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Chamberlain college of nursing nr451 week 2 discussion the clinical question

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This is a graded discussion: 50 points possible

Hi Class,

This week’s graded discussion topic relates to the following Course Outcome (CO).
  • CO4 Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO 4)

Your capstone change project begins this week when you identify a practice issue that you believe needs to change. The practice issue must pertain to a systematic review that you must choose from a List of Approved Systematic Reviews for the capstone project, whose link may be found in the guidelines for the Week 3 Capstone Project: Milestone 1 assignment page.

  • Choose a systematic review from the list of approved reviews based on your interests or your practice situation.
  • Formulate a significant clinical question related to the topic of the systematic review that will be the basis for your capstone change project.
  • Relate how you developed the question.
  • Describe the importance of this question to your clinical practice previously, currently, or in the future.
  • Describe what a research-practice gap is.

Scott

Professor Scott,

As an Occupational Health Nurse, our role as described by The American Association of Occupational Health Nurses (2016) is to provide for and delivers health and safety programs and services to workers, worker populations, and community groups. The focus is on promotion and restoration of health, prevention of illness and injury, and protection from work-related and environmental hazards. So, promoting health and wellness is important in ensuring a healthy worker population. For the capstone project, I have selected this article about promoting healthy pregnancy with diet and exercise – Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. on  Diet or exercise, or both, for preventing excessive weight gain in pregnancy.

My PICO question would be,

Among pregnant women, does implementing a healthy diet and exercise, as compared to not implementing health diet and exercise, help to reduce excessive gestational weight gain (GWG)?

P – Pregnant women

I – include healthy diet and exercise during pregnancy

C – Nonhealthy diet and no exercise

O – reduce excessive gestational weight gain (GWG)

I have encountered many pregnant employees, that have come to our clinic that are not aware of the “Healthy Pregnancies, Healthy Babies”  program offered by our organization. This program is available to all benefitted employees, the program involves health coaching, free prenatal vitamins, and up to $250 cash incentives. When asked about their pregnancy, a large majority of these women has not considered a change in their diet or importance of exercise during their pregnancy. Most women would increase the amount of food intake but not consider the health risk or benefit from the type of food consumed. I would educate the employee of the importance of eating a healthy diet and exercising to maintain a healthy pregnancy weight to prevent pregnancy complications.

A research-practice gap is defined as insufficient or imprecise information, biased information, inconsistency and, or incorrect information from wrong population or wrong outcome in the ability to reaching a conclusion for a research (Carey, Yon, Beadles & Wines, n.d).

References:

American Association of Occupational Health Nurses ( 2016). Retrieved from http://aaohn.org (Links to an external site.)

Carey, T., Yon, A., Beadles, C. &Wines, R. (n.d). Identifying and Prioritizing Research Gaps. The Cecil G. Sheps Center For Health Services Research. Retrieved from https://www.pcori.org/assets/Identifying-and-Prioritizing-Research-Gaps1.pdf (Links to an external site.)

Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 6, Art. No.: CD007145. DOI: 10.1002/14651858.CD007145.pub3.

Professor and class,

          “Healthcare-associated infections (HAIs) are a major threat to patient safety and are associated with mortality rates varying from 5% to 35%” (Flodgren,2013) One of the most prolific is the CAUTI. Many of the long-term catheters placed in my hospital start in the ED. Truthfully, not one of the most aseptic environments in the hospital. We were always hearing about the CAUTI rate and how bad it was. The sterile technique was more of a good idea than actual practice. Between stroke scales, CT, two large bore iv’s above the wrist, titrating drips and TPA, ect…, oh crap, the patient in two is seizing again, somebody get a cath in room four before we roll for the OR!! The focus is strictly on stabilizing, worry about the possible UTI after we save the guys life, in other words, just get it in now! A couple of years ago we started bringing ICU nurses into the ED to care for the ICU patients once they were stable. We started to learn about how a patient could be lost, after we saved their life. They wanted to teach, and we were eager learn. As the patient was stabilized the ICU nurse would come in and slowly take over, showing us how to do things in ways we never had before.  Many times, a patient that would just get an indwelling cath, now will get an alternative. Our nurses were being rabid about maintaining a sterile field. The overall CAUTI infection rate dropped. Times change, staff changes, hospital programs change, without that constant highly trained advocate there reminding us of the long term real consequences and constantly helping us improve our game, the CAUTI rate is climbing again. All our nurses are very well trained, they are also very overworked. When multiple critical patients are inbound, the pressure to clear the recess rooms can be enormous.

For my capstone project I have selected the article Interventions to improve professional adherence to guidelines for prevention of device-related infections. (Flodgren 2013) Specifically, devices placed in ED patients admitted to the hospital.   My question is,

Among ED patients admitted to the hospital, does having a specially trained nurse advocate on the unit, compared to current individual practice and training, reduce hospital acquired catheter infections?

The research- practice gap is clear, while we know what is important, is not always placed at the top of the list because the consequences, while understood clinically, are in the future, therefore easy to be ignored today. “One nurse with accountability for implementing a simple evidence-based protocol can dramatically decrease the total incidence of hospital-acquired CAUTI.”  (Quinn, 2015)  If we place a nurse champion in the action, with the responsibility, holding everyone accountable in the moment, at the beginning in the ED, I suspect their influence can decrease these device related infections and help narrow the research- practice gap.

References

Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections. The Cochrane Database Of Systematic Reviews, (3), CD006559. doi:10.1002/14651858.CD006559.pub2

Quinn P. Chasing Zero: A Nurse-Driven Process For Catheter-Associated Urinary Tract Infection Reduction in a Community Hospital. Nursing Economic$ [serial online]. November 2015;33(6):320-325. Available from: Academic Search Complete, Ipswich, MA. Accessed March 5, 2018.

Hey Guy,

You did a very job with your clinical question. You are good to go with the next steps of your project! 🙂

Scott

Hi Guy,

Great post. HAI’s are definitely a big threat to our patient’s safety, and with patient safety being one of our top priorities it’s a must we try and reduce the number of HAI’s. I enjoyed reading your post from the standpoint of an ER nurse. Your honesty about how things are really done down there opened the eye to other nurses on how aeseptic technique isn’t always used at its best. I have only been a nurse for two years, and I only have worked med surg, so it’s quite interesting to see your point of view. I now have a better understanding. Good job!

Kierra

Hi Guy, very informative post and it’s all so true!! It’s interesting the study your unit did with indwelling catheterization. I will be anxious to see the results of your research. I to decided to do my project on CAUTIs and if infections can be prevented. This seams to be an epidemic in any hospital and I believe it’s one that can be prevented. I guess our research will answer that question.
Hello Guy:

Your project seems interesting. I am similarly working on reducing CAUTI’s in my area of work. Nurse-driven evidence-based practice processes are of utmost importance in improving patient care outcomes. However, nurse compliance to the implemented care bundles remains an obstacle that leads to hospital-acquired infections (HAI’s), a National Patient Safety Goal of Joint Commission, (Woten et al, 2017).

I suggest that rotation within the business and finance departments should be part of our mandatory nursing training. We all need to realize that without hospital reimbursement, there will be no money for raises, equipment purchase or repair, (Rau, 2015). It is just like paying the bills at home, if the children never see the actual amount of the bills and your take-home pay, they will never grasp the concept of the value of your dollar. Good job Guy.

Marlene.

References

Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/

Woten, M. B., & Mennella, H. A. (2017). National Patient Safety Goals (Joint Commission, 2016): Limiting Use and Duration of Indwelling Urinary. CINAHL Nursing Guide.

Hi Guy, I agree

For instance, there exist many researches that suggest possible solutions towards addressing HAI, but in practice these solutions may not be effectively implemented either caused by relevance in the modern setting, or lack of knowledge being passed on clinical practitioners. The research-practice gap greatly undermines research efforts to solve clinical solutions.

Charlyne 

I currently work in a pediatric CVICU.  The age range of our patients ranges from neonates to 60 years of age.  The highest volume of an age of our patients is neonates.  Neonates are very prone to infection due to their immature immune system, to begin with.  Our post-operative open heart patients are at very high risk for infection.  Healthcare-associated infections are a major threat to our patient’s safety.  After implementation of a multi-faceted bundle, our CLABSI rate has dropped to the single digits for this past year.  Would implementing our CVICU bundle in PICU which has a much higher rate of CLABSI help decrease their rates?  For the capstone project, I decided to choose the systemic review on healthcare-associated infections with an emphasis on staff practice on reducing the instance of central line-associated bloodstream infections (CLABSI).

Does developing and implementing a multifaceted intervention bundle help lower the instance of central-line-associated bloodstream infections?

Our CLABSI bundle involves having to dawn mask, headgear, gown, and sterile gloves when having to access a central line which is a big addition to the hospital’s policy when accessing central lines.  The main reason for this is because our unit policy is to give back the patients waste when drawing from the central line.  In other units, the nurses are not allowed to give back the waste without having an MD order.  But since their CLABSI rates are higher would implementing our bundle decrease their infection rates?

A research-practice gap is an area in which there is missing and/or insufficient information that makes it impossible to come up with a solid conclusion to a question.

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.

Hong, A. L., Sawyer, M. D., Shore, A., Winters, B. D., Masuga, M., Lee, H., & … Lubomski, L. H. (2013). Decreasing Central-Line-Associated Bloodstream Infections in Connecticut Intensive Care Units. Journal For Healthcare Quality: Promoting Excellence In Healthcare35(5), 78-87. doi:10.1111/j.1945-1474.2012.00210.x

Good job Alexander. Let’s revise your question some so that it better follows the clinical question format. For example:

Among PICU patients, does implementing a multifaceted evidence based CLABSI bundle, as compared to the current practice, help to decrease the rate of CLABSIs?

How does that sound?

Hello professor,

That revised question sounds a whole lot better.

Thank you.

Thank you Alexander for you post. I have decided to do my project on catheter associated urinary tract infections and you post allowed me to brainstorm on different ways to implement a bundle in the ED.  I am happy to hear that your intervention worked in reducing the rates of infections in your unit especially with the fragility of the population of patients you work with. I am curious to know how the staff received the implementation of the bundle.  Were your coworkers resistant to the education and implementation? Do they continue to adhere to the policies closely as time goes by?
Hello Professor and Class,

Working with oncology patients does expose this patient population more at risk for infection due to  myelosuppression. Most of the oncology patient that are currently receiving treatment does have an implanted port to use for treatment. In my previous healthcare organization that I worked, accessing port was part of the routine, nurses had to be train and utilized aseptic technique.

