8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all patients. For years, hospitals nationwide have struggled with healthcare-associated infections (HAIs). Since HAIs are considered preventable events in a hospital setting the Centers for Medicare and Medicaid Services (CMS) established reimbursement changes and hospitals are focusing more on patient safety practices and improving processes to have better patient outcomes (Thornlow & Merwin, 2009). According to The Centers for Disease Control and Prevention (CDC, 2017), approximately seventy-five percent of hospital-acquired urinary tract infections are associated with a urinary catheter with a prolonged use being the most critical risk factor for developing a CAUTI. Also, CAUTIs can cause an overabundance of complications included but not limited to gram-negative bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-term acute care hospital (LTACH), prolonged and unnecessary use of indwelling urinary catheters is interrelated with a higher risk of catheter-associated urinary tract infections (CAUTI) and extended lengths of stay (LOS) (Felix, 2016). The purpose of this paper is to reduce the usage of indwelling catheter days and decrease CAUTI rates from 2.48 to below the target rate of 1.71 by utilizing prevention practices in a 72-bed long-term acute care hospital emphasizing on the assurance of a continuous improvement process. This proposal consists of implementing alternatives before deciding to insert an indwelling catheter, utilizing maintenance bundles, and daily assessment of the necessity of the catheter. All these interventions are aiming at preventing and decreasing catheter-associated urinary tract infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we are the frontline of patient care and safety. Although, sometimes we encounter situations where a CAUTI occurs, the quality of care we provide to our patients reflects by the interventions we take to prevent our patients from getting an infection. Every action we make while providing care for a patient is an essential step in the quality of their care. Most patients admitted into long-term acute care have wounds or infections that require long-term antibiotics. These patients come in from acute care hospitals, and in the majority of the cases patients already have an indwelling urinary catheter, however, there are situations where the patient doesn’t come with an indwelling catheter, and nurses get orders to place one on admission. Finding alternatives to either discontinue or insert a foley is an essential part of the daily nursing assessment and on the hospitalization of these patients. Important factors to consider while assessing the patient are mobility, cognitive status, gender, and wounds.
L.
Improving Urinary Catheterization
Reducing Catheter-Related Infections at Amsterdam Nursing Home in New York
Group Members
Introduction
Urinary catheters are vital tools that collect urinary in a drainage bag from the bladder.
They are important for patients with a compromised urinary function.
Urinary Catheters are a double-edged sword:
On the one hand, they simplify the handling of a basic bodily function.
On the other hand, they subject frail patients to the risk of infection, which may lead to death, falls, or confusion. The infection is referred to as catheter-associated urinary tract infections (CAUTI) (Parker et al., 2017).
Problem Statement
Catheter-related infections at Amsterdam Nursing Home in New York are currently quite high.
This project aims to find solutions to lower the current infection rate to manageable levels.
The high infection rates are posing diverse risks to the patients in post-acute and long-term care.
The current situation is leading to negative patient outcomes. It also results in unnecessary high healthcare costs.
Aims Statement
This project aims to decrease the infection rates from the use of urinary catheters from the current 10% infection rate to a maximum of 2% infection rate by the end to a 3 month timeframe in the elderly population at Amsterdam Nursing Home.
Establishing Measures
The following measures will prove that the object is working:
A drop in the infection rates from 10% to 2%.
A significant drop in the current expenditure used to treat complications due to infections (at least 50%).
An increase in patient satisfaction based on a survey to be filled by clients (at least 75%).
Selecting Changes
Appropriate Urinary Catheter Use.
Catheters should only be used for appropriate indications as outlined by the CDC. Also, the duration of use should be minimized in high risk patients.
Proper Techniques for Insertion and Maintenance.
High hygiene levels should be maintained. This is in reference to hand hygiene, use of sterilized products, and general cleanliness in the nursing room.
Also, catheterization should only be done by authorized personnel.
Regular maintenance of the catheters should be done. Catheters should be replaced as necessary (Gould et al., 2010).
Selecting Changes
Quality Improvement (QI) Programs.
All practitioners should be routinely educated on the proper use of catheters.
Appraisal programs should e conducted regularly to evaluate effective catheter use in the nursing home.
Administrative Infrastructure.
Provision of relevant guidelines.
Education and Training.
Sourcing of Supplies.
Surveillance.
Testing Changes
Use of Interworking Model.
Model comprised of Donabedian’s conceptual framework, Watson’s Theory of Caring, and Lewin’s Theory of Change (D'Antonio, 2018).
This model is crucial in re-educating staff to enact change, emphasize a nurse-driven initiative, and to assess quality
Testing Changes
Plan
The objective of testing changes is to see if t ...
Improving Urinary Catheterization
Reducing Catheter-Related Infections at Amsterdam Nursing Home in New York
Group Members
Introduction
Urinary catheters are vital tools that collect urinary in a drainage bag from the bladder.
They are important for patients with a compromised urinary function.
Urinary Catheters are a double-edged sword:
On the one hand, they simplify the handling of a basic bodily function.
On the other hand, they subject frail patients to the risk of infection, which may lead to death, falls, or confusion. The infection is referred to as catheter-associated urinary tract infections (CAUTI) (Parker et al., 2017).
Problem Statement
Catheter-related infections at Amsterdam Nursing Home in New York are currently quite high.
This project aims to find solutions to lower the current infection rate to manageable levels.
The high infection rates are posing diverse risks to the patients in post-acute and long-term care.
The current situation is leading to negative patient outcomes. It also results in unnecessary high healthcare costs.
Aims Statement
This project aims to decrease the infection rates from the use of urinary catheters from the current 10% infection rate to a maximum of 2% infection rate by the end to a 3 month timeframe in the elderly population at Amsterdam Nursing Home.
Establishing Measures
The following measures will prove that the object is working:
A drop in the infection rates from 10% to 2%.
A significant drop in the current expenditure used to treat complications due to infections (at least 50%).
An increase in patient satisfaction based on a survey to be filled by clients (at least 75%).
Selecting Changes
Appropriate Urinary Catheter Use.
Catheters should only be used for appropriate indications as outlined by the CDC. Also, the duration of use should be minimized in high risk patients.
Proper Techniques for Insertion and Maintenance.
High hygiene levels should be maintained. This is in reference to hand hygiene, use of sterilized products, and general cleanliness in the nursing room.
Also, catheterization should only be done by authorized personnel.
Regular maintenance of the catheters should be done. Catheters should be replaced as necessary (Gould et al., 2010).
Selecting Changes
Quality Improvement (QI) Programs.
All practitioners should be routinely educated on the proper use of catheters.
Appraisal programs should e conducted regularly to evaluate effective catheter use in the nursing home.
Administrative Infrastructure.
Provision of relevant guidelines.
Education and Training.
Sourcing of Supplies.
Surveillance.
Testing Changes
Use of Interworking Model.
Model comprised of Donabedian’s conceptual framework, Watson’s Theory of Caring, and Lewin’s Theory of Change (D'Antonio, 2018).
This model is crucial in re-educating staff to enact change, emphasize a nurse-driven initiative, and to assess quality
Testing Changes
Plan
The objective of testing changes is to see if t ...
Prevention of Central Line-Associated Bloodstream Infections (CLAB.docxstilliegeorgiana
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
Submitted by
Kerry Sean Murphy
Direct Practice Improvement Project Proposal
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)1
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
June 26, 2019
Appendix A
Ten Strategic Points
Comments or Feedback
Broad Topic Area
1. Broad Topic Area:
The topic is the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs).
Literature Review
2. Literature Review:
a. Background of the problem/gap:
· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs (Yaseen, et al., 2016).
· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections (Dick et al., 2015).
· The nurses need to have significant knowledge associated with evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs). Their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter in adult Intensive Care (ICU) units with (CVC) patients needs to change for the better (Kadium, 2015).
· Research has shown the existence of variations in the practice of nursing regarding the prevention of CLABSI, thus stressing the need for monitoring and education/training (Elbilgahy et al., 2015).
· There is a need for implementation of educational interventions to deal with the practice and knowledge gaps about CLABSIs prevention as well as ensuring that nurses apply prevention interventions which are evidence-based (Esposito et al., 2017).
