PICOT Statement And Literature Search - Vanessa Noa Grand Ca

PICOT Statement and Literature Search Vanessa Noa Grand Canyon University: NRS-433V 05/15/2019

PICOT Statement and Literature Search Vanessa Noa Grand Canyon University: NRS-433V 05/15/2019 PICOT Statement and Literature Search PICOT Question Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can cause permanent damage. The urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).

In patients with impaired urinary system(P), how does the use of indwelling catheter(I) compare with an intermittent catheter(C) affect the urinary tract infection(O) rate within the first 3 months of use? (T)

Paper For Above instruction

The use of urinary catheters is a common medical intervention aimed at managing urinary retention and incontinence in patients with impaired urinary functions. However, while these devices provide essential relief, they also pose significant risks, primarily urinary tract infections (UTIs), which are a leading cause of morbidity among catheterized patients. The literature reviewed offers a comprehensive understanding of the problem, its implications for nursing practice, and potential strategies to mitigate these risks.

All three studies collectively support the nurse practice issue of optimizing catheterization methods to minimize UTI risk. Feneley et al. (2015) highlight the epidemiology and adverse events associated with urinary catheters, emphasizing that prolonged use increases the risk of biofilm formation and antimicrobial resistance. Flores-Mireles et al. (2015) delve into the pathogenesis of catheter-associated UTIs (CAUTIs), outlining how biofilm creation and microbial colonization on catheters contribute to infections. Lastly, Conway and Larson (2012) provide evidence-based guidelines emphasizing proper aseptic technique, timely catheter removal, and maintenance of closed drainage systems, which are critical elements in clinical practice aimed at reducing CAUTI incidence.

These articles inform the PICOT question by providing evidence on how different catheterization practices—specifically, indwelling versus intermittent catheterization—affect infection rates. Feneley et al. (2015) support the notion that longer indwelling catheter durations correlate with increased risk, aligning with the intervention of early removal in the PICOT question. Flores-Mireles et al. (2015) emphasize microbial mechanisms that could be mitigated through appropriate catheter management, and Conway & Larson (2012) stress adherence to aseptic procedures, which directly impact the comparison of interventions in the PICOT question.

Regarding interventions, the studies compare closely with the PICOT components: Feneley's focus on duration of catheter use parallels the comparison groups, and Conway & Larson's emphasis on sterile technique and timely removal aligns with the intervention of choosing intermittent catheterization. The comparison in the PICOT—indwelling versus intermittent—is echoed in the literature’s emphasis on duration and technique, supporting a practice shift towards interventions that reduce infection risk.

Method of Study

Feneley et al. (2015) employed a qualitative, epidemiological analysis by reviewing historical data and case reports on adverse events related to urinary catheters, focusing on trends over time and risk factors. In contrast, Conway and Larson (2012) conducted a qualitative review of existing guidelines and policies, analyzing adherence and evidence-based practices in catheter management. The key difference lies in the former's epidemiological, data-driven approach versus the latter's policy and guideline analysis. A benefit of Feneley's method is its comprehensive historical perspective, identifying long-term risks; a limitation is potential lack of direct clinical trial data. Conversely, Conway and Larson's qualitative synthesis offers practical guidelines but may lack specific experimental evidence tailored to modern practices.

One benefit of Feneley's epidemiological review is understanding the scope of adverse outcomes in real-world settings, aiding risk assessment. Its limitation is reliance on secondary data, which may be incomplete. Conway and Larson’s review benefits clinicians by consolidating proven practices, though it may not account for emerging technologies or practices not yet incorporated into guidelines.

Results of Study

Feneley et al. (2015) reveal that prolonged catheterization significantly increases the risk of biofilm formation and antimicrobial resistance, leading to persistent UTIs and other complications. The data indicates that infections are more likely to occur after more than two weeks of indwelling catheter use, aligning with current clinical recommendations for timely removal. These findings suggest that limiting catheter duration can reduce infection rates.

Conway and Larson (2012) found that stringent adherence to aseptic insertion techniques, proper maintenance of closed drainage systems, and timely catheter removal correlate with decreased CAUTI incidences in ICU patients. They suggest that implementing these practices universally can substantially lower infection rates, emphasizing staff training and compliance. Together, the studies underscore that reducing catheter duration and maintaining sterile procedures are essential strategies for infection prevention, directly informing clinical practice and policy development.

The implications for nursing practice include emphasizing education on aseptic techniques, establishing protocols for early catheter removal, and promoting regular staff training to adhere to infection control guidelines. Adopting these strategies can significantly decrease CAUTI rates, improving patient outcomes and reducing healthcare costs.

Ethical Considerations

Two critical ethical considerations in conducting research on urinary catheterization include ensuring patient safety and maintaining confidentiality. While Feneley et al. (2015) relied on secondary epidemiological data, they had a responsibility to accurately report adverse events without bias, protecting patient anonymity. Conway and Larson (2012), reviewing guidelines, must have considered ethical standards for clinical practices, ensuring that recommendations prioritize patient safety and informed consent when applicable.

Both studies addressed these considerations by basing their analyses on de-identified data, respecting patient privacy, and adhering to ethical standards. They also emphasized that practices derived from their findings should enhance patient safety, aligning with ethical principles of beneficence and non-maleficence.

References

• Conway, L. J., & Larson, E. L. (2012). Guidelines to prevent catheter-associated urinary tract infection: 1980 to 2010. Heart & Lung: The Journal of Acute and Critical Care, 41(3), 236-240. doi:10.1016/j.hrtlng.2011.08.001
• Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 541-546. doi:10.3109/.2015.1177280
• Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiology, 13(5), 269-284. doi:10.1038/nrmicro3432
• Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support, marital status, and the survival times of terminally ill patients. Health Psychology, 24(2), 224-229. doi:10.1037/0278-6133.24.2.225
• Lee, N. G., Marchalik, D., Lipsky, A., Rushton, H. G., Pohl, H. G., & Song, X. (2016). Risk factors for catheter-associated urinary tract infections in a pediatric institution. The Journal of Urology, 195(4), 1121-1127. doi:10.1016/j.juro.2015.03.121
• 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), 277-285. doi:10.1136/bmjqs-2013-002683
• P., J. (2013). Urinary incontinence and the importance of catheter fixation. Journal of Community Nursing, 27(5), 24-29.