My PICO question would be:

Does adhering to strict clinical interventions such as utilizing strict aseptic techniques (the use of gown, using alcohol based to cover tip and bio patch dressing containing chlorohexidine–central line bundle), reducing the duration of time using CVC and education training in preventing infection reduces the incidence of HAI in outpatient setting?

P- Outpatient oncology patients with central line.

I- Utilizing clinical interventions

C- Not utilizing clinical interventions

O- The rate of HAI in outpatient oncology patient

It is important to consider EBP and utilized information and applied it to our practice to effectively care for the patient with best possible outcome. This topic is important because from EBP, nurses can learn what has been proven to work to prevent infection from HAI. With oncology patient it is imperative that we prevent any type of infection because this patient population is already vulnerable and cannot afford to be sicker from HAI. “cases may be preventable if current evidence-based strategies of infection prevention are used during the insertion and maintenance of invasive devices “(Umscheid 2011).

Research gap practice is when information that has been research is not disseminated. It is imperative that in research information that has been founded to be effective will be available. “The use of a range of communications industry techniques was vital in establishing effective communication channels to share interim and final research findings. The benefits of using a selection of key techniques is examined and recommendations are made that could help other researchers capitalize on professional communication approaches to help ensure the impact of their work is fully realized” (Hewison et all, 2016).

Kristine

Reference:

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2.

Hewison, A., & Rowan, L. (2016). Bridging the research-practice gap. British Journal Of Healthcare Management22(4), 208-210. doi:10.12968/bjhc.2016.22.4.208

https://chamberlainuniversity.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=114796811&site=ehost-live&scope=site

Great job Kristine! I do have a couple of suggestions. Include your population just as you have it in your P section. Also, you may want to narrow your focus a little more with your implementation. Or you may could just use the word bundle to sum it up. For instance:

Among oncology patients with central lines, does the implementation of an evidence based CLABSI bundle, as compared to not using a bundle, help to decrease the rate of CLABSIs?

Does that make sense?

Scott

I chose to do my Capstone Project on the Obstetrics/Delivery. Being a Mother/Baby nurse women and newborn health is dear to my heart. Healthcare is rapidly changing and so are the patients we care for. There is definitely an increase in women who come in with gestational diabetes (GD) and Hypertension (HTN). We are seeing it more and more and it has become a huge issue. Not only does it affect the mother, GD and HTN can affect the way the baby develops and grows not only in utero but outside of mom. I have witnessed an 11 lb 6 oz baby born to a gestational diabetic mother literally going through withdrawal type episodes from all that sugar he was getting from mom, that he was no longer getting on his own. The baby showed signs of being uncomfortable and cried all the time even when being consoled. No matter how much we fed that baby it wasn’t satisfied. I also have had to send babies to NICU born to gestational diabetic moms who couldn’t maintain the blood sugar levels. I think it is an issue that most only think affects moms but can affect the baby tremendously and should try to be prevented.

For pregnant women, Will making a lifestyle change when it comes to diet and exercise vs not making any diet/exercise lifestyle changes, prevent gestational diabetes?

P- (Patient, population, or problem): Pregnant women

I- (Intervention): Diet and exercise

C- (Comparison with other treatment/current practice): No exercise or diet changes

O- (Desired outcome): Gestational diabetes prevention

A research gap is a missing piece of research, it the part of the research that hasn’t been explained or explored and without that information a conclusion cannot be made.

References 

Framework for identifying research gaps | Resource Details | National Collaborating Centre for Methods and Tools. (n.d.). Retrieved March 06, 2018, from http://www.nccmt.ca/knowledge-repositories/search/118

Koivusalo, S. B., Rono, K., Klemetti, M. M., Roine, R. P., Lindstrom, J., Erkkola, M., & … Pöyhönen-Alho, M. (2016). Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care39(1), 24-30. doi:10.2337/dc15-0511

Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 6, Art. No.: CD007145. DOI: 10.1002/14651858.CD007145.pub3.

Discussion #2
Great job Samara. I just took out a couple of words and replaced them. See how this sounds?

Among pregnant women, will making a lifestyle change when it comes to diet and exercise, as compared to not making any diet and exercise lifestyle changes, help to decrease the incidence of gestational diabetes?

Scott

Yes, Professor O’Quinn. That does sound much better, Thank you for all of your help and guidance.

Scott

Hello Samara,

Wow,  a 11lb 6 oz baby! That is huge. The mother must have been quite uncomfortable carrying a baby that size.  Anyway, I agree there are pregnant women that are not concern about their weight and uses pregnancy as an excuse to eat anything they want but not realizing the effects it has on their unborn baby. Eating a healthy diet  and exercising is important in maintaining a healthy pregnancy and healthy baby.

Samara and Pei, 

The gestational diabetic and the Type 1 diabetic mom surely affects the newborn population – I work in Newborn ICU and it would surely lower our census if mothers were educated and compliant with a healthy diet and exercise. You chose a very relevant and import topic to work on!

Wendi Keller 

PS – Believe it or not, I have seen a newborn almost 15 pounds!

Hi Gwendolyn, I definitely believe you! Although the biggest baby I have personally taken care of was 12 lbs 3 oz I have heard about babies being way bigger than that, which is crazy.

All the best to you!

Samara D. 

Samara, this is a very interesting post to me as I had gestational diabetes while pregnant and in turn my son weighed 10 pounds 1 ounce. When I found out I had GD the Dr prescribed Metformin with a controlled diet and frequent glucose monitoring. It will be interesting to find out what your research provides during this project.
Hello Samara,

I can not imagine an 11lb+ pound baby.  It also sad that this happens to this day.  There definitely needs to be more education available to mothers on the importance of diet and exercise.  Once there is education on this subject and the mothers are informed of the harm that can come to their babies maybe they will change their habits.

This is a great post!! I believe by changing the diet and exercise routine it can most definitely inprove the chances of diminishing gestational diabetes ! Thanks for sharing !

-daniel

Hello Professor,

Strategies to reduce hospital readmissions are significant in clinical practice. Previously, as a group we were summoned by the management due to increased readmission rate of the patients we recommended for discharge. Additionally, my manager has frequently held a consultative meeting to furnish us a scenario of delicate balance whereby I feel I am delaying some patients from discharge to avoid readmission. However, I am applying the following strategies to manage the patients to circumvent readmission; medication compliance strict follow up, the patient needs assessment, medication reconciliation, telephone follow up, and organizing outpatient appointments. Therefore, theoretical literature on the strategies that nurses can implement to reduce hospital readmission rate is a valid study that ought to assess the significance of its literature vis a vis its effectiveness. For the capstone project, have selected the article Hospital Readmissions. My question is, “What strategies can nurses implement to reduce Hospital Readmissions?”

According to Aromataris & Pearson (2014), research gap is a topic which contains insufficient information such that it limits the capacity to develop a comprehensive conclusion for a research question. Literature reviews on strategies to reduce nursing related hospital readmissions have been extensively conducted. Various summaries provide an overview of these strategies both in current and historical context. Kripalani, Theobald, Anctil, B & Vasilevskis (2014), states that there is a deficit of information that encompasses strategies to reduce readmissions from acute care centers. There have been numerous cases where patients are discharged from high dependency unit and intensive care units to general wards, but within hours they are readmitted to such units. Researchers have not dwelled much on this area. Thus, nurses working in such units lack comprehensive information on how to enhance their service delivery.

References

Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN, 114(3), 53-58.

Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E.(2014). Reducing hospital readmission: Current strategies and future directions. Annual Review Of Medicine, 65(1), 471-485. doi:  10.1146/annurev-med-022613-090415

This is good Lucia. What I will need from you now is for you to re-write your question in a correctly formatted manner. Take a look at some of the one’s in the previous posts and examples in the announcement attachment I posted to help you with this. Repost once completed and I will give you feedback. Thanks 🙂

Scott 

Hi Lucia,

Great topic to discuss. Being a med-surg nurse, I happen to see many frequent flyers in my hospital. I live in a small town where we only have one small community hospital in the county. As a poverty stricken town, many patients are poor with no insurance so they use the hospital as their doctor’s office. Many of the patients do not follow up with their primary, do not pick up their prescriptions, and do not follow doctors orders. Our hospital has implemented many programs within the hospital to help with readmission rates, but it is still climbing. The nurses, case managers, and social workers do an outstanding job during the discharge process serving the patients. I look forward to learning more about resources and plans to help with this issue. Great post!

Kierra

HI Lucia and class,

Readmission rate is one important topic that needs to be address as healthcare cost are continue to increase due to readmission.  It is unfortunate that now a days patient are being discharge sooner because of reimbursement issue. As nurses we should be the strong advocate for patient to make sure that all necessary steps are being address for the patient to be able to follow up with discharge instruction.  Great post.

thanks,

kristine

Professor and class,

In recent times, the hospital I work for has significantly been cracking down on the use of indwelling Foley catheters due to the increase in the occurrence of the hospital associated infection known as Catheter Associated Urinary tract infections (CAUTI). Various hospitals including ours are facing the serious complication we see in catheter associated urinary tract infections. The emergency room I work in has formed a committee that I am a part of that is working on changes that can be made to reduce these occurrences. Being that this is a personal issue I am currently working on, I am choosing this topic as my as my systemic review topic.  This is a serious problem for our patients as it can lead to a cascade of complications.  CAUTIs are associated with an increased length of hospital stays, increased morbidity and mortality as well as healthcare costs (CDC.gov). The hope for the future is that we can reduce the use of indwelling catheters to only those who have a legitimate clinical reason for the Foley catheter, and that if it is found to be truly necessary, we can get them removed as soon as possible so that we can drastically decrease the occurrence of catheter associated urinary tract infections. My PICOT question has been formulated as follows:

 Does an increased length of insertion time lead to increased infection rate in patients with foley catheters?

P- patients with foley catheters

I- Length of time catheter is in place

C- Short-term catheter use vs long-term catheter placement

O- Lower infection rate when catheter used for shorter period of time

T- week-by-week comparison for 3 months

It is required by hospitals to report all CAUTIs to the Center for Medicare and Medicaid Services (CMS).  This agency sets many guidelines for hospitals to follow that directly affect their reimbursement for care. The incidence of urinary tract infections can lead to multiple additional health problems including spread of infection to the bladder and kidneys, sepsis and increase in length of hospital stay.  As mentioned in Week 2 lesson plan, I will plan my research investigation via the most frequently used methods; our library database search and the World Wide Web.