· The Quality Health Outcomes Model (QHOM) Investigating Prophylactic measures to eradicate the incidence of central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich et al., 2014)
b. Carrying out a review of literature topics with a key theme for each one.
c. Prevention of Central Line-Associated Blood Stream Infection (CLABSI) (Masse, Edmond, & Diekema, 2018).
· The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures (Gilmartin & Sousa, 2016).
· The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed uses Standardized Infection Ratios (SIRs). Clear Lake Regional Medical Center ("NHSN | CDC," 2018) uses SIRs, and this study will also utilize SIRs for measuring the effectiveness of preventive CLABSI maintenance bundles ("SIR Report | HAI | CDC," 2019).
Setting
· Adult ICU (El ...
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2CENTRAL LINE-ASS.docxsleeperharwell
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
Central Line-Associated Bloodstream Infections Literature Review
Kerry S. Murphy
Grand Canyon University
Translational Research and Evidence-Based Practice
DNP-820-O501
Dr. Kari Lane
September 26, 2018
Running head: CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
Central Line-Associated Bloodstream Infections Literature ReviewComment by Microsoft Office User: The heading of introduction is inferred in APA format
I. Introduction
Central Line-Associated Bloodstream Infection (CLABSIs) in a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter, refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). Central Line-Associated Bloodstream Infection is one of the leading causes of deaths each year in different countries across the globe. Central Line-Associated Bloodstream Infection has been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. The paper is an analysis of articles related to CLABSIs with the major themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. Comment by Microsoft Office User: Add a description of how the literature search was completed. Tell the reader how you did your literature search, which databases you searched, how many articles were found, and how you eliminated articles to come to the ones you included here.
II. Questions Posed in the Studies
a. Afonso, Blot, & Blot (2016) seeks to establish how hospital-acquired bloodstream infections can be prevented through the use of chlorhexidine gluconate-impregnated washcloth bathing in intensive care units. In the study by Chidambaram (2015), the question raised is, what associations dental procedure and CVCs have.
b. Kadium, M. (2015) inquired into how the education program for 1 month, based on the
evidence-based guidelines recommended by CDC, will improve registered dialysis nurses’ knowledge regarding CVC maintenance care?
c. CDC and NCBI (2011) raise the research question, how many people have been affected in the USA from 2001-2009?
d. Srinivasan, Wise, Bell, Cardo,Edwards, Fridkin, Jernigan, Kallen, McDonald, & Patel (2011) considers questioning the perception of central line-associated bloodstream infection.
e. Dougherty (2012) questions the potential solutions in reducing incidences of central-line associated bloodstream infections have to be created in line with the clinical setting and careful consideration of the patients and the organizational culture.
f. Lin, Apisarnthanarak, Jaggi, Harrington, Morikane, Thu, Ching, Villanueva.
1-Evidence-based practice is what keeps the health care system usandibabcock
1-Evidence-based practice is what keeps the health care system up-to-date with technology and best-practices; these practices help improve patient outcomes. The first article that I read was research about improving the procedures for collecting and testing urine specimens. In the study, they observed how the collection method was carried out and how long it took for the specimen to reach the laboratory for testing. It was determined that not only were the collection methods flawed but the specimens were sitting too long at room temperature; both influenced the test results. Having contaminated specimens were producing unreliable test results and people were getting a wrong diagnosis with a wrong treatment plan. This study helped identify the major problems along with creating solutions to those problems: mid-stream clean catch, using straight-catheters, proper way to get a specimen from an indwelling-catheter, and appropriate time for the specimen to sit at room temperature. This research article helped improve patient outcomes because it increased the accuracy of the test results which yielded a more specific diagnosis; appropriate treatments increased patient outcomes. In our facility when we collect a urine specimen we keep the specimen in the refrigerator and call the labs for a stat pick-up.
The second article that I read was on improves patient outcome fall prevention in 65+ adults. A prevalent safety issue is injuries that occur from Falls. Elderly and frail have a higher risk of falls that can lead into hip-fractures or even death. Accidental falls can result from an unsafe environment or environmental risk factors for example low blood pressure, dehydration, impaired mobility, unstable gait to name a few. To prevent/reduce the risk for falls staff need to maintain awareness of the environmental safety. I work in an Assisted living facility we have Fall-Risk Assessment tool that we use for each of our residents. But our main intervention is communication with staff and residents. We ensure that there is no trip hazard, we lower the bed to the lowest position when they are in bed, check their rooms and facility for potential safety issues, have mats on the floors next to their bed.
2-Two areas of nursing practice that have been under scrutiny in my facility involve Catheter Associated Urinary Tract Infections (CAUTIs) and Standard precautions. Both seem like basic concepts, but in nursing, sometimes the “basics” get swept to the back of your mind when you are focusing on other issues involved in patient care. Both of these concepts are integral parts of patient safety, which is and should be our number one priority.
In the healthcare setting, the use of an indwelling catheter can be a necessity on many occasions. As nurses, it is imperative that we assess the need carefully for catheter placement, as well as continuously assess the need for the catheter to remain in place. According to a study put forth by BMC Health Services R ...
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2.docxaudeleypearl
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2
Research-Based Literature Support for CAUTI
Kamila Julian
Chamberlain College of Nursing
NR 505: Advanced Research Methods: Evidenced Based Practice
July 2019
Running head: RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 1
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 8
Research-Based Literature Support for CAUTI
Preventing inappropriate use of a urinary catheter and the risk of patient harm associated with the use of indwelling catheters remains a significant challenge for healthcare facilities. The purpose of this paper is to provide research-based literature support from 10 (ten) different research-based references, on the prevention of CAUTI, evaluating interventions that support the use of nurse-driven protocols to reduce the incidence of CAUTI.
The following is the proposed PICO question: “How does the use nurse-driven protocol for evaluating the appropriateness and prevalence of catheter use or removal, compared with no protocol affect the CAUTI rates?”
The literature review from Fakih, Krein, Edson, Watson, Battles, and Saint (2014) aimed to engage healthcare workers to prevent CAUTI and prevent patient harm. A quantitative approach and a quasi-experimental design were used to assess the impact of guidelines for CAUTI prevention and reduce CAUTI rates in the state of Michigan through the use of a bladder bundle, promoting a daily evaluation of catheter indication (Fakih et al., 2014). The ability of the selected design to generate a cause and effect relationship collaborated in spreading educational insights and guidance to various stakeholders. A disadvantage of such design is the lack of control group, as internal validity is not easy to control once a probability of a stakeholder not following all the necessary steps of the protocol to generate true findings, for example nurses not consistent with their rounds to evaluate daily necessity of indwelling catheter, which are important in order to identify gaps and make appropriate and necessary modifications based on new evidence. Target population here are hospitalized patients from 163 units including ER, ICU, Surgical, and operating room from 71 acute care hospitals in the state of Michigan, with an equal probability of being selected resulting in random sampling and confidentiality (Fakih et al., 2014).
The aim of the study by Shehab (2017) is to analyze the impact of the protocol of care, from nurse’s knowledge, of patients that requires a urinary catheter. A quasi-experiment design was used to test assumptions of effective changes in nurse’s knowledge after caring out the protocol of care on patients with the urinary catheter by using a structured interview questionnaire and a nurse’s knowledge assessment tool (Shehab, 2017). An advantage of this study is to evaluate nurse’s readiness to follow protocols and to update their knowledge on how to provide the best EBP care for patients with a Foley catheter. ...
Running head PICOT AND LITERATURE SEARCH 1.docxtodd581
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
Running head PICOT AND LITERATURE SEARCH 1.docxglendar3
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS,21THE 10 STRATEGIC P.docxtodd801
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 21
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 28
DPI Project Milestone:10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project
Running head: THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 1
The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project
The 10 Strategic Points
Broad Topic Area
1. Broad Topic Area:
The topic taken into consideration is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention
Introduction
2. Introduction
· The paper is an analysis of the CLABSIs infection and how best the infection can be prevented or even eliminated among patients.
· The infection is characterized by a catheter gaining entry into the bloodstream, greatly affecting either the inferior or the superior vena cava or the vessels of the neck.
· The location of the catheter makes entry of pathogens into the bloodstream very occasional. Patients thus become sick easily.
· The risk factors associated with the infection can result from the healthcare provider and also the patients and include; contamination on insertion, the skin flora of the patient, non-intact dressing, poor nutrition, position of the central line, poor patient and healthcare provider hygiene.
