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Most patients, estimated at 15-25% of all patients, have urinary catheters. Nonetheless, 75% of hospital acquired urinary tract infections are due to a urinary catheter. The urinary catheters are also called a one-point restraint; hence, they have been associated with subsequent effects of “functional impairment, nosocomial infection, general discomfort, pressure ulcers and even death” (Newman, 2010). The catheters have been reported to be painful, to interfere with the quality of life of patients and to be uncomfortable. Higher mortality rates as a result of using urinary catheters are apparent among hospitalized older patients (APIC, 2008).
Evidence-based Prevention
Obtaining the best approach in the prevention of catheter associated urinary tract infections (CAUTIs) is very imperative in the nursing world. As a nurse, I determined the best preventive method for CAUTIs by analyzing extensive literature which showed various preventive approaches that have been used previously. Picking the most appropriate intervention was quite daunting as I had to review voluminous information on different health facilities and how these health facilities handled different cases of CAUTIs. A study by Saint et al. (cited in Newman, 2010), suggests that more than 50% hospitals pay minuscule attention to the use and monitoring of urinary catheters. In addition, more than 25% of the health workers in the surveyed health facilities were not knowledgeable about the period of catheterization. The health workers, aware of the risks associated with long-term urinary catheter use, should avoid inserting the catheter unless under unavoidable circumstances and catheterization time should be limited.
After great deliberation, the best preventive approach I adopted was to incorporate a qualified and skilled task force in the continuum of care of patients with urinary catheters. CAUTIs in 20% to 30% of patients with urinary catheters are attributed to long-term use (more than 30 days) of the urinary catheters. Therefore, it is necessary to avoid long use of these urinary catheters. As a nurse, I should critically evaluate the need for a urinary catheter and only use it under accepted scenarios in accordance with CAUTIs preventive measures. Therefore, in conjunction with other health workers, daily assessments should be carried out to determine the need for a urinary catheter and monitor progress of those who already have the catheter. Newman (2010) categorically stipulates the conditions under which the urinary catheter should be inserted and those under which it is inappropriate. Continuous monitoring enables the health workers to identify those at risk and thereby make prompt adjustments and improvements. The health workers that I will be working with should be fully informed on the best indications for use with urinary catheters. Therefore, it is apparent that effective prevention of CAUTIs cannot be achieved without adequate resources, of which the health workers are part.
Within the facility where I work as a nurse, I wrote a proposal and presented my objectives to the director of the hospital. I presented all the facts that I had gathered and convinced him that implementing the guidelines and the findings from evidence-based effective approach would not only help to prevent CAUTIs, but would also have a positive implication on the reputation of the hospital. I organized a seminar workshop, which was ideal for the purposes of bringing together the entire task force involved in the care of patients in the hospital, and especially in high acuity units because patients in the latter areas are most vulnerable to insertion of urinary catheters. Information was shared and every health worker asked to always keep the guidelines in mind. Other resources such as sterile equipment were easily mobilized as the administrative unit realized the essence of this action.
Developing professional standards
Any investigative approach adopted in nursing should follow a predefined structure of identifying a problem, coming up with an ideal research methodology based on study objectives and obtaining and analyzing findings for interpretation and presentation. Evidence based nursing is an excellent investigative approach employed for the development of professional standards in nursing because it improves and enhances the quality of nursing care at a relatively lower cost. This investigative approach is about provision of nursing care based on evidence. This way, nurses are able to employ the best practice guided by research and critical analysis (Keele, 2011). Evidence-based nursing practice is effective because it makes use of the latest knowledge in the nursing field. As a result, the nursing practice becomes acceptable and effective in the contemporary world.
According to the Honor Society of Nursing (2013), evidence-based nursing refers to “an integration of best evidence available, nursing expertise and the values and preferences of individuals, families and communities being served”. Evidence-based nursing bridges the gap between knowledge development and implementation. It makes use of the most current research and scientific information, which sometimes remains just in writing, specific to different nursing scenarios because it takes into account cultural and personal values and preferences of individual patients.
This kind of investigative approach is cost-effective because little is spent and outcomes achieved are valid because they are either based on already executed scientific methodologies or a consensus of expert opinions. Randomized controlled trials are systematically reviewed from databases like Cochrane, and this is what forms a basis of evidence based nursing. Results from this investigative approach therefore are adequately effective to change policies within a health facility. Evidence from this investigative approach is tailored to specific individuals, making it more effective. In addition to envisaging elements of nursing research and research utilization, evidence based research also includes the experts’ opinions as well as patients’ personal and cultural values and preferences (Keele, 2011).
