NUR-590 Benchmark – Evidence-Based Practice Project Proposal Final Paper
NUR-590 Benchmark – Evidence-Based Practice Project Proposal Final Paper
The wellness of a population’s health using improved patient safety protocols implores healthcare workers (HCWs) especially nurses, to develop evidence-based practice interventions to reduce and prevent occurrence of adverse events like hospital acquired infections (HAIs) and medication administration errors (MAEs) among others. These adverse events lead to poor patient outcomes, increase the overall cost of care and disease burden, and lowers the quality of care delivered by healthcare professionals. Hospital acquired infections are some of the leading healthcare concerns that affect patient safety and quality of care. Many patients suffer from these infections that result into lengthened stays in hospitals, increased cost of care, and in extreme circumstances death.
The 2010 IOM report had four key messages or recommendations for nurses to position themselves strategically in healthcare provision. Firstly, the report stresses the need for nurses to practice to the fullest level of their education and training without any hindrances imposed by state boards of nursing. The message influences nursing practice as it means that nurses should be barred from practicing what they have trained on in different specialties (Price & Reichert, 2018). Secondly, the report asserted that nurses should engage in lifelong learning to acquire higher levels of education and training based on a better education system. The message means that the nursing practice requires professional nurses to engage in continual professional development to attain the latest skills and knowledge in healthcare provision, especially the deployment of technology.
Nurse practitioners and other healthcare professionals transmit infections to patients through poor hand hygiene measures and protocols (Alotaibi & Federico, 2017). As such, nurses and other providers should leverage evidence-based practice (EBP) interventions to reduce and prevent the occurrence of hospital acquired infections and guarantee quality care. The use of evidence-based practice interventions allows these providers to offer better services through increased quality, increased engagement of patients and their preferences, and leveraging clinical experience and expertise. The purpose of this evidence-based practice project proposal paper is to discuss how nurses in pediatric settings can integrate hand hygiene measures and protocols to reduce and prevent the occurrence of hospital acquired infections. These measures and protocols include handwashing using soap and water alongside hand sanitizers compared to handwashing with water and soap alone.
Hospital acquired infections or nosocomial infections are newly acquired infections that patients contract during their stay in hospital settings or facilities. The transmission of the nosocomial infections happens through healthcare workers, patients, hospital equipment like catheters and interventional procedures that include catheterization. Studies demonstrate that healthcare workers who include nurse practitioners infect patients when they fail to adhere to effective hand hygiene measures like handwashing with soap or using alcohol-based sanitizers and hand rubs when handling and interacting with patient in the care process (Liana 2021). The use of evidence-based practice interventions using PICOT question is important in assisting nurses to implement better practices to reduce the susceptibility of patients acquiring nosocomial infections that have adverse effects on overall care delivery and quality. These infections lead to increased length of stay in hospitals, a rise in cost of healthcare and cause deaths, especially in critical care settings like pediatric units (Setty et al., 2019). Hand hygiene measures that include handwashing with soap and water alongside sanitizer will improve patient safety among healthcare workers. The implication is that healthcare workers will adhere to these measures in pediatric settings to reduce hospital acquired infections within six months’ period and improve quality outcomes.
Population- Healthcare workers in pediatric settings
Intervention-Hand Hygiene using handwashing with soap and water and sanitizer
Comparison-Handwashing with soap and water alone
Outcome- Reduced Hospital acquired infections
Time- in Six months
Refined PICOT Question
The refined PICOT question for the EBP project is “Among healthcare workers in pediatric setting (P), does hand hygiene practices that include handwashing with soap and water alongside hand sanitizer (I) compared to handwashing with soap and water alone (C) reduce hospital acquired infections (O) within six months (T)?”
Organizational Culture and Readiness
The culture of an organization is essential in implementing changes and it impacts its overall vision, mission and values and
employees’ perception in embracing new ways of executing tasks. A culture entails employees with strong norms and values, management and approaches to overall way of doing things. A culture that involves employees, possesses strong values and norms, and encourages an open-door policy with decentralized approach is important in achieving set change objectives in an organization (Real et al., 2017). To effectively implement this EBP project proposal, pediatric healthcare settings and practitioners should use a decentralized organizational and leadership structure. The model is effective in enhancing motivation of subordinates and enhancing growth and increased diversification. Decentralization in healthcare organizations leads to better communication and adoption of innovative practices, ideas and strategies to improve quality of care. Through decentralization, the management leads a transformational approach to enhance agility and respond to new and best practices in care delivery.
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The implementation of this EBP project proposal requires organizational culture that focuses on patient-centered care delivery. Through being patient-centered, an organization can support change programs to improve patient safety, quality and access while minimizing the occurrence of hospital acquired infections (HAIs). Increasing patient engagement and promoting inter-professional collaboration leads to a competitive advantage for healthcare organizations.
The evaluation of an organization’s readiness for change based on its culture is essential in implementing evidence-based practice projects. Readiness demonstrates the level to which organizational members are prepared to implement and embrace change, behaviorally and psychologically. Dearing (2018) opines that readiness is a psychological state of the mind that shows commitment to certain course of actions. As such, this EBP project proposal will leverage the Organizational Capacity Assessment Tool developed by the United Nations Development Program (UNDP) that assesses an organization’s readiness in promoting and enhancing the use of global health interventions. Through the tool, organizations identify substantive capacities and strengths that are present and the required one to attain their set objective. In this case, pediatric settings that aim to implement this EBP recommendations should demonstrate exemplary capacities in their attributes, have a superb and influential culture based on their missions, purposes and better values (De la Perrelle et al.., 2020). The capacity assessment tool looks at the various capabilities that include human resources, processes, financial resources, and systems as critical components of readiness for change implementation. Ready organizations possess sufficient strengths that include having the best skills, effective communication and adequate resources, availability of sufficient nurse workforce and effective engagement of their stakeholders.
The organizational readiness also evaluates the process and systems that require improvement to effectively implement the requisite changes (Vax et al., 2021). For instance, the improvement that pediatric care settings require include their patient handling process, the need for healthcare workers to adhere to hand hygiene measures and protocols, and delivery of patient-centered quality care. The organization will need quality improvement and collaborative approaches to enhance implementation. These organizations will also require quality data assessment tools for better and accurate analysis of their respective data (Dearing, 2018). The readiness will also include engagement of stakeholders and integration of information and communication technologies to ensure that all components to implement the project proposal are present. Using selected technologies, the project team and practitioners will pursue outcomes based on patient needs through enhanced alerts, reminders, and notifications on the need to comply with set hand hygiene protocols and measures that include effective handwashing and use of hand sanitizers to reduce hospital acquired infections in the pediatric settings.
