catheter are normally bathed by nurses. The healthcare has been experiencing increase in cases of CAUTI since 2010. This has highly been associated with poor insertion and position of the indwelling urinary catheters causing the tube blockage. This makes the urine accumulation in the bladder and thus, increasing risks for urinary tract infections and thus, the development of CAUTI condition. CAUTI condition is a preventable condition. It can easily be prevented by employment of evidence based practices in insertion of the tube and in management of the patients working with indwelling urinary catheter.

Why the Current Nursing Practice Need to be changed

The current indwelling urinary catheters practice need to be changed for a number of reason. One of the main reasons is that the current technique used in the administration of the catheter is the increase in the rate of CAUTI infection. The hospital is experiencing 36% increase in the rate of CAUTI currently as compared to the rate in the last five years. CAUTI has been recognized as a hospital acquired infection as a result of poor nursing practices (Strouse, 2015). In this regard, it is evident that this condition can highly be prevented. The healthcare organization has realized that this can be prevented by employing various evidence based practices during the insertion of the tube and during the nursing management practice for patients inserted with catheter. The employment of evidence based practice is anticipated to reduce the rate of CAUTI infection by 80%. In this regard, the healthcare organization plans on implementing evidence based practice to reduce the rate of CAUTI among the elderly and critically ill patients in the organization.

Identifying the Key Stakeholders in the Health Setting

The impact of the current indwelling urinary catheter practice affect a number of individuals in this healthcare organization. This include the patients, nurses, the management, family members, surrounding community, and physicians, among other individuals. Therefore, all these stakeholders, together with the informatics nurses will be involved in the current change.

Role of the Identified Stakeholders

Patients

Patients will play a major role in the initiation of change and its implementation. Since patients are directly affected by the situation, they have a duty to report their new symptoms and anticipate assistance from the nurses in charge. This continuous and sincere reporting of the symptoms will create a concern among the physicians, nurses and the healthcare management and thus, pushing them into defining a solution. The similarity in the symptoms and extensive reporting will be of great importance in pushing the concerned individuals into developing a viable solution for the problem.

Families and the surrounding Community

The family and the community will play a great role of pressuring the healthcare organization into speeding up the process of change. Normally, families bring their loved ones into a healthcare facility with the hope that they will regain their health and quality of life. In case an organization fails in doing this, the family members may consider transferring their patient to another healthcare organization. This increases the rate of competition and high need to offer quality care to retain its customers. The spread of the word regarding high rate of infection in the healthcare to the community results to loss of customers as patients consider visiting other healthcare organizations. This pressure from the community and families push the healthcare organization into employing immediate measures to harness the situation.

Nurses

Nurses have a duty to evaluate the symptoms, to identify the trend and similar characteristics among the affected individuals and to report the situation to the nursing leaders. Nurses will also be involved in researching on the practices or procedures that result to CAUTI condition and those that do not result to the situation for patients with similar conditions. This will assist in identifying the main cause or the actual practice that result to this condition. Therefore, nurses will have a great responsibility in collecting the actual statistics regarding the number of impacted individuals, the procedures that initiates the infection, the level of severity and proposing need for immediate attention. Nursing leaders will play a major role in ensuring that the right solution is found and effectively employed.

Healthcare Management

The healthcare management will play a major role in assisting the nursing department in the implementation of the identified changes. This include financing the research and the implementation processes, setting new healthcare organization goals

Informatics Nurses

Informatics nurses will play a major role in research more about the condition and its evidence based prevention or intervention practice from the published literature. This include various online databases, online medical sites, conference materials, and any other medical research work regarding CAUTI. The collected materials will be provided to the nurses and physicians to assist in identifying the best evidence based practices that can be employed to reduce the rate of infection in the healthcare center.

Physicians

Physicians will play a major role in defining the best viable solution for the identified problem. In this regard, they will be involved in making informed judgment with regard to the best measures to take. They will also assist in monitoring the viability of the employed solution based on the intervention outcome.

Evidence Summary

CAUTI is one of the hospitalized infection that can be prevented. It accounts for 80% of the total number of hospitalized infection. In this regard different researches have been employed to prevent these infections. The center for disease control and prevention (CDC) developed a guideline to assist in prevention of CAUTI. These guidelines contain three important components that include suitable utilization of indwelling urinary catheters, use of suitable methods for insertion of indwelling catheter, and the use of suitable methods for maintenance of the indwelling urinary catheter (Hus et al., 2012). There are a number of defined good practices that reduces the rate of infection. Method of bathing patients is one of them. Basin bathing and chlorhexidine wipes are known to increase the rate of infection among critical and elderly patients. The best recommended practice for cleaning patients with indwelling urinary catheters to prevent the rate of infection is by use of non-medicated cleansing wipes (Strouse, 2015).

