Application of Concepts from Caring Science
Decreasing Incidences of ICU-Related CAUTI Through Nurse Education
The use of indwelling catheters for patients in the Intensive Care Unit (ICU) has a significant role to play in determining the morbidity, incidence, and mortality of urinary tract infections acquired at the hospital (Galiczewski, 2016). A UTI is an inflammation resulting from bacteria or fungi colonizing the urinary tract. CAUTI results in cost escalation for the patient, the hospital, and the general healthcare system.
According to Jean Watson, the theory of caring’s core is that, in treating humans, they cannot be viewed as objects, nor can they be separated from nature, others, self, and the wider workforce. The theory of caring focuses on the human caring centrality and the transpersonal caring-to-caring relationship, as well as the potential for healing for both the patient and the one who offers the care (Watson& Woodward, 2020). This paper will discuss the application of Watson’s theory on preventing catheter-associated urinary tract infections (CAUTIs) in the ICU. Specifically, the paper will discuss the 7th Carita Balance: Teaching and Learning to Address the Individual Needs, Readiness, and Learning Styles.
The Rationale for the Problem Discussion
According to Feneley et al. (2015), urinary catheters are used to drain urine for patients who are unable to urinate on their own. Moreover, catheters are used to measure the amount of urine a patient produces while in intensive care, for testing the bladder or kidney, or during or after surgery. CAUTI includes infections where a patient had an indwelling catheter at the time or within a period of 48 hours prior to the event occurring. The catheter can be in place for whatever short or long period of time before the UTI occurs (Feneley et al., 2015).
Several risk factors for the development of CAUTI include prolonged catheterization, female gender, diabetes, malnutrition, urology service, and ureteric stents, among others. Many of these causes are relevant for ICU patients, including systemic antibiotics, elevated creatinine, other active infection sites, diabetes mellitus, and prolonged catheterization. Being female and having a pre-existing condition such as malnutrition also increases the patient’s risk of infection. Other independent risks of CAUTI include inserting the catheter outside of the operating room, assiduous monitoring, and ureteric stenting (Flores-Mireles et al., 2015). A potentially modifiable and important risk factor is the catheterization duration; thus, an indwelling catheter should be used for the shortest period possible. The rate of infection rises to 100% by the 30th day (Al-Hazmi 2015). The burden of CAUTI can be reduced through drainage port protection and proper positioning of the collection bag and tubing. Although antimicrobial treatment is effective for a short while during catheterization, there is still the risk of selective colonization by organisms that are multi-drug resistant, such as Pseudomonas aeruginosa as well as other gram-negative bacilli, yeasts, and enterococci (Al-Hazmi, 2015). CAUTI that is hospital-acquired was not found to be an independent risk factor for mortality, though it significantly contributes to morbidity (Parida & Mishra, 2013)
The Concept of Balance in Watson’s Theory
Teaching is more than the presentation of relevant content or simply urging the student to apply the information wisely to the situation that the student may be in. Even when the student urgently and clearly needs to learn and apply the information, a student may do so or fail to do so because of other factors beyond the need. In relation to teaching and Watson’s 7th Carita, teaching can be viewed as a field with different kinds of seeds that are sown in a student’s mind. When a student is taught, it offers opportunities for more seeds to be sown in the mind of the student. Mindfully watering the seeds of love, mindfulness, health, and compassion will help the student nurture the self and others (Watson & Woodward, 2020).
Gesmuundo (2016) points out that nurses’ education can significantly impact the care quality they provide to patients and the outcomes of the latter. Nurses’ ought to be empowered and then engaged in evidence-based practice to provide the best patient care. In this study, enhancing nurse education may decrease the hospital length of stay of ICU patients, increase CMS reimbursement and revenue for the hospital, and create a patient safety process that empowers nurses and patients to participate in their care plan. Hence, it is the proposal of this research that increasing nurses’ education will improve ICU patient outcomes by decreasing CAUTI incidences.
