Change Model Overview In This First Paragraph Provide 047572

Change Model Overview In this first paragraph, provide an overview of the John Hopkins Nursing Evidence-Based Practice Process

The John Hopkins Nursing Evidence-Based Practice (EBP) Process offers a systematic approach for integrating best research evidence into clinical practice, fostering quality improvement and optimal patient outcomes. Nurses should utilize this model because it provides a structured framework that promotes critical appraisal of evidence, collaboration among interdisciplinary teams, and sustainable implementation of practice changes. The model comprises eight interconnected steps that guide clinicians from identifying clinical problems to evaluating outcomes after implementing solution strategies. Its emphasis on evidence quality and team involvement ensures that the interventions are both effective and applicable in diverse healthcare settings. Adoption of the John Hopkins EBP Process thereby facilitates informed decision-making and continuous improvement within nursing practice, aligning with healthcare's evolving demands for evidence-based care.

Practice Question

The primary practice question developed for this project concerns the high incidence of catheter-associated urinary tract infections (CAUTIs) in hospitalized patients. The question is: In adult hospitalized patients requiring urinary catheterization, does the implementation of a nurse-led catheter removal protocol reduce the rates of CAUTIs compared to standard catheter management, over a three-month period? This question aligns with the PICO framework, where Population (adults hospitalized with urinary catheters), Intervention (nurse-led removal protocol), Comparison (standard management), and Outcome (reduction in CAUTI rates). Addressing this inquiry provides a foundation for systematic evaluation of practice modifications aimed at enhancing patient safety.

Define the Scope of the EBP

Urinary tract infections related to indwelling catheters are among the most common healthcare-associated infections (HAIs), accounting for nearly 30% of HAIs reported annually in hospitals (CDC, 2020). The Centers for Disease Control and Prevention estimates that over 400,000 CAUTI cases occur in U.S. hospitals each year, resulting in increased morbidity, longer hospital stays, and elevated healthcare costs (Klevens et al., 2007). The problem extends beyond individual patients, affecting healthcare facilities' quality metrics and reimbursement rates, creating a pressing need for evidence-based strategies to mitigate CAUTI incidence. On a broader scale, reducing CAUTI rates contributes to improved infection control, enhanced patient safety, and decreased antimicrobial resistance resulting from unnecessary antibiotic use. The economic burden and patient health implications underscore the critical scope of addressing this preventable complication.

Determine Responsibility of Team Members

The success of implementing a nurse-led catheter removal protocol hinges on a multidisciplinary team with clearly defined roles. The team should include infection control specialists to oversee adherence to aseptic procedures, nursing staff such as charge nurses and staff nurses responsible for executing the protocol and monitoring compliance, and physician champions to support and endorse practice changes. Additionally, quality improvement coordinators are vital for data collection and analysis, while a hospital administrator or nurse manager provides leadership support and resources. These stakeholders are chosen based on their influence in clinical decision-making, capacity to implement practice changes, and commitment to infection prevention. Their collaborative efforts are essential to facilitate a culture of safety and sustain the intervention’s benefits.

Conduct Internal/ External Search for Evidence and Appraisal of Evidence

The evidence gathered includes peer-reviewed articles, current clinical guidelines, institutional quality improvement data, and expert consensus statements. Studies such as Saint et al. (2016) provide high-quality quantitative research demonstrating the effectiveness of nurse-led protocols in reducing CAUTI rates. Clinical practice guidelines from the CDC (2019) offer authoritative, evidence-based recommendations for catheter management. The strength of this evidence varies, with randomized controlled trials and meta-analyses providing robust support for intervention strategies, while practice guidelines synthesize expert consensus and observational data. Appraising these sources reveals a consistent trend favoring proactive removal protocols and nurse-driven interventions. While some studies indicate variations in protocol adherence impacting outcomes, overall evidence strongly supports implementing targeted nurse-led strategies to lower CAUTI incidence.

Summarize the Evidence

Collected evidence indicates that nurse-led catheter removal protocols effectively reduce CAUTI rates. For example, Saint et al. (2016) found a significant decrease in infection incidence following the implementation of nurse-driven removal initiatives, emphasizing the critical role of nurses in infection prevention. Similarly, guidelines from the CDC recommend daily assessment of catheter necessity and prompt removal when no longer indicated, which reduces infection risk (CDC, 2019). An integrative review by Meddings et al. (2014) synthesizes multiple studies confirming the positive impact of structured removal protocols on patient safety outcomes. These findings underscore that proactive nurse involvement in catheter management, coupled with standardized policies, can substantially decrease urinary tract infections, improve patient care quality, and lower healthcare costs.

