Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI)

Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers. Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action. In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts. Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI). To Prepare: Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3. Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3. Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources. The Assignment (Evidence-Based Project) Part 3A: Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3. Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented. Part 3B: Critical Appraisal of Research Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research. Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI) .

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Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI)

Part A: Critical Appraisal of Research Articles Matrix

Part B: Critical Appraisal Narrative for the Four Articles in the Matrix

Scholarly research that is peer-reviewed is what serves as the source for the evidence needed for evidence-based practice (EBP). EBP is best practice as interventions have proven efficacy that is backed by scholarly evidence. The opposite of this would be common practice in which interventions are used just as a matter of course; or just because they have always been used that way (Melnyk & Fineout-Overholt, 2019). Catheter-associated urinary tract infections (CAUTI) are part of a collection of acquired conditions known as hospital-acquired infections (HAIs). They are a significant clinical problem in nursing practice, resulting in unwarranted morbidity and mortality. Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI).Because it is preventable, it is a quality improvement (QI) matter and its rates serve as a quality indicator or benchmark. A plethora of peer-reviewed research exists that provide evidence for a variety of measures that can be taken to prevent the rising rates of CAUTIs in the healthcare setting. The matrix above critically analyzes four of these articles and comes up with the following best practice recommendations:

1. It is better for two nursing staff to perform the procedure of urinary catheterization together, with one using a checklist to make sure the other colleague follows the steps as required (Fletcher-Gutowski & Cecil, 2019). This safety precaution has been proven to reduce the incidence of CAUTIs.
2. CAUTIs as infections are costly and increase the cost of hospitalization. A study has found that this cost however varies greatly depending on the patient’s acuity level (Hollenbeak & Schilling, 2018). According to this study, the critical care patient incurs the highest cost for a CAUTI. Reducing this cost should be a priority.
3. Having prolonged surgery is a predisposing factor for the development of a CAUTI for the patient undergoing a major operation (Qin et al., 2015). This means that microbes take advantage of the latency to colonize the urinary tract. Disinfecting the tract or repeatedly cleaning the meatus during prolonged surgeries would be a critical clinical decision.
4. Late catheter removal for surgical patients post-surgery causes or predisposes to CAUTI (Rimmer et al., 2020). This was especially true for the hysterectomy patients studied. Indwelling catheters should therefore be removed as early as is feasible.

References

Fletcher-Gutowski, S., & Cecil, J. (2019). Is 2-person urinary catheter insertion effective in reducing CAUTI? American Journal of Infection Control, 47, 1508-1509. Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI). https://doi.org/10.1016/j.ajic.2019.05.014

Hollenbeak, C.S., & Schilling, A.L. (2018). The attributable cost of catheter-associated urinary tract infections in the United States: A systematic review. American Journal of Infection Control, 46, 751-757. https://doi.org/10.1016/j.ajic.2018.01.015

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Qin C., de Oliveira, G., Hackett, N., Kim, J.Y.S. (2015). Surgical duration and risk of Urinary Tract Infection: An analysis of 1,452,369 patients using the National Surgical Quality Improvement Program (NSQIP). International Journal of Surgery, 20, 107-112. http://dx.doi.org/10.1016/j.ijsu.2015.05.051

Rimmer, M.P., Henderson, I., Keay, S.D., Khan, K.S., & Al Wattar, B.H. (2020). Early versus delayed urinary catheter removal after hysterectomy: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 247, 55-60. https://doi.org/10.1016/j.ejogrb.2020.01.011

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide 

• Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

• Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

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• Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

• Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

• Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

• The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research.Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI).  Here is the link https://academicguides.waldenu.edu/library/conceptualframework

• Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

• As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.” Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI).

• Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

• Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework. Critical Appraisal of Research on the Prevention of Catheter-Associated Urinary Tract Infections (CAUTI).