NUR 550 Assignment Posttraumatic stress disorder

NUR 550 Assignment Posttraumatic stress disorder

NUR 550 Assignment Posttraumatic stress disorder

Posttraumatic stress disorder is a major public health concern. Furthermore, the condition has been recently implicated in obesity and other metabolic dysfunctions. The increasing incidences of obesity among veterans with PSTD continue to pose a tremendous threat to the realization of goals in the Healthy People Act. Currently, it is estimated that about a third of the U.S population present with obesity and PSTD has been proven to be a predictor of obesity. The study conducted by Kubzansky et al. (2014) focused on the prevalence of PSTD and obesity among the veterans in Afghanistan. Based on the study, it was apparent that the other complications associated with PSTD include high blood pressure and another metabolic syndrome. Presence of obesity among the PTSD patients leads to poor prognosis and increases the health burdens as well as medication costs.

Mascret, et al. studied older adults on their acceptance level of a virtual reality headset to determine if this type of technology could be useful in fall prevention. A link for the study is here: . The study sample included 271 men and women over the age of 65 who were able to walk independently and had never used the virtual reality headset before. They were given information about the headset. Researchers questioned perceived usefulness, ease of use, and enjoyment using a Likert scale of 1 (strongly disagree) to 5 (strongly agree). This scale is valid as it tests the participants’ opinions toward the device. It may lack reliability as participants may be inclined to give a higher score to appear accepting of technologies (Mascret, et al., 2020). The researchers tested reliability using McDonald omegas, a statistical technique that checks reliability. Participants were also asked to rate their confidence to perform daily tasks without falling and physical activity goals toward fall prevention using similar scales. Participants were found to have less acceptance of the device if they were more confident in daily activities. Participants who had personal goals toward increased physical ability were more likely to accept the headset. All results were self-reported, but the scales remained consistent throughout the testing.


This section analyzes the existing studies conducted to explore the association between obesity and PSTD and how the co-morbidity affects the treatment outcomes among the veterans with PSTD. The review will focus on the studies published below five years ago. Based on the analysis, a deeper understanding of the relevance of the current study will be established. Furthermore, the existing gaps in the treatment and management of PSTD among the veterans will be explored. The articles were obtained from various scientific journals including PubMed, Sage, Google Scholars, and NCBI among others. The key terms used in the article search included PSTD, obesity and weight gain. Furthermore, a critical appraisal was conducted among the 20 selected articles. Finally, a total of seven articles that met the appraisal requirement were used in the literature review.

Synthesis of Literature

Part A: Main Components of Each Article

According to Masodkar, Johnson and Peterson (2016), there are no therapies for treating PSTD-associated obesity and this means that the realization of effective treatment and recovery of the veterans with PSTD is limited. Understanding the mechanisms involved in the development of obesity among PSTD patients is important in guiding the development of effective treatment strategies. The article is limited to the inefficiencies in the management of PSTD; though, does not provide a clear outline on how the issue can be addressed. However, based on the article, the burden of the problem in the PICOT statement can be explored.

Similarly, Scherrer et al. (2018) report that the possible modulators of the interaction between obesity and PSTD include alterations in the control of appetite hormone, altered neural and cognitive changes and disruptions in the inflammatory markers. The research findings in the study are consistent with the findings in the studies conducted by Masodkar, Johnson and Peterson (2016), which show that PSTD increases the risks of development of the metabolic syndrome and obesity. Developing programs that address the weight gain among the PSTD patients would thus serve as an important part and intervention in the management of PSTD among the veterans. On the other hand, the sample population recruited in this study was limited and thus unreliable. The article will be used in understanding the role of weight management in PSTD treatment as outlined in the PICOT question.

According to Dorflinger, Ruser and Masheb (2017), PSTD results from a traumatic experience and results in chronic stress conditions which may promote weight gain. Furthermore, the study indicated that the prevalence of PSTD tends to be high among veteran women compared to their male counterparts. In as much as various approaches are used in the management of PSTD among the veterans, there is a great necessity to improve the treatment process to facilitate quick recovery. The proposed measure, in this case, aims at expediting the recovery process among the veterans with PSTD and eventually reducing the time taken for them to fully normalize and re-integrate to their work. Various study findings show that there is a strong correlation between PSTD and development of obesity among the veterans. The veteran populations are an important target group because they are vulnerable to PSTD due to traumatic and stressful experiences they undergo in the course of work. An association between PSTD and weight gain among the veterans is an important topic worth exploring since it helps in guiding the process of designing treatment measures and management of veterans with PSTD. However, a large sample population should be recruited in the current study because the existing studies are vulnerable to bias due to limited sample population.

