Research-based Literature Support Assignment

Research-based Literature Support Assignment

Need to re-write my paper so must use same researchs but analize and see what i missed. Follow the rubric as is not the objectives but the rubric.

10 different research-based references was used and must look each one. See reference page for each plus any additional reference I used.

At the end its also a Proposed Implementation with a change model – PDSA (follow rubric and use references that I included)

All work is about nurse-driven protocols for CAUTI.  The protocols is the discussion of my proposed PICOT question (also there)


Any questions ask please. Dont assume as I cant fail!


NR 505: Advanced Research Methods: Evidenced Based Practice

July 2019



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). Research-based Literature Support Assignment

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. On the other hand, the time required to acquirer findings from the time of implementation phase through the end of evaluation phase, would take about 6 months, increasing the chance of unpredictable outcomes or in the event of inability to find the same nurse for a study update, which can lead to cessation of the research (Ayres, 2019). The study used a probability sampling method with sampling size containing 50 nurses working with patients undergoing urinary catheterization from 3 different departments (ICU, urology, and internal medicine) at Suez Canal University Hospital in Ismailia city. Conducting a study with a quality sample size produces useful results, in which oral consent is taken from participants assuring that their rights are protected with confidentiality and with the right to leave from the research at any time. A disadvantage of this sampling method is that mixing different levels of care will produce findings according to their level of knowledge; in this case, ICU nurses have an advanced nursing knowledge due to the level of patient’s acuity (Shehab, 2017).

Ghanem, Artime, Moser, Caceres, and Basconcillo (2015) study reviewed that implementation of nurses-driven protocol decreased urinary catheter utilization and improved patient care. The study used a quantitative approach, a quasi-experiment design with pre and post-interventions to evaluate if implementing such protocol containing daily assessment of foley catheter necessity and removal without physicians order in case no indication of such was identified (Ghanem et al., 2017). A benefit of utilizing a nurse-driven protocol is less delay in the catheter removal, while nurse’s empowerment can drawback from primary care providers point of view. Chart from all patients with urinary catheter, non-random sampling, was reviewed weekly on four units for 6 months, with a positive effect of guide improvement efforts and evaluating staff commitment and compliance, while a probability of encountering a small sampling size that can expose the subject producing a result that differ from the true population that could produce a 31.6% margin of error (Kadam, 2016). Research-based Literature Support Assignment

The aim of the study by Galiczewski (2016) is to examine evidences on preventive interventions and protocols implemented in ICU units and how they impact on CAUTI rates and patient outcomes. The quasi-experiment design used, reported the presence of adherence to CAUTI policy and the relationship between prevention and CAUTI reduction rate. As a result, the application of such can produce best practice protocols and interventions that lead to a high-quality care and positive patient outcomes. On the other hand, compliance with the policy can be an issue in acquiring adequate results. Sampling selection with including criteria as a) articles addressing prevention and control of CAUTI, b) patient population less than 18 years old with a foley catheter in an ICU unit, excluding studies involving intermittent catheterization, and studies involving the use prophylactic of antibiotic to prevent CAUTI producing a standardized criteria of catheter removal if not indicated. Due to no statistical significance to evaluate short-term versus long-term catheterization a limitation can occur (Galiczewski, 2015).

CAUTI literature review by Shehzadi, Ali, Bhatti, and Yaseen (2018) aim to assess the nurse’s insight regards to prevention of CAUTI in the ICU at Lahore public hospital. A cross-sectional descriptive study was used with a sample of 160 participants with all diplomas working on ICU at Lahore Hospital, through a non-probability sampling method. A questionnaire from knowledge, structure, and practice towards the prevention of CAUTI improved nurse s knowledge promoting quality care and prevention of CAUTI (Shehzadi et al., 2018).

