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Catheter-Associated Urinary Tract Infections Risk Prevention

The Methods of Evaluating the Effectiveness of Change

Evaluation is a very fundamental component of change management because it measures the performance of the new system or process (Acheterberg, Schoonhoven, & Grol, 2008). The implementation plan proposed three evidence-based solutions to prevent and reduce the risk of catheter-associated urinary tract infections (CAUTIs). The first recommendation included the introduction of checklists to enhance the effectiveness of supervision. The second strategy emphasized adherence to hand hygiene programs. The final intervention entailed the prevention of unnecessary catheterization by managing the insertion, use, and preservation of the catheters. The nursing home should employ the following techniques to assess the effectiveness of these strategies.

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First, it is essential to form a team of professionals to conduct an expert review of the new procedures. The proposals presented above were based on best practices from other residential care facilities. As such, the review panel should include change agents from the nursing homes that have implemented these solutions successfully. The experts will appraise the performance of the new procedures using predetermined benchmarks. The primary advantage of using external reviewers is that they will conduct an unbiased analysis (Gale & Schaffer, 2009). Nonetheless, the panel should also include representatives from the nursing home under review. The preceding action will ensure that the process is inclusive.

The second technique will involve the identification, retrieval, and analysis of information from the existing documents. The data collected from individuals is often subject to biases (Acheterberg et al., 2008). Thus, the patients’ medical reports, care plans, and discharge reports will provide crucial and authentic information. One of the solutions requires the nurses to avoid catheterizing elderly patients unnecessarily. The review of the catheterization checklists will determine if the nurses are adhering to this protocol. It is imperative to select these documents randomly to enhance the validity and reliability of the findings (Titler 2007). For instance, the collection of data from different units will ascertain whether the nurses are using standard procedures to catheterize the patients.

Thirdly, the use of a survey will be essential to gather crucial data from the nurses. The nurses will provide information about their personal experiences with the new policies and guidelines. The questionnaire will also give the staff a chance to identify the implications of the new proposals and the best clinical practices. In essence, the survey will provide feedback, which is critical to making policy and process adjustments (Titler, 2007). On the other hand, the nurses may not provide accurate information during clinical supervision of face-to-face interviews. Thus, the questionnaires will protect the anonymity of the staff. The use of questionnaires will allow the nurses and other caregivers to participate in the evaluation process directly (Oman, Duran, & Fink, 2008).

Finally, performance observations will be essential to document the current procedures and systems. The core value of observations is to gain first-hand experience about the performance of the new guidelines and protocols (Gale & Schaffer, 2009). This activity will entail taking part in the actual procedures and interacting with the nurses as they provide care. These observations will form the basis for authenticating the information gathered by using the previous techniques. In addition, this process will establish whether the nurses have incorporated the new protocols and guidelines in the clinical practice. Most importantly, this methodology will identify gaps and opportunities for continuous improvement.

Variables to Assess

The first variable to assess will be the frequency of catheterization. One of the underlying risk factors for CAUTIs is the unnecessary catheterization of patients (Ping, Traynor, & Hailey, 2014). The analysis of the hospital policy revealed that the rate of catheterization was still high despite the introduction of a new policy. The proposed solution required the hospital to combine supervision with urinary catheterization checklists. Thus, it is essential to determine the rate of adherence. The nursing home should compare the rates of catheterization before and after the implementation of the new guidelines. In addition, the incidence and prevalence rates of CAUTIs will be the best indicators of evaluating the efficacy of the checklists.

The second indicator to include in the assessment will be the perceptions of nurses towards perineal cleanliness. In addition, it will be crucial to measure the perineal clean practices and the factors that influence their choice. Ping et al. (2014) have found out that some health professionals do not adhere to perineal cleaning protocols because of their cultural beliefs. The cultural beliefs of the nurses will be a critical variable of the evaluation process. The proposed solution requires the nurses to promote hand hygiene practices when cleaning the perineal. The baseline findings indicated that the clinicians were not using standard procedures to wash their hands. As such, it will be necessary to determine the level of compliance with the new handwashing protocols.