Literature Review to Support the Concept of Nurse Education Increasing ICU Patient Outcomes
The CDC guidelines point out that the education of nurses in IUC use and management includes proper insertion, care, and management techniques, appropriate prevention, duration, and indication of potential IUC complications (DiGiulio, 2015). Nurses should be able to improve patient care, increase the outcomes in a positive way, and decrease the patients’ negative outcomes. Guidelines such as CAUTI and EBP are critical recommendations that have an impact on how nurses provide care. It is, therefore, important that nurses are updated on any policy revision and provided with annual education and training related to the indication and maintenance of IUC practices. In a study by Drekonja, Kuskowski, and Johnson (2010), there were inconsistencies in nurses’ IUC knowledge. Once the nurses were re-educated and trained, the results were a decrease in the number of days patients stayed with catheters and a decline in patient care inconsistencies. This made it clear that a lack of IUC knowledge was a barrier to nurse effectiveness in the prevention of CAUTIs. In comparison, Fink et al. (2012) pointed out in their research that less than 50% of the studies they reviewed identified a validation of skills regarding the insertion of IUC competency, and less than two-thirds offered practice education on CAUTI prevention during the orientation of nurses. In a more dated study, Goetz, Kedzuf, Wagener & Muder (1999) showed that educating nurses using a catheter care video review on revised CAUTI policies was effective at decreasing CAUTI incidences by 50% in a period of 18 months, thus showing that re-education can be effective.
Different methods of teaching have been used in an effort to reduce CAUTI incidences and to change practices. A combination of performance feedback and nursing education on CAUTI incidences after re-training and a focus on compliance by nurses regarding hand hygiene decreases CAUTI incidences, infection rates, and catheterization days (Schreiber et al., 2018). Educating nurses while ensuring that nurses wash their hands ever so often using antiseptic soap can reduce CAUTI infection incidences (Gordon, 2015). Additionally, combining staff nurse and nurse leaders’ education with decision-making authority, accountability, and autonomy regarding the use of IUC can reduce the rate of CAUTI infection rates (Meddings et al., 2017). These studies indicate that educating staff and feedback from staff may significantly reduce the rates of CAUTI. Hence, additional investigation on the education program and also on staff education in reference to the appropriate indication of IUC, care and maintenance, techniques in insertion and reversal, as well as regular feedback, are important in decreasing the rates of CAUTI in the ICU.
According to the guidelines set by the CDC, educating nurses on the insertion, prevention, and management techniques forms the foundation for the potential benefits to patient outcomes and the risk of preventing CAUTI (DiGiulio, 2015). The studies revealed a number of interventions, that is, nurse-driven protocols, nurse education, and nurse perceptions of IUCs. Although the studies have examined simple but slightly diverse interventions, they all showed a significant relationship between a decline in CAUTI rates and increasing nurse education. The studies also showed that nurses are at the forefront of affecting patient outcomes, positivity, and satisfaction. Patient management for IUCs is a significant tissue and a major risk of CAUTI that needs to be addressed, beginning within the inpatient setting, emergency room, and community, to prevent infections. Developing an education plan has been shown to be a good strategy for decreasing IUC use and duration and decreasing CAUTIs (Tatham et al., 2015). ER and ICU nurse knowledge of the IUC best practice guidelines is important for nursing. Gesmundo (2016) points out that guidelines enhance knowledge and promote excellence in nurses regarding patient care. Furthermore, increasing nurse’s knowledge is also important for the health care facility as it is founded on the use of best practices in nursing in the provision of safe quality care and aids in the prevention of HAIs, including CAUTIs. Education also plays an important role in patients through the promotion of safety and also in ensuring the implementation of preventive measures for reducing CAUTIs (Waskiewicz et al., 2019). Annual reinforcement and re-education of the needed behaviors will offer nurses the comprehension they need in practicing appropriate care and insertion techniques of catheters.
Conclusion
The 7th Carita By Jean Warson points out the usefulness of education in improving patient outcomes. In this study, nurse education in preventing and decreasing CAUTI incidences in the ICU is proposed. Literature review on the subject has shown that different nurse education strategies, including performance feedback, policy and guidelines re-education, hand washing, and video presentations, are effective channels that aid in decreasing CAUTI incidences. Nurses are at the frontline of patient care and are also in the best position to educate patients. Therefore, the present study will research nurse education and their subsequent patient education in reducing ICU-related CAUTI.
References
Al-Hazmi, H. (2015). Role of duration of catheterization and length of hospital stay on the rate of catheter-related hospital-acquired urinary tract infections. Research and reports in urology, 7, 41.
DiGiulio, S. (2015). ANA, CMS, & CDC develop tools to reduce catheter-associated urinary tract infections.
Drekonja, D., Kuskowski, M., & Johnson, J. (2010). Internet survey of Foley catheter practices and knowledge among Minnesota nurses. American Journal of Infection Control, 38(1), 31–37. http://dx.doi.org/10.1016/j.ajic.2009.05.005
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.
Fink, R., Gilmartin, H., Richard, A., Capezuti, E., Boltz, M., & Wald, H. (2012). Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in nurses improving care for health system elders hospitals. American Journal of Infection Control, 40(8), 715–720. http://dx.doi.org/10.1016/j.ajic.2011.09.017
Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284.