The literature review of Mcneill (2017) describes the importance of nursing care in preventing CAUTI by the implementation of EBP guidelines. A descriptive design was used and revealed that nurses are essential to each of the 4 components that can contribute to CAUTI prevention. The 4 components are: 1) avoid unnecessary placement of foley catheter, 2) use of aseptic technique during catheter insertion, 3) use of EBP guidelines to manager catheters, and 4) discontinue catheters as soon as possible. A limitation is the inability to determine cause and effect allowing only summations about it (Rahman, 2017). Sampling used probability method on patients with a foley catheter in a hospital setting. Development of guidelines containing recommendations for prevention and the importance of the nurse’s role in implementation into practice is positive finding, while a descriptive design might not generate appropriate finding to represent the entire group. Research-based Literature Support Assignment

Next literature review, from Sublett (2016), measures the effectiveness of a nurse-driven protocol to lessen CAUTI. A quasi-experiment was used where a pre and post-intervention data were collected on a 12-month period identifying issues and the need for a resolution. A significant decrease in CAUTI rate following the implementation of nurse-directed removal protocol was identified, and limitations of the study include consideration of what was and what was not accomplished by the study (Sublett, 2016). The target population is the patient in general so uses a probability sampling method to identify quality improvement methods designed to meet the needs of the patient. The disadvantage of the study is the sampling involves multi-hospitals causing different variable that might not be present in few institutions impacting the implementation of findings on certain institutions leading to a need of subsequent studies to achieve a desirable patient outcome.

Next literature review by Blanck, Donahue, Bretlinger, Stinger, and Polito (2014), tested the use of bundle approach of catheter care practices to reach a cutback in CAUTI by utilizing a quantitative, quasi-experiment design in adult critical care patients with urinary catheter using CINAHL, MEDLINE, Academic Search Premier, and Cochrane databases to evaluate that early discontinuation and cutback the number of catheters insertion can achieve the desired outcome (Blanck et al., 2014). The selected design can produce findings that generate methods that can measure and support improvements (advantage), but education alone is not consider sufficient to produce a reduction in CAUTI incidence (Blanck et al., 2014). The study was tested for 3 months the occurrence of CAUTI in adult (18-year-old or greater) critical care patients with a foley catheter in place for at least two calendar days after patient admission to CCU. Exclusion criteria included patients admitted to CCU without foley catheter, with a suprapubic catheter or intermittent catheterization, patient’s younger than 18 years of age, or those admitted with a UTI or developed prior the two calendar day criteria (Blanck, et al., 2014). Sampling size was “based on the number of catheter days combined with CAUTI incidence rates using a probability sampling method to account for variation in population size each month in the critical care unit (Blanck et al., 2014). No patient names or identification number was collected assuring patient’s confidentiality and anonymity. Because the study was only collected on adult patients in CCU, results do not apply to the entire population, such as to pediatric patients, becoming a disadvantage, while the inclusion and exclusion criteria were fundamental to determine the number of patients needed for an adequate quality sample size.

Barnhorst, Martinez, and Gershengorn (2015) study aim to guide in identifying appropriate measures for quality improvement strategies for health care providers to follow in which nurses play a fundamental role in identifying these initiatives. A quasi-experiment design was used to produce improved outcomes from interventions that generate findings showing how well an intervention works in usual practice. Such design assisted researches to build enough knowledge before proceeding to clinical trials (advantage). A limitation includes the need for a large infrastructure capable of supporting all units of analysis otherwise a limited number of outcomes can be associated with low-quality care (Mormer and Stevans, 2019). Sampling consists of data entry by technicians and nurses prior and after electronic health record implementation in which a probability sampling method found that using paper charting lead to a 17% error. An advantage of electronic health record can become accessible from anywhere and data can be captured in real-time at bedside (Barnhorst et al., 2015).

The last CAUTI literature review from Sitki, Kirkbride, and Forbes (2015) evaluate the nurse-driven protocol at a magnet teaching hospital through nurse’s perception, utilizing a descriptive design by the use of a self-developed survey containing open-ended questions. Because open-ended questions do not generate right or wrong answers, participants feel more comfortable answering, at the same time findings may be difficult to compare or analyze and depending on the number of questions, can be time-consuming, decreasing willingness to participate. A sample of 750 nurses completed the survey using a Chi-square statistics, to test if a relationship of two variables exists, in which inclusion criteria included RNs over 18 years of age, English-speaking, employed on the hospital’s nursing care units who may have used the nurse-driven protocol. No exclusion criteria were identified. A waver of consent was used and participant’s anonymity and confidentiality were protected.

