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SOLVED!! In this task you will identify a healthcare problem

Performance Assessment: Evidence Based Practice and Applied Nursing

INTRODUCTION

Evidence-based literature comes from many sources. The discipline of nursing has an abundance of research data and resources to guide clinical decisions. Therefore, it is of pivotal importance to understand the basic tenets of critical appraisal of such evidence for its use in interprofessional healthcare practices.
In this task you will identify a healthcare problem develop an evidence-based practice (EBP) question and review selected research and non-research evidence to find answers to that question.
Note that while you will be analyzing only one research-based and one non-research-based article in this task, an actual evidence-based practice change would require the support of many high-quality research studies.
REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The originality report that is provided when you submit your task can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Tasks may not be submitted as cloud links, such as links to Google Docs, Google Slides, OneDrive, etc., unless specified in the task requirements. All other submissions must be file types that are uploaded and submitted as attachments (e.g., .docx, .pdf, .ppt).

A.  Discuss the impact of a clinical practice problem on the patient(s) and the organization it affects.

1.  Identify the following PICO components of the clinical practice problem:

•   patient/population/problem (P)

•   intervention (I)

•   comparison (C)

•   outcome (O)

2.  Develop an evidence-based practice (EBP) question based on the clinical practice problem discussed in part A and the PICO components identified in part A1.
Note:  Refer to “Appendix B: Question Development Tool” for information on the creation of an EBP question.

B.  Select a research-based article that answers your EBP question from part A2 to conduct an evidence appraisal.

1.  Discuss the background or introduction (i.e., the purpose) of the research article.

2.  Describe the research methodology.

3.  Identify the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model.Note: The article you select should not be more than five years old. 
Note:  Refer to “Appendix E: Research Evidence Appraisal Tool” for information on how to level a research-based article.

4.  Summarize how the researcher analyzed the data in the article.

5.  Summarize the ethical consideration(s) of the research-based article. If none are present, explain why.

6.  Identify the quality rating of the research-based article according to the JHNEBP model.

Note:  Refer to “Appendix E: Research Evidence Appraisal Tool” for information on how to establish the quality rating.

7.  Analyze the results or conclusions of the research-based article and explain how the article helps answer your EBP question.

C.  Select a non-research article from a peer-reviewed journal that helps to answer your EBP question from part A2 to conduct an evidence appraisal.

1.  Discuss the background or introduction (i.e., the purpose) of the non-research article.

2.  Describe the type of evidence (e.g., case study, quality improvement project, clinical practice guideline).

3.  Identify the level of evidence using the JHNEBP model.

Note: The article you select should not be more than five years old. 
Note:  Refer to “Appendix F: Non-Research Evidence Appraisal Tool” for information on how to level the non-research-based article.

4.  Identify the quality rating of the non-research-based article according to the JHNEBP model.

5.  Discuss how the author’s recommendation(s) in the article helps to answer your EBP question.

D.  Recommend a practice change that addresses your EBP question using both the research and non-research articles you selected for Part B and Part C.

1.  Explain how you would involve three key stakeholders in supporting the practice change recommendation.

2.  Discuss one specific barrier you may encounter when implementing the practice change recommendation.

3.  Identify one strategy that could be used to overcome the barrier discussed in part D2.

4.  Identify one outcome (the O component in PICO) from your EBP question to measure the recommended practice change.

E.  Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

F.  Demonstrate professional communication in the content and presentation of your submission.

File Restrictions
File name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
RUBRIC

NOT EVIDENT

The submission does not identify a clinical practice problem or does not include a discussion of the impact of a clinical practice problem on the patient(s) and the organization it affects.

APPROACHING COMPETENCE

The submission includes a discussion of the clinical practice problem but does not logically address its impact on the patient(s) and the organization it affects.

COMPETENT

The submission includes a discussion of the clinical practice problem that logically addresses its impact on the patient(s) and the organization it affects.

NOT EVIDENT

The submission does not include each of the given PICO components of the clinical practice problem.

