NURS FPX 4030 Determining the Credibility of Evidence and Resources

Determining the Credibility of Evidence and Resources

NURS FPX 4030 Determining the Credibility of Evidence and Resources

Nursing practice is based on evidence, guidelines, and protocols. Research and articles provide evidence and recommendations that can help in increasing quality care through evidence-based practices (Gray et al., 2016). However, different researches based on different methodologies and interventions provide results to transform them into practices. For example, catheter-associated urinary tract infection (CAUTI) researches used interventions such as indwelling catheters, daily check-up, aseptic interventions, and other interventions (Atkins et al., 2020). The purpose of the paper is to evaluate the credibility of evidence and resources related to safety or quality issues of CAUTI prevention and use evidence-based practice models to implement the EBP change. 

Description of a quality or safety issue, or a chosen diagnosis

 Urinary tract infections (UTIs) are one of the most common and a high priority safety and quality health care acquired infections where the urinary system including kidney, ureters, bladder, and urethra. According to NHSN or National Health Care Safety Network, 75% of UTIs are CAUTI (Wanat et al., 2020), which is caused by infection secretion due to the insertion of a catheter tube in the bladder to drain the urine. 

Around 15 to 25% patients receive catheters during their hospital stay (CDC, 2021). It is a safety issue as it leads to mortality and morbidity. It is reported in study that every year 13,000 die due to CAUTI and the condition increased hospital stay days by 2 to 4 days (Taha et al., 2017). Further, it increased cost by $1200 to $2400, which is a quality care issue (Taha et al., 2017). 

The issue is also quality-based as failing to monitor and examine the indwelling catheter will increase CAUTI by 5% (Taha et al., 2017). Even though the infection can be prevented and treated, the risk of contracting infection increases with use of inappropriate catheters, technique in inserting catheters, hygiene, and other issues (Parker et al., 2017). Nurses and health care professionals need to take care of different challenges to prevent and manage the CAUTI by using evidence-based practice and monitor its outcome by using the EBP change model that fits the issue and the organization (Giles et al., 2020).  

NURS FPX 4030 Determining the Credibility of Evidence and Resources

Rationale for applying an evidence-based approach

The evidence-based approach selected for increasing quality of care and safety of patients against CAUTI is to critically analyze clinical and statistical significance of intervention to adopt a nurse-led infection prevention, control, management, and treatment. The rationale behind selecting the approach is it helps in understanding a study by critically evaluating its design, methodology, intervention, outcome, and effectiveness in CAUTI management. 

By applying the approach on different research articles and comparing their interventions aid in determining, which interventions are beneficial in preventing, managing, and treating CAUTI (Gray et al., 2016). The approach also includes extracting evidence and transforming the evidence into practice by using transformational leadership, change culture, and Iowa evidence-based practice model to implement and evaluate outcome of implemented intervention (Buckwalter et al., 2017). Further, it helps in systematic decision-making along with selecting best EBP based on parameters (Skela-Savič et al., 2020). 

Criteria to evaluate credibility of evidence

The very first criteria to evaluate credibility of evidence is to determine the relevance of the study to the particular issue (Enam et al., 2018). For example, only articles and research papers on CAUTI and UTIs contribute in finding the effectiveness of studies. The second key criterion is to analyze timeliness of the research as it aids in identifying recent problems and challenges associated with the CAUTI and effectiveness of previous interventions along with new or updated interventions and their effectiveness. 

The third criterion is to evaluate authenticity of the source as it highlights whether the authors have knowledge and tools to conduct the study, whether the research belongs to organization, which has authority in the field, and whether the journal the article it is published is peer-reviewed or not (Gray et al., 2016). As peer reviewed journals include credits, quotations, citations, and other documentation, it reduces chances of misinformation. The fourth criterion is to analyze if the source and article is secondary or primary research so that primary research can be evaluated along with secondary research (Enam et al., 2018).

The fifth criterion is to critique the article by using a critical analysis framework to determine any biases, unethical practices, assumptions, faulty methods, and other aspects of study and its significance to evaluate the credibility (Gray et al., 2016). 

NURS FPX 4030 Determining the Credibility of Evidence and Resources

Evaluating credibility of evidence from CAUTI research

As CAUTI is a quality, safety, and infection management issue, the evidence should be from a randomized control trial or other quantitative research on interventions with scientific methodology, which includes observations and trials (Skela-Savič et al., 2020). Parker et al. (2017) used quantitative research with pre-post control analysis to determine effects of implementing appropriate catheters to prevent and control CAUTI. 