Batch et al. (2017) explored the factors contributing to weight changes among the veterans. A total 62,822 study participants were recruited and the intervention developed was the Motivating Overweight/Obese Veteran Everywhere (MOVE) program. The findings from the study indicated that the effectiveness of such programs in the management of PSTD differed by gender with women reporting lower symptoms of PSTD compared to the males. By average, the weight loss was 5% of the total weight and this provides vital data for the PICOT analysis. However, the study failed to outline the criteria used in diagnosing PSTD despite the sample population being sufficient.

Furthermore, Hoerster, et al. (2015) employed quantitative research in exploring the risk factors of obesity among the veterans in the US and Iraq presenting with PSTD. Data used in the study were collected from the VA Puget Sound Healthcare System and the recruitment of the sample used was based on the PSTD checklist. The study reported that 16.3% of the patients were positively diagnosed with depression and out of this, 37.8% tested positive of PSTD with 8.4 having binge eating disorders (Hoerster, et al., 2015). Based on the research findings, it was concluded that PSTD and depression and strongly associated with a binge. Addressing the issue of obesity among patients with PSTD would result in improved treatment outcomes for the targeted population.

Part B: Compare and Contrast the Articles

The various studies explored in this review analyze the role of PSTD in obesity development; though, they fail to respond completely to the PICOT question. According to the study conducted by Klingaman et al. (2016) and Klingaman et al. (2016), it was evident that the Veterans with PSTD significantly benefit from the weight reduction programs compared to those who do not present with PSTD symptoms. The findings in these studies are similar to what was reported by Masodkar, Johnson and Peterson (2016). However, there is need to explore further the need to integrate a comprehensive intervention aiming at promoting weight reduction in the course of treating veterans with PSTD. Evidence-based care approaches are developed to promote the patient’s wellbeing and this becomes more effective when patient-centered approaches are engaged. Based on the review findings, introducing the weight reduction programs can significantly reduce the PSTD symptoms among the veteran especially when they have both obesity and PSTD (Klingaman et al., 2016). The findings from these studies provide preliminary backgrounds for addressing the issue of obesity and PSTD among the veterans. The impacts of PSTD are severe in case they are not managed in time. Engaging a comprehensive treatment framework that incorporates both the pharmacotherapy and weight reduction programs are essential and these would help reduce the gaps existing in the treatment process and management of veterans with PSTD.

Areas of Further Studies

Furthermore, Kubzansky, Bordelois, Jun, Roberts, Cerda, Bluestone and Koenen (2014) conducted a study to analyze the role of obesity in the treatment outcomes of the patients with PSTD. The study involved a prospective design where patients initiated on the PSTD treatment in 1989 were followed up until 2005. The symptoms of PSTD were measured and recorded accordingly. Weight gain was determined using the body mass index which was calculated as weight in kilograms. The study findings indicated that obesity among the PSTD resulted in poor treatment outcomes. Therefore, clinicians should be keen to address the weight issues among PSTD patients. Similar findings were obtained by Masodkar, Johnson and Peterson (2016) who reviewed the role of the correlation between obesity and PSTD and how the co-morbidity affects the effectiveness of treatment interventions developed for PSTD. The current study focuses on exploring the effectiveness of the weight reduction programs as part of the treatment and management interventions for PSTD disorder. There is sufficient evidence from the existing pieces of literature that integration of the weight management programs in the treatment of PSTD results in good prognosis; however, no practical demonstration has been done to confirm this.  Considering that soldiers are at high risk of developing complications associated with obesity; developing effective measures to address all their health needs is critical and this will result in enhanced re-integration into the society. Thus, a need exists to examine the nature of these interventions and how they can be deployed to help the veteran population, particularly those with PTSD symptomatology.