Several studies and existing literature supports the incorporation of hand hygiene improvement measures to reduce hospital acquired infections. In their study, Ni et al. (2020) demonstrates that implementation of hand hygiene measures leads to a reduction in hospital acquired infections transmitted by healthcare workers. Using a qualitative design, the authors discuss the outcomes of a research in a large teaching hospital in China about the incorporation of hand hygiene measures to prevent infections and improve patient safety. The authors demonstrate that using handwashing has the potential to reduce HAIs in different care settings, including pediatric units. The article is emphatic that healthcare workers should embrace these interventions as best practices to enhance quality of care and patient outcomes. The study by Setty et al. (2019) implores organizations and healthcare providers to establish hand hygiene measures as one of the evidence-based practices in care management. Using a narrative approach, the authors implore on healthcare workers to disseminate best information to manage and reduce the ever-rising cases of medication errors and adverse events that lead to longer stays in healthcare facilities and increased cost of medication.
Nurses as part of the healthcare workforce should embrace hand hygiene measures to reduce infections and guarantee patient safety and quality care as well as better outcomes. However, many do not embrace these measures. Therefore, it is essential for health organizations and other stakeholders to make the hand hygiene interventions more attractive to nurses since they are frontline care providers and interact more with patients than any other health and medical professionals. Zhao et al. (2017) emphasize the need to make hand hygiene interventions more attractive to nurses and other healthcare workers for effective integration. The study demonstrates that with requisite training and awareness, nurses can implement better practices and make informed choices and decisions on the incorporation of hand hygiene measures to enhance patient safety.
In her study, Liana (2019) explores the effectiveness of hand hygiene practices with the aim of reducing hospital acquired infections. The author notes that all patients hospitalized are at risk of contracting nosocomial infections with certain categories being at the greater risk than others. The study observes that children, the elderly and individuals with compromised immunity are more likely to get an infection while in hospitals. Longer stays in hospitals, use of indwelling catheters, overuse of antibiotics, and the failure by healthcare workers to wash their hands increase the risk for getting nosocomial infections. According to Centers for Disease Control and Prevention (CDC) hospital acquired infections (HAIs) account for close to 1.7 million infections with close to 100,000 individuals dying each year due to associated complications (Liana, 2019). The implication is that healthcare workers should practice proper hand hygiene based on the World Health Organization’s recommendations. These include before touching a patient, after touching them patient, after getting into contact with inanimate surfaces and objects in the patient’s environment, and after having exposure to bodily fluids. They should also have proper hand hygiene before cleaning and aseptic procedures.
Hand hygiene lowers the transmission of pathogens in healthcare settings and healthcare providers need to encourage patients, their families and visitors to regularly decontaminate their hands to reduce infections. The implication is that establishment of proper hand hygiene measures and protocols help reduce nosocomial infections. The study by Staniford et al. (2020) is a systematic review of literature on hand hygiene and environmental disinfection strategies that enhances hygiene standards in pediatric settings. The study emphasizes the need for healthcare workers to change their behaviors with the aim of embracing best practices in handwashing like using soap and water as well as alcohol-based products. nurse practitioners and other healthcare workers should have positive attitude toward hand hygiene measures, have information on protocols and procedures to integrate these interventions with the aim of enhancing patient safety.
In their study, Hillier et al. (2020) explore correct procedures needed for effective hand hygiene. The authors emphasize the significance of nurses possessing relevant knowledge and understanding about evidence-based guidelines like increased use of sanitizers alongside handwashing with hands and water. The authors are categorical that healthcare workers need sufficient knowledge, information and awareness to enhance and integrate the use of these interventions to reduce hospital acquired infections. Using hand hygiene measures, healthcare workers can control and stop the spread of emerging and re-emerging disease’ epidemics and pandemics like the Coronavirus disease of 2019 (COVID-19) in different healthcare settings. The study implores these providers to leverage evidence-based interventions in their care practice and settings to mitigate infections’ transmission.
Clean hands protect individuals from serious infections when they are hospitalized in any facility. The Center for Disease Control and Prevention (CDC) asserts that hand hygiene is the best way to prevent infection. However, many healthcare workers are hesitant to clean their hand leading to healthcare associated infections. In their study Akanji et al. (2017) emphasize the need to institutionalize formal hand hygiene education and feedback compliance among nurses to mitigate and prevent hospital acquired infections. The study shows the need to increase engagement of nurses and other healthcare workers to offer feedback on the most effective interventions to improve patient safety through reduce rate of nosocomial infections. The implication is that organizations and healthcare providers should develop and implement evidence-based practice interventions to reduce different types of infections associated with healthcare settings like central line-associated bloodstream infections that are among the leading types of HAIs.
The study by Azar et al. (2017) shows the need to use agile implementation model to mitigate HAIs among healthcare workers to reduce nosocomial infections. The authors are categorical that nurses and other healthcare workers can deploy various interventions to prevent and reduce the possibility of infections like central line associated bloodstream infections (CLABIs) and catheter-line associated urinary tract infections (CAUTIs) as well as ventilator-associated pneumonia. These studies show that hospital acquired infections are a major healthcare challenge that requires effective evidence-based interventions and best practices as demonstrated in this research proposal. Healthcare workers in pediatric settings have an obligation to reduce and prevent these infections through effective hand hygiene protocols and measures that include handwashing with soap and water as well as using sanitizer.
Change Model or Framework
Evidence-based practice change models are essential as they offer guidelines on the implementation of effective interventions to enhance quality care and patient outcomes. The need to improve patient safety among healthcare workers in pediatric settings through interventions like hand hygiene measures that include washing hands with soap and water alongside sanitizers to prevent and reduce hospital acquired infections is essential. The selected model for this EBP project proposal is the Iowa model. The Iowa model is an effective EBP framework that focuses on the entire healthcare network that comprises of patients, practitioners, infrastructure and all stakeholders to enhance the application of best practices to improve care.