· Symptoms include redness, swelling, discharge at the central line exit, fever, chills, respiratory distress, and altered cognitive state.
· The infection can be prevented, through monitoring of the patients for any signs and symptoms, ensuring proper hygiene practices, and keeping patients educated about management of their central line.
· The paper gives all these information in detail, why there is a need to address Central line-associated bloodstream infections (CLABSIs) and how best the infection can be handled both by the health care givers and the patients.
Literature Review
3. Literature Review:
1. Primary points basis four sections in the Literature Review:
a. Background of the problem/gap:
· Researchers have dedicated numerous efforts towards the cause and the probable symptoms related to Central line-associated bloodstream infections (CLABSIs) that one needs to be on the look-out for.
· Attention has thus been shifted from the different measures to prevent the occurrence of the infection among patients.
· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs.
· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections
· The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients.
b. Theoretical foundations (models and theories to be the foundation for the project)
· The efficacy of training of nu.
Importance of infection control in ICU
Ventilator-associated Pneumonia definition and bundles, Central line-associated infection and its bundles and foley's catheter-associated infection and its bundles
this presentation in reference to CDC and IMO
Infection Control Guidelines for Prevention of Catheter Associated Urinary Tract Infection
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
A brief description of your employment historyYour career .docxsodhi3
A brief description of your employment history
Your career goals (both short and long term)
Tell me about a leader you look up to. This can be someone you know or don't know, famous or familiar to you, and can even be a TV/Movie character and does not need to real. Describe what this person does makes them your role model.
(My name is Danny Z. i'm a full time student )
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A budget is a plan expressed in dollar amounts that acts as a road map to carry out an organization’s objectives, strategies and assumptions. There are different types of budgets that healthcare organization use to manage its financial and managerial goals and obligations.
Discuss the difference between an operating budget and a capital budget. What are the steps in creating each budget?
At least 150 words; APA Format
.
A 72-year-old male with a past medical history for hypertension, con.docxsodhi3
A 72-year-old male with a past medical history for hypertension, congestive heart failure, chronic back pain, and diabetes is admitted to the hospital for hypotension suspected from a possible accidental overdose. What are the criteria for discharge? Explain the importance of utilizating hospital recommendations and teachings. List some meaningful community resources in the response.
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Code of Ethics: This is a synopsis of some of the most important ethical
considerations you need to be aware of as a professional in the real estate
industry.
Terminology:
Agency: The fiduciary relationship created between a principal and an agent whereby the agent
can act on behalf of the principle for certain transactions. Agency is usually created when the
principal signs a listing agreement to list their property for sale or a management contract to rent
a property for instance.
Agent: The broker or sales associate acting on behalf of the principal (see Agency)
Client: The person with whom the broker or sales associate has a legal contract to represent.
Customer: Is not contractually bound to the industry professional
Principal: Person who hires an agent to act on his or behalf.
Code of Ethics:
#1: The agent has a responsibility to promote the interests of their client(s) and treat all involved
in any real estate transaction in an honest and fair manner. They must disclose if they are a
dual agent (representing both buyer and seller in a transaction) or a designated agent
(represent either the buyer or seller depending on state law), or they are a limited representative
(will provide only certain duties in the transaction per state law).
#2: Agents must openly acknowledge to clients any personal interest they might have in any
transaction prior to showing a property; they must acknowledge any personal relationships
involved. Ex: Agent says, “I want to disclose to you before we look at it, that this property
belongs to is my brother and my sister in-law is his agent.”
#3: The Agent will not allow anyone that is not pre-authorized by the owner, to access the
property of the client.
#4: Never overstate benefits or attributes of a property or opportun.
a brief explanation of the effect of Apartheid in South Africa. Prov.docxsodhi3
a brief explanation of the effect of Apartheid in South Africa. Provide two specific examples that demonstrate how people adapted. Finally explain the impact and implications of the changes we have seen in recent years. Cite specific cases. Your original post must be no less than 600 words.
.
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Similar to 8Catheter-Associated Urinary Tract Infections (CAUTI)Walden .docx
Prevention of Central Line-Associated Bloodstream Infections (CLAB.docxstilliegeorgiana
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
Submitted by
Kerry Sean Murphy
Direct Practice Improvement Project Proposal
Doctor of Nursing Practice
Grand Canyon University
Phoenix, Arizona
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)1
Prevention of Central Line-Associated Bloodstream Infections (CLABSIs)
June 26, 2019
Appendix A
Ten Strategic Points
Comments or Feedback
Broad Topic Area
1. Broad Topic Area:
The topic is the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs).
Literature Review
2. Literature Review:
a. Background of the problem/gap:
· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs (Yaseen, et al., 2016).
· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections (Dick et al., 2015).
· The nurses need to have significant knowledge associated with evidence-based practices for the prevention of central line-associated bloodstream infections (CLABSIs). Their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter in adult Intensive Care (ICU) units with (CVC) patients needs to change for the better (Kadium, 2015).
· Research has shown the existence of variations in the practice of nursing regarding the prevention of CLABSI, thus stressing the need for monitoring and education/training (Elbilgahy et al., 2015).
· There is a need for implementation of educational interventions to deal with the practice and knowledge gaps about CLABSIs prevention as well as ensuring that nurses apply prevention interventions which are evidence-based (Esposito et al., 2017).
· The Quality Health Outcomes Model (QHOM) Investigating Prophylactic measures to eradicate the incidence of central line-associated bloodstream infections (CLABSIs), based on the opinions of the experts as well as the analysis of the research literature (Hentrich et al., 2014)
b. Carrying out a review of literature topics with a key theme for each one.
c. Prevention of Central Line-Associated Blood Stream Infection (CLABSI) (Masse, Edmond, & Diekema, 2018).
· The Quality Health Outcomes Model (QHOM) is used to study healthcare quality and outlines relationships existing between interventions, characteristics, and outcomes of patients, and the characteristics of the healthcare system. This model/framework has been used by various researchers to test the effectiveness of infection prevention measures (Gilmartin & Sousa, 2016).
· The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) developed uses Standardized Infection Ratios (SIRs). Clear Lake Regional Medical Center ("NHSN | CDC," 2018) uses SIRs, and this study will also utilize SIRs for measuring the effectiveness of preventive CLABSI maintenance bundles ("SIR Report | HAI | CDC," 2019).
Setting
· Adult ICU (El ...
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2CENTRAL LINE-ASS.docxsleeperharwell
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
Central Line-Associated Bloodstream Infections Literature Review
Kerry S. Murphy
Grand Canyon University
Translational Research and Evidence-Based Practice
DNP-820-O501
Dr. Kari Lane
September 26, 2018
Running head: CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS2
Central Line-Associated Bloodstream Infections Literature ReviewComment by Microsoft Office User: The heading of introduction is inferred in APA format
I. Introduction
Central Line-Associated Bloodstream Infection (CLABSIs) in a fatal infection that results from bacteria or viruses entering the bloodstream through the central line. A central line, also known as a central venous catheter, refers to a tube used by doctors to administer medication, fluids or to collect blood from the body of a patient (Deason & Gray, 2018). Central Line-Associated Bloodstream Infection is one of the leading causes of deaths each year in different countries across the globe. Central Line-Associated Bloodstream Infection has been an area of interest for many healthcare researchers representing a diverse body of knowledge about the infection while still expanding on what is already known. The paper is an analysis of articles related to CLABSIs with the major themes of concern to the authors including risk factors, interventions, CLABSIs and Hospital Acquired Infections (HAIs), benefits of the preventive measures and the common symptoms of CLABSIs. Comment by Microsoft Office User: Add a description of how the literature search was completed. Tell the reader how you did your literature search, which databases you searched, how many articles were found, and how you eliminated articles to come to the ones you included here.