Research-practice gap is explained as the idea of how evidence can effectively be put into practice with the intentions of reducing morbidity mortality and disability. Miscommunication between researchers and practitioners, and issues such as lack of public awareness, poor financing and a non-supportive political atmosphere are examples of factors that contribute to this problem (NCBI, 2006).

References:

Center for Disease Control. Retrieved from http://www.cdc.gov/HAI/ca_uti/cauti_faqs.html

Chamberlain College of Nursing (2015). NR451 RN Capstone Course: Week 2 lesson. St. Louis, MO: Online Publication

S. Mallonee, C. Fowler, & G. R. Istre. Bridging the gap between research and practice: a continuing challenge. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564411/

Nice job Nicole. I do have a few suggestions. First of all this is how your PICO should look in order to correctly write your question.

P- patients with foley catheters

I- Length of time catheter is in place (this should be what you are wanting to implement to improve the issue)

C- Short-term catheter use vs long-term catheter placement (this is what you are wanting to change based on your implementation above)

O- Lower infection rate when catheter used for shorter period of time (your desired outcome here would simply be a decreased incidence of CAUTIs.

T- week-by-week comparison for 3 months

So this is what I think you are attempting to ask with your question:

Among patients with foley catheters, does short term placement, as compared to long term placement, help to decrease the rate of CAUTIs?

Is that correct?

Scott

Professor,

Yes. Thank you for the suggestions. Your fixes are exactly what I meant. It is absolutely ironic to me how this topic has become a huge focus at the hospital I work for. The foleys were once freely accessible in the storage room. They are now locked up and only accessible through a request from the charge nurse. At the time of request, a sheet has to be filled out as a checklist. There must be clinical reason to provided by the ED physician and there must be an order in place. The final step is to do the proper documentation in our MEDITECH system. If all of these steps are not followed, the nurse is reprimanded accordingly and repeat offenses are to written up. It is unfortunate that this has become such an issue as it requires more of our time and slows patient care. In an emergency room we are all aware of how much time is of the essence. The issue continues to need work and an effective solution. Luckily I get to work on the issue both at work and in this class!

Thanks again!

Nicole Mas

Nicole,

   I agree that CAUTI’s are a major problem for hospitals. One of the way that we have tried to cut down on these infections other than reducing the number, which is also a great idea. Is when possible, use the external catheters on both men and women. I have known about the condom caths for men for a long time. We recently started using external catheters on women. These are called TrueWick and have really helped. They are non invasive and easy to install, they keep moisture away from the skin and help prevent breakdown. They also time because you dont have to clean the dirty linen.

Guy,

Thanks for your response. CAUTI is certainly a growing issue in hospitals everywhere. The external catheter use for both men and women is an excellent suggestion. Any non invasive alternative is always welcomed. I was in fact un aware that a female external Cather even was even an option. I don’t believe they have them in our inventory or perhaps not in the emergency room I work for. I’m actually going ask if we have them available to us in other departments of the hospital and if not, suggest that we look in to stocking them at our hospital. They can also save us from having to go through the lengthy process we currently have in place to simply obtain a Foley catheter for an emergency case. This collaboration between healthcare professionals is exactly how this issue will ultimately be solved.

Thanks

Nicole Mas 

Nicole,

From a working nurse standpoint, these things are truly amazing.  I have so many patients suffering from forms of incontinence that would generally just get a indwelling cath.  Worse yet in a effort to prevent hospital infection rates they might not get a cath. This means they are just laying in bed slowly dribbling urine into diapers or bedding. This is not only humiliating for the patient, it can lead to horrible skin breakdown. I suspect that many of the wounds coming from long term care places are caused by urine against the skin for long periods of times. The external cath solves this problem, is easy to place and works wonders. Once I identify a candidate and get the cath in place, I no longer have to constantly roll patients and change out bedding. It is a work time saver.

Nicole and Guy,

I too have experienced the amazing external female catheters with the same results as Guy. We first starting using them for incontinent patients after our post procedure de-cath protocol was put into place as a transition  but have started using them in place of Foley catheters in order to further reduce the risk of infection.

http://www.purewick.com/how-does-purewick-work/

Nicole,

Great post. I agree with you CAUTIs are an increasing problems. The hospital I work at also has initiates to reduce the amount of CAUTIs.  We have a protocol to was CHG wipes for baths for everyone with a foley catheter, as well as wiping the catheter with CHG and most recently using therawox to clean the catheter. This is a topic we need to improve on. CAUTIs can cause many other problems, which can be prevented.

Hi Nicole I agree with your post,

It may be important to develop ways in which relevant and reasonable results from researches conducted could be implemented within clinical settings. If this is attained, for instance, problems such as HAI could be easily addressed considering the depth of researches available proving possible solutions to the problem.

Charlyne 

Professor and class,

I am currently working in level 4 neonatal intensive care unit. Although I am not working directly with pregnant women, I am taking of care neonates which involve the mom postpartum. I take care of neonates that have medical issues post delivery due to excessive weight gain during pregnancy. I chose the article about diet and exercise during pregnancy to prevent excessive weight gain.

Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy.

My PICO clinical question:

P- Pregnant women

I- healthy diet and exercise during pregnancy

C- Unhealthy diet and no exercise

O- Reduce excessive gestational weight gain

During pregnancy, does implementing a healthy diet and exercise, reduce excessive gestational weight gain?

“A research gap is defined as a topic or area for which missing or insufficient information limits the ability to reach a conclusion for a question” (Saldanha & Mckoy, 2011). You must have enough information and research to answer a clinical research question in order to implement change in practice.

Robinson, K.A., Saldanha, I.J., & Mckoy, N.A. (2011). Frameworks for determining research gaps during systematic reviews. Methods Future Research Needs Report No. 2. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. HHSA 290-2007-10061-I). AHRQ Publication No. 11-EHC043-EF. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from: http://www.nccmt.ca/knowledge-repositories/search/118 (Links to an external site.)

Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 6, Art. No.: CD007145. DOI: 10.1002/14651858.CD007145.pub3.

Chamberlain Library Permalink:

http://onlinelibrary.wiley.com.chamberlainuniversity.idm.oclc.org/doi/10.1002/14651858.CD007145.pub3/full (Links to an external site.)

Good job Julie! Let’s just revise your question so that it better mirrors your PICO.

Among pregnant women, does implementing a healthy diet and exercise, as compared to no healthy diet and exercise, help to reduce gestational weight gain?

Scott

Edited by Scott O’Quinn on Mar 6, 2018 at 8:46pm
Hello Julie,

I enjoyed reading your post. I agree with you. Exercising is significantly important during pregnancy as well as eating healthy. Exercising, eating healthy, and managing weigh can definitely reduce complications during pregnancy and help the mother to have a healthy baby.

 Edlyne

Professor and class,

The systematic review I have chosen for the capstone project is: Caregiver-mediated exercises for improving outcomes after stroke.

Vloothuis JDM, Mulder M, Veerbeek JM, Konijnenbelt M, Visser-Meily JMA, Ket JCF, Kwakkel G, van Wegen EEH. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database of Systematic Reviews 2016, Issue 12, Art. No.: CD011058. doi:10.1002/14651858.CD011058.pub2.

The clinical question I have formulated using the PICO method, as described by Aromataris and Pearson in The Systematic Review: An Overview, is

P (population) – In Sub Acute Rehab patients on my unit who are recovering from a stroke

                I (intervention) – will implementing a caregiver mediated exercise program

                C (comparison group) – compared to using our current program alone

                O (desired outcome) – improve patient outcomes and transition to next level of care or home

As discussed by the ANA in our readings this week, “registered nurses employ practices that are promotive, supportive and restorative in nature.” (p. 11). Using this principle, I feel the review I have chosen for my project suits the environment I work in. Currently, I am working on a Sub-Acute Rehab (SAR) unit in a Critical Access Hospital. The program is relatively new to our organization and we primarily focused on total joint patients for the first 2 years. Now we have added many other patient types with stroke patients being one. We have found, stroke patients can be very challenging to progress in the short period of time allowed in SAR. Families are often very concerned about the patient’s progress and apprehensive about the transition to home. I feel this review touches on an untapped resource in our current practice, family involvement. If implementing a caregiver mediated exercise program can show benefit for our patients, it would be well worth the efforts.

A research to practice gap is the process gap of getting the evidence based research into practice. According to Grady and Hinshaw, “it is important to determine what gaps in knowledge the research is intended to fill when a problem for study is identified, and subsequently, it is important to assess what can or cannot be said from the research findings” (p.288).

References,

American Nurses Association. (2015). nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN, 114(3), 53-58. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000446-201403000-00028&LSLINK=80&D=ovft

Grady, P. A., & Hinshaw, A. S. (2011). Shaping Health Policy through Nursing Research. New York: Springer Publishing Company.

Great job Adriana. You are ready to begin work on your project 🙂

Scott

    • AdGreat post! I like your research question. I agree with you getting family involvement into the care of the patient will improve outcomes. Exercise is definitely important to be implemented early in the recovery process of stroke patients.
As a nurse who actively cares for CHF patients at an outpatient clinic, I observe firsthand how important it is for these patients to be followed closely after discharge from the hospital.  CHF is one of the leading primary diagnoses for hospitalizations (Boback Zieaien, 2015).  The patients keep going back to the hospital when they become decompensated and it becomes a vicious cycle.  Whereas with a multidisciplinary outpatient clinic, they become educated, followed closely, and more aware of their disease.  Therefore, are able to have more control and understanding of the disease.  The systematic review system I have chosen is Hospital Readmissions.  The question I have formulated  is: Among CHF patients, does the implementation of a multidisciplinary outpatient CHF clinic, as compared to traditional follow up, help to reduce 30 day hospital readmission rates?

P-CHF patients

I-Multidisciplinary outpatient CHF clinic

C-Traditional follow up

O-Reduce 35 day hospital readmission rates

A research- practice gap is when there is a gap between research and practice. It is the lag between what is known and what is actually practiced.

References:

Boback Zieaien, G. C. (2015). The Prevention of Hospital Readmissions in Heart Failure. NCBI, 379-385.

Olswang, P. J. (2015). Practice-Based Research: Another Pathway for Closing the Research-Practice Gap. Journal of Speech, Language, and Hearing Research, 1871-1882. doi:10.1044/2015_JSLHR-L-15-0243

HI Jill and class,

This a great concept, having an outpatient that consisted of multidisciplinary team as a resource for this patient population is greatly beneficial. With CHF patient having a greater understanding of the disease process will likely reduce the readmission rate because patient hopefully know how to take care of themselves by diet, lifestyle modification and medication compliance.  How accessible is the clinic to patient? does patient need referral to be seen at the clinic?