The model helps and guides the project team to execute practice decisions using accessible research evidence (Collaborative et al., 2017). The Iowa model is suited for this project as it is detailed and applies a pragmatic problem-solving perspective in the implementation of EBP and takes an organizational system approach to generate the desired results to the clinical problem at hand. The Iowa model allows the staff to use the EBP process to question and critically evaluate current nursing practices and if they can enhance care provision by using current evidence. The model suits this EBP project proposal as it is focused on promoting quality care among the target patient populations.
Stages of the Iowa Model
The Iowa Model of EBP has seven stages that focus on the problem at hand which to reduce the rate of hospital acquired infections (HAIs) in pediatric settings in six months. The first step is to identify the problem that required change. For example, the project team or organization should identify if the issue is problem-based or knowledge-focused trigger that can lead to the need for changes in the practice or nursing setting. In this case, the issue is to reduce the rate of HAIs among pediatric patients by instituting hand hygiene measures among healthcare workers. The second step in the Iowa Model is to demonstrate if there is a priority for the healthcare organization or facility to implement the new practice change. In this case, the level of priority for hand hygiene measures and protocols is high with the aim of reducing HAIs among the healthcare workers in the setting. Studies are categorical that HAIs threaten patient safety and quality care because of their adverse effects like longer stays in hospitals and complications.
The third step is to develop a team that will form, implement, evaluate and integrate the EBP change. The created team should include all interested stakeholders whose role would to appraise the project, synthesize existing literature and evidence, present the findings and implement recommendations to solve the problem at hand. The team should include nurse practitioners, project team manager, administrative representatives and other critical stakeholders to assist in designing the infrastructure for the project’s implementation.
The fourth stage of the change model is to gather and analyze research related to the desired change. The team should evaluate the level and merit of existing evidence. In case the evidence and its merit are not present, the team should conduct a fresh literature search. The team should also formulate and reframe the PICOT question and statement to effectively conduct evidence search for related studies through literature review. The fifth step of the Iowa Model is to review and analyze the obtained literature and ensure that the evidence supporting the EBP is scientifically sound. When the team ascertains the credibility and reliability of the available evidence, it can implement a pilot change to assess its effectively in addressing the practice issue, in this case, reducing HAIs among healthcare workers through hand hygiene measures. The sixth step is to appraise the pilot practice change based on its level of success in addressing the identified issue in the practice setting. The last step is to implement changes realized through the pilot program and evaluate the outcomes, whether they are cost-effective and should be sustained, or if factors requires more changes or should be canceled altogether.
The evaluation of the project’s implementation will demonstrate if the program will impact the target patient population and lead to behavioral change among the healthcare workers to reduce the rate of HAIs. The assessment will be based on real transformation as evidenced through reduced cases of infections and integration of hand hygiene protocols and measures. The implication is that the need to reduce the rate of HAIs is essential in healthcare settings, especially for pediatric care, and implementing interventions using the Iowa model will be important. The Iowa model is based on planning an action process and includes research evidence to translate it into bedside implementations. While there are other models and theoretical frameworks that can be used for this project, the Iowa model makes sense the most as it not only straight forwards to adopt but also the most appropriate for the practice setting.
Execution of any changes in an organization or facility comprises of different components that require a project team to develop a plan. Implementation entails the actualization of the ideas developed in the proposed EBP project that are divided into several identifiable steps. The implementation plan will entail integrating hand hygiene measures in pediatric setting among healthcare workers to mitigate hospital acquired infections. The implementation plan has several steps or components that include setting, timelines and resources, methods and instruments, intervention of delivery process and data collection model. The plan also entails management of various aspects of the project like challenges, facilitators and feasibility of the project.
Setting of the Project and Subjects
The setting for the project will be a pediatric hospital with the different cadres of healthcare workers (HCWs) being involved in service delivery to patient population that will be the primary subjects taking part in the proposed project. The chosen participants should have been in the unit for 12 months. The project will choose 20 healthcare workers to be part of the implementation process. The second aspect of the project is attaining consent or approval from participants and the Institutional Review Board (IRB). Participants’ consent is important as it demonstrates their willingness to participate in the project willingly. The project will attain authorization from the review board and comply with ethical requirements to protect the subjects.
Timelines for the Implementation
The project’s implementation duration is six months when different activities will take place as indicated in the time schedule in appendix. The activities include establishing a multidisciplinary team in the first two weeks, and collection of resources and experts for the process in the last two weeks of the first month. The second month will have activities that include training of nursing staff for three weeks to ascertain that they have sufficient knowledge and skills based on available resources to execute hand hygiene measures aimed at reducing hospital acquired infections. In the first week of the third month, the project team and manager will identify possible barriers which may impact or influence implementation. The duration will also be leveraged to enhance stakeholder engagement and participation and gathering of their views and input for final implementation. The remaining duration will be used to implement the proposed with the pilot change initiative taking place in the first week of the period. The project team will conduct a review of the project in the fifth month to ascertain if there are any changes and modifications needed in the project. The evaluation of the project will occur simultaneously to ascertain its effectiveness to the target population and goals of reducing infections in pediatric settings.
Studies show that success of EBP projects mainly depend on the existence of required resources (DeNisco, 2019; Luciano et al., 2019). Implementing the project needs human resources that will consist of competent trainers who will impart the team with necessary skills and knowledge. The most appropriate resource for this EBP project proposal are nurse practitioners and clinical nurse leaders. Engagement of nurse practitioners and nurse leaders having the appropriate skills enhance the success of quality improvement projects. Apart from human resources, the project will need financial resources to fund its implementation. The financial resources as captured in the appendix will be used for compensating different stakeholders that include trainers and purchasing of the required stationeries like the training manuals. Changes needed in the implementation of the solution will entail more education and awareness among caregivers as most of pediatric patients do not understand protocols proposed to mitigate hospital acquired infections.
Design in Data Collection and Effectiveness
The EBP project proposal will use a qualitative design as it is effective in understanding thoughts, concepts and experiences of participants through techniques that include interviews, focus groups, and a literature review. The design is effective because it entails collecting opinions from healthcare workers on the need to improve hand hygiene measures to prevent and reduce the prevalence of hospital acquired infections (DeNisco, 2019). The design is effective as it encourages healthcare workers in the chosen settings to comply with hand hygiene measures for effective care delivery and quality patient outcomes.