APPROACHING COMPETENCE

The submission includes each of the PICO components of the clinical practice problem, but 1 or more of the given components are inaccurate or incomplete.

COMPETENT

The submission includes each of the given PICO components of the clinical practice problem. Each of the given components is accurate and complete.

NOT EVIDENT

The submission does not include an EBP question.

APPROACHING COMPETENCE

The submission includes an EBP question, but the EBP question does not appropriately address the clinical practice problem or does not include all the PICO components.

COMPETENT

The submission includes an EBP question that appropriately addresses the clinical practice problem and includes all the PICO components.

NOT EVIDENT

An article selection is not provided.

APPROACHING COMPETENCE

The selected article is not research based or does not answer the EBP question from part A2.

COMPETENT

The selected article is research based and answers the EBP question from part A2.

NOT EVIDENT

The submission does not include a discussion of the background or introduction.

APPROACHING COMPETENCE

The submission does not accurately address a discussion of the background or introduction of the research-based article.

COMPETENT

The submission accurately addresses a discussion of the background or introduction of the research-based article.

NOT EVIDENT

The submission does not include a description of the research methodology.

APPROACHING COMPETENCE

The submission includes a description but inaccurately describes the research methodology.

COMPETENT

The submission includes a description that accurately describes the research methodology.

NOT EVIDENT

The submission does not identify a level of evidence for the research-based article.

APPROACHING COMPETENCE

The submission identifies a level of evidence that is not accurate according to the JHNEBP model.

COMPETENT

The submission accurately identifies a level of evidence that is based on the JHNEBP model.

NOT EVIDENT

The submission does not include a summary of data analysis.

APPROACHING COMPETENCE

The submission includes a summary of data analysis, but the summary does not accurately describe how the researcher analyzed the data in the article.

COMPETENT

The submission includes a summary that accurately describes how the researcher analyzed the data in the article.

B5:ETHICAL CONSIDERATIONS

NOT EVIDENT

The submission does not include a summary of ethical considerations. Or, the submission does not include an explanation of why no ethical considerations are present if the research-based article contains none.

APPROACHING COMPETENCE

The submission includes a summary of ethical considerations, but the summary does not logically describe the ethical consideration(s) of the research-based article. Or, if no ethical considerations are present in the research-based article, the submission does not logically explain why none are present.

COMPETENT

The submission includes a summary that logically describes the ethical consideration(s) of the research-based article. Or, if no ethical considerations are present, the submission includes a logical explanation of why none are present.

NOT EVIDENT

The submission does not identify a quality rating of the research-based article.

APPROACHING COMPETENCE

The submission identifies a quality rating that is not accurate according to the JHNEBP model.

COMPETENT

The submission accurately identifies a quality rating according to the JHNEBP model.

NOT EVIDENT

The submission does not include an analysis of the results or conclusions of the research-based article.

APPROACHING COMPETENCE

The submission includes an analysis of the results or conclusions, but the analysis does not logically evaluate the results or conclusions of the research-based article. Or the analysis does not appropriately explain how the results or conclusions helps answer the EBP question.

COMPETENT

The submission includes an analysis that logically evaluates the results or conclusions of the research-based article and appropriately explains how the results or conclusions helps answer the EBP question.

NOT EVIDENT

An article selection is not provided.

APPROACHING COMPETENCE

The selected article is not a non-research article or does not answer the EBP question from part A2.

COMPETENT

The selected article is a non-research article and answers the EBP question from part A2.

NOT EVIDENT

The submission does not include a discussion of the background or introduction.

APPROACHING COMPETENCE

The submission includes a discussion that does not accurately address the background or introduction of the non-research-based article.

COMPETENT

The submission includes a discussion that accurately addresses the background or introduction of the non-research-based article.

NOT EVIDENT

The submission does not include a description of a type of evidence.

APPROACHING COMPETENCE

The submission includes a description of a type of evidence, but the description does not accurately describe the type of evidence used in the article.