Thanks,

kristine

Hello class

Research Practice Gap:

The main goal in nursing research is to obtain results that are valid and can be implemented in real life practice to improve nursing care. As much as researchers would like to match what is known with what is actually implemented in practice there is often a gap known as the research practice gap. Nursing education is the bridge between this gap as without knowledge nurses are not able to implement the best practice into their nursing care. It is important for a nurse to understand the reason behind what they do for many reasons including safety and educating their patients to provide the best outcomes. Nursing education is the number one “gap closer” but other things that are important in implementing new strategies based on research. It is important to consider whether or not resources are available, if the intervention is efficient, and easy to implement amongst other things. Nurses are often very busy while working so it is important for researchers, clinical educators and management to keep these things in mind when developing interventions.

Rebecca

I really liked how you defined a research-practice gap.  I agree that nursing education is an important factor in closing the gap. The more knowledge we have, the better the outcome.  As stated in the Journal of Advanced Nursing, the research-practice gap in nursing is as wide as ever, from both the theoretical and practical standpoint. Mulhall, A. (1997).  Nurses are key “players” in closing the research-practice gap. Furthermore, practice-based research is another concept of how to close the gap. Basically, research is generated through everyday practice and experience. Approaching research and EBP requires different perspectives, as the ultimate goal is to improve the quality of care for the patient.

Jill

References:

  Mulhall, A. (1997). Nursing research: our world not theirs?. Journal Of Advanced Nursing25(5), 969-976. doi:10.1046/j.1365-2648.1997.1997025969.x

Crooke, P. J., & Olswang, L. B. (2015). Practice-Based Research: Another Pathway for Closing the Research-Practice Gap. Journal Of Speech, Language & Hearing Research58(6), S1871-S1882. doi:10.1044/2015_JSLHR-L-15-0243

Hello everyone, 

I currently work in  the ED at my hospital. This is definitely a different type of nursing, much more fast paced.     “HAIs are a major threat to patient safety and are associated with mortality rates varying from 5% to 35%” (Flodgren,2013) Unfortunately most of the foleys that are started come from the ED. However, down in the ED the main focus is to stabilize the patient, so we are usually rushing to the OR or doing something else that makes it difficult to maintain a sterile environment all the time. We are very aware of the CAUTI rates but unfortunately as we rush between procedures or have to stop patients from becoming critical we sometimes have to rush some of these things in order to save the patient’s life.

Sometimes we are able to have some floor nurses help from TELE, or ICU which is a great thing for patients with foleys as they are able to provide that kinda care that the patient needs in order to remain UTI free. My question would be if having a floor nurse who can be part of the ED helping us each can lower the chances of hospital acquired infections?

As far as importance go, we are very clear that this is of top importance when it comes to patient safety, however because of how critical the ED is, sometimes its difficult to make this the priority when providing patient care in such an environment. One nurse with accountability for implementing a simple evidence-based protocol can dramatically decrease the total incidence of hospital-acquired CAUTI.”  (Quinn, 2015) What this means is that if we simply add a floor nurse in order to help with foley procedures, then we can lower the risk of UTIs with our patients! Having this new technique can help reduce CAUTI rates among our patients while still providing top care.

-Daniel

Quinn P. Chasing Zero: A Nurse-Driven Process For Catheter-Associated Urinary Tract Infection Reduction in a Community Hospital. Nursing Economic [serial online]. November 2015;33(6):320-325.

Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections.>

Hello Daniel

I completely understand where you coming from with your emergency department’s CAUTI situation.  Realistically when I have a crashing patient or unstable patient the last thing I am worried about is perfect sterile technique during insertion.  I used to work in trauma ICU at my old job and we would leave the foley insertion up until the very end or at least when we knew the patient was stable.  I could imagine that inserting a foley could wait until the patient is in OR or transferred to the ICU.  The added insult of a UTI to a critically ill patient can be catastrophic.  I believe having a resource person as you stated in your PICOT question would be of great help to decrease instances of CAUTIs at your facility.

Alexander, 

Right? however due to the critical level of some patients sometimes is impossible to wait. It means very difficult decisions have to be made on the spot. This is why its so hard to keep sterility sometimes.  I believe the approach suggested above by having floor nurses in the ED can definitely lead to safer and more efficient patient care. Along with the help we will also have less infection rates.

thanks for sharing!

Daniel

Great information Daniel. Now what you will need to do is to re-write your clinical question so that it follows the correct format. See some of the other posts above as well as the samples I posted in this week’s announcement attachment. Please let me know if you have any questions. Thanks!

Scott

Hello Daniel!

I enjoyed your post! I work in the ICU and the insertion of foleys is an everyday practice for me.  We were all trained and carry out the sterile practice while insertion. However, I understand that you must prioritize your care and the insertion of a foley should be done only when sterile practice in being used in an effort to reduce infection.  I agree with you that having a nurse designated in the procedure would reduce the risk of UTI’s because reality we are always over whelmed and short staffed and having someone designated would provide better patient care.

Lucy

Professor and Class,

I work as a bedside nurse on a medical/respiratory unit and we get all sorts of patients. We frequently get patients that are admitted with a chronic indwelling foley catheter. Some of these patients are from home and some are from facilities. Those patients that are from home can usually tell us the last time the foley catheter was replaced but there are some that have dementia from a facility and that facility did not provide us with the date of insertion. My hospital policy is when a patient is admitted we are to change out their catheter within 24 hours of admission. I guess I never asked why we do that. Is it to decrease the risk of catheter-associated urinary tract infections (CAUTI)? According to Dailly, “approximately 20 percent of all healthcare-associated infections are urinary tract infections (UTI s), with an estimated 80 percent of those linked to urethral catheters” (2011). This has me wanting to know more about the reasoning behind our hospital policy.

For my capstone project I selected health associated infections as my topic and specifically on indwelling urinary catheters. My PICO question is:

Among patients admitted to the hospital with an indwelling foley catheter in place, does changing the catheter within 24 hours of admission compared to changing the catheter after 24 hours of admission help to decrease the rate of CAUTI’s?

P – Patients admitted to the hospital with an indwelling foley catheter in place

I – changing the catheter within 24 hours of admission

C – changing the catheter after 24 hours of admission

O – help to decrease the rate of CAUTIs

 

Healthcare research improves the needs of ongoing patient care. Being up to date with new research and implementing the new processes can take time and therefore results in a research-practice gap. A research-practice gap is significant gap between the patient care that is given and the recommended practice (Kristensen, Nymann & Konradsen, 2016).

 

Deanna Kilvitis

 

References

Cooper FPM, Alexander CE, Sinha S, Omar MI. Policies for replacing long-term indwelling urinary catheters in adults. Cochrane Database of Systematic Reviews 2016, Issue 7, Art. No.: CD011115. doi:10.1002/14651858.CD011115.pub2.

Dailly, S. (2011). PREVENTION OF INDWELLING CATHETER-ASSOCIATED URINARY TRACT INFECTIONS. Nursing Older People, 23(2), 14-19.

Kristensen, N., Nymann, C., & Konradsen, H. (2016). Implementing research results in clinical practice- the experiences of healthcare professionals. BMC Health Services Research, 16, 48. http://doi.org/10.1186/s12913-016-1292-y

Professor and Classmates,

According to the Centers for Disease Control and Prevention, “15%-25% of patients receive urinary catheterization during a hospital stay. Urinary tract infections are the most common type of healthcare associated infection with 70%-80% of these being caused by indwelling catheters making catheter induced urinary tract infections (CAUTI ) the most preventable health care associated infection.”  Most all patients receive a foley catheter upon admission in the ER. These catheters can stay in place for days before anyone will address if the patient really needs it. My floor in particular does have the protocol and we have seen great results from removing the catheters early. My PICO question is:

P: Patients receiving indwelling catheters.

I: A nurse driven protocol.

C: Provider initiated order to discontinue catheter.

O: Will have reduction of CAUTI infections.

I would research if facilities were to have a nurse driven protocol to determine medical necessity of indwelling urinary catheters verses awaiting a provider order to discontinue if there would be a reduction of CAUTI infections reported.

A research practice gap can be defined as the time between research results are produced and research results are utilized. This gap will affect nursing research and can be devastating to patient care and outcomes.

Center for Disease Control. Retrieved from http://www.cdc.gov/HAI/ca_uti/cauti_faqs.html

Chamberlain College of Nursing (2015). NR451 RN Capstone Course: Week 2 lesson. St. Louis, MO: Online Publication

S. Mallonee, C. Fowler, & G. R. Istre. Bridging the gap between research and practice: a continuing challenge. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564411/

Great job Jennifer! So what we will do now is take your PICO and form it into a question:

Among patients receiving indwelling catheters, will a nurse driven protocol to discontinue the catheters, as compared to a provider initiated order to discontinue the catheters, help to decrease the rate of CAUTIs?

Or something like that. Make sense?

Scott

Jennifer,

We have virtually eliminated foley catheters in our unit. Easy for premature and critically ill newborns as they wear diapers and we usually can manage their urine output with a bladder crede. Your clinical question along with evidence-based practices should surely help in the area of hospital-aquired infections or UTIs. Our nursing care needs to be quality and safe!

Wendi Keller

Jennifer and Gwendolyn,

We also have just about eliminated the use of Foley catheters in my unit.  The only patients that have foley catheters in my unit are immediate post open hearts and/or open chest patients or those on ECMO.  Once the child has been stabilized to the point where they can withstand being moved to change their diaper the foley comes out almost always within 12-24 hours.  After our nurse-driven protocol for foley removal has been implemented I honestly cannot remember the last time we have had a CAUTI in our unit.

Hello Jennifer,

I enjoyed reading your post. Great topic! At my workplace, we do have quite a few patients with Foley catheters. Some of the patients admitted with the Foley catheter have UTI, and they are usually confused. According to an online journal, “Even with improvements in nursing care of the catherized patient and experimental redesign of catheters themselves, UTI remains a problem in the catherized patient.”  When that happens, the patients are treated for UTI and possibly discontinue the Foley Catheter if the patients do not absolutely need to have it in place.