II. Questions Posed in the Studies
a. Afonso, Blot, & Blot (2016) seeks to establish how hospital-acquired bloodstream infections can be prevented through the use of chlorhexidine gluconate-impregnated washcloth bathing in intensive care units. In the study by Chidambaram (2015), the question raised is, what associations dental procedure and CVCs have.
b. Kadium, M. (2015) inquired into how the education program for 1 month, based on the
evidence-based guidelines recommended by CDC, will improve registered dialysis nurses’ knowledge regarding CVC maintenance care?
c. CDC and NCBI (2011) raise the research question, how many people have been affected in the USA from 2001-2009?
d. Srinivasan, Wise, Bell, Cardo,Edwards, Fridkin, Jernigan, Kallen, McDonald, & Patel (2011) considers questioning the perception of central line-associated bloodstream infection.
e. Dougherty (2012) questions the potential solutions in reducing incidences of central-line associated bloodstream infections have to be created in line with the clinical setting and careful consideration of the patients and the organizational culture.
f. Lin, Apisarnthanarak, Jaggi, Harrington, Morikane, Thu, Ching, Villanueva.
1-Evidence-based practice is what keeps the health care system usandibabcock
1-Evidence-based practice is what keeps the health care system up-to-date with technology and best-practices; these practices help improve patient outcomes. The first article that I read was research about improving the procedures for collecting and testing urine specimens. In the study, they observed how the collection method was carried out and how long it took for the specimen to reach the laboratory for testing. It was determined that not only were the collection methods flawed but the specimens were sitting too long at room temperature; both influenced the test results. Having contaminated specimens were producing unreliable test results and people were getting a wrong diagnosis with a wrong treatment plan. This study helped identify the major problems along with creating solutions to those problems: mid-stream clean catch, using straight-catheters, proper way to get a specimen from an indwelling-catheter, and appropriate time for the specimen to sit at room temperature. This research article helped improve patient outcomes because it increased the accuracy of the test results which yielded a more specific diagnosis; appropriate treatments increased patient outcomes. In our facility when we collect a urine specimen we keep the specimen in the refrigerator and call the labs for a stat pick-up.
The second article that I read was on improves patient outcome fall prevention in 65+ adults. A prevalent safety issue is injuries that occur from Falls. Elderly and frail have a higher risk of falls that can lead into hip-fractures or even death. Accidental falls can result from an unsafe environment or environmental risk factors for example low blood pressure, dehydration, impaired mobility, unstable gait to name a few. To prevent/reduce the risk for falls staff need to maintain awareness of the environmental safety. I work in an Assisted living facility we have Fall-Risk Assessment tool that we use for each of our residents. But our main intervention is communication with staff and residents. We ensure that there is no trip hazard, we lower the bed to the lowest position when they are in bed, check their rooms and facility for potential safety issues, have mats on the floors next to their bed.
2-Two areas of nursing practice that have been under scrutiny in my facility involve Catheter Associated Urinary Tract Infections (CAUTIs) and Standard precautions. Both seem like basic concepts, but in nursing, sometimes the “basics” get swept to the back of your mind when you are focusing on other issues involved in patient care. Both of these concepts are integral parts of patient safety, which is and should be our number one priority.
In the healthcare setting, the use of an indwelling catheter can be a necessity on many occasions. As nurses, it is imperative that we assess the need carefully for catheter placement, as well as continuously assess the need for the catheter to remain in place. According to a study put forth by BMC Health Services R ...
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2.docxaudeleypearl
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 2
Research-Based Literature Support for CAUTI
Kamila Julian
Chamberlain College of Nursing
NR 505: Advanced Research Methods: Evidenced Based Practice
July 2019
Running head: RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 1
RESEARCH-BASED LITERATURE SUPPORT FOR CAUTI 8
Research-Based Literature Support for CAUTI
Preventing inappropriate use of a urinary catheter and the risk of patient harm associated with the use of indwelling catheters remains a significant challenge for healthcare facilities. The purpose of this paper is to provide research-based literature support from 10 (ten) different research-based references, on the prevention of CAUTI, evaluating interventions that support the use of nurse-driven protocols to reduce the incidence of CAUTI.
The following is the proposed PICO question: “How does the use nurse-driven protocol for evaluating the appropriateness and prevalence of catheter use or removal, compared with no protocol affect the CAUTI rates?”
The literature review from Fakih, Krein, Edson, Watson, Battles, and Saint (2014) aimed to engage healthcare workers to prevent CAUTI and prevent patient harm. A quantitative approach and a quasi-experimental design were used to assess the impact of guidelines for CAUTI prevention and reduce CAUTI rates in the state of Michigan through the use of a bladder bundle, promoting a daily evaluation of catheter indication (Fakih et al., 2014). The ability of the selected design to generate a cause and effect relationship collaborated in spreading educational insights and guidance to various stakeholders. A disadvantage of such design is the lack of control group, as internal validity is not easy to control once a probability of a stakeholder not following all the necessary steps of the protocol to generate true findings, for example nurses not consistent with their rounds to evaluate daily necessity of indwelling catheter, which are important in order to identify gaps and make appropriate and necessary modifications based on new evidence. Target population here are hospitalized patients from 163 units including ER, ICU, Surgical, and operating room from 71 acute care hospitals in the state of Michigan, with an equal probability of being selected resulting in random sampling and confidentiality (Fakih et al., 2014).
The aim of the study by Shehab (2017) is to analyze the impact of the protocol of care, from nurse’s knowledge, of patients that requires a urinary catheter. A quasi-experiment design was used to test assumptions of effective changes in nurse’s knowledge after caring out the protocol of care on patients with the urinary catheter by using a structured interview questionnaire and a nurse’s knowledge assessment tool (Shehab, 2017). An advantage of this study is to evaluate nurse’s readiness to follow protocols and to update their knowledge on how to provide the best EBP care for patients with a Foley catheter. ...
Running head PICOT AND LITERATURE SEARCH 1.docxtodd581
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
Running head PICOT AND LITERATURE SEARCH 1.docxglendar3
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS,21THE 10 STRATEGIC P.docxtodd801
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 21
THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 28
DPI Project Milestone:10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project
Running head: THE 10 STRATEGIC POINTS FOR THE PROSPECTUS, 1
The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project
The 10 Strategic Points
Broad Topic Area
1. Broad Topic Area:
The topic taken into consideration is the Central Line-Associated Bloodstream Infections (CLABSIs) and prevention
Introduction
2. Introduction
· The paper is an analysis of the CLABSIs infection and how best the infection can be prevented or even eliminated among patients.
· The infection is characterized by a catheter gaining entry into the bloodstream, greatly affecting either the inferior or the superior vena cava or the vessels of the neck.
· The location of the catheter makes entry of pathogens into the bloodstream very occasional. Patients thus become sick easily.
· The risk factors associated with the infection can result from the healthcare provider and also the patients and include; contamination on insertion, the skin flora of the patient, non-intact dressing, poor nutrition, position of the central line, poor patient and healthcare provider hygiene.
· Symptoms include redness, swelling, discharge at the central line exit, fever, chills, respiratory distress, and altered cognitive state.
· The infection can be prevented, through monitoring of the patients for any signs and symptoms, ensuring proper hygiene practices, and keeping patients educated about management of their central line.
· The paper gives all these information in detail, why there is a need to address Central line-associated bloodstream infections (CLABSIs) and how best the infection can be handled both by the health care givers and the patients.
Literature Review
3. Literature Review:
1. Primary points basis four sections in the Literature Review:
a. Background of the problem/gap:
· Researchers have dedicated numerous efforts towards the cause and the probable symptoms related to Central line-associated bloodstream infections (CLABSIs) that one needs to be on the look-out for.
· Attention has thus been shifted from the different measures to prevent the occurrence of the infection among patients.
· There arises an urgency to intervene and develop effective measures to curtail the incidence of CLABSIs.
· The use of proper hand hygiene and skin aseptic techniques over the insertion site is necessary for preventing microbial infections
· The nurses need to have the significant knowledge associated with evidence-based practices for the Central line-associated bloodstream infections (CLABSIs), their attitude towards the guidelines and the utilization of the hygienic measures for the Central Venous Catheter (CVC) patients.
b. Theoretical foundations (models and theories to be the foundation for the project)
· The efficacy of training of nu.
Importance of infection control in ICU
Ventilator-associated Pneumonia definition and bundles, Central line-associated infection and its bundles and foley's catheter-associated infection and its bundles
this presentation in reference to CDC and IMO
Infection Control Guidelines for Prevention of Catheter Associated Urinary Tract Infection
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
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Code of Ethics: This is a synopsis of some of the most important ethical
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Terminology:
Agency: The fiduciary relationship created between a principal and an agent whereby the agent
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Agent: The broker or sales associate acting on behalf of the principal (see Agency)
Client: The person with whom the broker or sales associate has a legal contract to represent.