COMPETENT

The submission includes a description that accurately describes the type of evidence used in the article.

NOT EVIDENT

The submission does not identify a level of evidence for the non-research-based article.

APPROACHING COMPETENCE

The submission identifies a level of evidence that is not accurate according to the JHNEBP model.

COMPETENT

The submission accurately identifies the level of evidence according to the JHNEBP model.

NOT EVIDENT

The submission does not identify a quality rating for the non-research-based article.

APPROACHING COMPETENCE

The submission identifies a quality rating that is not accurate according to the JHNEBP model.

COMPETENT

The submission accurately identifies the quality rating according to the JHNEBP model.

NOT EVIDENT

The submission does not include a discussion of the author’s recommendation(s) that helped answer the EBP question.

APPROACHING COMPETENCE

The submission includes a discussion, but the discussion does not logically explain how the author’s recommendation(s) helped answer the EBP question.

COMPETENT

The submission includes a discussion that logically explains how the author’s recommendation(s) helped answer the EBP question.

NOT EVIDENT

The submission does not include a practice change recommendation.

APPROACHING COMPETENCE

The submission includes a practice change recommendation, but the recommendation does not appropriately address the EBP question. Or, the recommendation does not accurately utilize both the research and non-research articles to show how the change should be made.

COMPETENT

The submission includes a practice change recommendation that appropriately addresses the EBP question and accurately utilizes both the research and non-research articles to show how the change should be made.

NOT EVIDENT

The submission does not include an explanation of 3 key stakeholders.

APPROACHING COMPETENCE

The submission includes an explanation of 3 key stake holders’ involvement, but the explanation does not describe how 1 or more of the stakeholders would appropriately support the practice change recommendation.

COMPETENT

The submission includes an explanation of how 3 key stakeholders would appropriately support the practice change recommendation.

NOT EVIDENT

The submission does not include a discussion of a specific barrier that might be encountered when implementing the practice change recommendation.

ANSWER

C361 – MLM1 – Performance Assessment 1

Introduction

Urinary tract infections (UTIs) are infections that occur in any part of the urinary systems such as the urethra, kidney, or bladder. Most UTIs involve the lower urinary tract, and due to the morphology of their body, women are at greater risk than men of getting the UTIs. Over 75% of the UTIs that are hospital-acquired are directly linked with the use of urinary catheters, tubes that assist in draining the urine from the bladder, and are inserted via the urethra (Centers for Disease Control and Prevention, CDC, 2020). Patients who use urinary catheters for prolonged periods of time are at greater risks of developing the UTIs compared to those who use it fewer times (CDC, 2020). This essay examines different research that is present regarding Catheter-Associated UTIs (CAUTIs).

Impact of the Problem on the Patient

            The problem of CAUTIs has many potential and actual negative impacts on patients. One of these is the increased rate of readmissions among the patients. Patients who acquire UTIs after the use of urinary catheters risk being readmitted after discharge, since the infections mostly manifest themselves only after the patients are declared free of illness (Meddings et al., 2019). Another implication that this problem may have on patients is that there is increased costs of care, as patients have to spend more than they anticipated for them to achieve their recovery. Also, much of the costs associated include the time lost not working as the patients stay in the hospitals, hence an indirect loss of income.

Impact of the Problem on the Organization

            Facilities which have increased problems of hospital-acquired CAUTIs spend more on average compared to those with lesser cases. Specifically, more readmissions mean that more of the hospital resources are used, and this leads to straining the current expenditure. Also, in some of the cases, the facilities linked with the CAUTIs may face legal punishment that would mean a direct loss of income to the victims (Meddings et al., 2019). Lastly, the problem is likely to have detrimental effects on the reputation of the organization, where potential clients may have fear receiving services as a result of the past incompetence.