Batch, B. C., Goldstein, K., Yancy Jr, W. S., Sanders, L. L., Danus, S., Grambow, S. C., &           Bosworth, H. B. (2017). Outcome by Gender in the Veterans Health Administration  Motivating Overweight/Obese Veterans Everywhere Weight Management. Journal of Women’s Health.

Dorflinger, L. M., Ruser, C. B., & Masheb, R. M. (2017). Night eating among veterans with            obesity. Appetite117, 330-334.

Hoerster, K. D., Jakupcak, M., Hanson, R., McFall, M., Reiber, G., Hall, K. S., & Nelson,            K. M. (2015). PTSD and depression symptoms are associated with binge eating   among US Iraq and Afghanistan veterans. Eating behaviors17, 115-118.

Klingaman, E. A., Hoerster, K. D., Aakre, J. M., Viverito, K. M., Medoff, D. R., &           Goldberg, R. W. (2016). Veterans with PTSD report more weight loss barriers than Veterans with no mental health disorders. General hospital psychiatry39, 1-7.

Kubzansky, L. D., Bordelois, P., Jun, H. J., Roberts, A. L., Cerda, M., Bluestone, N., & Koenen, K. C. (2014). The weight of traumatic stress: a prospective study of posttraumatic stress disorder symptoms and weight status in women. JAMA Psychiatry71(1), 44-51.

Masodkar, K., Johnson, J., & Peterson, M. J. (2016). A review of posttraumatic stress disorder and obesity: exploring the link. The primary care companion for CNS disorders18(1).

Scherrer, J. F., Salas, J., Lustman, P. J., Van Den Berk-Clark, C., Schnurr, P. P., Tuerk, P., … & Chard, K. M. (2018). The role of obesity in the association between posttraumatic stress disorder and incident diabetes. JAMA Psychiatry75(11), 1189-1198.


Assessment Description

Submit your literature review from NUR-550 for your NUR-590 instructor to review. If your NUR-550 instructor indicated areas for revision be sure to incorporate these improvements prior to submitting your paper for this assignment.

You will use the revised literature review for your final written paper in Topic, 8 detailing your evidence-based practice project proposal.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.


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Urinary Tract Infection is an infection that involves any part of the urinary system, including kidneys, ureters, urethra, and bladder. The common type of UTI is a healthcare-associated infection common in various healthcare organizations. CAUTI accounts for 75% of all the infections associated with the urinary urethra. Despite the cases of CAUTI receiving a great attention, the cases have remained high in the healthcare system. Therefore, measures which are taken to reduce CAUTI should have a positive impact in the patient outcome. The PICOT question guiding this research is: Among patients using indwelling urinary catheters, what is the efficacy of using CAUTI bundle care compared to no intervention in lowering the rates of CAUTI by 25% within six months? The purpose of this assignment is to write a review of the research articles and their comparisons concerning the provided evidence-based project.

Search Methods

A literature review is key to the success of the project. Therefore, a literature review was accomplished using databases accessed through the university. Some of them include Cochrane databases of systematic reviews. The American Journal of Psychiatry, Ovid, ProQuest, PubMed, MEDLINE, CINAHL, and journals by Professional organizations such as CDC using only recent articles of 5 years or less, and obtaining appropriate evidence from databases required using keywords related to the project topic. Therefore, the keywords used include urinary tract infection, bundle care intervention, and nurse education. These key words were essential in finding relevant articles that support the PICOT question.

Literature Review

Elkbuli et al. (2018) carried out a study on CAUTI among the trauma population. Their study aimed at determining whether the implementation of a 5-S CAUTI bundle would reduce CAUTI rates among trauma patients. This quantitative included 2926 trauma patients. The findings showed that 94 of these patients developed CAUTIs. Secondly, the average injury severity score was 16 in patients with CAUTIs compared with 9 in non-CAUTI patients (p < .0002). It was evident that the implementation of a 5-S CAUTI bundle would reduce CAUTI rates among trauma patients. Therefore, this article will support the PICOT question as it shows that using CAUTI bundles among trauma patients significantly reduces CAUTI rates.

Another article authored by Davies et al. (2018) also relays more information on the PICOT question. Their study compared pre and post-outcomes after the implementation of the CAUTI bundle. This quantitative study was carried out among 6236 patients in a trauma care environment. The findings showed that fewer patients in the post-bundle group received a urinary CAUTI bundle decreasing CAUTI rates in patients. This is the desired outcome that the PICOT question would want to meet.