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Principal: Person who hires an agent to act on his or behalf.
Code of Ethics:
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.
A 65-year-old obese African American male patient presents to his HC.docxsodhi3
A 65-year-old obese African American male patient presents to his HCP with crampy left lower quadrant pain, constipation, and fevers to 101˚ F. He has had multiple episodes like this one over the past 15 years and they always responded to bowel rest and oral antibiotics. He has refused to have the recommended colonoscopy even with his history of chronic inflammatory bowel disease (diverticulitis), sedentary lifestyle, and diet lacking in fiber. His paternal grandfather died of colon cancer back in the 1950s as well. He finally underwent colonoscopy after his acute diverticulitis resolved. Colonoscopy revealed multiple polyps that were retrieved, and the pathology was positive for adenocarcinoma of the colon.
Develop a 1- to 2-page case study analysis in which you:
Explain why you think the patient presented the symptoms described.
Identify the genes that may be associated with the development of the disease.
Explain the process of immunosuppression and the effect it has on body systems.
.
A 5-year-old male is brought to the primary care clinic by his m.docxsodhi3
A 5-year-old male is brought to the primary care clinic by his mother with a chief complaint of bilateral ear pain with acute onset that began “yesterday.” The mother states that the child has been crying frequently due to the pain. Ibuprofen has provided minimal relief. This morning, the child refused breakfast and appeared to be “getting worse.”
Vital signs at the clinic reveal HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. Weight is 40.5 lbs. The mother reports no known allergies. The child has not been on antibiotics for the last year. The child does not have history of OM. The child is otherwise healthy without any other known health problems.
Physical examination reveals: Vital signsl HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. Weight is 40.5 lbs. Bilateral TMs are bulging with severe erythematous. Pneumatic otoscopy reveals absent mobility. Ear canals are nomal.
After your questioning and examination, you diagnose this child with bilateral Acute Otitis Media.
.
92 S C I E N T I F I C A M E R I C A N R e p r i n t e d f r.docxsodhi3
92 S C I E N T I F I C A M E R I C A N R e p r i n t e d f r o m t h e O c t o b e r 1 9 9 4 i s s u e
ome creators announce their inventions with grand
éclat. God proclaimed, “Fiat lux,” and then flooded
his new universe with brightness. Others bring forth
great discoveries in a modest guise, as did Charles
Darwin in defining his new mechanism of evolu-
tionary causality in 1859: “I have called this principle, by which
each slight variation, if useful, is preserved, by the term Natur-
al Selection.”
Natural selection is an immensely powerful yet beautifully
simple theory that has held up remarkably well, under intense
and unrelenting scrutiny and testing, for 135 years. In essence,
natural selection locates the mechanism of evolutionary change
in a “struggle” among organisms for reproductive success, lead-
ing to improved fit of populations to changing environments.
(Struggle is often a metaphorical description and need not be
viewed as overt combat, guns blazing. Tactics for reproductive
success include a variety of nonmartial activities such as earlier
and more frequent mating or better cooperation with partners
in raising offspring.) Natural selection is therefore a principle of
local adaptation, not of general advance or progress.
Yet powerful though the principle may be, natural selection
is not the only cause of evolutionary change (and may, in many
cases, be overshadowed by other forces). This point needs em-
phasis because the standard misapplication of evolutionary the-
ory assumes that biological explanation may be equated with
devising accounts, often speculative and conjectural in practice,
about the adaptive value of any given feature in its original en-
vironment (human aggression as good for hunting, music and
religion as good for tribal cohesion, for example). Darwin him-
self strongly emphasized the multifactorial nature of evolu-
tionary change and warned against too exclusive a reliance on
natural selection, by placing the following statement in a max-
imally conspicuous place at the very end of his introduction: “I
am convinced that Natural Selection has been the most impor-
tant, but not the exclusive, means of modification.”
Reality versus Conceit
N A T U R A L S E L E C T I O N is not fully sufficient to explain evo-
lutionary change for two major reasons. First, many other caus-
es are powerful, particularly at levels of biological organization
both above and below the traditional Darwinian focus on or-
ganisms and their struggles for reproductive success. At the low-
est level of substitution in individual base pairs of DNA, change
is often effectively neutral and therefore random. At higher lev-
els, involving entire species or faunas, punctuated equilibrium
can produce evolutionary trends by selection of species based
on their rates of origin and extirpation, whereas mass extinc-
tions wipe out substantial parts of biotas for reasons unrelat-
ed to adaptive struggles of constituent species in “normal”
t.
a 100 words to respond to each question. Please be sure to add a que.docxsodhi3
a 100 words to respond to each question. Please be sure to add a question and answer a fellow student's question.
Q1. Mead argues that most human understanding of the "self" of animals is fallacious. What is his argument, please explain.
Q2. What does Lacan mean by the subject's assumption of the imago in the short excerpt from the Mirror Stage?
.
A 12,000 word final dissertation for Masters in Education project. .docxsodhi3
A 12,000 word final dissertation for Master's in Education project. A UK L7 writing.
Submitting the dissertation
The dissertation will be submitted online via
blackboard.
Presentation Style
Your research project needs to be clearly presented:
·
The front page should include your
name, project title (around 15 words), your supervisor’s name, the date it
was completed;
·
Work should be presented single
sided, in Arial, minimum font size 11 and be one and a half spaced;
·
A contents page detailing the section
and any tables/charts should be included;
·
Any quotes of less than 12 words
should be identified by quotation marks and kept as part of the paragraph text;
·
Quotes of 12 words and above should
be separated out from the text, indented on the left and right and be displayed
in italics (no quotation marks required);
·
All tables and charts should be
numbered appropriately and have a title;
·
Each section of your project should
be started on a new page;
·
All pages should be numbered;
·
Each section should be numbered (e.g.
1. Introduction) and any charts/graphs within the section should be numbered
accordingly. For example if you are writing about something in section 4.1 (the
first sub-section) then the first chart or graph would be 4.11. So charts and
graphs (if included) are numbered according to the section/sub-section.
Word limit
The project should be written up in
no more than 12,000
words
. This includes everything except the reference list, any appendices
and acknowledgements.
A
final checklist:
1.
Does
your abstract say succinctly what the project set out to do and what has been
found?
2.
Does
your contents page signpost chapter subheadings as well as chapter headings?
3.
Has
your introduction made clear the sub questions/objectives you are addressing in
this enquiry
4.
Is
a framework presented in your lit review chapter and a methodological approach
presented in your methodology chapter, and is it clear how this framework and
methodology inform your data collection, presentation of findings and
discussion and reflections? Have you discussed your positionality?
5.
Does
your discussion chapter relate closely to the data in your results chapter and
tie back to the literature in your literature review?
6.
Have
you answered your research questions?
7.
Have
you carefully considered any ethical implications of your research?
8.
Have
you included a signed, anonymised ethics form in the appendix?
9.
Does
your conclusion summarise what has been found out about the questions you set
yourself in your introduction?
10.
Have you kept to the 12,000 word
limit?
11.
Have you met
all
the assessment criteria?
M
odule
Bibliogr
a
p
h
y
Compulsory
reading:
B
r
y
m
an
,
A
.
(
20
1
6
)
.
S
o
ci
a
l
r
e
s
ea
r
ch
m
e
t
h
o
d
s
(
5
t
h
e
d
.
)
.O
x
f
o
rd
:
O
x
f
o
r
d
U
n
i
v
e
r
sity
P
r
e
ss.
Further optional reading
:
A
l
de
r
s
o
n
,
P
.
&
M
o
rr
o
w
,
V
.
(2
011
)
.
T
h
.
9/18/19
1
ISMM1-UC 752:
SYSTEMS ANALYSIS
Fall 2019 – Lecture 3
Instructor: Dr. Antonios Saravanos
Incremental Model
• Development and delivery of
functionality occurs in increments
• Works well when requirements are
known beforehand
• Projects are broken down into sub-
projects
Source: Project Management for IT-Related Projects (p.