Identify the PICO components

P – Patient/ Problem/ Population

The Problem being put in central focus is CAUTIs in patients admitted to the facility, with a large focus on patients who are in the acute care settings. The patients are already admitted to the facility but due to problems associated with indwelling catheters, they develop UTIs. Patients who had catheters within two days are also examined for the problem of the CAUTIs.

I – Intervention

The intervention entails education of healthcare givers on some of the safety precautions when inserting catheters in patients. Also, there should be a standard application of the usage of different indwelling catheters, including but not limited to guidelines on the timely removal and other elements in usage (Saint et al., 2016). The education has to be timed, where it is completed on a quarterly basis using teaching tools that are standardized. Also, the use of detailed procedures and policies regarding catheter insertion and removal should be mentioned in the education.

C – Comparison

The comparison of the intervention is done with current practices that have minimal education regarding catheter use and insertion. Also, in the current practices, there are many policies regarding catheter use that are difficult to understand as well as implement. Some of them are also vague as they do not provide the nurses with the right information regarding catheter application.

O – Outcome

The outcome of care that should follow the interventions would be decreased CAUTIs in hospital units. A secondary outcome would be the decrease of the costs of care on the patient as the patient would no longer have to leave work and spend much of their time doing follow-up visits in the hospital. Also, there is likely to be reduced expenditure in the healthcare organization following the reduced rate of readmissions (Parker et al., 2017). The overall results would be the presence of a more knowledgeable staff and also increased patient satisfaction.

Evidence Based Practice Question

Does provider-training reinforcements that include standardized policies, education on catheter insertion standards, catheter care, and catheter removal on patients who develop CAUTIs lead to a decreased prevalence of CAUTIs when compared with implementation of the catheter administration using the present resources and knowledge of the healthcare givers?

B: Research Article

Background/Introduction

The article by Ferguson (2018) seeks to improve the nurse education regarding CAUTI prevention in two healthcare facility units within acute settings that have higher CAUTIs prevalence, with an aim of improving the knowledge base of nurses regarding catheter usage, and hence promoting patient care outcomes.

Methodology

The author starts by identifying the knowledge base of the providers that is the present knowledge of the nurses and physicians involved. The author uses a questionnaire to access this information on catheter care and insertion (Ferguson, 2018). He then conducts an interactive and multifaceted training on CAUTI prevention among the nurses and physicians affected. The different approaches used to train the nurses are aimed at boosting the present knowledge base of the nurses. It is also timed (one hour) to ensure that the interviewer sticks to only the relevant areas.

Level of Evidence

The article falls in the category of level II evidence.

Data Analysis

Data analysis in the study is based on statistical analysis, where the nurse’s prior knowledge is obtained through standard tests, and the results taken and compared with the results of the same test after the training. Also, the study assesses the different policies that are present regarding the use of catheters, and checks for the suitability of implementation of similar policies in care (Ferguson, 2018). The ratings in the tests are scored on a rate of 1 to 5, where one means least effective and 5 means the most effective. An average of the scores in different categories gives the overall scores, which are used in making the decisions. The CAUTI rates are compared in two inpatient units for a three-month period, and it is evident that there are better results in both units of reduced CAUTIs infections following the implementation of the training.

Ethical Considerations

All the participants in the project were selected on a voluntary basis. That is, there was no coercion in reaching the participants. Also, there was a high level of confidentiality and anonymity that was maintained among the participants. Nurses, as well as patients, also had the chance not to take part in the study, and no names of the study participants were included in the findings (Ferguson, 2018).

Quality Rating

According to the JHNEBP model, the article’s quality rating is ‘high.’

Analysis of the Results / Conclusions

The article collected data from two hospital inpatient units to assess for the care of patients who have CAUTIs. Before the training regarding the proper usage of catheters and policies surrounding catheter usage among clinicians, the two units had CAUTI rates of 7.49 and 4.12 per 1000 catheter days, and this reduced to 0 and 1.56 per 1000 catheter days respectively (Ferguson, 2018). The hands-on demonstration and the teaching were therefore relevant in the reduction of the number of CAUTIs in the two units.

