NURS 716 DISCUSSION 1: DEVELOPING A CLINICAL QUESTION

NURS 716 DISCUSSION 1: DEVELOPING A CLINICAL QUESTION

NURS 716 DISCUSSION 1: DEVELOPING A CLINICAL QUESTION

Clinical Question Development

Delivering evidence-based practice (EBP) healthcare services is an essential consideration by healthcare organizations. These healthcare organizations should teach their prelicensure nursing students and licensed nursing professionals how to apply EBP in all practices to improve the healthcare delivery model (Horntvedt et al., 2018). With EBP knowledge, the healthcare providers increase their chance of providing the target patient population with high-quality care based on the most appropriate evidence, thus minimizing medical errors and hospital stays. In our healthcare organization, patient numbers have been declining. Still, from the statistics, there is a high possibility that the main cause of such decline is associated with Hospital Acquired Infections (HAIs). The paper will focus on catheter-associated urinary tract infections (CAUTI), one of identified HAIs in our healthcare facility that have increased by 4 percent in the last six months. However, for the research to be more accurate, the Iowa Model of EBP.

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According to Aiken et al. (2011) Iowa model is the most effective model that helps nursing professionals support any EBP project in their healthcare organizations. The main reason for such assertions is based on the Iowa model providing a systematic guide on handling clinical problems to ensure that the intervention is effective. Hence, in addressing the increased rates of CAUTI in our healthcare organization, Iowa Model is the most effective model that will guide in addressing the problem and match it with the best intervention to prevent healthcare compromise that increases patient risks.

The Iowa model presents itself as an application-oriented guide within the EBP process. The first step involves evaluating the triggers that may have led to a clinical problem where these triggers may be knowledge-focused and problem-focused. The knowledge-focused triggers mainly involve when new guidelines or research findings are implemented. On the other hand, problem-focused triggers refer to healthcare issues arising from clinical problem identification and financial or risk management data (Green, 2020). Hence, CAUTI increase cases are a problem-focused trigger in our healthcare organization.

Iowa model’s second step is determining if the identified problem needs to be prioritized by the healthcare organization, unit, or department. Regarding the identified problem in the healthcare organization, CAUTI cases increase healthcare costs for patients and healthcare organizations due to patients overstaying in the hospital. Cudjoe and Heidelberg-Horton (2019) state that over 560,000 patients experience CAUTI each year in the US. Apart from contributing to hospital overstays and increased treatment costs, there is always an increase in mortality and morbidity rates. Considering the increase of CAUTI rate has been high over the last six months, the hospital needs to act fast since the situation risks its sustainability and competitiveness. That is because the patients will be more attracted to other healthcare organizations as they seek safe and quality healthcare services.

The Iowa third step is to create a project team to help the healthcare organization develop, evaluate and implement an EBP change. The team will be essential to ensure that they implement the most appropriate change for CAUTI issues in our healthcare organization. The team will comprise of interprofessional EBP project team involving the nurses, physicians, infection preventionists, clinical educators, senior healthcare executives, and patient safety officers (McClusky, 2018). The reason for incorporating these representatives within and outside the nursing unit is to ensure that the team evaluates and implements the change effectively since they can consult and brainstorm to find the most appropriate implementation strategies.

The EBP project will also involve Iowa’s fourth step, gathering the necessary information and critically analyzing the evidence to inform the required practice change (Aiken et al., 2011). Also, this step is important since it helps create an appropriate PICO-related research question and search for related studies. Most studies have evaluated the most effective strategies that healthcare organizations can emulate to reduce CAUTI-related issues. From the research, hand hygiene has been discussed, but there are still gaps in how the hospitals can ensure that nurses and other healthcare providers comply with such implementation changes (Jones et al., 2021). Considering the implications of any hospital-acquired infection, American Nurse Association provides a streamlined, evidence-based, and innovative clinical tool that will enable nurses to reduce CAUTI implications through the American Nurse Association CAUTI prevention tool (ANA, n.d). Therefore, the PICO question will be, “For patients in acute care, is the application of the America Nurse Association CAUTI prevention tool compared to handwashing strategies more effective in reducing CAUTI infections?”