Galiczewski, J. M. (2016). Interventions for the prevention of catheter-associated urinary tract infections in intensive care units: an integrative review. Intensive and critical care Nursing, 32, 1-11.
Gesmundo, M. (2016). Enhancing nurses’ knowledge on catheter-associated urinary tract infection (CAUTI) prevention. Kai Tiaki Nursing Research, 7(1), 32-40.
Gesmundo, M. (2016). Enhancing nurses’ knowledge on catheter-associated urinary tract infection (CAUTI) prevention. Kai Tiaki Nursing Research, 7(1), 32-40.
Goetz, A. M., Kedzuf , S., Wagener, M., Muder, R. R. (1999). Feedback to nursing staff as an intervention to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 27(5), 402–404. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10511486
Gordon, P. R. (2015). The effects of nursing education on decreasing catheter-associated urinary tract infection rates.
Meddings, J., Saint, S., Krein, S. L., Gaies, E., Reichert, H., Hickner, A., … & Mody, L. (2017). A systematic review of interventions to reduce urinary tract infection in nursing home residents. Journal of Hospital Medicine, 12(5), 356.
Parida, S., & Mishra, S. K. (2013). Urinary tract infections in the critical care unit: A brief review. Indian Journal of Critical Care Medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 17(6), 370–374. https://doi.org/10.4103/0972-5229.123451
Schreiber, P. W., Sax, H., Wolfensberger, A., Clack, L., & Kuster, S. P. (2018). The preventable proportion of healthcare-associated infections 2005–2016: systematic review and meta-analysis. Infection Control & Hospital Epidemiology, 39(11), 1277-1295.
Tatham, M., Macfarlane, G., MacRae, M., Tully, V., & Craig, K. (2015). Development and implementation of a catheter-associated urinary tract infection (CAUTI)’Toolkit’. BMJ Open Quality, 4(1).
Waskiewicz, A., Alexis, O., & Cross, D. (2019). Supporting patients with long-term catheterization to reduce the risk of catheter-associated urinary tract infection. British Journal of Nursing, 28(9), S4-S17.
Watson, J., & Woodward, T. K. (2020). Jean Watson’s theory of human caring. SAGE Publications Limited.
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Question 
Application of Concepts from Caring Science
Summary: A theory can be used to guide practice. This assignment is an exercise in supporting a clinical practice with theory and evidence.
Application of Concepts from Caring Science
Topic: ICU What is Ventilator Associated Pneumonia (VAP), and How to Prevent It? Or How to prevent clabsi or caution
Briefly support why it is a problem with evidence from the literature. This is not the major focus of the assignment, so do not elaborate. Create a clinical nursing (not medical) theory in the form Concept A | Proposition | Concept B. Think of the structure like two nouns and a verb. While the term proposition is much more complex in the dictionary, in our use, it is the connecting term between the two concepts. Examples include Concept A improving Concept B, Concept A is related to Concept B, when Concept A increases, then Concept B also increases, etc. When you get to research, you will explore this further as you develop independent and dependent variables. How to use these statistics will be in research and statistics courses.
This clinical theory is identified as an empirical theory when you get to the C-T-E model later in this course. It is empirical in that they can be measured.
Identify and define your concepts. Identify how they could be measured in a research study. Be careful that you do not use compound concepts. If you find the words “and” or “or” in your theory, you are probably too complex.
If you research your question and seek funding, you will need a theoretical model to guide the research. In our assignment, we are using Watson. You will identify the concepts in Watson’s theories that are represented by the concepts you are using in your clinical theory. Match the proposition in her theory with your proposition. To help, the 10 Caritas Processes are Concept A. Choose the one that matches your concept. To clarify, let’s look at Caritas 1 Embrace and use it in middle-range theory. Sustaining humanistic-altruistic values by the practice of loving-kindness, compassion, and equanimity with self/others (Concept A – Very complex and abstract) improves (Proposition) subjective inner healing (Concept B).
Remember that the paper is not about the problem. It is about constructing a clinical theory and matching it to a middle-range theory and conceptual model your clinical theory represents.
Conclude the paper with your discoveries made in your readings and the impact on the nursing profession of your discoveries. Explore briefly and discover questions that require further research. Summarize the paper in the conclusion.
Expectations
- Length: 5 pages, including title and reference pages
- References: 3 to 10. There should be enough to support the links between the concepts of the problem and the concepts of Watson’s Theory of Caring.
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