PDSA Change Model – Proposed Implementation

           The primary purpose of the Plan-Do-Study-Act (PDSA) is to “help improve the quality of care making healthcare more efficient, safe, patient-centered, and effective” (Taylor, McNicholas, Nicolay, Darzil, Bell, and Reed, 2014). The Relationship of clinical education and practice creates the best quality-learning environment through EBP (Donelle and Kirk, 2015). The PDSA model can test the effectiveness of nurse-driven protocols to lessen CAUTI and optimize the implementation of nurse-driven protocols to cutback the occurrence of CAUTI by implementing EBP principles based on the assessment of medically necessity criteria for catheter placement and removal. The results demonstrated a significant improvement in patient outcomes, nurse’s knowledge, empowerment, and help produce best practice guidelines for healthcare professionals. To avoid resistance to the implementation of the study, review and document all the necessity of catheter continuation, adhere to aseptic technique placement and maintenance, implement infection surveillance, and develop action plans to address areas of improvement(s) (Kueny, Shever, Mackin, and Titler, 2015).

By becoming facilitators in the implementation of EBP at bedside practice, we can contribute to high-quality patient care and guide the development of clinical standards and quality improvements in health care.


Ayres, C. (2019). 13 Advantages of Disadvantages of Longitudinal Studies [Blog post]. Retrieved from

Blanck, A., Donahue, M., Brentlinger, L., Stinger, K., and Polito, C. (2014). A quasi-experimental study to test a prevention bundle for cateter-associated urinary tract infections. Journal of Hospital Administration. 3(4). doi:10.5430/jha.v3n4p101

Donnelly,P. and Kirk,P. (2015). Use the PDSA model for effective change management. Education for Primary Care. Retrieved from

Fakih, M., Krein,S., Edson, B., Watson, S., Battles, J., and Saint, S. (2014). Engaging health care workers to prevent catheter-associated urinary tract infection and advert patient harm. American Journal of Infection Control. doi:10.1016/j.ajic.2014.03.355

Galiczewski, J. (2015). Interventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review. Intensive and Critical care Nursing. doi:10.1016/j.iccn.2015.08.007

Hayes, A. (2019). Systematic Sampling: The importance of quality sample size. Retrieved from

Kadam, R. (2016). Challenges in Recruitment and retention of clinical trials subjects. Perspectives in Clinical Research. 7(3): 137–143.

doi: 10.4103/2229-3485.184820

Kueny, A., Shever, L., Mackin, M., & Titler, M. (2015). Facilitating the implementation of evidence- based practice through contextual support and nursing leadership. Journal of healthcare leadership, 7, 29–39. doi:10.2147/JHL.S45077

Mormer, E. and Stevans, J. (2019). Clinical Quality Improvement and Quality Improvement Research. Perspectives of the ASHA Special Interest Groups. 4(1). Retrieved from

McNeill, L. (2017). Back to Basics: How Evidence-Based Nursing Practice can Prevent CAUTI. Society of Urologic Nurses and Associates. doi:10.7257/1053-816X.2017.37.4.204

Rahman, S. (2017). The advantages and Disadvantages of using Qualitative and Quantitative Approaches and Methods in Language Testing and Assessment Research: A literature Review. Journal of Education and Learning. doi: 10.5539/jel.v6n1p102

Shehzadi, A., Ali, A., Bhatti, M., and Yaseen,I. (2018). Knowledge and Attitude of Nurses towards the prevention of Catheter Association urinary Tract Infection in ICU, S of A Public Hospital Lahore. Saudi Journal of Nursing and Health Care. Retrieved from

Shehab, M. (2017). Impact of Protocol of Care of Patients Undergoing Urinary Catheterization on Nurse’s Knowledge. International Journal of Caring Sciences. 10(2). Retrieved from

Sitki, K., Kirkbride, G., and Forbes, G. (2015). Evaluation of a Nurse-Driven Protocol to Remove Urinary Catheters: Nurses’ Perceptions. Urologic Nursing. 35(2), 94-99. doi:10.7257/1053-816X.2015.35.2.94

Sublett, C. (2016). Application to the evidence base: a nurse-driven protocol for removal of Indwelling urinary catheters across a multi-hospital academic healthcare system. Urologic Nursing. 36(5). doi: 10.7257/1053-816X2016.36.5.250

Taylor, M., McNicholas, C., Nicolay, C., Darzil, A., Bell, D., and Reed, J. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. Retrieved from

Research-based Literature Support Assignment