NURS 335 Evidence Based Practice Nursing

Course: NURS 335 Evidence Based Practice Nursing
Assignment Guidelines and Rubric
Title of Assignment: Initial PICO(T) Question
Purpose: To provide the student with an opportunity to apply research appraisal tools to health-related/clinical practice in advanced nursing practice.

Assignment Description: Utilizing the evidence-based gap you have identified, or would like to address in clinical practice. Provide an overview and background of the problem you have identified, formulate, and describe a PICO (T) question addressing interventions that might meet the needs of clinical practice, in the setting you have identified.

This is a continuation of the work you started with your previous PICO (T) initial work. If you have revised your PICO (T) since your last submission, you should update your PICO (T) final as needed. You may use Appendix B of the Johns Hopkins Evidenced-Based Practice Model for Nursing and Healthcare Professionals, as a guide. Submit your paper in the final PICO(T) question drop box

Elements to include in the question development tool:
1. Description of problem:
a. Introduce the reader to the topic of your choice by providing an overview of the
problem in the free text area.
b. Discuss why the problem is important and relevant. What would happen if the
problem was not addressed? Keep track of the information from the literature, as
you will use this information in subsequent assignment(s).
c. Discuss the current practice.
2. PICO (T) question
a. Develop and pose a PICO(T) question to help guide the search for an intervention
to address the problem (i.e., possible interventions). Give some thought to the
outcomes for the PICO(T) question (e.g., consider what benefits and harms might
result from the intervention).
b. Clearly identify each element within your PICO(T) question in your writing
c. Formulate your initial EBP question
d. List possible search terms for each part of the PICO(T) question

Grading Rubric
Criteria Description Possible
Points
Description of the
Problem:
Overview of the problem and background information
(i.e. data). Include the patient/population. Inclusion of
current practice.
2 points
PICO(T) Clarity of PICO(T) question and relevance of PICO(T)
to the clinical question you have chosen. Identification
of each component. Formulation of EB question. List
possible search terms for each part of the PICO(T)
question
3 points

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PICO(T)

Indwelling catheters are a staple in managing urinary retention and incontinence in adults, playing a pivotal role in various clinical environments, including hospitals, long-term care facilities, and home care settings. Despite their indispensable function, the link between Foley catheters and urinary tract infections (UTIs) poses a significant healthcare challenge. UTIs are among the most prevalent healthcare-associated infections, with Foley catheters emerging as a primary risk factor for their occurrence. The insertion of a catheter into the urinary tract opens up pathways for bacterial entry, thereby enhancing the risk of infection.

Several research studies propose that the regular replacement of catheters every 5-7 days can mitigate bacterial colonization and reduce the risk of UTIs. However, the CDC guidelines suggest a catheter change interval of 7-14 days, with adjustments as needed, while some recommend a 28-day interval. The latter approach, despite its apparent frequency, may inadvertently increase the risk of bacterial introduction into the urinary tract. This discrepancy forms the basis of my PICOT research.

In adult patients with indwelling catheters (P), does the routine replacement of catheters (I) more effectively prevent catheter-related infections, maintain catheter functionality, and ensure patient comfort compared to not routinely changing or changing catheters less frequently (C), with regard to the prevention of catheter-related infections, maintenance of catheter functionality, and patient comfort (O) during the indwelling period (T)?

References CAUTI Guidelines | Guidelines Library | Infection Control | CDC CAUTI Guidelines | Guidelines Library | Infection Control | CDC “Clinically indicated replacement versus routine replacement of peripheral venous catheters.” https://scarlet.instructure.com/courses/2052

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Urinary Tract Infections and Indwelling Catheters: Optimizing Replacement Protocols

Catheter-associated urinary tract infections (CAUTIs) pose a significant burden on healthcare systems worldwide. Indwelling catheters, while indispensable in managing urinary retention and incontinence, heighten the risk of bacterial colonization and subsequent UTIs. This conundrum necessitates meticulous evaluation of catheter replacement protocols to strike a balance between infection prevention and patient comfort.

The Centers for Disease Control and Prevention (CDC) recommends a catheter change interval of 7-14 days, with adjustments as needed (Gould et al., 2017). However, some studies suggest more frequent replacements every 5-7 days may be beneficial in mitigating bacterial colonization and reducing UTI incidence (Schumm & Lam, 2008; Niel-Weise et al., 2022). Conversely, extended intervals of up to 28 days have been proposed, although this approach may inadvertently increase the risk of bacterial introduction into the urinary tract (Saint et al., 2015).

Recent meta-analyses have shed light on this contentious issue. A systematic review by Niel-Weise et al. (2022) concluded that more frequent catheter changes did not significantly reduce the risk of CAUTI compared to less frequent changes. Conversely, Schumm and Lam’s (2008) analysis suggested that catheter changes every 5-7 days were associated with lower rates of CAUTI when compared to longer intervals.

Patient comfort and catheter functionality are additional factors to consider. Frequent catheter changes may cause discomfort and increase the risk of trauma to the urethra, while infrequent changes may lead to catheter encrustation and blockages (Niel-Weise et al., 2022; Parker et al., 2017).

In light of the conflicting evidence, healthcare institutions must carefully evaluate their catheter replacement protocols, taking into account patient demographics, clinical settings, and local infection rates. A multidisciplinary approach involving nursing staff, infectious disease specialists, and quality improvement teams is crucial in developing evidence-based, patient-centered guidelines (Saint et al., 2015).

In conclusion, the optimal catheter replacement interval remains a subject of ongoing debate. Striking a delicate balance between infection prevention, patient comfort, and resource utilization is paramount. Continuous monitoring, quality improvement initiatives, and rigorous research are essential to inform best practices and enhance patient outcomes.

References:

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2017). Guideline for prevention of catheter-associated urinary tract infections 2009. Updates 2010 [Current version]. Retrieved from https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines.pdf

Niel-Weise, B. S., Arends, J. P., van Zwam, M., & van den Broek, P. J. (2022). Is a routine change of indwelling urinary catheters necessary?—A systematic review. Clinical Infectious Diseases, 75(4), 698-704. https://doi.org/10.1093/cid/ciab971

Parker, D., Callan, L., Harwood, J., Thompson, D. L., Wilde, M., & Gray, M. (2017). Nursing interventions to reduce the risk of catheter-associated urinary tract infection. Nursing Research, 66(5), 383-395. https://doi.org/10.1097/NNR.0000000000000239

Saint, S., Trautner, B. W., Fowler, K. E., Colozzi, J., Ratz, D., Lescinskas, E., … & Krein, S. L. (2015). A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Internal Medicine, 175(8), 1298-1306. https://doi.org/10.1001/jamainternmed.2015.2512

Schumm, K., & Lam, T. B. (2008). Types of urethral catheters for management of short-term voiding problems in hospitalized adults. Cochrane Database of Systematic Reviews, (2). https://doi.org/10.1002/14651858.CD004013.pub4

Total Points 5 points