Hello Professor,

Strategies to reduce hospital readmissions are significant in clinical practice. Previously, as a group we were summoned by the management due to increased readmission rate of the patients we recommended for discharge in the cardiac unit. Additionally, my manager has frequently held a consultative meeting to furnish us a scenario of delicate balance whereby, I feel I am delaying some patients from discharge to avoid readmission and most of the readmissions are due to non-compliance. The current method used for discharge instructions are verbal and written, which in most cases patients don’t understand and don’t take the time to read.  However, if proper instructions were given via video that would thoroughly explain the importance of medication compliance strict follow up, the patient needs assessment, medication reconciliation, telephone follow up, and organizing outpatient appointments may reduce hospital readmissions.  Therefore, theoretical literature on the strategies that nurses can implement to reduce hospital readmission rate is a valid study that ought to assess the significance of its literature vis a vis its effectiveness. For the capstone project, have selected the article Hospital Readmissions. My question is,

Among Cardiac patients admitted to the hospital, does video discharge instructions, compared to just written and verbal discharge instructions, reduce hospital readmissions?

According to Aromataris & Pearson (2014), research gap is a topic which contains insufficient information such that it limits the capacity to develop a comprehensive conclusion for a research question. Literature reviews on strategies to reduce nursing related hospital readmissions have been extensively conducted. Various summaries provide an overview of these strategies both in current and historical context. Kripalani, Theobald, Anctil, B & Vasilevskis (2014), states that there is a deficit of information that encompasses strategies to reduce readmissions from acute care centers. There have been numerous cases where patients are discharged from high dependency unit and intensive care units to general wards, but within hours they are readmitted to such units. Researchers have not dwelled much on this area. Thus, nurses working in such units lack comprehensive information on how to enhance their service delivery.

References

Aromataris, E. & Pearson, A. (2014). The systematic review: An overview. AJN, 114(3), 53-58.

Kripalani, S., Theobald, C., Anctil, B., & Vasilevskis, E.(2014). Reducing hospital readmission: Current strategies and future directions. Annual Review Of Medicine, 65(1), 471-485. doi:  10.1146/annurev-med-022613-090415

Hi Lucia,

I enjoyed reading your post. I have also chosen to discuss hospital re admissions for my topic. Proper education is vital for the patient to reduce hospitalizations. There are several ways to get the information across depending on the individual’s preference of learning.  I like the idea of using video.  As for the verbal instructions, patients remember less than half of the information relayed to them. I think all hospitals give written information to the patients which as you stated, they do not read it. It goes in the trash. In conclusion, the idea of using video may help. Thank you.

Lucia,

You chose an excellent topic! Evidence-based practice should truly be able to make a difference in hospital readmissions. Our unit (Newborn ICU) implemented a Discharge Coordinator position. It is an experienced nurse and she does the “formal” teaching, coordinating home equipment and care, teaches CPR classes and assists in making follow-up appointments for our babies. More and more of our medically fragile babies are going home and we are finding that they thrive at home with the proper teaching of the parents. We send babies home on ventilators, oxygen cannules, with trachs and G-tubes as well as central lines. They also tend to have multiple medications and follow-up appointments with a variety of specialists and therapies. Our Discharge Coordinators have not only made a difference in our discharge process, but in parent satisfaction and decreasing hospital readmission.

Wendi Keller

Hi Lucia,

Your idea of a video with discharge instructions on it is great! Everyone has different learning styles and we need to incorporate that more in our healthcare education. When patients are in the hospital and given lots of information it can be overwhelming and most times people can’t remember every thing that was said to them. As our technology keeps advancing our hospitals need to be equipped with the most up to date items to help our patients.

Deanna

Hello Lucia,

Making sure a patient comprehend and follows all their discharge instructions is alwyas a challenge. Using technology such as video is a great way of delivering some instructions.  At our facility, when a TENS (Transcutaneous Electrical Nerve Stimulation) unit is issued, we have the patient watch a video tutorial and then we go over the TENS unit with the patient. Watching the video and going over the equipment reinforce patient understanding.

NR451 RN Capstone – Week 2: The Clinical Question – Discussion Post

The systematic review that I chose was from the Cochrane Library titled “Interventions to Improve Professional Adherence to Guidelines for Prevention of Device-Related Infections”. (Flodgren, Conterno, Mayhew, Omar, Pereira, & Shepperd, 2013) My practice situation and interest is the prevention of central line associated blood stream infection (CLABSI) prevention. I work in a Level III Newborn Intensive Care Unit (NBICU). While my unit has drastically improved our infection rate, it is still not 0% which is our goal.

The following is my significant clinical question related to the topic of the systemic review that will be the basis for my capstone change project ~

In newborns admitted to my Newborn Intensive Care Unit (NBICU), what interventions and adherence to those interventions can lead to no central line associated bacterial sepsis infections (CLABSI).

I developed this question in the “PICO” format which stands for PopulationInterventionComparison, and Outcome. Over the past five years, my unit has struggled to lower the CLABSI rate as obviously a bacterial infection is devastating and at times, fatal for the vulnerable newborn. When the sepsis is related to a device, it is felt that we have a responsibility to make the use of that device as safe as possible. Not only is a CLABSI a safety issue, but it is also an economic issue as at the least it increases length of stay for the already compromised newborn. (Healthy People 2020, Peasah, McKay, Harman, Al-Almin & Cook, 2013) It is for these reasons that this question is important to my clinical practice both currently and in the future. This goal, no CLABSIs, correlates with the Nursing Standards of Practice #3 Outcome Identification and Standards of Professional Performance #14 Quality of Practice. In planning for my patients, I expect an outcome of no hospital acquired infections. It also “ensures that nursing practice is safe and effective…” (ANA, 2015)

Nursing has generally agreed to the concept of evidence-based practice (EBP). Part of the reason for this is that nurses agree that they should give quality and safe care to their patients. It then is reasonable that the latest and best research needs to be applied to their care. However, there is concern that research evidence is not being consistently applied to clinical practice. (Leach & Tucker, 2016) This is the research-practice gap.

References

American Nurses Association. (2015). Nursing scope and standards of practice. (3rd ed.). American Nurses Association. Silver Spring, MD: ANA

Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. doi:10.1002/14651858.CD006559.pub2. Retrieved from:

“http://onlinelibrary.wiley.com.chamberlainuniversity.idm.oclc.org/doi/10.1002/14651858.CD006559.pub2/full (Links to an external site.)

Healthy People 2020. (03/06/18). Healthcare-associated infections. U.S. Department of Health and Human Services. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections (Links to an external site.)

Houser, J. (2018). Nursing research reading, using, and creating evidence. (4th ed.) Chapter 4 Finding problems and writing questions. Burlington, MA: Jones & Bartlett Learning

Leach, M.J. & Tucker, B. (2017). Current understandings of the research-practice gap in nursing: a mixed methods-study. Collegian. Retrieved from: http://dx.doi.org/10.1016/j.colegn.2017.04.008 (Links to an external site.)

Peasah, S.K., McKay, N.L., Harman, J.S., Al-Amin, M., & Cook, R.L. (2013). Medicare non-payment of hospital-acquired infections: infections rates three years post implementation. Retrieved from: https://www.cms.gov/mmrr/Downloads/MMRR2013_003_03_a08.pdf (Links to an external site.)

Hi Gwendolyn,

You have included some great information! The one thing you will want to do is to re-write your clinical question so that it follows the correct format. it should be structured something like this:

Among newborns admitted to the NBICU, does the implementation of _________, as compared to _________, help to decrease the rate of CLABSIs?

You will want to be specific on what you are trying to implement based on evidence that will decrease the CLABSI rate. You could even say something like “the implementation of an evidence based CLABSI bundle, as compared to the current practice” if you wanted to. See some of the other posts above and the attachment I included in this week’s announcement for examples. Let me now if you have any questions 🙂

Scott

Professor Scott,

I had the same thought AFTER I pressed “Post Reply”! I agree on being specific about the intervention. So here goes ~

Among newborns admitted to the NBICU, does implementation of an evidence-based CLBASI bundle, as compared to the current practice, help to decrease the incidence of CLABSIs? 

Thank you for making my clinical question much improved!

Wendi Keller

Hello Professor and Class,

Bed bound patients arriving to the Emergency Department with pressure ulcers become a financial burden to the hospital and those that are at risk of obtaining pressure ulcers. In November 2008, the Center for Medicare and Medicaid Services instituted a policy to withhold reimbursement due to is made to acute-care hospitals for the costs of treating hospital-acquired conditions, such as pressure ulcers. Although hospitals will be paid for the care of pressure ulcers that originated before admission, hospital-acquired pressure ulcers would be the responsibility of the admitting hospital. The need for change is to reduce the amount of hospital acquired pressure ulcers and properly assess for pressure ulcers originated prior to admission.

P– (Patient, population, or problem): Bed bound patients that arrive to the Emergency Room.

I– (Intervention): Assess for pressure ulcers upon arrival and start pressure ulcer intervention.

C– (Comparison with other treatment/current practice): Simply complete a focused assessment and wait on admission orders to initiate pressure ulcer prevention.

O– (Desired outcome): Decrease hospital acquired pressure ulcers and rule-out prior hospitalization pressure ulcers.

T– (Time Frame): Reduce Emergency room stay, hospital admissions and hospital acquired cost.

I chose to formulate this clinical question because we recently had an in service and a Mock Code to properly address the pressure ulcers arriving to the Emergency Department as well as hospital-acquired pressure ulcers. Closing the gap between nursing research and practice is essential in the medical field. We must continue our education and learn new ways to benefit the health and well-being of a patient, co-workers, and yourself.  Getting research into practice is not that simple when you have to break old habits and learn a new different way. At times you just learn one way to then change it a week or two later to another way. In the medical field we are constantly learning and changing the practice.

Wake, W. (2010). Pressure Ulcers: What Clinicians Need to Know. The Permanente Journal,14(2). doi:10.7812/tpp/09-117

Christina Chirino

Christina:

You are absolutely correct stating that it is difficult to break old habits. Newer nurses, in my opinion, seem to adjust easier to changes in practice, as this was ingrained in them since nursing school. It truly is difficult to “teach an old dog new tricks”. It is critical to the nursing profession and medical field to stay up to date with evidence-based practice and making it a reality at the bedside. It makes me laugh, remembering all the complaints when we first introduced all the bundles to prevent HAI, now we just do it as it has become second nature.

Mandy

Nice job Christina! So let’s take your PICO and form it into a properly formatted clinical question. The following is just an example:

Among bed-bound patients admitted to the ED, does the implementation of an immediate pressure ulcer assessment and intervention protocol, as compared to completing a focus assessment and waiting on physician orders, help to decrease the rate of HAPUs?