Monitoring Methods and Instruments
The implementation process will use an audit tool and satisfaction survey to assess the success of progress of the plan. The satisfaction survey will evaluate the effectiveness of the measured implemented to reduce the prevalence of HAIs in pediatric settings. The team will use the audit tool to complete the project audit process to ensure that all tasks and activities mentioned are implemented well. The tool will improve the auditing of collected data on certain hand hygiene interventions and their overall outcomes. The project will also use questionnaires to collect data from participating nurses as they will provide the requisite information on the effectiveness of hand hygiene measures and protocols.
Delivery of the Intervention
The delivery process will entail project team members consisting of nurse practitioners and leaders in different capacities who will develop and execute these interventions like setting hand sanitizer stations at various points of care. These points will include nursing stations and places within the pediatric wards and other key points to improve hand hygiene protocols. The participants will be trained to allow them execute their tasks and duties. Training will comprise of offering information to nurse leaders concerning aspects of the proposed solution to supervise the practitioners and ensure that they implement their mandate effectively.
Stakeholders to Implement the Plan
Stakeholders are important in implementing the EBP project as they offer resources, inputs, support, and execute the recommendations. The EBP project will involve several stakeholders that include clinical nurse leaders, nurse practitioners, organizations’ management, patients and their families, and suppliers who will ensure that all aspects of the EBP project are attained. The protect team and trainers will also be essential stakeholders as they will offer direction on the overall implementation of the interventions.
Components of the Implementation: Challenges, Barriers and Proposed Strategies
The overall success of this project will depend in the team’s management of various components that include facilitators, barriers and development of effective strategies to respond effectively to all circumstances that may hinder overall implementation (Melnyk & Fineout-Overholt, 2019). Organizational managers and leaders will play a critical role as they will offer the requisite support and allocate resources once they embrace the project and approve it. Critical challenges that may arise include time and resource limitations, insufficient knowledge and skills among healthcare workers, and negative attitude that may fuel resistance. These challenges will hamper effective implementation and should be addressed well by the concerned stakeholders. Again, mitigating these challenges and barriers will require use of effective strategies like sticking to the timelines to avoid scope creep, and engaging all stakeholders for resource allocation and deploying effective communication modalities.
A core aspect of the implementation plan is the feasibility of the project. In this case, the project manager and team will assess the feasibility using a cost-benefit analysis approach (Vandermause et al., 2017). The cost of implementing the project will be evaluated against the overall benefits that it shall have on the target population. The cost of the EBP will include funds to compensate different stakeholders like the trained and purchase of the required project implementation materials. The pediatric units of the organizations should implement the plan as its cost-benefit analysis will lead to a positive effect on the organization.
Evaluation is a critical aspect of project management’s implementation as it assesses if the project’s execution is successful, what needs to be altered and if the work provide is sufficient to offer proof for funding and being supported by stakeholders (Albarqouni et al., 2018). In this case, the evaluation of the EBP project proposal to reduce HAIs in pediatric setting by healthcare workers, will entail assessing the expected outcomes, review of data collection tools, selection of an appropriate statistical test and methods to collect date and measure outcomes.
Expected Outcomes for the EBP Project Proposal
The EBP project is about improving outcomes that will lead to patient safety, quality of care and better intervention by healthcare workers in pediatric settings to reduce and prevent the occurrence of HAIs. The anticipated outcomes from the project comprise of dissemination of knowledge among healthcare workers to reduce HAIs, improvement of patient safety measures and establishing organizational frameworks and polices to integrate hand hygiene protocols and culture among healthcare workers. The proposals will reduce the prevalence of HAIs and expand the adoption of hand hygiene measures that include handwashing with soap and water alongside use of hand sanitizers and alcohol-based hand rubs.
Data Collection Tools Based on Research Design
The selected research design for the project is qualitative as it is an effective approach that leads to understanding of participants’ thoughts, idea and experiences in relation to the proposed interventions and its effectiveness to the selected population (Hunter, 2017). The project’s chosen data collection tool is institutional interviews where the participants will fill questionnaires to detail their experiences and thoughts on the topic. These will include views and opinions and best practices on hand hygiene to enhance quality care and patient safety in pediatric settings by the healthcare workers. Interviews are appropriate tools to collect data since they are flexible, and enhance validity and reliability. Collected data through interviews capture original sentiments, views, and opinions of healthcare workers in pediatric settings. Interviews improve confidentiality, accuracy and information precision as it comes from participants with experience based on their work settings.
Statistical Test for the EBP Project & Outcome Evaluation
Statistical tests offer a framework for making effective decisions concerning a certain study sample. Statistical tests evaluate the hypothesis concerning the significance of observable sample. Tests also evaluate the interactions between predictor variables and outcome variables and estimate the variance between two or more groups. The proposed EBP project will deploy regression test which demonstrate the cause-and-effect model to the issue under study. The project will use a qualitative research design and interviews to collect data (Rebekah & Ravindran, 2018). Regression test is the most appropriate tools for the project as it provides information on the cause and impact of the interventions.
Outcome measurements and evaluation will use the collected data through analyzing the responses and feedback from the population sample. The project will deploy satisfaction survey to assess the effectiveness of measures used to reduce the occurrence of HAIs. A reduction of the number of reported HAIs among the pediatric patients will demonstrate positive outcomes. If the outcomes fail to produce the expected or positive results, the team will analyze aspects that may have led to the failure of the project and correct them (Melnyk & Fineout-Overholt, 2019). For instance, they may have to alter the approach or methodology to attain expected outcomes.
The sustainability of the project will entail having the team create plans to maintain, extend, review or end the proposed solutions after overall execution. Plans to maintain the project will include integration of the recommended practice standards as part of best practices and organizational culture in all areas of the facility, especially in the pediatric unit. The team or organization will continually review and revise the practices and components of the project to align with new scientific evidence, especially translational research findings, to reduce hospital acquired infections (Schirm et al., 2018). They should also align these aspects with organization’s goals, best practices and quality improvement initiatives and policies.
The proposed EBP project shows that nurses and other healthcare workers in pediatric settings can reduce hospital acquired infections (HAIs) through hand hygiene practices. The existing evidence as captured by the review of literature shows that handwashing interventions alongside sanitizing using alcohol-based products are effective in reducing the occurrence of nosocomial infections in pediatric settings as children are among the population groups with increased susceptibility to infections. The EBP’s change model, Iowa model, will be appropriate in its implementation based on the steps required to execute the project. The model requires integration of a learning environment that will encourage implementation of best evidence to improve patient safety and guarantee quality outcomes. Implementing these interventions will lead to better patient outcomes, especially patient safety, that will enhance overall quality of care among the targeted population. As such, pediatric care nurses and healthcare workers should embrace these recommendations to reduce susceptibility of children to nosocomial infections to enhance best outcomes and care interventions.