Other recommended best practices include catheterizing patients just when it is very necessary, emphasizing on the significance of effective hand washing for all nurses and use of gloves for the insertion process (Pratt & Pellowe, 2010). Others include the use of sterile equipment to insert catheters, employment of suitable daily perineal care and after each bowel movement. Urine clarity should also be noted. The main noted mistakes in the insertion process is the use of aseptic insertion technique. This increases the contamination risks from the multiuse tube (Carter et al., 2014). Most nurses use multiuse lubricant for catheter tube insertion instead of a single-use packet. Lubricants reduces friction and other discomforts during the insertion process, however single-use packet is highly recommended to reduce contamination (Pratt & Pellowe, 2010). Another best practice recommended for reducing the rate of infection is reducing the length of catheterization. The use of catheters for a long duration increases the chances of developing infections and thus, they should be removed as soon as possible (Bernard et al., 2012).

In a research Meddings et al. (2015), established that Foley catheter is commonly used and it also possess the greatest risk developing CAUTI. To reduce the rate of infection, nurses should consider using any other catheter rather than Foley catheter. In case the use of Foley is unavoidable, close monitoring is needed to notice any changes that would demonstrate onset of infection among patients (Meddings et al., 2015). It is also important for nurses to identify urinary retention risk factors, and enhancing proper management of these patients. This should be enhanced by clearly documenting on the patient urinary retention condition to enhance proper management all through (Johansson et al., 2013).

Best Recommended Practice

The best practice that should be recommended to our healthcare organization is the use of the best insertion procedures as well as the best patient management or maintenance procedures. The insertion procedures should ensure the use of single-packet lubricant to reduce the rate of contamination. Nurses should ensure thorough wash of hands before and after insertion or maintenance process. Gloves should be worn during the process. Sterile equipment will be used in all insertion process while aseptic insertion technique will be highly avoided. The healthcare will avoid the use of Foley which is said to have a high rate of infection. The recommended maintenance practice include reducing the catheterization days, cleaning patients with non-medicated wipe and also close monitoring of the patient urine to not any change of color.

Best Practice Change Model

The main issue in this healthcare organization is the lack of information regarding evidence practice in catering for indwelling urinary catheter. In this regard the best change model to employ is ACE Star knowledge transformation model. This model is employed since it enhances evidence translation into practice. The model assist in making the best decision regarding the best practice to implement. The model has five stages. These stages include discovery, evidence topic summary, action translation, integration of practice and finally evaluation stage. The model assist in the collection of all possible information regarding the topic of change (Stevens, 2013). This information is obtained in the first stage through research. The integrative review is conducted and the summary on the best practices identified. The identified practices are then translated into action. Best evidence is then is then obtained through practice integration. The organization is then involved in evaluation process to establish the effectiveness of the employed process.

The change process in this case will involve researching for the best practice to cater for patients using indwelling urinary catheter. The research will be conducted extensively and the research outcome summarized. The research process will involve informatics nurses. The best practices will be selected by the nursing leaders and the physicians involved in the management of these patients. The integration of the new intervention measures to the current process and implementation of change will involve the involved nurses and the nursing leaders. The poor practices in this process will be eliminated and only the best recommended practices will be utilized. The integration process will involve training and supervision to ensure that the recommended practices are employed effectively. The monitoring process will involves nurses, physicians and the nursing leaders who will be keen to check on the rate of infection within a certain period of time as compared to the rate at the moment. Effective integration of change will be noticed by the decrease in the rate of infection (Stevens, 2013).

Barrier to the Successful Implementation

The successful implementation of this process can be obstructed by a number of issues. Some of these issues include need for training nurses on slight changes in their usual procedures. This may create confusion since the change is slight and thus making it easier to be forgotten. Another major challenge is that the new changes may experience resistance from the nurses. Many nurses may still fail to see the importance of slight change of the procedures and thus, refusing to implement these changes. This may demand more supervision and make it hard for the management to implement these changes. Close supervision ay demand increase in the number of nurses in the department since it demand a reduction in the nurse to patient ratio. This may be expensive to the organization. The organization may also be required to use more in purchase of more protective gears for the job, and any other required facility to enhance the new changes. This may make it hard for the management to accept all the recommended changes.

Possible Ethical Implication Arising

Nurses have an ethical obligation to cater for its patients and ensure their wellbeing. They are required to ensure good care that will ensure the wellbeing of the organization. In this regard, nurses and the entire change team should ensure that the employed measures do not results to more complications but they improve the patient’s wellbeing. The possible ethical issue that can occur in this case include making no change or worsening the patient situation with the current changes. This can be taken as a failed experimental process which directly involved human sample unethically. Thus, mistakes should be avoided and only the evidently identified measure employed as required to avoid more complications that would initiate ethical issues.

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