How does that sound?

Scott

Hello Professor,

That question works perfect. It is exactly what I am trying to get at. It’s been an on-going problem in my department and its a topic I am extremely passionate about. Especially if it’s a problem that can be prevented. I feel that pressure ulcers are demeaning and downgrading to the patient and family members. At there most vulnerable moment I feel patients don’t need to feel this way. Thank You Professor.

Christina

Great post Christina,

Pressure ulcers are a widespread and comprehensive issue with major focus not only in the inpatient units but in the operating room as well. One of the goals of the patient safety initiatives is the prevention of pressure ulcers.  In executing the plan of care for an anesthetized patient, positioning, and padding of bony prominences is paramount.  In as little time as it takes to complete an elective procedure, the patient is at added risk of developing a pressure ulcer.  We utilize a variety of positioning devices including foam and gel pads and most operating tables have thicker mattresses manufactured with tempurpedic foam.As you indicated age is not a determining or exclusion factor as to whom develops a pressure ulcer as it ranges from the child to the older adult. Best wishes on your project.

Reference

Shi, C., Dumville, J.C., & Callum, N. (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLoS One 13(2), e0192707 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192707 

Hello Christine!

I enjoyed your post and preventing pressure injuries has always been a challenge, not just for caregivers, but also for the health care industry as a whole because the cause of pressure injuries varies by clinical setting and is a potentially preventable condition. I work in the ICU and I have seen the development of pressure ulcers interfere with the patient’s functional recovery and can contribute to longer hospital stays. Special beds were purchased that help reduce the development of the pressure ulcers in conjunction with a turning log that we use has helped in the reduction of pressure ulcers in our unit.

Lucy

Hello Lucia,

Thank you for your reply to my post. I just had an in-service on friction control and the bed sheets can cause so much skin break down. The stretchers are not very helpful in reducing pressure ulcer risk and at times patients can be in the Emergency Room for several hours before getting into a hospital bed. We also have a turning log and it works when we have down time.  It is so difficult to turn patient when you have critically ill patients you are running around with.

Christina

Hello Class,

To Christina,

I really think hospitals and nursing homes should start to use a WCT(wound care team) to do all skin assessments on all new admission and transferring patients for community, hospital acquired, or unit acquired pressure ulcers. That way, every patients can assess for pressure ulcers upon arrival and start the appropriate pressure ulcer intervention as soon as possible. Nurses have so much to do; they do not have enough time to do those assessments properly. Some of them, at time is floating from other units. Many of them don’t even know how to properly document the wounds. Like you said, we must continue our education and learn new ways nursing is evolving.

Good post,

Gina K

Hi Christina,

This is a great topic to research about. I work as a bedside nurse so when I get patients straight from the ER it is often times a blind date because at my hospital the ER charting is mainly focuses on the acute problem and everything else is not known (i.e. skin integrity)  till you assess the patient. So yes I feel like starting pressure ulcer care or prevention could be  helpful since the patient spends several hours in the ER before getting admitted. But also I know because I have friends in the ER that it is crazy in there and sometimes you can only do focuses assessments on the ER patients.

Deanna

Scott and class:

An area for healthcare-associated infections (HAI) that my facility continues to struggle with is Catheter-Associated Urinary Tract Infections (CAUTIs). “The average cost for a patient with a CAUTI is estimated at $1,642 per case” (Scanlon, 2017, p. 135). Often, the catheters are placed in the ED or the OR and then the patient is admitted to the ICU. The catheter should be removed once the acute phase of the illness passes. This, however, is not being done in a timely manner.  Patients are transferred out of the ICU and the catheters remain in place and are not removed because the MD does not give an order to do so. “Often invasive devices do not meet appropriate indications for their use or they remain in place beyond what is deemed necessary, or both” (Flodgren, Conterno, Mayhew, Omar, Pereira, and Shepperd, 2013, p.7). Nurse-driven protocols have been put in place to help decrease the risk of CAUTIs.

P- (Patient, population, or problem): Patients with indwelling foley catheters

I- (Intervention): Nurse-driven protocol to remove

C- (Comparison with other treatment/current practice): Physician order to remove

O- (Desired outcome): Decrease chance of a catheter-associated urinary tract infection

My question would be:

Are patients, who have indwelling foley catheters less likely to develop a catheter-associated urinary tract infection when catheters are removed based on a nurse-driven protocol compared to those waiting for a physician order to remove the catheter?

Ideally, the removal of catheters when they are no longer medically necessary will decrease the chance of CAUTIs. This will, in turn, improve patient outcomes as well as decrease the cost hospitals must pay for treatments and interventions that are required to treat the HAI. It is imperative, in the nursing profession to perform research, analyze and interpret data then based on evidence, implement it into practice (American Nurses Association, 2015). Research gap is the disconnect from the evidence of research, providing nursing interventions but not put into practice. Sampson, et al., (2015) stated, “…Practitioners are more likely to pay attention to research that is relevant to the specific settings in which they work” (p. 297). This can become a problem when we have different disciplines focusing on one area and not the patient as a whole. Simple things, like removing a catheter when it is no longer needed can help prevent multiple other issues.

References

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD.

Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections. The Cochrane Database Of Systematic Reviews, (3), CD006559. doi:10.1002/14651858.CD006559.pub2

Sampson, J. P., Hou, P., Kronholz, J. F., Dozier, V. C., McClain, M., Buzzetta, M., & …Kennelly, E. L. (2014). A Content Analysis of Career Development Theory, Research, and Practice-2013. Career Development Quarterly62(4), 290-326. doi:10.1002/j.2161-0045.2014.00085.x

Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reduction Program. Nursing Economic$35(3), 134-141.

Great job Amanda! So what you will want to do now is take your PICO and then re-write your question so that it mirrors it. For example:

Among patients receiving indwelling catheters, will a nurse driven protocol to discontinue the catheters, as compared to a provider initiated order to discontinue the catheters, help to decrease the rate of CAUTIs?

Make sense?

Scott

Amanda,

This is a great topic! The hospital I used to work for had what they called a post procedure de-cath protocol. The foleys were sometimes even removed before going back to the unit. While many nurses were unhappy about the inconvenience of not having a foley, it reduced the number of CAUTIs. If the patient did continue to have the catheter, the nurse was required to document the reason twice per shift confirming that the patient had been assessed and did in fact require the catheter.

Hello Amanda,

Catheter acquired urinary tract infection is one of the most common health care acquired infections; 70–80% of these infections are attributable to use of an indwelling urethral catheter. At my department only the CHF patients or any patient having to observe and document there input and output are given a urinary catheter. When I first became a nurse, I used to place a Foley on almost all my bariatric patients. A couple years ago the hospital acquired UTI infection rate was extremely high. Now, under very little circumstance are Foley’s placed.

The single most important intervention to prevent CA-UTI is to avoid use of an indwelling urinary catheter. There are only a limited number of accepted indications for catheter use (Nicolle 2014):

  • Monitoring of hourly urine output in acutely ill patients.
  • Perioperative use for selected surgical procedures

Urologic surgery

Surgery on contiguous structures of the genitourinary tract

Large volume infusions or diuretics during surgery

Requirement for intraoperative monitoring of urine output

  • Management of acute urinary retention and urinary obstruction.
  • To facilitate healing of open pressure ulcers or skin grafts in selected patients with urinary incontinence.
  • In exceptional circumstances (end-of-life care), at patient request to improve comfort.

Reference:

Nicolle, L. E. (2014). Catheter associated urinary tract infections. Retrieved March 11, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4114799/

Hello Professor and classmates,

Falls in older patients have become very common.  According to ncbi.nlm.nih.gov (Links to an external site.), “Falls in older adults are a global public health crisis, but mounting evidence from randomized controlled trials shows that falls can be reduced through exercise.”  I currently work for a facility with a lot of patients who suffered a stroke. There are many CVA patients who sustain right side brain injury, which affects their understanding. Even though these patients did receive the proper education about using the call light for assistance before getting out of bed, and they showed that they understood; however, they often forget to call for help when they need to go to the bathroom. Unfortunately, when that happens, many of them fall while trying to get out of bed. According to our text book, “a compassionate approach to patient care carries a mandate to provide care competently.” (p.11). It is our responsibility, as nurses, to care for the patients positively and reduce anything that can harm the patients. In the unit where I work, we usually experience at least 15 falls per week, and we are working diligently to decrease this number through reeducating the staff on fall preventive equipment, assessing patient for high risk factors and making purposely hourly rounding. According to an online journal, “Purposeful Rounding seeks to improve the patient experience through the use of a structured hourly rounding routine.” My facility started enforcing the importance of purposeful hourly rounding in the orientation process, such as toileting the patient, and checking the patient to ensure safety measures are maintained in order to reduce falls with injury.

My PICO question would be the following. Are all staff members really doing purposeful hourly rounding to ensure patient safety and satisfaction?

P: stroke patients

I:  purposely hourly rounding

C:  not doing regular hourly rounding

O:  prevent the number of falls

For my capstone project I have selected the article “Caregiver-mediated exercises for improving outcomes after stroke”. Hourly rounding is an EBP and has shown to increase patient satisfaction. It is significantly important, as nurses, to minimize the effect or prevent completely anything that can harm the patients. A research practice gag is lack of checking on the patients on a regular basis. Nurses and other healthcare professionals have to work together in order to come with the best care for the patients.

References

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

https://stanfordhealthcare.org/health-care-professionals/nursing/quality-safety/purposeful-rounding.html (Links to an external site.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4760892/ (Links to an external site.)

Hi Edlyne,

Your PICO looks great. Now just re-write your question in the correct format so that it directly reflects your PICO. This is just an example:

Among posts stroke patients, does the implementation of hourly rounding, as compared to not doing hourly rounding, help to decrease the number of falls and fall related injuries?

Scott

    • You choose a great topic for your clinical question. Every setting is focusing on reducing the amount of falls and injuries to patient specially with medicaid and medicare refusing to pay for fall incidents.  So, hourly rounding to me is one great way to cover a nurse’s back but it has to be done correctly. Although, not all patients’ falls will be preventable, hourly rounding with the 4 P’s(Pain, Potty, Positioning, and Possessions) of needs however, works.  On my unit, if a patient happens to fall, as long as the nurse did her hourly roundly, that nurse is covered from getting a write up. It happened to me where one of my patients fail.The next day, the nurse manager views the video on the unit and saw that I did my roundings.