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Appendix 1: APA Checklist
|Running Head-No running Head
|Title of document appears at the top of first page
|Introduction paragraph or section not labeled
|Double line Spacing
|Margins 1 inch
|Paragraph formatting left aligned with a ragged right edge
|Punctuation after quotations
|Section Heading- Level 1 headings centered and in bold, title case
Level 2-flush left bolded and in title case
Level 3-flush left, bolded in title case and italicized
|Reference page-start on a new page titled “References,” title centered and bolded
Appendix 2: Timelines
|Creation of multidisciplinary team
|Collection of resources
|Resources of allocation
|Identification of Barriers
|Identification of barriers
Week 3 & 4
|Review & Implementation
|Review & Implementation
|Evaluation and completion
Appendix 3: Draft Budget and Resource List
a). Budgetary Estimates:
|Cost (U.S. $)
|Production of Materials: Training manual, demonstration and equipment, engagement of stakeholders
|Education campaign and awareness
b). Required Human Resources
- Nurse Leaders
- Clinical nurses
- Nurse Practitioners
- Project manager
- IT personnel
Appendix 4: Employee Satisfaction Survey Tool
Employee Satisfaction Survey
Please rate the following items on a scale from 1 to 5, with 1 being “strongly disagree” and 5 being “strongly agree.”
|I am satisfied with the level of work that is expected of me each day.
|The training I received adequately prepared me for this position.
|My work environment is comfortable, allowing me to do my job without difficulty.
|The equipment I use functions well and makes my job stress-free.
|My supervisor is always available to answer any questions that I may have during the workday.
|I am made to feel as though I am a part of the team.
|Hard work and attention to detail are properly rewarded.
|The pay and benefits offered by this company are reasonable.
|I look forward to coming to work every day.
|I believe that there are ample opportunities for promotions within this company.
|I would recommend family and friends to apply for work here.
|I plan to be working here five years from now.
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Appendix 5: Iowa EBP Model
Appendix 5: Project Audit Tool/Checklist
The healthcare sector, healthcare professionals, and other stakeholders have, in the past and present, focused on improving patient outcomes using various strategies. Such strategies aim at improving the efficiency of patient care and the safety of patients while in the patient care environment. The efforts and initiatives aimed at improving care outcomes are usually triggered by a host of incidences happening in the care settings, such as patient falls, patient injuries, pressure ulcers, and healthcare-acquired infections, among other incidences. (Jaul et al.,2018) Among the most common healthcare-acquired infections are catheter-associated urinary infections (CAUTIs). CAUTIs have been shown to cause various negative impacts, such as increased healthcare spending, longer hospital stays, and other adverse impacts, such as death. Therefore, this evidence-based practice project focuses on lowering the rates of CAUTI among patients in admission settings and using indwelling catheters(Shadle et al.,2021). As such, the purpose of this paper is to formulate aproposal for the EBP. Various aspects which will be explored include the problem statement, the organizational culture, the literature review, the change framework, and the implementation and evaluation plans.
Hospital-acquired infections have been shown to be on the rise in the past and present. One of the most common types of such infections is catheter-acquired urinary tract infections caused by the use of urinary catheters, especially indwelling ones. According to Flores-Mireles.(2019), CAUTIs lead to various adverse impacts. Even though the condition is largely preventable, it continues to cause havoc as it leads to increased patient morbidity and mortality, longer hospital stay, and increased healthcare spending (Kranz et al.,2020). This problem can, however, be prevented by applying various nursing interventions. It is important to note that, while various nursing interventions have been implemented, especially single activity-based interventions, the problem still persists hence calling for the use of more robust approaches which can integrate various interventions such as the use of CAUTI bundle.
Organizational Culture and Readiness
The process of evidence-based practice is impacted by various aspects, some of which are organizational aspects. The implication is that the EBP implementers should take their time and assess the nature of the organization, such as its culture related to EBP implementation and the readiness of various staff. Such a step is key in determining how easy or difficult the process of implementing an EBP project can be since a positive culture is needed for a successful implementation to occur (Cleary‐Holdforth et al.,2021). The assessment revealed that the organization’s leaders support patient improvement initiatives such as the EBP process for better patient outcomes. The organization also focuses on gaining magnet status, which has made them support various change initiatives. The assessment of the organization’s aim and mission showed that it focuses on offering exemplary and excellent patient services by using the latest care strategies at affordable costs. In addition, it was also noted that the organization adores interprofessional collaborations and teams in the provision of care. Therefore, it is evident that the organization’s culture is ready for change and also supports EBP.
The organization’s culture and readiness were assessed using a chosen tool, the System-Wide Integration of the EBP survey tool. This tool has widely been applied, especially to assess an organization’s capacity to adapt to and cope with change (Melnyk et al.,2022). This tool was used to explore the staff’s and the leader’s understanding of the proposed change of application of the CAUTI bundle to control the CAUTI rates. The survey tools showed that up to 91% of the staff support the proposed change, which is a majority. In addition, the majority of the leaders also supported the initiative, as up to 80% indicated that they were ready for the change. Therefore, this tool also revealed that the organization’s culture could support and sustain the proposed change.
Even though the culture supports the proposed change, it is worth noting that there are potential barriers and weaknesses that may derail implementation. For example, lack of support by minority leaders as staff can be a major drawback. The assessment will also be key in exploring the staff knowledge in using the proposed CAUTI bundle, which will then help to formulate strategies for improving their knowledge. The leaders supporting the initiative will play an important role in availing the required resources and supporting the project through making effective decisions and formulating change champions who can then help on driving the change initiative as appropriate. It was also important to identify the relevant stakeholders (Melnyk et al.,2022). Therefore, various stakeholders were identified, stakeholders include physicians, nurses, unit leaders, nurse managers, patients, and their families
The identified problem which informed the formulation of this project is increased rates of CAUTI in patient care settings. Therefore, the use of CAUTI bundles has been proposed as a potential EBP intervention. As such, it was important to perform a literature review to explore the existing evidence on the use of CAUTI bundles to reduce the rates of CAUTIs among patients admitted to the hospital and using indwelling urinary catheters. A PICOT question formulated earlier was used in the literature search. The formulated PICOT was: Among patients using indwelling urinary catheters, what is the efficacy of using CAUTI bundle care as compared to no intervention in lowering the rates of CAUTI by at least 60% within six months?