The study by Reynolds et al. (2022) examined the effect and sustainability of a multifaceted intervention to reduce CAUTI rates. Their study occurred in three large adult intensive care units in a healthcare facility. The authors observed three different outcomes. For example, the urine culture rates dropped, catheter utilization also dropped, and CAUTI incidence rates. The findings of this study make it important in the evidence based-project as it shows an analysis of how a multifaceted approach led to reduced rates of CAUTI.

Mundle et al. (2020) conducted a study to explore the impact of implementing a CAUTI bundle care on developing CAUTI rates. This research took place in internal medicine units where all admitted patients were eligible to participate. The study found that using the intervention reduced the CAUTI rates by 79% among patients. This significant outcome makes the study reliable and important in supporting the proposed intervention since it shows a reduction in the rates of CAUTI upon using CAUTI bundles.

Another study by Sultan et al. (2022) focused on investigating the impact of using a CAUTI bundle in preventing CAUTI among critically ill patients. This research was done in intensive care units among 80 patients in an Egyptian hospital and found that implementing CAUTI bundle care reduced CAUTI by 50%. The outcome of this article is important in supporting the evidence-based project as it aligns with the desired outcome of the proposed PICOT question.

According to Tyson et al. (2020), implementing a nurse-driven protocol for catheter removal is important in decreasing the CAUTI rate. Their study aimed to compare the rates of CAUTI and indwelling urinary catheter use before and after using a nurse-driven CAUTI bundle approach among patients in the surgical trauma intensive care unit. They found that catheter utilization was reduced when nurse-driven protocols were implemented among the patients. In doing so, it is imperative to approve that the findings of this study are significant in supporting the proposed ideas on the PICOT question.

Another study by Shadle et al. (2021) also explored the impact of using CAUTI bundle care in reducing CAUTI rates. This study adopted a quantitative study design approach where the data on the study was collected from EHRs. The study found that no catheter-associated urinary tract infections were reported during the intervention period. This outcome shows that implementing bundle care among patients was important in reducing CAUTI rates. This article supports the proposed intervention since it showed that bundle care significantly reduced the rate of CAUTI in intensive care settings.

Pajerski et al. (2022) also researched CAUTI, where their research aimed to reduce the rates of CAUTI using a care bundle approach. This research was carried out in a traumatic brain injury rehabilitation unit. The findings of the study showed a significant reduction in CAUTI rates. The outcome of the study supports the findings of another author in supporting the importance of CAUTI bundle care in addressing the issue of CAUTI among patients. This supports the proposed intervention because the results show that utilization of the CAUTI bundle care approach reduced the CAUTI rates to zero during the intervention.

Soundaram et al. (2020) conducted a study to explore the effectiveness of implementing a CAUTI bundle in reducing CAUTI incidence. This study was carried out in the adult intensive care units, where every patient admitted to the units was recruited to participate. The study found that cases of CAUTI were reduced by 60%. This is a desired outcome that can be replicated in future studies. Consequently, this proposed intervention will support its implementation using this article as it has shown the efficacy of the CAUTI bundle in reducing the rates of CAUTI.

Another study by Ravi and Joshi (2018) aimed to explore the efficacy of the CAUTI care bundle in lowering the incidences of CAUTI. This research was conducted in a zonal hospital. The authors found that the catheter care bundle approach, along with the education of the staff, reduced the CAUTI incidence by 60.64. This outcome is important in the PICOT question as it supports the proposed intervention.

Comparison of the Articles

The articles in this study include the ideas of various authors on the efficacy of using CAUTI bundle care. The selected articles approached their research question using a quantitative research design, making these studies look similar on the approach design that these empirical studies apply to address the issue of CAUTI bundle care. Again, the articles have varying sampled participants. While others have large sampled patients, others resorted to acquiring information from electronic health records. The intervention used in each study differs in the ways of data analysis and the tools deployed in analyzing the collected data. However, they reach an outcome that supports the significance of the bundle care intervention. Therefore, all these articles are significant in supporting the ideas of the proposed intervention as they approach CAUTI through various interventions that give a positive result.