18)
2
9/18/19
2
Incremental Cycle
Incremental Model
9/18/19
3
Iterative Model
• Ideal for situations where not all requirements are
known up front
• Need for development to begin as soon as possible
Source: Project Management for IT-Related Projects (p. 19)
5
Iterative Cycle
9/18/19
4
Iterative Model
Incremental vs. Iterative
• Incremental fundamentally means
add onto. Incremental development
helps you improve your process.
• Iterative fundamentally means re-
do. Iterative development helps you
improve your product.
9/18/19
5
• Is iterative and incremental the
same thing?
Incremental vs. Iterative
Source: http://www.applitude.se/images/inc_vs_ite.png
10
9/18/19
6
Iterative and Incremental Combined
A Simple Software Development Method
• Initial Planning
• Design
• Implementation
• Testing
Source: Making Things Happen: Mastering Project Management (p. 30)
12
n
9/18/19
7
Alistair Cockburn
• What’s Alistair’s take on Iterative vs. Incremental?
Incremental vs. Iterative
• in incremental development, you do each of those
activities multiple times … that is, you go around the
requirements – design – programming – testing –
integration – delivery cycle multiple times. You
“iterate” through that cycle multiple times. (“iterate” –
get it? sigh…)
• in iterative development, you also do each of those
activities multiple times … you go around the
requirements – design – programming – testing –
integration – delivery cycle multiple times. You
“iterate” through that cycle multiple times. By Gummy!
Both of those are “iterative” development! WOW!
9/18/19
8
Incremental vs. Iterative (cont’d)
• Of course, the $200,000 question is,
do you repeat the cycle “on the same
part of the system you just got done
with” or “on a new part of the
system”? How you answer that
question yields very different results
on what happens next on your
project.
Roles
• Product Owner (Business)
– Represents the customer
– Controls the product backlog
– Signs off on deliverables
• The Scrum Master
– Ensures scrum values are understood and kept
– Tracks progress and finds ways to overcome obstacles
• The Development Team
– The people actually responsible for delivering the system
– Self-organizing unit
– Members of the team are generalists not specialists
• Cross functional (Each member of the team knows all aspects of the
product that is being developed)
16
9/18/19
9
The Agile System Development Methodology
17
Manifesto for Agile Software Development
18
9/18/19
10
Manifesto for Agile Software Development
Source: http://www.applitude.se/images/inc_vs_i.
96 Young Scholars in WritingFeminist Figures or Damsel.docxsodhi3
96 | Young Scholars in Writing
Feminist Figures or Damsels in Distress?
The Media’s Gendered Misrepresentation
of Disney Princesses
Isabelle Gill | University of Central Florida
A gender bias seems to exist when discussing Disney princesses in entertainment media that could have
significant consequences for girls who admire these heroines. Prior research and my own extensions have
shown that modern princesses display almost equal amounts of masculine and feminine qualities; how-
ever, my research on film reviews shows an inaccurate representation of these qualities. These media
perpetuate sexist ideals for women in society by including traditionally feminine vocabulary, degrading
physical descriptions, and inaccuracies about the films, as well as syntax and critiques that trivialize the
heroines’ accomplishments and suggest the characters are not empowered enough. The reviews also
encourage unhealthy competition between the princesses and devote significantly more words to these
negative trends than to positive discussions. These patterns result in the depiction of the princesses as
more stereotypically feminine and weak than is indicated by the films themselves, which hinders the cre-
ation of role models for girls.
Despite significant strides women have made
toward combatting sexism in American
society, news and entertainment media rep-
resentations of women continue to be one of
the many obstacles left before reaching
equality. Numerous studies have identified
gender bias in the ways media represent
women (Fink and Kensicki; Niven and
Zilber; Shacar; Wood). Media tend to favor
representations of women who are “tradi-
tionally feminine” as well as not “too able,
too powerful, or too confident,” over more
complex representations (Wood 33). For
example, research by Janet Fink and Linda
Jean Kensicki shows that when media aimed
at both men and women discuss female ath-
letes, their focus is on sex appeal, fashion,
and family rather than athletic accomplish-
ment. Female scientists as well as female
members of Congress also fall victim to this
trend. Interviews with male scientists often
portray them as primarily professionals
while interviews with female scientists tend
to reference their professionalism while high-
lighting domesticity and family life (Shacar).
Similarly, media descriptions of the female
members of Congress focus on domestic
issues even though the congresswomen por-
tray themselves as having diverse interests
(Niven and Zilber). In sum, biased, gendered
representations of women are common in
various forms of media.
Media misrepresentation of women in
these ways can lead to significant social
consequences, such as reinforcing anti-
quated gender roles and diminishing the
perception of women’s impact on society
(England, Descartes, and Collier-Meek;
Fink and Kensicki; Graves; Niven and
Zilber; Shacar; Wood). Since media are
Gill | 97
Gill | 97
likely one of the most p.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
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The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
1. 8
Catheter-Associated Urinary Tract Infections (CAUTI)
Walden University
Leadership Competencies in Nursing and Healthcare
NURS-4220-5
Catheter-Associated Urinary Tract Infections (CAUTI)
The healthcare system must provide safe and quality care to all
patients. For years, hospitals nationwide have struggled with
healthcare-associated infections (HAIs). Since HAIs are
considered preventable events in a hospital setting the Centers
for Medicare and Medicaid Services (CMS) established
reimbursement changes and hospitals are focusing more on
patient safety practices and improving processes to have better
patient outcomes (Thornlow & Merwin, 2009). According to
The Centers for Disease Control and Prevention (CDC, 2017),
approximately seventy-five percent of hospital-acquired urinary
tract infections are associated with a urinary catheter with a
prolonged use being the most critical risk factor for developing
a CAUTI. Also, CAUTIs can cause an overabundance of
complications included but not limited to gram-negative
bacteremia, sepsis, and mortality (Skanlon, 2017). In a long-
term acute care hospital (LTACH), prolonged and unnecessary
use of indwelling urinary catheters is interrelated with a higher
risk of catheter-associated urinary tract infections (CAUTI) and
extended lengths of stay (LOS) (Felix, 2016). The purpose of
this paper is to reduce the usage of indwelling catheter days and
decrease CAUTI rates from 2.48 to below the target rate of 1.71
by utilizing prevention practices in a 72-bed long-term acute
care hospital emphasizing on the assurance of a continuous
improvement process. This proposal consists of implementing
alternatives before deciding to insert an indwelling catheter,
2. utilizing maintenance bundles, and daily assessment of the
necessity of the catheter. All these interventions are aiming at
preventing and decreasing catheter-associated urinary tract
infections (CAUTIs).
The role of nurses in the prevention of CAUTIs is critical; we
are the frontline of patient care and safety. Although, sometimes
we encounter situations where a CAUTI occurs, the quality of
care we provide to our patients reflects by the interventions we
take to prevent our patients from getting an infection. Every
action we make while providing care for a patient is an essential
step in the quality of their care. Most patients admitted into
long-term acute care have wounds or infections that require
long-term antibiotics. These patients come in from acute care
hospitals, and in the majority of the cases patients already have
an indwelling urinary catheter, however, there are situations
where the patient doesn’t come with an indwelling catheter, and
nurses get orders to place one on admission. Finding
alternatives to either discontinue or insert a foley is an essential
part of the daily nursing assessment and on the hospitalization
of these patients. Important factors to consider while assessing
the patient are mobility, cognitive status, gender, and wounds.
Literature review
In 2009, The Centers for Disease Control and Prevention
created guidelines for prevention of catheter-associated urinary
tract infections including recommendations to use external
catheters in cooperative male patients without urinary retention
or bladder outlet obstruction, intermittent catheterization in
patients with spinal cord injury and with bladder emptying
dysfunction. Although there is not much literature on any
alternative external devices to use with females, intermittent
catheterization, frequent perineal care for incontinent patients
and the use of bedpans are still adequate alternatives to an
indwelling catheter. The use of external continent devices
(ECD) in men such as condom catheters also known as Texas
catheters is an alternative to the insertion of indwelling
catheters for indications such as cognitive dysfunction due to
3. acute or chronic illness and men with neurogenic bladder
dysfunction (Gray, Skinner, & Kaler, 2016).