An article search strategy was also used to access the most relevant articles and evidence as appropriate. The search was accomplished in various article databases such as PubMed, google scholar, CINHAL, and Cochrane databases. The search also focused on peer-reviewed articles published in the last five years. Various search terms were also used in the search for relevant articles, including CAUTI, CAUTI bundles, intervention, and prevalence. Even though the search yielded several articles, the most relevant was chosen, and the literature review of the ten articles was performed and presented in the next section.
Elkbuli et al.(2018) conducted a study on the prevention of CAUTI among the trauma population. This study aimed at determining the efficacy of using a 5-S CAUTI bundle in the reduction of CAUTI rates among trauma patients. In a quantitative study, the researchers recruited a total of 2926 trauma patients. The analysis of the data showed that the use of the 5-S bundle led to a significant reduction in CAUTI rates among trauma patients (p-value of 0.002).
Davies et al.(2018) also conducted a study to explore the impact of using a CAUTI bundle. In a pre-and-post-study design, the researchers recruited a total of 6236 patients to take part in the study. The analysis of the data compared the rates of infections before the application of the CAUTI bundle and after its implementation. The results showed that the rates of CAUTI after the implementation of the CAUTI bundle were significantly lower compare as compared to the rates before, showing the efficacy of the CAUTI bundle.
Recently, Reynolds et al. (2022) conducted research that aimed at exploring the impact and sustainability of a multifaceted intervention in lowering CAUTI rates. This study was conducted in three large adult intensive care units among patients using urinary catheters. The analysis of the data showed a significant impact of bundle care. For example, the researchers noted a drop in CAUTI rates and the use of indwelling catheters. The positive impacts were directly associated with the implementation of the CAUTI bundle care as a strategy.
In a similar study, Mundle et al. (2020) explored the effectiveness of implementing a CAUTI bundle in preventing CAUTI incidences. The researchers conducted the study in internal medicine units where every patient admitted during the study took part in the study. The analysis of the data showed significant results relevant to this study as the researchers observed a 79% reduction in the rates of CAUTI among the patients, showing that the implementation of the CAUTI bundle care positively impacted CAUTI rates.
Sultan et al. (2022) explored the effect of using a CAUTI bundle to help prevent CAUTI occurrence among critically ill patients. In a quantitative study, the researcher recruited a total of eighty patients admitted to the intensive care units. The analysis of the data showed that the implementation of the CAUTI bundle led to a significant reduction in CAUTI rates. For example, they noted that upon the implementation of the CAUTI bundle, the CAUTI rates among the ICU patients were reduced by 50%, showing the efficacy of the intervention.
Another relevant study was conducted by Tyson et al. (2020), which focused on implementing a nurse-driven protocol designed to support catheter removal approaches to help reduce CAUTI rates. The aim of the study was to compare the CAUTI rates and the use of indwelling urinary catheters before and after implementing a nurse-driven CAUTI bundle among patients admitted to the surgical trauma intensive care unit. The analysis of the collected data led to significant results. For example, upon the implementation of the protocol, the researchers noted a significant reduction in the rates of catheter use. In addition, they also found that the protocol led to a reduction in CAUTI rates.
Shadle et al. (2021) also conducted a study to determine the impact of using a CAUTI bundle to reduce CAUTI rates. In a quantitative study design, the researchers collected data using electronic health records. The analysis of the collected data also showed relevant results. For example, the researchers realized that during the study, no CAUTI cases or incidences were reported showing that the CAUTI bundle implemented was highly effective in preventing and controlling the CAUTI rates.
More recently, Pajerski et al. (2022) carried out research that explored the impact of using CAUTI bundles in controlling the rates of CAUTI. This study was conducted in a trauma brain injury rehabilitation unit. Upon the analysis of the data, the researchers noted that there was a reduction in the CAUTI rates when the CAUTI bundle care approach was implemented. Soundaram et al. (2020) also carried out research with the aim of exploring the impact of implementing a CAUTI bundle in the control and prevention of CAUTI rates and incidence. The researchers carried out the study in adult intensive care units. The analysis of the data showed that upon the use of the CAUTI bundles, the cases of CAUTI were observed to reduce significantly by sixty percent. As such, this is another study that shows the efficacy of using a CAUTI bundle in controlling and preventing CAUTI incidences and rates.
Another study was conducted by Ravi and Joshi (2018). This study was conducted with the major aim of exploring the efficacy of a CAUTI care bundle in lowering CAUTI rates. The researchers used a bundle care approach which included training and educating the nursing staff on how to appropriately use and manage the indwelling catheters. Upon the analysis of the data, the researchers also noted a significant reduction in the rates of CAUTI among admitted patients. Therefore, this is another study that shows the efficacy of using CAUTI bundles in the prevention and control of CAUTI.
Change Model or Framework
Change models play a crucial role in the implementation of evidence-based practice projects since they offer foundations upon which the project is implemented (Jayatilleke & Lai, 2018). As such, the selected change model for this project is Kurt Lewin’s change model. According to Lewin change occurs in three distinct faces, and there are two major forces involved in a change process, the driving and restraining forces. The driving forces are known to enhance the change process, while the restraining forces oppose the change. As such, the driving forces have to overcome the restraining forces for the change process to occur successfully.
The three phases include unfreezing, change, and refreezing. In the first phase, which is refreezing, the major activity is creating an urgent need for change by pointing out the evidence of why the change should urgently be undertaken (Hussain et al.,2018). Letting the stakeholders know that there is a need for change requires effective communication. The second phase, which is the change phase, is associated with the implementation of the proposed intervention, where the change implementers implement the initiatives to help solve the identified clinical issue. The third phase is known as refreezing. This stage entails using various efforts to ensure that the implemented change becomes part of the organization’s culture and supporting the staff to accept and sustain the change.
The stages of the model will be applied to implement the CAUTI bundles. In the unfreezing stage, the stakeholders will be alerted to the urgent need for change to help reduce the rates of CAUTI in the care setting. Appropriate communication channels will be used to inform the staff of the need to address the issue of rising CAUTI cases. The second phase, which is the change phase, will involve training the nursing staff on the proposed new bundle and how to use it. The process will then be followed by the implementation of the CAUTI bundle to help reduce the rates of CAUTI. Effective communication will also be key in this phase(Hussain et al.,2018). The last phase, which is the refreezing stage, will entail sustaining the implemented change and ensuring that the CAUTI bundle becomes part of the organization’s protocol for preventing CAUTI incidence.