C: Non-Research Article

Background Introduction

The article by Abubakar et al. (2020) compiles the resources that are used in education of staff in hospitals and assesses for their effectiveness in care. The aim of the article is to reduce the number of healthcare associated infections by creating a conceptual framework through the implementation of a catheter lifecycle model.

Type of Evidence

Among the evidence types used in the article is the systematic review of articles regarding CAUTI education. The authors also utilize multiple databases to identify articles, and they do this using specific search terms such as UTI and Catheters.

Level of Evidence

Level V Evidence.

Quality Rating

According to the JHNEBP model, the article’s quality rating for the article is ‘high.’

Author’s Recommendations

The recommendations of the author are based on the findings that the number of instruments that are applied in the assessment of the knowledge of CAUTI prevention by health workers are limited. Hence, from the findings, it is right to conclude that there are presently no standard tools that are available for utilization in hospital settings for CAUTI prevention (Abubakar et al., 2020). The authors recommend that nurses should receive regular education that would help in decreasing the prevalence of CAUTIs.

Recommended Practice Change Based on Evidence Based Practice Question

To enhance improved knowledge on CAUTI prevention among healthcare givers, there is need for regular training regarding the standard practices when inserting, using, and removing urinary catheters. In most of the cases, nurses only receive such specific training during their school education, and for those who are lucky, during their induction into the hospitals they work for (Abubakar et al., 2020). Given the increased number of cases in the number of recorded CAUTIs, it is evident that this education is not enough. There is need for more regular training, such as on a monthly basis.

Key Stakeholders

Nurse educators are top in the list of key stakeholders that would help in supporting my recommendation of practice change. These nurse educators would help in relaying to the nurses about accurate and up-to-date information regarding catheter infection (Meddings et al., 2019). Other key stakeholders include the nurse supervisors and nurse managers, who would take part in regulating the practice changes.

Barrier to Implementation

Lack of dedication towards the training could be a major challenge in the implementation of the recommended change (Saint et al., 2016). In most of the units, there is short-staffing of nurses, and it becomes hard to engage them in training as they have heavy workloads they have to cover during the intended training time.

Strategy to Overcome the Implementation Barrier

A possible way of overcoming this implementation barrier is scheduling the training plans to be friendly in terms of the nurse availability. This could include engaging additional members of staff on locum basis so as to improve the involvement of the nurses in the training.

Indicator to Measure the Outcome

The indicator that would be used is to assess the outcome would be the reduction in the CAUTI rates. This is best assessed after applying the education for a period of 12 months.

References

Abubakar, S., Boehnke, J. R., Burnett, E., & Smith, K. (2020). Examining Instruments Used To Measure Knowledge Of Catheter-Associated Urinary Tract Infection Prevention In Healthcare Workers: A Systematic Review. American Journal of Infection Control. https://doi.org/10.1016/j.ajic.2020.07.025

Centers for Disease Control and Prevention, CDC, (2020). Healthcare-associated Infections (HAI): Catheter-associated Urinary Tract Infections (CAUTI). https://www.cdc.gov/hai/ca_uti/uti.html

Ferguson, A. (2018). Implementing a CAUTI Prevention Program in an Acute Care Hospital Setting. Urologic Nursing38(6). DOI:10.7257/1053-816X.2018.38.6.273

Meddings, J., Manojlovich, M., Fowler, K. E., Ameling, J. M., Greene, L., Collier, S., & Saint, S. (2019). A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Annals of Internal Medicine171(7_Supplement), S30-S37. https://doi.org/10.7326/M18-3471

Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding Inappropriate Urinary Catheter Use and Catheter-Associated Urinary Tract Infection (CAUTI): A Pre-Post Control Intervention Study. BMC health services research17(1), 314. https://doi.org/10.1186/s12913-017-2268-2

Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E., & Faulkner, K. (2016). A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. New England Journal of Medicine374(22), 2111-2119. DOI: 10.1056/NEJMoa1504906

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