Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

Identifies a practice issue statement that is an independent nursing decision, and is relevant to the systematic review topic chosen from among the approved list provided in the course. Describes the scope of practice issues. Example: The number of falls in your facility has been increasing, especially during shift change. What do you believe may be causing this? Are there any new interventions that could be put into place that would lessen or eliminate the falls? This is where you begin your initial search into the problem or practice issue identified. Identifies the practice area.

Identifies how rationale behind how the practice issue was selected as a practice issue/problem. Documents the practice issue in a logical manner.

Identifies and documents types of evidence that must be gathered for review of the Practice Issue. Describes rationale for each type of evidence that is selected.

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

States practice problem in own words, with reference to the population, setting, and magnitude and in measurable terms. Describes practice setting in measureable terms. Example: Consider the example given in the evidence summary above. The setting is the long term care facility where falls have been increasing and a trend has been identified that it seems to occur mainly during shift change. What do you believe may be causing this? What can be done to lessen or eliminate the falls? How does this number of falls relate to other months that have been tracked?

Identifies a source of evidence that is a nursing topic and is the subject of a systematic review article. Provides a complete reference for the systematic review article that was chosen from the list, as well as any optional scholarly source in support of the project topic.

Identifies the objectives of the article. Identifies questions being addressed by author/s. Explains relationship to the chosen practice issue

Summarizes, in own words, suggested interventions by the author/s to improve patient outcomes. Summarizes main findings of the author/s including strength of evidence for each main outcome. Describes the relevance to the Milestone 2 paper.

Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal

Outlines evidence-based solutions to consider for the capstone project. Discusses any limitations to the studies included in the systematic review that he/she believes may impact use of the evidence provided in their project

Health-Associated Infection

Cooper, F., Alexander, C., Sinha, S. & Omar, M. (2016). Policies for replacing long-term indwelling urinary catheters in adults. Cochrane Database of Systematic Reviews, 2016(7), Art. No.: CD011115. doi:10.1002/14651858.CD011115.pub2

The nursing practice issue to be addressed is whether or not incorporating antibiotic prophylaxis when using long-term indwelling urinary catheters reduces the incidence of symptomatic bacteruria for adults’ patients with lower urinary tract problems. As a result, it intends to answer the question: In adults with lower urinary tract problems, does the use of long-term indwelling urinary catheters in combination with antibiotic prophylaxis, versus indwelling urinary catheters used in isolation, affect the incidence of symptomatic bacteruria over a period of three months?

Nurses are typically advised to use antibiotics with caution, particularly when facing the possibility of resistance development. Still, for adult patients suffering from lower urinary tract problems and using long-term indwelling urinary catheters, the catheters present an additional risk of infection. That is because they act as avenues for infection, especially from repeated handling. Despite the warning linked with antibiotics use, analysis shows that reducing the risk of infection is the best outcome for the patient. Antibiotic prophylaxis improves the capacity for preventing infection, thus presenting a good possibility for application by nursing personnel Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

_X_ Clinical

___ Education

___ Administration

___ Other (List):

___ Safety/risk management concerns

_X_ Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

_X_ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Using catheters increases the risk of the patients’ acquiring opportunistic infections. As such, the research intends to show that using antibiotic prophylaxis can reduce the risk of acquiring opportunistic infection.

___ Guidelines

_X_ Expert Opinion

___ Patient Preferences

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

A literature search will be conducted to understand how past publications view the current topic.

Expert opinion and clinical expertise will be collected to understand how nursing personnel understand the problem. Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.

Even when used in clear environments, catheters still present a route for opportunistic infection. This occurs through regular handling by the nursing personnel. The risk for infection is higher among adult patients suffering from lower urinary tract problems since their immune system appears compromised and they can easily be infected. As such, it is prudent to adopt a proactive approach by using antibiotic prophylaxis that effectively prevents the possibility of opportunistic infection.

Cooper, F., Alexander, C., Sinha, S. & Omar, M. (2016). Policies for replacing long-term indwelling urinary catheters in adults. Cochrane Database of Systematic Reviews, 2016(7), Art. No.: CD011115. doi:10.1002/14651858.CD011115.pub2

The article intended to determine the effectiveness different policies for replacing long-term indwelling urinary catheters in adults.

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

The article answer the question of whether there are any differences in the outcomes from the different policies applied in replacing long-term indwelling urinary catheters in adults. This is an acknowledgement that each policy presents a risk of infection although at different levels. This shows that even with the best policy, there is still some risk of infection Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal. By including antibiotic prophylaxis, the risk of infection is greatly reduced.

The article concludes that the best policy for replacing urinary catheters must take into account certain factors that include the patients’ satisfaction, quality of life, type of trauma on the urinary tract, economics, replacement method used, environment-specific performance difference at home and hospital, catheter replacement strategy, and lubrication used.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)

The article makes it clear that additional evidence is required before a conclusion can be reached. More information must be collected on the different policies for a complete evaluation.

The project considers the position that antibiotic prophylaxis can play in reducing the possibility of infection so that the differences in policies for handling catheters become of less significance.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

The major study limitation will be how to decide from among the many types of antibiotics that are available in the market. In essence, there are many pathogens that can cause infection. Using the many types of antibiotics on a single patient is unrealistic, while using one type means that the prophylaxis does not offer protection against the other types of antibiotics Capstone Project Milestones: Practice Issue and Evidence Summary Worksheet & Design for Change Proposal.