Implementation is one of the most important phases of an EBP project cycle. Therefore, a conducive environment should be created to enhance the implementation process. It is also important to explore various aspects, such as the setting and how to access the potential subjects. As discussed earlier, this project involves using CAUTI bundles to reduce or lower the rates of CAUTI among patients using indwelling urinary catheters (Elkbuli et al.,2018). Therefore, the targeted setting for the project is the admission wards with patients who used indwelling urinary catheters. The patients to be considered are those who will be admitted to the admission units and using the indwelling catheters. The other targeted population is the nurses who offer nursing care to the patients in these settings. The data for evaluating the project will be obtained from electronic health records. Therefore, there will be no need to obtain informed consent. Nonetheless, the organization leaders will need to offer permission to allow the implementation process.
It is also important to consider a suitable timeline for the proposed project. A timeline acts as a guide to knowing when particular activities should be accomplished (Melnyk & Fineout-Overholt, 2019). Therefore, a period of six months has been proposed for the project. It is hoped that this duration will be sufficient to cover various project phases such as project, initiation, literature review, project implementation, monitoring, and evaluation. This duration will also be used in obtaining project feedback from the stakeholders, such as indications of carrying out corrective measures to help solve various identified problems.
The Budget and Resource List
The success of a project heavily depends on the availability of needed resources; therefore, it is important to procure the necessary resources in time. There will be a need to train the staff on the use of the new CAUTI bundle. Therefore, both material and financial resources will be required to support such an education and training process (Melnyk & Fineout-Overholt, 2019). Besides, additional resources will also be needed to help in the development of the CAUTI bundle protocol to be used in controlling and preventing the CAUTI rates. Human resources will also be required to help accomplish the project goals. The budget implication is that the project team will need to get sufficient resources that can help in training and educating the nursing staff, purchasing the training materials, hiring the educators, collecting data, data analysis, project monitoring, and well as outcome evaluation. It has been projected that the cost of the project will be $36,000, and the detailed budget and resource list have been included in the appendix.
The Study Design
A study design is important in guiding a project; therefore, it is important to choose various aspects of study design appropriately. As such, the design chosen for this project is the quantitative design which will be used in both data collection and analysis. This design has been chosen since the targeted project data is quantitative. Statistical tests will also be used as part of the project to analyze the project data, which further corroborates the use of the quantitative study design as compared to the qualitative study approach (Jolley, 2020). The quantitative study approach also supports easier data collection and analysis. The quantitative study approach is also relatively cheaper in comparison to the qualitative study design and approaches.
Methods and Instruments
Instruments and methods are a crucial part of the implementation plan, and they are important for various activities such as data collection, data analysis, and data evaluation. One of the instruments to be used in this project is the questionnaire. Questionnaires will be applied to test the nurse’s knowledge of CAUTI prevention and management. The nurses’ knowledge will be assessed before and after the education (Gunawan et al.,2021). The rationale for choosing questionnaires is that they are easier to use in collecting data. Another instrument is electronic health records which will be used to obtain the baseline data on CAUTI rates. The same instrument will also be used to obtain data on CAUTI incidences after the implementation of the proposed CAUTI bundle care.
The Process of Delivering the Intervention
The success of the implementation process hinges on the process of delivering the intervention. As part of the plan, the intervention will be delivered in various phases. In the initial phase, an assessment of the clinical setting is to be undertaken through a needs assessment approach to explore the nature of the needs (Grove & Gray, 2018). The assessment involves studying the CAUTI statistics within the organization, including the impacts and trends among patients admitted to the facility. The assessment also involves assessing the nurses’ levels of knowledge and awareness regarding CAUTI and control of CAUTI using CAUTI bundles. The process will be key in coming up with relevant strategies to use in the project. The next step will entail educating and training the nurses on the use of the proposed CAUTI bundles to help reduce the rates of CAUTI. The next step will then involve the implementation of the intervention, where the efficacy of the intervention will be tested. As part of the plan, the staff will be closely supervised for a considerable duration to ensure that they are correctly and adequately implementing the bundle elements. The next part involves collecting the data associated with the intervention and analyzing the data to determine the efficacy of the intervention in reducing the CAUTI rates.
The Stakeholders Required to Complete the Project
Stakeholders form a crucial part of the project. As such, it is crucial that they be identified in time so that they can be involved from the onset of the project (Lehane et al.,2018). Early involvement of stakeholders helps in limiting the chances of resistance. The following stakeholders have been identified; the chief executive officer, the nurse manager, the unit managers, the hospital finance officer, the nursing staff working in the admission wards, and the physicians. The hospital’s chief executive officer will give permission to accomplish the project in the organization. The nurse manager will play a critical role in coordinating the unit activities related to the project implementation. The unit managers will discharge duties related to each unit. The finance officer will also help with feasibility assessment, financial viability, and the best ways to acquire the needed resources. The nurses are at the forefront of the project and will help in the active implementation of the intervention. The physicians also take part in the treatment of the patients admitted to the wards and, therefore, will support the nursing team in implementing the proposed CAUTI bundle.
Potential Barriers or Challenges to The Plan
Implementing an evidence-based practice project may face various challenges or barriers which may need to be mitigated if the project implementation process is to be a success. The implication is that appropriate strategies should be formulated in time to help overcome the challenges or barriers. Among the potential challenges are potential difficulties in obtaining the resources needed, especially financial resources (Lehane et al.,2018). Project failure may be the result if sufficient funds are not obtained. Therefore, a solution should be explored. One of the solutions is writing funding proposals to potential sponsors or financiers. The other expected barrier or challenge is resistance by the leadership or the nursing staff. The nursing staff may offer resistance to the use of the proposed bundle since it may need more time. The resistance can be reduced by training the nurses to help them have a better understanding of the proposed initiative to reduce the chances of resistance.