The fifth Iowa model step includes critiquing and synthesizing the discovered research (Aiken et al., 2011). Hence, the step will involve the evaluation of the effectiveness of the American Nurse Association CAUTI prevention Tool in preventing CAUTI in a hospital environment. Most researchers have embraced the incorporation of the proposed CAUTI prevention tool due to the dynamic nature in which it approaches the CAUTI issue. That is because it engages the nurses in three areas that help reduce CAUTI rates. These areas include inappropriate use of short-term catheters, the care necessary during urinary catheter placement, and the need for timely urinary catheter removal (Meddings et al., 2019). Our healthcare organization must embrace the proposed initiative due to its authenticity and reliability (Zurmehly, 2018). That is because American Nurse Association (ANA) collaborated with the Partnership for Patients (PfP), part of the Centers for Medicaid and Medicare Services. Both organizations worked towards reducing 30-day hospital readmission by 20 percent and hospital-acquired complications by 40 percent (Lawrence et al.,  2018). The CAUTI prevention tool is also effective since it helps nurses evaluate the key components in completing bladder assessments. That is because the tool help in prioritizing and differentiating interventions depending on personalized assessment findings involving incontinence, urinary retention, and bladder emptying, which are essential factors when preventing CAUTIs. 

As the sixth Iowa model suggests, there is a need to evaluate if there is enough research on practice change implementation. The different scholarly databases present various research concerning CAUTI prevention tools by ANA. For instance, PubMed has 14 studies evaluating the CAUTI prevention tool by ANA, with Google Scholar having over 291 studies and data from reliable healthcare websites filtered within the last five years. Hence, such research will aid in implementing the change in our healthcare organizations.

The seventh and the eighth step of the Iowa model depends on the feasibility of the proposed change practice. Hence, the as a researcher, there will be a need to carry out a pilot program that will emphasize the need for nurses and other healthcare providers to avoid inappropriate use of short-term catheters, involve the care necessary during urinary catheter placement, and the need for timely urinary catheters removal for utmost three months to assess if there will be any change in CAUTI numbers. After realizing that the change practice is efficient, the healthcare organization will need to fully implement the CAUTI prevention tool by American Nurse Association to improve acute care patient safety and health quality.

In conclusion, the paper has evaluated ways that our healthcare organization can reduce instances of CAUTI, which has been one factor that led to the decline of patients in the organization. The need to address the CAUTI issue is mainly inclined towards ensuring that the healthcare organization maintains its competitiveness and sustainability by following the Iowa model for evidence-based practices in nursing. Also, since healthcare organizations’ main aim is to improve patients’ well-being, incorporating the America Nurse Association CAUTI prevention tool is essential since it proves its effectiveness in reducing CAUTIs compared to other interventions such as handwashing.

References

Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical care, 49(12), 1047–1053. https://doi.org/10.1097/MLR.0b013e3182330b6e

ANA (n.d) ANA CAUTI Prevention Tool. https://www.nursingworld.org/practice-policy/work-environment/health-safety/infection-prevention/ana-cauti-prevention-tool/

Cudjoe, K. G., & Heidelberg-Horton, D. V. (2019). Proper indwelling catheter use to prevent CAUTIs. Nursing made Incredibly Easy, 17(6), 16-19. doi: 10.1097/01.NME.0000585108.94257.45

Green, C. (2020). Application of the Iowa Model, an Evidence-Based Practice Model, When Initiating Clinical Project Pilots to Evaluate How Self-Care Techniques Affect Simulated Nursing Performance. SAGE Publications Ltd.

Horntvedt, M. E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC medical education, 18(1), 1-11. https://doi.org/10.1186/s12909-018-1278-z

Jones, K. M., Mantey, J., & Mody, L. (2021). Current Practices in Infection Prevention: A 3-year Survey of Michigan Nursing Homes’ Urinary Tract Infection Prevention Strategies. American Journal of Infection Control, 49(6), S7. https://doi.org/10.1016/j.ajic.2021.04.028

Lawrence, K. G., Bliss, D. Z., Dailey, M., Trevellini, C., & Pontieri-Lewis, V. (2019). The CAUTI Prevention Tool Kit: A Professional Practice and Collaborative Project of the Wound, Ostomy and Continence Nurses Society. Journal of Wound Ostomy & Continence Nursing, 46(2), 154-157. doi: 10.1097/WON.0000000000000505

McClusky, J. L. (2018). One Year CAUTI Free: A Multi-Disciplinary Team Approach to Reducing CAUTI in a Pediatric Intensive Care Unit. American Journal of Infection Control, 46(6), S76. DOI:https://doi.org/10.1016/j.ajic.2018.04.143

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 medicine, 171(7_Supplement), S30-S37. https://doi.org/10.7326/M18-3471

Zurmehly, J. (2018). Implementing a nurse-driven protocol to reduce catheter-associated urinary tract infections in a long-term acute care hospital. The Journal of Continuing Education in Nursing, 49(8), 372-377. https://doi.org/10.3928/00220124-20180718-08