A selected standard of practice is not only based on its success rate, but also on its congruence with cultural and personal values and preferences of patients. In determining the preferred standard of practice, patients’ complaints should be factored in. For example, if it is the painful issue associated with CAUTIs, investigators should aim to look for literature that provides evidence or guidelines on how to alleviate pain in patients having CAUTIs or related infections. In case there is no literature on this, investigators should look for cases where pain has been addressed in seriously ill patients since patients with CAUTIs are equated to those requiring high acuity care. In addition, the practice should gain the approval of experts within the field for example doctors, and should be acceptable to the patient.
Once an ideal standard of practice has been obtained, it is put into use through advocacy and mobilization. The practice needs acceptance from various spheres within the health care fraternity. Therefore intense sensitization and mobilization will enable other health workers to gradually accept it after in-depth deliberations with the investigators. The health workers will need to understand the rationale for using this practice and if need be pamphlets and brochures can be designed for reference purposes. It is only after everyone understands the importance and justification for using a particular kind of care that effective use and implementation of the standard can be achieved.
Team Dynamics and Conflicts
Team dynamics refers to the study of team formation and its functions. A team can either be primary or secondary. A primary team/group is that in which members have face-to-face interactions and mainly involves personal relationships. Hence, written and formal rules are not required. In the nursing environment, a primary group is composed of nurses only. A secondary group on the other hand is more dynamic and formal and will include individuals in other disciplines such as doctors and surgeons. In order for a group to be effective, it should have the capacity to meet its goals with the aid of great communication skills and a common understanding among the members.
When people are working in a group, it is normal to have conflicts that are interpersonal, intrapersonal, intergroup or personal group conflicts. Resolving conflict has been explained using Filley’s model (cited in Cherie & Gebrekidan, 2005), which describes the conflict resolution process as one which entails six steps. The first step is antecedent conditions and this step dictates that certain conditions need to pre-exist, for example unequal distribution of resources or lack of mutual agreement with regard to a particular goal, in order for a conflict to occur. Individuals realize that they are incompatible based on the pre-existing conditions in what is referred to as perceived conflict, which is the second step of Filley’s model. This realization proceeds on to affect individuals’ feelings leading to felt conflict that gives rise to fear or threat.
Fourthly, conflict increasingly becomes manifested in behavioral form such as debate or problem-solving. At the peak of a conflict, action is taken to resolve this conflict by directly engaging in a confrontation through debates, competition, oppression or engagement in activities that counteract the conflict. It is after coming into terms with the conflict that a consensus is reached or one of the involved parties accepts defeat, thereby agreeing with the views or intentions of its rival party. Ultimately, in the final step, it is very important that the defeated team does not hold any grudge and accepts the defeat in good faith with no intentions of getting back at its rival teams. When this is achieved, both teams join hands and work hard to promote the success of the institution.
In a health care environment, team work is inevitable because different health workers work together to achieve a common objective. As mentioned earlier, it is very natural to have conflict as different team members and teams differ on one, two or more issues. However, what really matters is how the differences are resolved and how impeccable solutions are arrived at. When a conflict occurs, it is very important for the involved parties to embrace the best approach of resolving the conflict without causing any harm. The solution should always be based on mutual agreement in any health care setting, without getting into physical fights.
In conclusion, health care is a very critical area that requires a lot of professionalism in dealing with emerging issues. The most eminent element is the ability to work together as a team with an aim to achieve an institution’s objective. There is no single dimension of health care that does not require people working together as a team. Since health workers are always seeking to provide better services, research and team work go hand in hand.
References
APIC. (2008). Guide to the elimination of catheter-associated urinary tract infections: Developing and applying facility-based prevention interventions in acute and long-term care settings. Web.
Cherie, A., & Gebrekidan, A. B. (2005). Nursing leadership and management. Web.
Honor Society of Nursing. (2013). Evidence-Based Nursing Position Statement. Web.
Keele, R. (2011). Nursing research and evidence-based practice: ten steps to success. Sudbury: Jones & Bartlett Learning.
Newman, D. K. (2010). Prevention and management of catheter-associated UTIs. INFECTOUS DISEASE SPECIAL EDITION. Web.
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