Suggestions for Future Research

In the future, more studies must develop a more technological approach to CAUTI. More studies in the recent past include the importance of technologically generated patient data to address an issue such as CAUTI. The inclusion of these strategies in the future would enable studies to consider a wide range of data through the years and analyze the trend over time. Such studies are significant in giving an outcome with high generalizability. This would create another line of thinking in research that could improve quality. Besides, it supports the use of technology in offering bundle care intervention.


CAUTI is one of the common issues in healthcare that has been attracting the attention of many scholars worldwide. The above review shows the findings of various scholars on the issues and the direction that future research on bundle care would have on CAUTI. The constant improvement of patient safety and quality will be defined by the drastic reduction of healthcare issues such as CAUTI within the healthcare system. Therefore, these studies’ outcome effectively supports the proposed intervention.


Davies, P. E., Daley, M. J., Hecht, J., Hobbs, A., Burger, C., Watkins, L., … & Brown, C. V. (2018). Effectiveness of a bundled approach to reduce urinary catheters and infection rates in trauma patients. American Journal of Infection Control46(7), 758-763   Https://

Elkbuli, A., Miller, A., Boneva, D., Puyana, S., Bernal, E., Hai, S., & McKenney, M. (2018).   Targeting catheter-associated urinary tract infections in a trauma population: a 5-S bundle preventive approach. Journal of Trauma Nursing| JTN25(6), 366–373. 10.1097/JTN.0000000000000403

Mundle, W., Howell-Belle, C., & Jeffs, L. (2020). Preventing catheter-associated urinary tract infection: A multipronged collaborative approach. Journal of Nursing Care Quality35(1), 83-87. Doi: 10.1097/NCQ.0000000000000418

Pajerski, D. M., Harlan, M. D., Ren, D., & Tuite, P. K. (2022). A clinical nurse specialist–led initiative to reduce catheter-associated urinary tract infection rates using a best practice guideline. Clinical Nurse Specialist36(1), 20-28.Doi: 10.1097/NUR.0000000000000643.

Ravi, P. R., & Joshi, M. C. (2018). Role of “bladder care bundle” and “infection control nurse” in reducing catheter-associated urinary tract infection in a peripheral hospital. Journal of Marine Medical Society20(2), 116. Doi: 10.4103/jmms.jmms_8_18

Reynolds, S. S., Sova, C. D., Lewis, S. S., Smith, B. A., Wrenn, R. H., Turner, N. A., & Advani, S. D. (2022). Sustained reduction in catheter-associated urinary tract infections using multifaceted strategies led by champions: a quality improvement initiative. Infection Control & Hospital Epidemiology43(7), 925-929.

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A bundle-based approach to prevent catheter-associated urinary tract infections in the intensive care unit. Critical Care Nurse41(2), 62-71.

Soundaram, G. V., Sundaramurthy, R., Jeyashree, K., Ganesan, V., Arunagiri, R., & Charles, J. (2020). Impact of care bundle implementation on the incidence of catheter-associated urinary tract infection: A comparative study in intensive care units of a tertiary care teaching hospital in South India. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine24(7), 544.

Sultan, M. A., Ahmed, H., & Kandeel, N. A. (2022). The Effect of Implementing CAUTIs Bundle on Prevention of Hospital-Acquired Urinary Tract Infections among Critically Ill Patients. Mansoura Nursing Journal9(1), 141-153.

Tyson, A. F., Campbell, E. F., Spangler, L. R., Ross, S. W., Reinke, C. E., Passaretti, C. L., & Sing, R. F. (2020). Implementation of a nurse-driven protocol for catheter removal to decrease catheter-associated urinary tract infection rate in a surgical trauma ICU. Journal of Intensive Care Medicine35(8), 738-744.

NUR-550 Literature Review – Resubmission – Rubric

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NUR-550 Resubmission of Literature Review

50 points

Criteria Description

NUR-550 Resubmission of Literature Review

  1. 5: Excellent

50 points

The Literature Review paper from NUR-550 is submitted.

  1. 4: Good

46 points


  1. 3: Satisfactory

44 points


  1. 2: Less Than Satisfactory

40 points


  1. 1: Unsatisfactory

0 points

The Literature Review paper from NUR-550 is not submitted.