Nursing clinical practice gap

Nursing clinical practice gap

Summative Assessment

Evidence-Based Practice Project: Addressing a Clinical Challenge

This assignment requires you to develop a PICOT question addressing a significant clinical challenge in your area of practice. The project should reflect the application of EBP principles throughout the process. You will identify a clinical problem, develop a PICOT question and conduct a literature review.

Instructions: 

1. Problem Identification and Literature Review: Clearly identify a significant clinical problem within your area of expertise, justifying its selection based on evidence of a practice gap and its potential for improvement through EBP. Conduct a thorough literature review to support your choice and inform the development of your intervention. (Minimum of 5 peer-reviewed sources).
2. PICOT: Based on the literature review, design a PICOT question to address the chosen problem. Provide rationales for each part of your PICOT question.
3. Barriers and Theory Application: Identify 2-3 barriers that may exist for implementing your intervention. Using nursing theory, describe how you would overcome those barriers.

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Nursing clinical practice gap

I. Problem Identification and Literature Review

Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections, contributing to increased morbidity, extended hospital stays, and higher healthcare costs (Gould et al., 2017). The Centers for Disease Control and Prevention (CDC) estimates that 75% of UTIs acquired in the hospital are associated with a urinary catheter, and among those, 15-25% of hospitalized patients receive urinary catheters during their stay (CDC, 2021). Despite this prevalence, research shows that many catheters remain in place longer than necessary due to unclear protocols or delayed physician orders, presenting an urgent clinical practice gap (Meddings et al., 2014).

Nurse-led interventions, including autonomous catheter removal protocols, have demonstrated effectiveness in reducing catheter dwell time and preventing CAUTIs. A systematic review by Meddings et al. (2017) showed that empowering nurses to assess catheter necessity and remove catheters based on clinical criteria reduced CAUTI incidence by up to 43%. However, implementation varies across healthcare systems, signaling a need for evidence-based, standardized approaches.

Implementing nurse-led catheter removal protocols addresses the identified clinical gap by empowering nurses to act promptly within their scope of practice. This intervention is supported by current evidence and aligns with hospital goals of improving patient safety and reducing infection rates.

II. PICOT Question

P (Population): Hospitalized adult patients with indwelling urinary catheters
I (Intervention): Nurse-led catheter removal protocol
C (Comparison): Physician-initiated catheter removal
O (Outcome): Reduction in catheter-associated urinary tract infections (CAUTIs)
T (Time): Within 30 days of implementation

PICOT Question: In hospitalized adult patients with indwelling urinary catheters (P), how does implementing a nurse-led catheter removal protocol (I), compared to physician-initiated removal (C), affect the incidence of catheter-associated urinary tract infections (O) within 30 days of implementation (T)?

Rationale: The population focuses on adult patients with urinary catheters, a group highly vulnerable to CAUTIs. The intervention (nurse-led removal) empowers nurses and reduces catheter dwell time. The comparison (physician-initiated removal) reflects standard practice. The outcome (reduced CAUTIs) aligns with patient safety goals, and the 30-day time frame allows for measurable evaluation.

III. Barriers and Nursing Theory Application

Barrier 1: Resistance to role expansion – Nurses may face institutional or hierarchical resistance to assuming responsibilities traditionally managed by physicians.
Barrier 2: Lack of standardized training – Without a unified protocol and adequate education, nurse-led removal could be inconsistently applied.

To address these, Lewin’s Change Theory can guide implementation. The three stages—unfreezing, change, and refreezing—support organizational adaptation (Cummings et al., 2020). In the unfreezing stage, leadership will present CAUTI data to raise awareness. During the change phase, staff will be trained on criteria for removal. Finally, in the refreezing stage, the protocol becomes institutional policy, reinforced through performance metrics and feedback.

IV. References

Centers for Disease Control and Prevention. (2021). Catheter-associated urinary tract infections (CAUTI). https://www.cdc.gov/hai/ca_uti/uti.html

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., & Micaroni, S. P. (2020). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 111, 103738. https://doi.org/10.1016/j.ijnurstu.2020.103738

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., & Pegues, D. A. (2017). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control and Hospital Epidemiology, 31(4), 319–326. https://doi.org/10.1086/651091

Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review. BMJ Quality & Safety, 23(4), 277–289. https://doi.org/10.1136/bmjqs-2012-001774

Meddings, J., Saint, S., Fowler, K. E., Gaies, E., Hickner, A., & Krein, S. L. (2017). The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results from a National Survey. Infection Control & Hospital Epidemiology, 38(7), 857–863. https://doi.org/10.1017/ice.2017.90