Develop Recommendations for Change Based on Evidence

The evidence supports adopting a nurse-led catheter removal protocol as a best practice to reduce CAUTI rates. This entails developing standardized assessment criteria for daily catheter necessity, empowering nurses to remove catheters without awaiting physician orders when appropriate, and providing targeted education on infection prevention. The recommendation is to pilot this protocol over a three-month period within the inpatient units, with targeted staff training sessions and ongoing compliance monitoring. The anticipated outcome includes a measurable reduction in CAUTI rates, documented through ongoing surveillance data, and improved staff adherence. A multidisciplinary team will review progress bi-weekly, making data-driven adjustments as necessary to optimize outcomes. Sustaining the change involves integrating the protocol into standard nursing procedures, ongoing education, and continuous performance evaluation.

Action Plan

The implementation plan begins with staff education, including training sessions detailing the protocol and evidence supporting its efficacy. Next, infection control will update current policies to incorporate the protocol as standard practice. The timeline spans approximately four weeks, starting with staff training, followed by a two-week pilot phase. During this period, compliance and infection rates will be closely monitored, with data collected weekly for evaluation. Midpoint assessments will involve feedback sessions with staff to identify barriers and facilitators. After the pilot, a comprehensive review will determine whether to adopt the protocol hospital-wide, based on outcome data. The plan also includes establishing a reporting system for ongoing CAUTI surveillance and incorporating feedback mechanisms to capture staff and patient perspectives.

Evaluating Outcomes and Reporting Results

The primary outcome measure is the CAUTI rate per 1,000 catheter days, tracked continuously during the pilot phase. Success will be evaluated by comparing pre- and post-implementation infection rates, with a goal of at least a 25% reduction. Data analysis will involve statistical process control charts to monitor trends and variability, providing objective evidence of improvement. Findings will be communicated to key stakeholders via formal reports, department meetings, and presentations, highlighting reductions in infection rates, compliance levels, and patient safety improvements. External dissemination may include posters at infection control conferences or publication in peer-reviewed journals to share best practices beyond the institution.

Identify Next Steps

If the pilot demonstrates significant reductions in CAUTI rates, efforts should focus on expanding the protocol across other hospital units, adjusting guidelines to suit different patient populations, and formalizing the protocol within hospital policies. To ensure sustainability, ongoing staff education, regular audits, and continuous feedback loops will be established. Leadership involvement is critical to embed these practices into the institutional culture and allocate necessary resources for long-term maintenance. Additionally, integrating the protocol into electronic health records to prompt daily assessments could improve compliance and accountability throughout the organization, making the practice change enduring and scalable.

Disseminate Findings

Dissemination strategies will include internal presentations to hospital leadership, nursing staff, and infection control teams, emphasizing data demonstrating infection rate reductions and process improvements. External sharing can occur through publication in peer-reviewed journals, participation in healthcare conferences, and collaboration with regional infection prevention networks. Utilizing social media and professional networks enhances visibility and encourages adoption of similar protocols elsewhere. Transparent communication of both successes and challenges fosters a culture of continuous improvement and positions the institution as a leader in evidence-based infection prevention practices.

Conclusion

This project underscores the significance of evidence-based nursing interventions in reducing healthcare-associated infections, specifically CAUTIs. Utilizing the John Hopkins EBP Process enables systematic problem assessment, evidence appraisal, tailored implementation, and evaluation, ensuring sustainable practice change. The multi-level approach—from team collaboration and evidence synthesis to pilot testing and dissemination—aligns with the model's principles, fostering a culture of safety and continuous quality improvement. Emphasizing nurse empowerment, standardized protocols, and ongoing monitoring solidifies the foundation for a safe, effective, and replicable infection prevention strategy. Ultimately, this evidence-based initiative demonstrates how structured nursing processes can lead to tangible improvements in patient outcomes and institutional performance.

References

• Centers for Disease Control and Prevention. (2019). Guideline for Prevention of Catheter-Associated Urinary Tract Infections. https://www.cdc.gov/infectioncontrol/guidelines/urinary-tract-infections/index.html
• Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Reports, 122(2), 160–166.
• Meddings, J., Rogers, M. A., Psaila, B., & Saint, S. (2014). Preventing catheter-associated urinary tract infection in the United States: A national effort. JAMA Internal Medicine, 174(2), 248–250.
• Saint, S., Chenoweth, C., & Healthcare Infection Control Practices Advisory Committee (HICPAC). (2016). Prevention of catheter-associated urinary tract infections. Infection Control & Hospital Epidemiology, 37(11), 1312–1324.
• Dearholt, S. L., & Dang, D. (2012). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines (2nd ed.). Sigma Theta Tau International.
• American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). American Nurses Publishing.
• Institute for Healthcare Improvement. (2018). Bundle strategies to prevent CAUTI. IHI Resources.
• O’Neill, L. A., & McVeigh, L. (2020). Infection prevention and control practices in healthcare. Nursing Standard, 34(4), 50–58.
• World Health Organization. (2019). Global guidelines for the prevention of surgical site infection. WHO Press.
• Johnson, J. K., & Pearson, F. (2017). Implementing evidence-based protocols in hospital settings. Journal of Nursing Administration, 47(3), 137–143.