Constructing the Written Evidence Based Proposal

Abstract

The prevalence of urinary tract infections (UTI) increases with age. The illness cluster is common among the elderly. Moreover, infections occur among female more often than among male with the ratio of 2:1. UTI is an inflammation in the urinary tract that causes morbidity resulting in long-term medical care for the patients. The causal agent is bacterial infections with evidence of bacteria in urine; while severe infections spread to affect the kidneys. The risk factors of UTI include urinary tract obstruction, neurogenic bladder dysfunction, improper use of urinary catheters and external urine collection devices. Due to asymptomatic nature of early infections, diagnosis becomes difficult until the symptoms manifest at the stage, when the infection is causing complications.

Jean Watson published the book The Philosophy and Science of Caring in 1979 basing on the principle of caring for patients and developing relationships with them (Watson, 1979). She assessed the science of caring from the perspective of human-to-human interpersonal relationship. The nursing care requires care factors, transpersonal caring relationship and the personal moments that recognize human-to-human interactions. The purpose of Watson’s theory is the consideration of patient caring as a holistic process, where the body, the mind, and the soul must be nurtured to complete the cycle of healing (Smith & Parker, 2001). The patient vulnerability is the time when an individual is most in need for care in their lives, which is the major factor justifying Watson’s approach.

Catheter-associated urinary tract infections (CAUTI) are considered to be the main complication of UTI health challenge. CAUTI results from improper use of catheters triggering the need to insert catheters that will solve the challenge of high risk of microbial infections. Catheterization is a health care professional activity. Therefore, the high risk of associated infection from the use of catheters suggests that high percentages in CUATI are classified as hospital acquired infections. Therefore, the problem suggests the need for a control policy and personnel training to prevent the infections.

In order to effectively manage the challenge of UTI, the education, training and retraining, especially in the field of use and function of catheterization, is required. Evaluation activities include developing a long-term training schedule on the professional use of catheters and managing patients with UTI. Proper intervention may be in place; but evaluation of the trained and skilled catheter nurses will assist in measuring the efforts of trying to eliminate CAUTI and UTI.

Constructing the Written Evidence Based Proposal: Final

Problem Description

Urinary tract infections are a common public health challenge with high prevalence among the elderly population (Hutchinson & Sleeper, 2010). The infections lead to complications associated with chronic diseases, hence accelerating health problems among the patients. Trying to eliminate or reduce UTI through effective treatment is a constant challenge for healthcare facilities due to the asymptomatic nature of the earlier infections. The UTI asymptomatic characteristic suggests that the correct diagnosis is crucial at an advanced stage when complications and damages have become irreversible. The complex nature UTI leave little option to its management. Thus, catheters become the effective option in management of the infections for the patients. However, the issue of using the catheter associated with urinary tract infections add to the treatment challenge and also may bring complications in several ways.

First, the UTI are hard to diagnose. Therefore, by the time the infection is diagnosed, it may be too late to help the patient. Secondly, CAUTI are asymptomatic infections. Moreover, researchers have been able to identify the Catheter Associated-Asymptomatic Bacteriuria (CA-ASB) (Trautner, 2011). In a hospital setting, it is difficult to distinguish between the two infection brought by catheter use. Although CAUTI and CA-ASB require different medical treatment, it is common to deem CA-ASB treatment unnecessary. Thus, the factor increases chances of complications, compromises patient care, and brings in the issue of microorganism drug resistance (Trautner, 2011). Dr. Reddy and colleagues highlighted the CAUTI-related complications and are working on Sharklet technology, which can solve the infection problems.

Solution Description

Education interventions have been considered the main factor in managing UTI as well as CAUTI. The intervention should apply to both healthcare services professionals and patients. Education for the two stakeholder groups of audience is significant because individual patients need to understand the nature of their infection and the necessity of practices to avoid complications. On the other hand, healthcare professionals require knowledge on UTI process management including the use of catheters. The medical professionals have to possess the knowledge of new catheterization technologies that focus on preventing re-infections.

