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Introduction
This paper presents an explicit critique of the article, Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm, by Fakir and others. Reflectively, the review will authenticate relevance of the research article which has comprehensively captured the conceptualization ideas discussed within its periphery of ideal and actualization. Besides, the critique paper reflects on the methodology strategy and adopted methods which appear to have employed quantitative analysis. In addition, the critique investigates research designs and conceptualized results which are quantifiable and assess the same in terms of relevance in the present strategies for preventing the catheter urinary tract infection.
Article critique
The article, Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm, is a summary of research on the prevalence of the catheter-associated urinary tract infections (CAUTIs) in hospitals. The research article reviews the impact of the CAUTIs and nursing driven indwelling catheter protocol in terms of reducing the CAUTIs. Through quantitative evaluation, the research involved reviewing the CAUTI prevention strategies that hospitals adopt and why they are more effective in some hospitals than others. The highest effectiveness score was noticed in hospitals which had a proactive implementation process as indicated in the article. Therefore, hospitals with high levels of success in CAUTI prevention tend to have clear road maps, comprehensive team work, and strategy nursing role allocation. It is apparent that “HCW engagement at the hospital level is an essential component for successful implementation of the CAUTI prevention work” (Fakih et al. 2014, p. 225).
As established by Fakir, Krein, Edson, Watson, Battles, and Sanjay (2014), the best strategy for preventing catheter-associated urinary tract infection lies in proactive engagement of the heath care workers. The authors noted that several efforts have been directed by different health agencies to reduce devise use. For instance, the authors noted that the efforts of CDC and HICPAC have resulted in creation of several guidelines for preventing CAUTI through involvement of the healthcare personnel. The main indications suggested by the agencies are;
“(1) acute urinary retention or bladder outlet obstruction, (2) accurate measurements of urinary output in critically ill patients, (3) preoperative use for selected surgical procedures, (4) to assist in healing of open sacral or perinea wounds in incontinent patients, (5) prolonged immobilization requirement, and (6) improved comfort for end-of-life care” (Fakir et al. 2014, p. 224).
Through qualitative research, Fakir, Krein, Edson, Watson, Battles, and Sanjay (2014) noted that involvement of an ideal CAUTI prevention group might reduce infections by more than 40% in a very short time. However, the authors are categorical that the strategy to involve different health care workers must be sustainable. Therefore, “sustainability is achieved if the improvements are maintained or augmented after implementation; for CAUTI prevention, the improvements are reflected in an increase in appropriate catheter use and a reduction in CAUTI events” (Fakir et al. 2014, p. 226). When successfully implemented, the authors concluded that engaging the health care workers will be critical in sustaining all the prevention programs, “thereby providing the ability to implement changes that will enhance patient safety” (Fakir et al. 2014, p. 228).
As part of the socio-adaptive change in prevention of CAUTI, the authors are categorical in insisting that all the preventive strategies must integrate the health care workers. This is achievable through a continuous engagement process comprising of defining the scope of care to the stakeholders, engaging the support of essential groups, ensuring that the collaborative nature is streamlined, and pinpointing the leadership of the prevention process (Fakih et al. 2014). The authors established that open engagement of the relevant agencies in the CAUTI prevention is not only achievable but also sustainable.
From a research spanning for more than two years, the authors noted that proper prevention of infection is both possible and within the reach of health care workers who have the necessary skills and goodwill from the hospitals. Therefore, through a proactive protocol implementation, it is possible to manage the CAUTI rate, duration, number, and costs involved in the prevention. Besides the quality improvement protocol, factors identified in the articles as equally important in CAUTI prevention include nurses’ education, continuous assessment of the feedback, and revue of the scope of shareholder involvement. These factors ensure that the protocol attracts full commitment from the health care workers who are the agent of their implementation (Fakih et al. 2014).
In the article, Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm, the authors identified the technical elements of proactively addressing behavioral and socio-adaptive factors that must be incorporated in CAUTI prevention to make it successful. For instance, through qualitative research, the authors noted that observing the quality improvement protocol is significant in reduce the CAUTI, irrespective of the heath care environment. In fact, “feedback between the nurses and the project team fostered communication, collaboration, and improved protocol compliance” (Fakih et al. 2014, p. 225). Through reduced use of catheter, the authors concur that it is possible to reduce the CAUTI infection rates by aggressively implementing the “nurse-directed catheter removal protocol” (Fakih et al. 2014, p.225).
Since the purpose of this proposed study is to evaluate the effectiveness of the nurse driven indwelling catheter protocol in decreasing hospital acquired UTIs, the above findings offer empirical evidence from which the scope of the study will be based. Specially, the findings capture factors which directly and indirectly affect nursing-based protocol for CAUTI prevention. The main factors identified include quality improvement, health care workers involvement, reduction of catheter use, and maximum commitment through training. Therefore, the article is effective in exploring these concepts in addressing prevention of hospital acquired UTIs.
The research article, in my opinion, fails to comprehensively reflect on the aspects discussed in the text. As a matter of fact, the article is silent on segmentation of the research targets who are the nurses, geographical location of the research target, and the dynamics and unique aspects of the segment or sector of study. In addition, the research does not capture focus of the study as pointed towards understanding a quantifiable aspect of CAUTI care environment. Also, the findings and recommendations presented in this research article are restrictive and may not paint actual picture of structural aspects of CAUTI care across the globe.
As a matter of fact, most of the references used in this article are outdated and may not present an accurate literature review on current issues of the topic. Therefore, in my opinion, since the article was done in 2014, the authors ought to have used updated recent literature in order to put into account various social and health dynamics that directly impact prevention and treatment of CAUTI. Besides, the authors are not specific on timeframe for the alleged causes and measurement indices for an otherwise result. As observed in the research methodology, the authors employed the use of quantitative research methodology which measures assumptions given and reflectively develops quantifiable results. However, this method does not comprehensively capture the key theme which is reflection on influence of perceived and real environmental factors on CAUTI treatment and prevention. In order to obtain actual and study psychological reaction for response given, a researcher should adopt a non biased tool for obtaining data. Therefore, the research article would have been more specific if both qualitative and quantitative data collection and analysis approaches were simultaneously employed in the research. In my opinion, this recommendation will minimize biasness in conceptualization of data generated.
Critique of conclusion and implications
The article concludes that “the most important ingredient of success is engaging HCWs at the unit and hospital level, thereby providing the ability to implement changes that will enhance patient safety” (Fakir et al. 2014, p. 228). The conclusion by the authors that significant CAUTI reduction is possible through reducing the use of urinary catheter is backed by the evidence presented. Through intervention study, the authors established that “urinary catheter use, and ultimately CAUTI rates, can be effectively reduced by the diligent application of relatively few evidence-based interventions” (Fakir et al. 2014, p. 225). The most essential part of a properly written research paper should reflect on conceptualization and maintain originality. The conclusion doesn’t provide a clear link between one variable to another and is majorly based on assumptions. Besides, the analysis presented may not present a complete reflection of actual situation in different healthcare environments.
Reference
Fakih, M., Krein, S., Edson, B., Watson, S., Battles, J., & Saint, S. (2014). Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. American Journal of Infection Control, 42(1), 223-229.
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