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DEVELOPING A CLINICAL QUESTION ASSIGNMENT INSTRUCTIONS
OVERVIEW
The effective development of an evidence-based project utilizes a conceptual framework to guide the process. For purposes of this assignment, the Iowa Model of Evidence-Based Practice is the identified model. There is a link available within the course. An evidence-based practice project requires the development of a well-designed clinical question. This is supported by the use of the PICO format. The idea for a question will originate from a trigger (per the Iowa Model) which could come a metric in the practice setting such as a nurse sensitive indicator. In some CASES, a trigger could be revealed in the current literature where innovations and ideas are discussed. A PICO worksheet is provided as a part of the assignment instructions for use in the development of a question. A case scenario is provided to give a clinical perspective for the development of a question and subsequently the development of a proposal later in the course.
INSTRUCTIONS
As a nurse in a healthcare organization, it has become evident that patient outcome data have been consistently declining in some patient care settings. Some of the outcomes under inspection include hospital acquired pressure injuries (HAPI) (4% increase in the last 6 months), patient falls, (3 % increase in the last 6 months) and catheter associated urinary tract infections (CAUTI) (4% increase in the last 6 months).
You have been asked to investigate contributing factors to the declining outcomes and participate with a team approach to developing an evidence-based practice project. As you started this exploration, you came across this article Aiken Article, which served as a starting point for the assignment you have been given. The purpose of the Aiken article is to provide a perspective as to some of the variables that can contribute to patient morbidity and mortality. You have the opportunity to explore other influences as well within the literature.
Depending on the problem focus you select based on the data provided, you will need to secure current articles to support you as you develop the clinical question. For example, you may want to retrieve peer review articles on patient falls or one of the other problem areas. It would be recommended that you address only one of the problem areas. You have the freedom to make that decision as to which you believe is the top priority.
To complete this assignment:
1. Access the link to the Aiken article found in the Learn section of this module. This article will provide some background information that links nurse-patient ratios to patient outcomes. The article is provided to get you started on the development of an evidence-based project (EBP).
2. Refer to the Iowa Model (available in the textbook) to serve as a guide in the development of the EBP project. Be sure to explain, in detail, how each step of the Iowa Model supports the project development.
3. Based on the information in the article, develop a PICO question to address the problem of a decline in patient outcomes.
4. Use the Developing a Clinical Question Template to develop the PICO: Include the PICO worksheet as a part of the assignment.
5. Include additional articles as background information to provide information for the problem areas identified. (3–4 articles)
6. Discuss the influence of Scripture on the imperative for utilizing current evidence to deliver safe and quality patient care.
Include a title page and a reference page as a part of the assignment using current APA Manual.

Note: Your draft assignment will be checked for originality of your work before submitting your final assignment. Your assignment will be checked via the Turnitin plagiarism tool.

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Developing a Clinical Question Grading Rubric | NURS716_D01_202230

Criteria	Ratings				Points
The Iowa Model Is Used as the Guide to the Project Development	25 to >22.0 pts Advanced The use of the Iowa Model is clear. Each step of the model is clearly defined and there is detailed explanation as to how each step is developed and supports the project development. The information supersedes an adequate description of the use of the model. There are no questions in the mind of the project leader as to the use of the model.	22 to >17.0 pts Proficient The use of the Iowa Model is clear. There is adequate description of each step of the model and sufficient detail as to how each step of the model was used to support the project development. Minor edits for clarity and readability may be required.	17 to >0.0 pts Developing The use of the Iowa Model is not clear. There is little or no detail as to the definition of the steps of the model and how the model supported the project development.	0 pts   Not Present	25 pts
PICO Statement	45 to >40.0 pts	40 to >31.0 pts	31 to >0.0 pts	0 pts	45 pts
	Advanced	Proficient	Developing	Not Present
	The PICO format is thoroughly completed. Each element of the PICO is clearly written. The problem statement/question is clear in identifying the variables and population. No editing is required.	The PICO format is adequate. The problem statement/question is clearly stated. Some minor edits may need to be made for clarity and readability.	The PICO format is not followed. None of the elements are fully developed. The problem statement/question is incomplete.
Quality of Work	30 to >26.0 pts	26 to >20.0 pts	20 to >0.0 pts	0 pts	30 pts
	Advanced	Proficient	Developing	Not Present
	Correct use of current APA format, grammar, and structure is followed. The work is thorough and clear. There is evidence of additional resources to provide robust background information on the topic. Meets citation requirement.	Correct use of current APA format, grammar, and structure is evident with few minor errors. The work is thorough and clear but there may be lack of detail in some areas. There is evidence of additional resources, but they don’t strongly support the topic. May not meet citation requirement.	Multiple APA format, grammar, and/or structure errors exist. The work is not thorough and/or lacks clarity. There are no additional resources used to support the topic. Does not meet the citation requirement.
Total Points: 100