Implementation of catheter maintenance bundles is a
fundamental piece in the prevention of CAUTIs. Bundles are a
group of interventions. Unfortunately, many times staff are not
aware of the existence of bundles. Therefore, education on the
concept is a critical piece of implementation. A CAUTI bundle
includes interventions such as appropriate catheter use,
utilization of aseptic technique during catheter insertion, a
closed drainage system, and removal of the catheter as soon as
possible. (Meddings, Rogers, Krein, Fakih, Olmsted, & Saint,
2014). Appropriate indications for the use of an indwelling
catheter include relief for patients with acute urinary retention
or bladder outlet obstruction, accurate measurements of urinary
output in critically ill patients, preoperatively for select
surgeries, for incontinent patients with open sacral or perineal
wounds and to assist in wound healing, patients requiring
prolonged immobilization, and comfort for patients at end of
life care (CDC, 2016). Utilization of aseptic technique during
catheter insertion is a crucial step in preventing infection. In
most cases, a Registered Nurse of a Licensed Vocational Nurse
insert the catheter; consequently, policy and procedures, unit
guidelines, skill checks, nursing competencies, random audits,
and continuing education should be promoted (McNeill, 2017).
The maintenance of urinary catheters starts with the insertion of
the catheter. Staff must perform hand hygiene and use gloves
anytime the catheter or tubing is manipulated. Securement of
the catheter with a stat-lock to the patient’s leg helps prevent
pulling. A closed-draining system must be maintained to avoid
the entrance of germs. The bag should be below the patient’s
bladder and off the floor and emptied before it's three-quarters
full by using a container for patient use only and not allowing
the spigot touch the container. Daily meatal care is necessary to
reduce chances of infection (McNeill, 2017). Removing the
catheter as soon as possible is vital in the bundle to prevent
CAUTIs. The longer a catheter is in place, the higher risk for a
4. patient to acquire an infection. Research has shown the risk of
developing bacteriuria on catheterized patients as high as 3% to
10% per day and close to 100% after the catheter has been in
place for 30 days (McNeill, 2017).
Daily assessment for the continuance of a catheter should be
nurse-driven and supported by charge nurses, physicians, and
infection control interventionists. In the United States, the
statistics are alarming, approximately five million catheters are
placed annually, and 50% of the patients do not meet
appropriate criteria, and 40% of physicians are unaware of their
patients have a urinary catheter in place (Mori, 2014).
Advocating for patient’s safety is vital, prevention is the key in
reducing CAUTIs, and this can be accomplished not only by
limiting foley catheter insertions but by early removal of such
devices (Yatim, Wong, Ling, Tan, Tan, & Hockenberry, 2016).
Daily ongoing catheter needs assessments, and reminder
protocols for early removal of catheters have proven
effectiveness in reducing CAUTIs (Mori, 2014).
Quality Improvement Process and PDSA
The quality improvement (QI) process occurs when performance
problems are identified. There is no standard definition of
quality; quality is a feature of a product or service (Spath,
2013). Because performance problems affect the quality of
service provided, actions must be taken to identify and resolve
the issue that is causing a decrease in performance (Spath,
2013). To improve a performance problem, an analysis of
measurable collected data needs to occur to find the gaps in
performance. Once the data is analyzed, a plan for necessary
changes develops, interventions are tested, implemented, and
measured again to check the effectiveness of the project.
Throughout the years, healthcare and other industries have used
different systematic performance improvement models that have
been created assisting in the delivery of a high-quality
performance level (Spath, 2013).
The process improvement model that will be used to reduce
catheter-associated urinary tract infection (CAUTI) is the Plan-
5. Do-Study-Act-Cycle. As described by Spath (2013), currently
the PDSA is the most recognized process improvement known.
The PDSA model guarantees continuous improvement by
repeating the cycle allowing the improvement team to learn
from failures and successes assisting them to plan for the next
process change. The long-term acute care hospital where I
currently work is a 72-bed facility of which eight beds are ICU.
Most of the patients admitted to this facility come in from acute
care hospitals to wean off the ventilator, long-term antibiotic
treatment, wound care, and hyperbaric oxygen treatments. Their
length of stay ranges from 25 to 28 days. Time is crucial in the
prevention of CAUTIs for these patients, the more days they
have a catheter in place the higher chances of them acquiring a
CAUTI.
References
Centers for Disease Control and Prevention. (2017). Catheter-
associated Urinary Tract Infections (CAUTI). Retrieved from
https://www.cdc.gov/hai/ca_uti/uti.html
Thornlow, D. K., & Merwin, E. (2009). Managing to improve
quality: The relationship between accreditation standards, safety
practices, and patient outcomes. Health Care Management
Review, 34(3), 262–272. doi: 10.1097/HMR.0b013e3181a16bce
Gray, M., Skinner, C., & Kaler, W. (2016). External Collection
Devices as an Alternative to the Indwelling Urinary Catheter.
Journal of Wound, Ostomy and Continence Nursing,43(4), 413.
doi:10.1097/won.0000000000000251
Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A
CAUTI Reduction Program. Nursing Economic$, 35(3), 134-
141.
Centers for Disease Control and Prevention. (2016). Catheter-
Associated Urinary Tract Infections (CAUTI). Guideline for
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(2009). Retrieved from
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6. Meddings, J., Rogers, M. A. M., Krein, S. L., Fakih, M. G.,
Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary
urinary catheter use and other strategies to prevent catheter-
associated urinary tract infection: An integrative review. BMJ
Quality & Safety, 23(4), 277.
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Corley, L. (2015). INSPIRING CHANGE. CAUTI awakenings.
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doi:10.7257/1053-816X.2017.37.4.204
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1
Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly
Illustration section of the lesson.
Name: __________Lishan Brown___________
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this
topic. (This MUST involve a nursing practice issue.)
The topic is hospital acquired infections. The nursing practice
issue is catheter associated urinary tract infections and the high
incidence on an acute rehabilitation unit.
Briefly describe your rationale for your topic selection. Include
7. the scope of the issue/problem.
The nursing practice issue I would like to investigate is
healthcare associated infections (HAI), particularly catheter
associated urinary tract infection (CAUTI). CAUTI is very
important to investigate because I believe HAI’s can be
decreased, if not prevented. Being that nurses are educated on
the possible causes or symptoms of HAI’s, we can be more
proactive in our treatment plans. If a patient falls, that can be an
unpredictable event but HAI’s are more so predictable. With
CAUTI, making sure that the perineal area is cleaned on a
regular, consistent basis is important. Providing proper
interventions to not keep an indwelling catheter in longer than
necessary is also important.
Urinary tract infections are one of the most common hospital
acquired infections. At least 80% of urinary tract infections an
be attributed to an indwelling urinary catheter. There are
approximately 13,000 annual deaths associated with catheter
associated urinary tract infections (CAUTI). CAUTIs can
lengthen hospital stays, increase morbidity and mortality, and
raise healthcare costs.
Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate
your PICOT question.
The practice problem is members of the healthcare team are not
properly cleaning the perineal area of patients who have
indwelling catheters and indwelling catheters are placed for
unnecessary longer periods of time.
PICOT question- In (P) patients with an indwelling catheter on
an acute rehabilitation unit, does (I) cleansing the perineal area
every eight-hour period compared to (C) routine daily cleansing
of the perineal area (O) decrease the catheter associated urinary
tract infection with patients over a (T) six month period?
List the systematic review chosen from the Cochrane Database
8. of Systematic Reviews from the Chamberlain library. Type the
complete APA reference for the systematic review selected.
Interventions to improve professional adherence to guidelines
for prevention of device‐related infections.
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.
List and briefly describe other sources used for data and
information. List any other optional scholarly source used as a
supplement to the systematic review in APA format.
In my search for evidence, I found an article about nurse-driven
CAUTI prevention. This evidence is relevant to my PICOT
because I would like to find a way to decrease or eliminate the
instances of CAUTI in a hospital setting. The article gives a
history of prevalence of CAUTI then goes into costs related to
CAUTI. The article also mentions ways of preventing CAUTI.
The article also discusses an algorithm used to decrease the
prevalence of CAUTI.
I also found an article about the causes of CAUTI and how to
properly clean the perineal area as an educational tool.
Reference
Russell, J. A., Leming-Lee, T. ‘Susie,’ & Watters, R. (2019).
Implementation of a Nurse-Driven CAUTI Prevention
Algorithm. Nursing Clinics of North America, 54(1), 81–96.
https://doi-
org.chamberlainuniversity.idm.oclc.org/10.1016/j.cnur.2018.11.