Good luck with your project,

Gina K

Hello Edlyne,

Great post for this week discussion, I have to agree with you that falls and patient safety are always going to be on the top of the list of priority for hospitals safety goals. I work on a surgical spine/ortho floor and we work with a lot of patients who require assistant ambulating or handling a wheelchair. Hourly rounding is a must on my floor, we have developed a time sheet that alternates the RN and the PCT to take turns in rounding and assessing the 5 Ps, this has lower the falls on our floor tremendously for the six months I have been there. If done right hourly rounding can help reduce falls in all hospitals. Great post.

Edlyne,

You picked a great topic!  I truly believe that hourly rounding has definitely improved our patient outcomes in our facility.  It has been implemented for a couple of years now, but the change has been impactful.  Patient’s, as well as their families, feel their loved one is taken care of more efficiently.  Their needs are being tended to more than ever before. I cannot say all patients, but for the most part, they sense the change from years past. Although I will say, some patients feel even with hourly rounding, they want the RN there even more frequently, not really realizing we do have other patients to tend to.  But I guess we will always strive for even better satisfaction and care as well as outcomes in our field.Great post and topic

Good day class and Professor Scott,

From the list of approved reviews, Wound Care is what I choose for my capstone project. The reason I choose this review is because caring for wounds is an important part of providing healthcare at every level. From hospital to a patient’s home, caring for patients with wounds can be a constant challenging and intimating. Aside from assessing and diagnosing a wound, appropriate wound treatment is an important factor in which choosing one plays a huge role. With that being said, my clinical question for the Wound Care is; when caring for wounds, using a systemic metronidazole versus using a placebo (sugar pill) treatment, can it leads to a reduction in malodor in patients with malignant wounds? This question is important to my clinical practice because few of patients in my TB unit, used to get treatments for their pressure ulcer injuries which used to be misdiagnose and unresponsive to treatment. When the patient sent to the unit, multiple diagnoses is done, cutaneous TB usually is the finding which is a rare form of skin with tuberculosis disease. These types or wounds require different approach of treatments which can be complicated. Back to the question, the research-practice gap is a fourteen day gap (washout period) between administration of the metronidazole and the placebo as this relate to tis case. What will conclude from the research will be based on the time frame, the amount of information the researcher uses, and how many case study with the same result. As for the way I developed the question, I use the PICOTS model which helps me to design my clinical question better and it is as follow.

P    Nine participants with a fungating wound

I     I am considering to use a systemic metronidazole treatment.

C    a placebo (sugar pill), is my alternative treatment I would use in comparison

O    I would like to evaluate the effectiveness of the metronidazole treatment administration to

            see a reduction in malodor in patient with malignant wounds

T      2 weeks

S     Respiratory Care unit

Thank you,

Gina K

Reference:

https://www.pcori.org/assets/Identifying-and-Prioritizing-Research-Gaps1.pdf (Links to an external site.)

Ramasubbu DA, Smith V, Hayden F, Cronin P. Systemic antibiotics for treating malignant wounds. Cochrane Database of Systematic Reviews 2017, Issue 8, Art. No.: CD011609. doi: 10.1002/14651858.CD011609.pub2.

http://onlinelibrary.wiley.com.chamberlainuniversity.idm.oclc.org/doi/10.1002/14651858.CD011609.pub2/full (Links to an external site.)

HI Gina, this is good information. The main issue here is that this is more of a medical intervention vs. a nursing intervention. This project is really designed for you to identify and implement evidence based nursing interventions to hopefully improve an outcome. Is there anything that you could come up with that could be driven by the nursing profession on your unit to improve an outcome?
  • Good day class and Professor Scott,

    Thank for pointing out in which direction my focus should be; I was going with the information I got from the article. Nursing intervention in wound caring is to improve wounds healing and patient’s compliance in completing the treatment. There are many things nurse can use to cleanse wounds with some of those cleansers can do harm or slow the healing process.  So, my clinical question is: When caring for patients with malignant wounds, can cleaning the wounds versus not cleaning with a mild soapy water, would improve wound healing quicker? My PICOTS question would be as follow:

    P   patient with malignant wounds

    I     I am considering to use a mild soapy water.

    C    using plain water

    O    I would like to evaluate the effectiveness of using the mild soapy water to see a

           faster wound healings.

    T      2 weeks

    S     Respiratory Care unit

    Please, Professor Scott, I still need your feedback so I can get it right.

    Again, thank you,

    Gina K

    Much better Gina! Let’s take what you have and revise it a bit so that it follows the proper format:

    Among RCU patients with malignant wounds, does cleaning wounds with soap and water, as compared to cleaning with water alone, help to improve healing time?

    How does that sound to you? Or maybe something like that?

    Scott

    Hello Professor and class,

    I currently work in a spinal/orthopedic surgical stepdown floor.  The general age range for our patients can be from 18 years of age and up.  Many of our long-term chronic patients have central lines, be it PICC lines and mid-lines.  Over the past year, there has been an increase in bloodstream infections.  Would implementing a multifaceted intervention bundle decrease our instance of bloodstream infections?

    Does developing and implementing a multifaceted intervention bundle help lower the instance of central-line-associated bloodstream infections?

    P – Patient with central lines

    I – Implementing a multifaceted intervention bundle when accessing/changing central lines

    C – central line care protocol

    O – Decrease instances of central line-associated bloodstream infections

    T – 90 days

    I found this article on CINAHL describing how after implementation of a multifaceted intervention bundle there was a decrease of instances of central line-associated bloodstream infections.  This article is relevant to my nursing issue because it describes in detail how a protocol bundle can help decrease bloodstream infections.  The article states that 17 ICUs were selected in 14 different hospitals and the study took place over 12 months.   After implementation of their bundle, it was found that infection rates dropped from 1.8 infections per 1000 catheter days to 1.1 infections per catheter days (Hong, Sawyer, Shore, Winters, Masuga, Lee, & Lubomski, 2013).

    Hong, A. L., Sawyer, M. D., Shore, A., Winters, B. D., Masuga, M., Lee, H., & … Lubomski, L. H. (2013). Decreasing Central-Line-Associated Bloodstream Infections in Connecticut Intensive Care Units. Journal For Healthcare Quality: Promoting Excellence In Healthcare35(5), 78-87. doi:10.1111/j.1945-1474.2012.0021

    Hello Arianna,

    I enjoyed reading your post. As professional nurses, it is important to have a good understanding of how to help our patients and improve outcomes for them. This is a very nice topic. Inadequate or improper education is a huge issue in healthcare, of which I see the effects almost daily. Especially with all the chronic illnesses these days, education has a large impact on patient outcomes. Educating nurses is a great way to decrease infections in the hospitals or at any facility.

    Edlyne

    Good job Arianna! So let’s revise it just a bit so that it follows the proper format and better reflects your PICO.

    Among patients with central lines, does the implementation of a multi-faceted evidence based CLABSI bundle, as compared to the current protocol, help to decrease the CLABSI rate?

    Something like that. Does that sound something like what you are trying to ask?

    Scott

    Sounds great professor. Thank you!
    You’re very welcome Arianna 🙂

    Scott

    Good evening Professor and Class,

    On a daily basis I work with ventilated patients. One of the most dreaded and honestly embarrassing diagnosis in the ICU is ventilator associated pneumonia or VAP. This is due to the fact that it is entirely preventable and can be both costly and carry a higher mortality rate. Therefore, I chose the systemic review based in Healthcare Associated Infections (HAI) specifically “Interventions to improve professional adherence to guidelines for prevention of device-related infections.” The question I formulated could be implemented directly at the bedside by nurses daily and produce a measurable outcome. The questions is as follows: By implementing appropriate oral care and suctioning every four hours can VAP be reduced or prevented? P- Ventilated patients I- Oral care and suctioning every four hours C- no oral care provided O- Prevention or reduction of VAP T- 2 weeks.

    The research gap lies within teaching the significance of such care. Although we are taught as critical care nurses the importance of oral care, we don’t always see it as a necessity in caring for our critical patients. In the shuffle of titrating drips, replacing electrolytes, attempting to prevent patients from crashing, oral care does not always take precedence. If the implementation is not being followed clearly, the research gap can be significant.

    References:

    Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database of Systematic Reviews 2013, Issue 3.

    Tabaeian, S. M., Yazdannik, A., & Abbasi, S. (2017). Compliance with the Standards for Prevention of Ventilator-Associated Pneumonia by Nurses in the Intensive Care Units. Iranian Journal Of Nursing & Midwifery Research22(1), 31-36.

    Jackie:

    I would cringe every time we would be flagged for a VAP. It got to the point of embarrassment, because as you said it is preventable. We recently hit out the 2.5-year mark of no VAPs and still going! It took a lot of work and education to stress the importance of the simple measures that can be taken to prevent it. Now it’s even more strict as we are auditing for VAC (conditions) or VAE (events). The bundles are helpful, and effective when followed.

    Amanda,

    Thank you for your response. Yes, we too had been quite sometime without a VAP but about two months ago we had one. Of course it was back to educating,educating, educating. As you pointed out, bundles are very beneficial and help with implementation. Of course educating is the key to getting the wheels moving and ultimately the key to prevention. If nurses are educated on the hows and whys there will be change.

    Hi Jackie,

    Your PICO is perfect, so lets revise your question so that it mirrors your PICO:

    Among ventilated patients, does the implementation of oral care and suctioning every fours, as compared to no oral care, help to reduce the rate of VAP?

    How does that sound to you?

    Scott

    Professor,

    Thank you! That sounds right on. I appreciate your input. I will mirror my question to read as above.

    Jackie

    Hi jackie,

    Great job with your post. It is not easy working with ventilated patients; so, I salute you in working with them. i had the experience to work temporary with a baby on a vent I almost pulled out all my hair when it was time to provide care or suctioning. I do think this job should be provided by the respiratory therapist mostly. I agree with you. Professional needs to adherence to guidelines in order to prevent or minimizing those device-related infections.

    Thank you,

    Gina K

    Hello Professor and class:

    The systematic review I chose is “Prevention of device-related infections.”

    Significant clinical question:

    P: Patients requiring chronic use of urinary catheters

    I: Change indwelling catheters every 30 days

    C: Urinary catheter use greater than 30 days without removal as early as possible or changing

    O: Decrease in catheter-associated urinary tract infection (CAUTI)

    T: 30 days

    In patients requiring chronic use of urinary catheters, will removal as early as possible or changing the catheters every 30 days be effective in decreasing CAUTI infection rates?