Evaluation is one of the most important stages and the last stages of evidence-based practice project initiatives. As such, it is crucial to come up with an evaluation plan which can be applied in assessing the impact of the implemented intervention. This phase is also crucial in exploring how effective the strategies or methods used in the project have been (Dang et al.,2021). As part of the evaluation plan, it is important to explore the expected outcomes as far as the project is concerned. In the previous sections, it was indicated that the nursing staff would need training regarding the use of the proposed CAUTI bundle. Therefore, among the expected outcomes is improved nurse knowledge and skills in the use of CAUTI bundles to control the rates of CAUTI (Elkbuli et al.,2018). The next expected project outcome is the reduction in CAUTI rates. It is hoped that the implementation of the CAUTI bundle will lead to a reduction in CAUTI rates by at least 60%. Such a feat will be used as a reflection of the efficacy of the intervention. Another expected outcome is that the organization will adopt the CAUTI bundle protocol as a standard intervention for preventing and managing CAUTI in the organization. Such an expectation will be made easier by positive project outcomes.
The Data Collection Tools
Data collection tools are important in the project phases, especially the evaluation phase in obtaining project data to be used in evaluating the efficacy of the implemented intervention. One of the data collection tools is electronic health records. The electronic health records will be applied to obtain data on the rates of CAUTI after implementing the CAUTI bundle protocol. This data will then be compared with the baseline data which was obtained at the start of the project. Such a comparison will ventilate more on whether the intervention has been effective or not.
The next targeted tool is the questionnaires. The questionnaires will be used to assess the nurses’ skills and knowledge concerning the use of the CAUTI bundle to prevent and control CAUTI. The knowledge gained after education will be compared with the baseline knowledge to determine the efficacy of the education program. Questionnaires will also be used to assess the attitude of patients and nurses concerning the implementation of the new CAUTI bundle. Questionnaires will be appropriate as the project utilizes a quantitative design approach. The tool is also valid as they have been validated and shown to be effective in measuring knowledge (Yaddanapudi& Yaddanapudi, 2019). The tool is reliable since the same set of questions will be used
The Statistical Tests
Statistical tests are used in the data analysis process to help determine the efficacy of the intervention. The major thrust of this project is to compare the rates of CAUTI in the admission units before and after the implementation of a CAUTI bundle. Therefore, one of the most appropriate statistical tests to use in this case is paired t-test. The paired t-test has been chosen since it has been shown to be effective in measuring the variation between a set of paired samples. This project will focus on the pre and post-test rates scores and CAUTI rates. Therefore, the chosen statistical test will help in determining the significance of the considered set of scores. Mean will also be used, especially in the nurse knowledge scores regarding the use of CAUTI bundles to control the rates of CAUTI.
The Methods of Use and the Evaluation of the Outcomes
Methods and strategies used in the project may impact project outcomes; hence it is important to explore them. The questionnaire to be applied in the project, as part of the plan, is expected to have scaling questions, multiple-choice questions, and dichotomous questions. It is important to use different formats and approaches to questions since the project should determine various changes associated with the implemented initiative. Various validated scales will be used in formulating the scaling questions and use scales, such as 1 to 5. On the other hand, the dichotomous questions require the research subjects to either answer a yes or a no. It is important to use these kinds of questions for a complete evaluation of the project (Melnyk & Fineout-Overholt, 2022).
Strategies to Be Taken If the Outcomes Do Not Provide Positive Results.
Quality improvement projects and evidence-based practice projects are usually designed with the hope and aim of positive outcomes. Indeed, positive outcomes are usually achieved under normal circumstances (Linsely et al.,2019). It is important to note that in some cases, positive outcomes may not be the results observed. Hence the project team should always put measures in place that can be used as part of the mitigation process in the event that the results obtained are not positive. As part of the plan, among the strategies to be used in the event that the results are not positive is the do a reexamination of the implemented intervention. Reexamination can be vital in offering insights into particular or specific areas which might have led to the observed failure. Another expected strategy is the extension of the project timeline. Extending the project timeline can be necessary to help the project team identify areas of weakness, revise vital parts of the project and implement corrective measures to help in improving the chances of the project succeeding.
The Plans to Maintain, Extend, Revise, and Discontinue the Proposed Solution
An implemented evidence-based practice project can lead to various outcomes; in some cases, the outcomes can be desirable, while in other cases, the outcomes may not be desirable. Therefore, it is important to put in place an appropriate plan to maintain, extend, revise, or discontinue the implemented solution or initiative as part of the overall plan; the project will be maintained if the outcomes turn out to be as expected. In other words, the project will be maintained if the outcomes are positive and the implemented solution is positively affecting or impacting the patients.
As part of the plan, the project will also be maintained if it is cost-effective. Healthcare cost has recently become an important point in the healthcare environment as the costs have been going up. As such, any quality improvement projects or evidence-based practice projects should be cost-effective. Therefore, this project will not be different and will, therefore, be maintained if it is cost-effective. In some cases, the evaluation phase may produce or give results that are not conclusive. In such cases, there may be a need to get appropriate results that can be used in evaluating the project outcomes. Such cases require that the project be extended. Therefore, the project will be extended if the outcomes and inconclusive (Melnyk & Fine-Overholt, 2022). The major purpose of extending the project is to obtain appropriate additional data that can then be applied to determine the effectiveness of the project.
Under certain conditions, the project may need to be revised. A revision will be pursued if the strategies do not align with the project outcomes. The revision will be undertaken to get more time which can be used in adopting improvement interventions. Such improvement interventions will increase the chances of the project succeeding. As part of the plan, the project may also be discontinued under particular instances or circumstances. For example, discontinuation will occur in the case that the project causes harm to the patients and the staff. The solution will also be discontinued if it pauses a risk to the lives of the staff and the patients.
The adverse impacts of CAUTI have led to research efforts over the years to help control and prevent these infections. Therefore, various evidence-based interventions exist. However, it is worth noting that these evidence-based interventions have shown varied efficacy; in addition, the problem still persists in the patient care setting. As such, the proposed evidence-based approach or intervention is the use of a CAUTI bundle. As opposed to single interventions which can be applied to prevent and reduce the rates of CAUTI, a bundle-based care approach entails combining or integrating various interventions for better outcomes. Therefore, the bundle care approach chosen entails various activities that can have a synergistic effect of reducing CAUTI rates or preventing them. It is expected that the proposed evidence-based practice solution of using a CAUTI bundle will lead to a significant reduction in the number of patients acquiring CAUTI in hospital settings. The literature review performed showed that the use of CAUTI bundles in controlling the rates of CAUTI could largely be effective when appropriately applied. This write-up has also explored various aspects of the project, such as literature review, organizational culture and readiness for change, the change framework, project implementation, and project evaluation.
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