Patient education is considered to be the primary healthcare tool for health challenges prevention. Thus, it is required to combat UTI and CAUTI. Before the medical treatment technologies are applied to decrease CUATI infections, it is important to educate patients about the possible complications that come even from the successful catheter use. Although there is controversy, Medicare insurance agency was the first to initiate the program of educating patients about CAUTI infections and the ways to avoid the infections (Saint et al., 2008). Medicare put emphasis on patient education through the decision not to pay bills associated with CAUTI, citing the evidence that the infections can be avoided. Although their claims are supported by factual information, the catheterization phenomenon is complex and considered not effective if there is an alternative.

Since it is an unavoidable treatment, the solution remains at the stage of trying to reduce infections associated with their uses and adopting new technologies. While stakeholders develop interest in reducing UTI and CAUTI associated health challenges, policy making is slowly finding its way to health facilities serving these patients (Saint et al., 2008). Insurance companies are the direct stakeholders who fund medical treatment. Thus, their concern about UTI steered curiosity to create formal policies in an effort to find the non-infection method for catheter use. Research institutions have also joined the race to finding effective solutions to UTI management. While new technologies of catheterization such as the upcoming Sharklet catheter (Reddy et al., 2011), are promising, they need to combine with education intervention among the patients, trained and untrained medical personnel, professional nurses and catheter specialists as the integrated strategy for the health challenge.

Implementation Plan

Implementation plan is the precise description of actions required to improve the preplanned success activities. Implementation plan requires putting theoretical solutions into practice. The strategy must occur within the organization. The implementation plan for educating patients and employees about managing UTI and preventing CAUTI includes achieving the following goals and objectives.

The first goal is to educate the patients on current and new catheter use and maintenance. The step should be done frequently based on the schedule with the understanding that health care challenges are dynamic with problems that require update on treatment and management.

The second objective is to educate health care professionals who are tasked with operating catheters. Also, the education plan should be done frequently because of new the needs to learn new catheter technologies as they appear in the market.

The third step is development of the organization’s policy on UTI challenges in terms of management, prevention and catheter use. The policy can be adopted by the federal or state authority. Among other strategies, the policy must include education guideline for both patients and professionals, who are likely to deal with UTI patients.

Implementation requires identifying and developing solutions to the underlying problem. The existing problems include the comprehensive challenge of UTI problem and catheterization. The solution to the underlying issue includes introducing education policy within the health institutions. Moreover, the information should spread to the general public as well. With the problem and solution identified, a significant part of implementation process is collecting and allocating resources to achieve the objectives. Therefore, the human resource department should recruit a competent UTI specialist to train patients and healthcare professionals. Moreover, timing is a great asset in solving the UNI and CAUTI problems. The implementation strategy should focus on developing the detailed schedule for training. Finally, the policy implementation should have a precise deadline.

Evaluation Plan

Evaluation plan for the program will determine whether the goals and objectives have been achieved. The evaluation will assess whether the educational intervention for management of UTI and proper use of catheter reached its target audience, who are the patients and health care professional. Determining the impact of the intervention will involve assessing the target audience’s behavior and knowledge before and after education. Evaluation of the results will involve minor review through observation and use of a structured questionnaire for patients and for health care professionals. An extended monitoring of the change in UTI and CAUTI complications will be done to determine the effectiveness of educational intervention and policy introduction.

The extended monitoring strategy will be complex, because it will involve designing an evidence-based study project to determine the effectiveness of education, training and policy intervention in managing UTI and preventing CAUTI. The study will use the variable of reducing complications of UTI and decreasing the prevalence of CAUTI over a lengthy period of monitoring. The assumption suggested for the evidence-based research is that education, training, and policy interventions are effective in reducing UTI complication and CAUTI prevalence.

The part of the evaluation process will also involve assessing the resources, techniques and strategies used for implementing the proposed changes. For example, the education and training delivery strategies will be assessed to determine their success. The result from the assessment will be used to suggest practical and cost-effective education and training strategy to target the audience, which is considered having different knowledge about UTI management and catheterization.

Dissemination Plan

The purpose of disseminating evidence-based intervention strategies is to promote physical activity among health care management, care providers and patients in order to solve the identified problem (Brownson et al., 2007). Dissemination involves passing evidence-based change results to target audiences and suggesting guidelines to solve the underlying issue. For example, information on the effectiveness of education, training and policy intervention in reducing complication of UTI and prevalence of CAUTI should be available in all health facilities nationwide. The resources used to develop evidence-based guidelines require distribution of the information to the stakeholders.