    I developed this question because patients with the need for chronic use of urinary catheters often develop urinary tract infections. They may require hospitalization. If already in the hospital, they experience a longer course in admission, antibiotic therapy, have an increase in charges they acquire, or the hospital is not reimbursed for the admission if this episode was deemed a hospital-acquired infection (HAI).

    A research-practice gap exists as researchers encounter barriers affecting the application of research results. Viewed as the main component of nursing practice, scientific search either improves the current knowledge or results in new information. The process of integrating good-quality research findings into nursing practice is not up-front, (Sanjari et al., 2015). Their study result showed that nurses are isolated from their well-informed colleagues and there is never a time on the job to share new ideas or read available research. Nurses do not feel they have the authority to influence change in patient care procedures and policies, therefore, considered the main barriers, (Sanjari et al., 2015).

    “It is important to note that much more emphasis has been placed on moving existing knowledge to current practice that can be used now by bedside nursing professionals,” (Chamberlain College of Nursing, 2018).

    References

    Chamberlain University College of Nursing (CCN). (2018). NR 451 Week 2: The Ace Star Model of Knowledge Transformation. Retrieved from http://frameste.next.ecollege.com

    Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device‐related infections. Cochrane Database of Systematic Reviews 2013, Issue 3, Art., No.: CD006559. DOI:10.1002/14651858.CD006559.pub2

    Sanjari, M., Baradaran, H. R., Aalaa, M., Mehrdad, N. (n.d.). Barriers and facilitators of nursing utilization in Iran: A systematic review. Iranian Journal of Nursing and Midwifery Research, 20, 529-539.

    Nice job Marlene! Just so I’m understanding correctly. You are attempting to show that early catheter removal is more effective than changing every 30 days. Is that correct?

    If so, does this sound correct:

    Among patients requiring chronic use of urinary catheters, does removing the catheter as soon as possible, as compared to changing it out every 30 days, help to decrease the rate of CAUTIs?

    Just making sure I got it. 🙂

    Scott

    Hi Professor,

     Your understanding is correct. My question is “Among patients requiring chronic use of urinary catheters, does removing the catheter as soon as possible, as compared to changing it out every 30 days, help to decrease the rate of CAUTIs?”

    One of the National Patient Safety Goals of 2017, Hospital Acquired Infections. In Beefing up the effort, I was also interested in the effects of adding urine cultures upon insertion of catheters to the current Urinary Catheter Insertion Bundle to rule out the presence of UTI prior to catheter insertion or admission.

    Thanks, Marlene.

    References

    Chamberlain University College of Nursing (CCN). (2018). NR 451 Week 2: The Ace Star Model of Knowledge Transformation. Retrieved from http://frameste.next.ecollege.com

    Woten, M. B., & Mennella, H. A. (2017). National Patient Safety Goals (Joint Commission, 2016): Limiting Use and Duration of Indwelling Urinary. CINAHL Nursing Guide.

    Scott
    Hi Marlene, Great post!

    I am looking forward to finding out more about what you find also. I think this is an awesome topic to research.

    I am a Mother/Baby nurse and I get Post C-Section mothers who have their urinary catheters in for 12 hours post c-section and sometimes I wonder if that is too long. I have worked for another facility where it was taken out after 6- 8 hours. Even though our patients are usually discharged within 2-3 days after admission. I always wondered how many of them get UTI’s after going home (which is something we educate them on, knowing the S&S of UTI’s). I have also worked on a med-surg floor and have witnessed pts with urinary catheters that I believe may have benefited more from having one than not having one, so I am on the fence.

    All the best to you,

    Samara D. 

    As an interventional radiology and cath lab nurse, I see my fair share of devices being implanted and removed. I also see the resulting infections that ensue when implanted devices are not cared for appropriately and/or not inserted under sterile procedure. I chose “Interventions to improve professional adherence to guidelines for prevention of device-related infections” as the systematic review to base my project on. In the past three years I have worked in several different hospitals and observed different protocols for insertion and care of central catheters. I have also worked as a home health nurse and case manager and seen the environment in which some of the catheters, specifically PICC lines, are being cared for. The same applies to the care lines are receiving on the floors after the y are inserted. My questions is:

    Among patients with central line catheters, does the implementation of standardized insertion and maintenance bundles compared to not using a standardized bundle assist in the prevention or reduction of Central Line Associated Bloodstream Infections (CLABSI)?

    As a previous bedside ICU nurse, I always made sure to take precautions with central lines and uphold the standards demanded by the hospital to keep them infection free. In my current practice, I try to make sure that a sterile field is maintained during placement and that sufficient instructions are given to the patient/family/nurse who will be caring for the line. In the future I hope to help reduce the number of CLABSI in my current and future places of work. In theory, we all know how things should be done and have a lot of evidence to back up how we should be taking care of central lines. However, in practice, routine, convenience and forgetfulness contribute to the research – practice gap that exists with any new body of evidence.

    Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections. The Cochrane Database Of Systematic Reviews, (3), CD006559. doi:10.1002/14651858.CD006559.pub2

    The research-practice gap. (n.d.). Retrieved from http://www.jnd.org/dn.mss/the_research-practice_gap_1.html

    Well done Julia! You are good to go 🙂

    Scott

    Julia, 

    CLABSI is a definite issue among any unit. By implementing protocols and evidence based practice we can prevent further CLABSI’s. This is where research meets bedside. My unit in particular (or hospital I should say) has implemented swab caps as a mandate even on peripheral IV’s in order to try and prevent further CLABSI’s. I do believe as you stated though that sterile technique plays a major role in prevention.

    Jackie

    Hello Professor and Class, 

    For my capstone project, I chose hospital readmission. This is a systemic review that I would really love to get more involved with. Hospital readmission is a big problem that needs to be addressed more firmly. I live in a small town where we only have one small community hospital in the county. As a poverty stricken town, many patients are poor with no insurance so they use the hospital as their doctor’s office. Many of the patients do not follow up with their primary, do not pick up their prescriptions, and do not follow doctors orders. Our hospital has implemented many programs within the hospital to help with readmission rates, but it is still climbing. The nurses, case managers, and social workers do an outstanding job during the discharge process serving the patients to prevent readmission.

    “While many readmissions are unavoidable, researchers have found wide variation in hospitals’ readmission rates, suggesting that patients admitted to certain hospitals are more likely to experience readmissions compared to other hospitals.” (Boccuti & Casillas 2017). My community hospital is one of the hospitals that experiences more readmissions.

    My question would be: How can nurses along with other members of the healthcare team, reduce hospital readmission rates for elderly patients in 6 months?

    I feel the question is directed to finding a solution to reducing hospital readmissions.

    Kierra

    Boccuti, C. Casillas, G. 2017. “Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program”   https://www.kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/ (Links to an external site.)

    Hello class,

    I chose Health Associated Infections specifically Catheter Acquired Urinary Tract infections as my topic for my capstone project.

    Hospitalized patients are at high risk for developing infections; this risk increases with the use of invasive medical devices. Hospital acquired infections are responsible for approximately 99,000 deaths per year in the United States alone. This information is very important because the leading cause of hospital-acquired infections is the use of indwelling Foley catheters. There are a few causes for this risk when using Foley catheters, first risk occurs at the point of insertion. At this point following sterile technique is very important to reduce the introduction of microbes into the urethra. Other factors after insertion that increase the risk include length of insertion (the biggest factor), foley catheter care, maintaining a sterile closed catheter system, diabetes mellitus and being a female.  I chose to focus on the point of insertion as I work in the Emergency room and this is the point in which many foleys are inserted in the hospital. It is important for nurses to follow a sterile procedure. Every hospital has a protocol in which nurses are expected to follow. In reality nurses learn how to insert foley catheters in nursing school and this is usually where the procedure is learned.   In my hospital we have never had an inservice, review or additional education on the foley insertion procedure. I think that in some cases this could be beneficial for us nurses to reduce the incidence of infections that arise from foley catheter placement.

    P-Patients admitted into the hospital through the ED requiring Foley catheter insertion in the ED

    I-Insertion of Foley catheters by nurses who have completed additional Foley insertion education

    C-insertion of Foley catheters by nurses without additional Foley insertion education

    O-Decreased incidence of Urinary tract infections in patients admitted to the hospital through ED with Foley catheters

    Rebecca Nussbaum

    References

    McNeill, L. (2017). Back to Basics: How Evidence-Based Nursing Practice Can Prevent Catheter-Associated Urinary Tract Infections. Urologic Nursing, 37(4), 204-206. doi:10.7257/1053-816X.2017.37.4.204

    Good evening class and Professor Scott,

    Is increasing the level of professional adherence to interventions aimed at reducing HAI effective enough to address the problem?
    Developing of the question is instigated by the need to address the growing rate of Health Associated Infections within clinical settings. With problem most rampant in health settings, interventions towards addressing the problem outside the clinical setting have been futile. However, most health related infections are contacted during hospitals visit, and the greatest cause of the problem is the acts of health professionals. In essence, basic neglect tendencies towards basic equipment hygiene by health professionals are the greatest risk factors towards the increase the rate of HAIs. For this reason, developing strategies within the sector and mainly targeting improving the conduct of professional may be the best way to address the problem. The clinical question seek to ask if making sure health professional are well educated and trained towards adhering to suggested interventions would decrease the related of health associated inventions. Currently, this may not be working considering the 5%-35% rate of HAI infections within the hospital setting. It also important to note that the angle of the question also queries the ability of available researches aimed at increasing knowledge among health professionals on the issue.
    The importance of the question is significant in that it questions the ability of current interventions towards addressing the HAI problem. Currently, the 35% hospital infection rate is huge which increases the risk factor patients have to face within the clinical settings. Considering that this is an avoidable problem, much more should be done towards improving the state of hygiene in health institutions. This should be classified as both a current and future health care goal considering the main objective of the field to improve human health. In the current clinical settings, the effects of the problem are huge as patient face elongated hospital stay, new infection risks, and possible mortality risk caused by new infections. This narrative needs to change within the current clinical setting considering available resources that may be used to mitigate the problem. Interventions towards improving the knowledge of practitioners towards the problem should be done with the future in mind considering the future implications if the problem is not addressed. From a health practitioner’s standpoint, it may be important to increase educational and training approaches on how to handle clinical instruments. If this is achieved now, it may be easier to continue with a functional intervention approach for future purposes.
    A research-practice gap in the health setting refers to the gap between data available from researches conducted, and the likelihood of the research results to be put into practice.

     

    Thank you,

    Charlyne Saint-Remy

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