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The behavior of the nurses will also be a critical indicator of measuring the level of compliance. This process should determine the factors that influence the nurses’ attitudes towards the new protocols and guidelines. Yates, Davies, Gorely, Bull, and Khunti (2009) have found out that individual beliefs and perceptions influence the intention to modify one’s behavior. It is necessary to analyze how the organizational culture and norms influence the nurses’ behavior. For instance, some of the nurses may have not transitioned to the new system. Pieterse, Caniëls, and Homan (2012) have found out that the quest to maintain the status quo increases the risk of resistance to change.

Disseminating the Evidence

The process of implementing evidence-based practice (EBP) is often long and complicated. Nonetheless, the continuous dissemination of information reduces the risk of failure significantly (Acheterberg et al., 2008)). Gale and Schaffer (2009) have underscored the significance of communicating the findings of the EBP project. The purpose of introducing the new solutions was to prevent and reduce the incidences of CAUTIs in the nursing home. The results will play a significant role in validating the need to reinforce the policy and procedural changes. Other care facilities can also use this information to enhance their respective practices. In addition, effectual communication will sustain the momentum of change (Pieterse et al., 2012). The nursing home should use the following techniques to disseminate the evidence.

First, poster presentations will be essential to disseminate information in the workplace or during meetings. The professional poster will convey a summary of the facts (Titler, 2007). Oman et al. (2008) have highlighted the significance of using diagrams, flowcharts, and paragraphs to simplify the message. The posters will also provide a summary of the new guidelines, policies, and procedures. This data will minimize the need to read the entire document, which is time-consuming. Posters are superior to oral presentations because they optimize the utilization of resources (Gale & Schaffer, 2009). Further, the use of posters will ensure that every person in the nursing home has access to accurate information. The essence of this assertion is that not all nurses may have the time to participate in conferences and workshops (Acheterberg et al., 2008).

The second technique will entail podium presentations during conferences, seminars, and workshops. This technique will provide the platform for efficient interaction and networking. The primary advantage of this approach is that the audience will have the opportunity to ask questions and make proposals (Gale & Schaffer, 2009). The podium presentations will facilitate the exchange of information through two-way communication, unlike the posters. The nursing home can organize regular conference meetings and seminars through which nurses can interact with experts in the health care industry. The forums can also include clinicians from other hospitals that have already implemented the proposed solutions. According to Oman et al. (2008), such interactions enhance the learning process.

Thirdly, the monitoring and evaluation team can publish their findings and recommendations in journal reports. The posters and podium presentations only provide a summary of the findings. The primary limitation of the previous approaches is that they do benefit a larger audience (Titler, 2007). The publication of the results in a report or journal article will have a significant effect on the broader community of health professionals. For example, the panel of experts can produce their findings in the form of a case study. The report will contain the outcomes of the planned change, including the barriers. This information will benefit other nursing homes that are planning to change their processes and systems. The published work can also provide background information for conducting additional research.

References

Acheterberg, T., Schoonhoven, L., & Grol, R. (2008). Nursing implementation science: How evidence based nursing requires evidence based implementation. Journal of Nursing Scholarship, 40, 302–310.

Gale, B., & Schaffer, M. (2009). Organizational readiness for evidence-based practice. The Journal of Nursing Administration, 39(2), 91–97.

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Oman, K. S., Duran, C., & Fink, R. M. (2008). Evidence-based policies and procedures: An algorithm for success. Journal of Nursing Administration, 38(1), 47–51.

Pieterse, J. H., Caniëls, M. C. J., & Homan, T. (2012). Professional discourses and resistance to change. Journal of Organizational Change Management, 25(6), 798-818.

Ping, Y., Traynor, V., & Hailey, D. (2014). Urinary continence care in Australian nursing homes. Australian Journal of Advanced Nursing, 32(2), 39-46.

Titler, M.G. (2007). Translating research into practice. American Journal of Nursing, 107(6), 26–33.

Yates, T., Davies, M., Gorely, T., Bull, F., & Khunti, K. (2009). Effectiveness of pragmatic education program designed to promote walking activity in individuals with impaired glucose tolerance. Diabetes Care, 32(8), 1404-1410.

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