Therefore, in an effort to ensure that the evidence-based intervention is put into practice, the obtained information and guidelines should be published in targeted journals and presented in health care conferences across the country. Moreover, as the part of the policy, the information and guidelines should be available in all health care facilities. Dissemination is important because it will attract inquiry about the solutions and response that will be used in addressing any gap that may be found during the application of the proposed intervention.

Review of Literature

Several authors have contended that urinary tract infection is a common illness among the elderly persons and have therefore suggested the age to be an important factor while diagnosing the infection (Chisholm, 2015; Haddock, 2015; Hutchinson & Sleeper, 2010). It has been claimed that UTI is becoming a serious problem because its symptoms are atypically presented among the elderly persons. UTIs can lead to the increased morbidity and many life-threatening complications. Several factors predispose patients to the disease. The most common factors documented include urinary tract obstruction, neurogenic bladder dysfunction, use of urinary catheters and external urine collection devices.

In the most recent studies, it has been suggested that catheter-associated urinary tract infection (CAUTI) is now presenting new challenges that increase the likelihood of getting the infections and the methods to prevent its acquisition have been studied (ANA, 2015). The other influencing factor apart from age is found in the analysis of Woodford (2010), who suggested that gender differentials can predispose a person to the infections. UTIs have been diagnosed using different methods such as urine culture (Armstrong, 2015), and unit-based educational program (Woodford, 2015).

The authors argue that the infection is preventable though minimizing host factors and implementation of a Foley insertion and catheterization. In fact, it is suggested that urinary catheter removal post-op day 1 or post-op day 2 offers a better chance of preventing the infections. Also, there are suggestions of surgical care improvement project (SCIP) implementation, especially in the cases of CAUTI; Reuter (2014) reports to have reduced the CAUTI cases by up to 45%.

In terms of its treatment, there are wide arrays of methods from nutritional, chemical, physiological therapy points of view. One of the most significant approaches, in which a caution is given, is treatment of the infection with antibiotics (Pizzorno & Murray, 2010). The nutritional method, which is prominently discussed and highly appreciated as the natural remedy, is the use of cranberry juice and its supplements (Scheld, Grayson & Hughes, 2010). Taking the contrary view, Haddock (2015) has suggested diagnosis using urinalysis and urine culture. Using a semi-experimental design, Mungadi, Mbibu, and Eltahaway (2013) have suggested that there is the need for practitioners to recognize signs and symptoms of UTIs so as to avoid further complications.

Miller (2015) reports the similar strategy, but suggested consensus criteria. However, Hutchinson and Sleeper (2010) have provided that there is a real challenge in treatment, especially among the adult patients because the rate of recurrence is high. Research by Haddock (2015) does not explicitly give the treatment suggestions, but provides that indication of infection is revealed through the outcomes measures. The factors include presence of pyuria, proteinuria, hematuria and bacteriuria in the process of urinalysis

Based on the analyses above, the literature proves that the infection is more common in older adults than in other age groups. Also, the predisposing factors are different. Managing all of them can significantly reduce the chances of one being infected. In terms of prevention, home-based and hospital-based approaches are necessary to avoid the infections. Finally, the real cure is difficult to find for adult population due to the high rates of recurrence. Moreover, antibiotics are not safe for managing the disease. Nutritional approaches and the strategies of lifestyles changes are more important for treatment. Therefore, the long-term empirical studies generated through research (Catto, 2014; Griebling, 2014; Mungadi, Mbibu, & Eltahaway, 2013) can only make conclusions that the challenge is existing. Thus, achieving the effective solution for UTIs will present the biggest breakthrough in the field of medicine.

Conclusion

Urinary tract infections are considered a chronic disease that has been affecting mostly the elderly population. The infections add significant health burden to old populations who have other health challenges. Evidence-based research is required to develop effective UTI and CAUTI prevention strategies. Education on UTI management and catheter use, as well as information sharing among patients and health care professional including nurses has been proposed. If effective, the intervention method will develop into a health policy aimed at reducing the constant challenge of UTI and CAUTI.

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