The second aspect is to determine the role and credentials of nurses and researchers and setting of research as specialization in quality management and infection control. For example, Giles et al. (2020) used Australian hospitals and nurses and other HCPs from the hospital to conduct the study. As nurses play a critical role in catheter handling and management, nurse-led programs should be included to identify evidence that supports and contrary to the different approaches. For example, Zurmehly (2018) used nurse driven protocol to prevent CAUTI. This approach increases generalizability of the study and researchers can adopt methodology or design to continue the research. 

The third aspect is to consider research with appropriate sampling size, study design, bias control, generalizability, duration of research, and approach to evaluate data and evidence to find best possible interventions. For example, Reynolds et al. (2021) conducted a study for four years with bias control and CAUTI prevention strategies to initiate a QI framework. The fourth aspect is to compare studies with similar interventions and methodologies to find the best EBP. For example, Giles et al. (2020) and Reynolds et al. (2021) used a multifaceted approach to prevent CAUTI.  

NURS FPX 4030 Determining the Credibility of Evidence and Resources

Importance of incorporating credible evidence into an EBP model

A EBP model such as Iowa EBP model helps in incorporating credible evidence by identifying problem and concern, setting up research team to conduct literature review, extract evidence, and discuss evidence critique and synthesize the evidence (Bordoni, 2019), implement the change on a small scale, evaluate the effectiveness of evidence and intervention in preventing and managing CAUTI, and implementing the change on a big scale if it is successful or go back to research process to conduct research to find new evidence or update the intervention (Skela-Savič et al., 2020). This approach prevents unnecessary use of intervention, which is not beneficial and helps in implementing the change effectively with accountability, timeline, role-based practice, and criteria to evaluate outcome (Gray et al., 2016). 

NURS FPX 4030 Determining the Credibility of Evidence and Resources

References

Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., & Hopkins, S. et al. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science15(1). https://doi.org/10.1186/s13012-020-01001-2

Bordoni, B. (2019). The benefits and limitations of evidence-based practice in Osteopathy. Cureus. https://doi.org/10.7759/cureus.6093

Buckwalter, K., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A., & Rakel, B. et al. (2017). Iowa model of evidence-based practice: revisions and validation. Worldviews On Evidence-Based Nursing14(3), 175-182. https://doi.org/10.1111/wvn.12223

CDC. (2021). Catheter-associated urinary tract infections (CAUTI) | HAI | CDC. Cdc.gov. Retrieved 20 May 2021, from https://www.cdc.gov/hai/ca_uti/uti.html.

Enam, A., Torres-Bonilla, J., & Eriksson, H. (2018). Evidence-based evaluation of ehealth interventions: systematic literature review. Journal Of Medical Internet Research20(11), e10971. https://doi.org/10.2196/10971

Giles, M., Graham, L., Ball, J., King, J., Watts, W., & Harris, A. et al. (2020). Implementation of a multifaceted nurse‐led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A pre‐ and postintervention study. Journal Of Clinical Nursing29(5-6), 872-886. https://doi.org/10.1111/jocn.15142

Gray, J., Gray, J., Grove, S., & Sutherland, S. (2016). Burns and Grove’s the practice of nursing research (8th ed.).

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). https://doi.org/10.1186/s12913-017-2268-2

Reynolds, S., Sova, C., Lewis, S., Smith, B., Wrenn, R., Turner, N., & Advani, S. (2021). Sustained reduction in catheter-associated urinary tract infections using multi-faceted strategies led by champions: A quality improvement initiative. Infection Control & Hospital Epidemiology, 1-5. https://doi.org/10.1017/ice.2021.135

Skela-Savič, B., Gotlib, J., Panczyk, M., Patelarou, A., Bole, U., & Ramos-Morcillo, A. et al. (2020). Teaching evidence-based practice (EBP) in nursing curricula in six European countries—A descriptive study. Nurse Education Today94, 104561. https://doi.org/10.1016/j.nedt.2020.104561

Taha, H., Raji, S., Khallaf, A., Abu Hija, S., Mathew, R., & Rashed, H. et al. (2017). Improving catheter associated urinary tract infection rates in the medical units. BMJ Quality Improvement Reports6(1), u209593.w7966. https://doi.org/10.1136/bmjquality.u209593.w7966

Wanat, M., Borek, A., Atkins, L., Sallis, A., Ashiru-Oredope, D., & Beech, E. et al. (2020). Optimising Interventions for Catheter-Associated Urinary Tract Infections (CAUTI) in primary, secondary and care home settings. Antibiotics9(7), 419. https://doi.org/10.3390/antibiotics9070419

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 Nursing49(8), 372-377. https://doi.org/10.3928/00220124-20180718-08