001
Memorial Sloan Kettering Cancer Center (2018). Caring for
Your Urinary (Foley®) Catheter. Retrieved from
https://www.mskcc.org/cancer-care/patient-education/caring-
your-urinary-foley-catheter
Briefly summarize the main findings (in your own words) from
9. the systematic review and the strength of the evidence.
The main findings from the systemic review were that there
weren’t sufficient evidence to properly corroborate the research.
The trials were too small and there was inadequate reporting of
information. Because the findings were too small, it was
difficult to determine which intervention would be optimal in
CAUTI care. The strength of the evidence was weak for the
change process.
Outline one or two evidence-based solutions you will consider
for the trial project.
An evidence-based solution would be the CAUTI Prevention
Tool by the American Nurses Association. This streamlined
evidence-based tool is used to reduce CAUTI by fewer catheters
being used, timely removal, and insertion, maintenance and post
removal care.
Reference
American Nurses Association (2009). Streamlined Evidence-
Based RN Tool: Catheter Associated Urinary Tract Infection
(CAUTI) Prevention. Retrieved from
https://www.nursingworld.org/~4aede8/globalassets/practiceand
policy/innovation--evidence/clinical-practice-material/cauti-
prevention-tool/anacautipreventiontool-final-19dec2014.pdf
Star Point 3: Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that
may be in place to support your intervention planning (These
may come from your organization or from the other sources
listed in your Summary section in Star Point 2).
Care standards for urinary catheter care would be proper
education to staff and those in use of the indwelling catheter
(importance of infection prevention, symptoms of urinary tract
infection, proper care of an indwelling catheter).
Provide written criteria for the necessity of an indwelling
catheter by using the CAUTI Prevention tool.
10. Following procedures for the insertion and maintenance of an
indwelling catheter (proper handwashing, use of aseptic
techniques for insertion an removal of catheter, securing the
tubing and drainage bag, maintaining sterility, replacement of
supplies).
Having proper documentation of insertion, maintenance and
removal.
Reference
The Joint Commission (2017). Requirements for the Catheter-
Associated Urinary Tract Infections (CAUTI) National Patient
Safety Goal for Hospitals. Retrieved from
https://www.jointcommission.org/assets/1/6/R3_Cauti_HAP.pdf
List your stakeholders (by title and not names; include yourself)
and describe their roles and responsibilities in the change
process (no more than 5).
Nurse Leader- the person leading the trial, responsible for
ensuring the success of the project and day to day intricacies of
the project.
Nurse Manager- Person overseeing the trial to ensure the nurse
leader and provide assistance as necessary.
Unit Nurses- team members who are assisting in carrying out
the change process and day to day bedside care with patients
with indwelling catheters.
Patient- consents to a clinical trial and helping to identify
symptoms of CAUTI.
What specifically is your nursing role in the change process?
Other nursing roles?
My nursing role in the change process is to be at the forefront
of change process. As the nurse leader, I would want to ensure
that all supplies, education, proper documentation is in place
throughout the trial to ensure effectiveness. Unit nurses are
responsible the placement of an indwelling catheter, the daily
care management, and the removal of the indwelling catheter.
Nurses are also responsible for specimen collection. Nurses are
11. also the main person to diagnose a patient who is suspected of
CAUTI.
List your stakeholders by position titles (charge nurse,
pharmacist, etc.).-Why are the members chosen (stakeholders)
important to your project?
MD- Doctor of Medicine
DO- Doctor of Osteopathic Medicine
Nurse Educator
RN- Registered Nurse/ Unit Nurse
CNA- Certified Nursing Assistant
Nurse Manager
These members are important to the project because they are all
a part of the team who is essentially caring for a patient with an
indwelling urinary catheter. They are important in making
necessary changes to decrease the incidents of catheter
associated urinary tract infection. It all begins with proper
education right down to actually caring for the patient who has
an indwelling catheter. The MD/DO are responsible for ordering
the indwelling catheter for the patient. Unit nurses and CNA’s
are important in the day to day care of the indwelling catheter.
The nurse manager is important in making sure policies are
followed for the change process and provide additional
assistance if necessary.
What type of cost analysis will be needed prior to a trial? Who
needs to be involved with this?
The type of cost analysis which would be needed prior to a trial
would be a cost effectiveness analysis. A cost effectiveness
analysis is a method of analyzing the cost and health outcome of
an intervention. The finance department would need to be
involved in this portion of the change process. This is necessary
to see how much funds can be allocated to the project for
additional resources. It is also important to know the initial cost
to the hospital for CAUTI’s compared to after the completion of
the trial to see if there was an improvement. Having the quality
12. control department involved ensures policy and procedures are
being followed as well.
Reference
Jamison DT, Breman JG, Measham AR, et al., editors. Priorities
in Health. Washington (DC): The International Bank for
Reconstruction and Development / The World Bank; 2006.
Chapter 3, Cost-Effectiveness Analysis. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK10253/
Star Point 4: (Implementation)
Describe the process for gaining permission to plan and begin a
trial. Is there a specific group, committee, or nurse leaders
involved?
The process of gaining permission to plan and begin a trial first
begins with management of the hospital. One cannot perform a
trial without the permission of management. There also needs to
be the onboarding of the finance department to see how much
resources can be allocated to the project. Quality assurance is
important for ensuring policy and procedures are being
followed. There also needs to be permission from other nurses
on the unit for their cooperation. Having signed permission
from patients are also important to begin the trial. Patients need
to be aware of what they are getting into and if they would
cooperate or not.
Describe the plan for educating the staff about the change
process trial and how they will be impacted or asked to
participate.
First, coordination with a nurse educator is important in order
for them to educate staff members on the change process. Nurse
educators can educate staff members of the proper way of
preventing CAUTI and an ongoing refresher course throughout
the trial period. Educators could be available for all shifts
throughout the day in order for convenience to the staff.
Educators can come to the unit to educate for added
13. convenience. Online educational learning exercises would be an
also added benefit.
Outline the implementation timeline for the change process
(start time/end time, what steps are to occur along the timeline).
The implementation timeline for the change process would be
over a six-month period. This would include the education of
staff members on proper catheter care and documentation. Also
included in this timeline would be the trial of patients who have
consented to be a part of the change process.
List the measurable outcomes based on the PICOT. How will
these be measured?
The measurable outcomes based on the PICOT would be the
number of CAUTI incidents over a six-month period. This can
be measured by the incident reports for CAUTI, the necessary
medications needed to treat CAUTI and also the number of
indwelling catheterizations utilized on the unit.
What forms, if any, might be used for recording purposes during
the pilot change process. Describe.
Forms that may be used for recording purposes would be
documentation of education and refresher for staff members.
Consent forms from patients detailing the intention of the trial
would be important. Staff would be required to document each
time perineal care was given or any catheter care to the patient.
Staff would also be given a self-assessment on their readiness
and understanding of catheter care in order to effectively care
for the population of patients with indwelling catheters.
What resources are available to staff (include yourself) during
the change pilot?
Resources that would be available to staff during the pilot
would be extra catheter care supplies, such as Foley catheter
bags, tubing, stat locks, perineal soap, etc. Educational
resources for staff and patients on recognizing CAUTI, ways of
preventing CAUTI and general care for an indwelling catheter.
14. Will there be meetings of certain stakeholders throughout the
trial? If so, who and when will they meet?
Meetings throughout the trial will be held with stakeholders on
the progress of the trial and if any necessary changes need to be
made. Meetings will be held weekly during the first month and
twice per month for the remainder of the trial. All stakeholders
would be invited to the meetings to get a progress of is
happening during the trial. Opinions can be shared on what
could be effective or changes that can be made to make the trial
a success.
Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
Reporting of the outcomes will be posted throughout the staff
rooms on the unit in the form of a data report. A meeting at the
end of the trial will also be held to discuss how effective the
trial was or wasn’t. The data from the report can then be given
to management to consider further implementation or
recommendations.
What would be the next steps for the use of the change process
information?
Using the information from the trial, ongoing changes can
continue to be made regarding CAUTI using the takeaway from
the trial. After seeing what worked and what didn’t, staff can
adapt what was successful and build on that information and
make progress in decreasing the incidents of CAUTI on the unit.
2.2019 Update. DLP