Preventing Catheter-Associated UTIs: Implementing a “Clinical Activity Template” to Incorporate EBP

Submitter Information

Author: Ruth Zimmerman, RN, MSN
Title: Project Manager, Education
Institution: Kaiser Permanente Southern California
Email: Ruth.K.Zimmerman@kp.org
Coauthors: Vini Angel, DNP, RN, CNE Santa Monica College, Yolanda Ramirez, RN, MPH Kaiser Permanente Southern California

Competency Category(s)
Evidence-Based Practice, Informatics, Quality Improvement, Safety

Learner Level(s)
Pre-Licensure ADN/Diploma, Pre-Licensure BSN

Learner Setting(s)
Clinical Setting

Strategy Type
Case Studies

Learning Objectives

This Clinical Activity Template (CAT) was designed to develop KSAs from the QSEN category of Evidence-Based Practice. This activity was created for second semester, pre-licensure, ADN students.

 

Student Objectives:

Describe reliable sources for locating evidence reports and clinical practice guidelines.

Base individualized care plan on patient values, clinical expertise, and evidence.

Appreciate strengths and weaknesses of scientific bases for practice.

 

Faculty Objectives:

Utilize a “Universal Template” (previously submitted to QSEN website) to structure learning activities within any QSEN category, focusing on pre-determined KSAs.

Simplify the process of creating QSEN-related learning activities that integrate classroom content into the clinical setting.

Appreciate the value of a modifiable template as a means of assigning QSEN learning activities across the curriculum.

Raise faculty and student awareness regarding current service initiatives in the clinical setting (including financial, legal, and ethical implications).

Strategy Overview

Research shows that by implementing a specific set of nursing interventions (a bundle) with patients who have indwelling catheters, catheter-associated urinary tract infections (CAUTIs) can be prevented. Nursing students must be prepared to integrate this knowledge into the clinical setting by seeking out necessary resources to find the evidence, comparing those findings to current practice on the nursing unit, and implementing the interventions according to eidence-based practice and patient-centered care.

As Medicare/Medicaid reimbursement decreases, healthcare reform takes shape, and patient acuity worsens, healthcare organizations across the nation are focusing on prevention now more than ever. Preventable complications such as CAUTIs have now made the Center for Medicare & Medicaid Services’ (CMS) list of “Never Events”. This makes CAUTIs part of every RN and Hospital Administrator’s vocabulary, so it is expected that the students are aware of this, as well.

This Clinical Activity Template (CAT) for evidence-based practice has been completed based on the Universal Template tool, which was previously submitted. This design and KSA format allows faculty to assess student competency in the stated KSAs, as well as providing students with the opportunity to assess themselves. The “Knowledge” must be completed prior to entering the clinical setting, since this is the foundational concept of situated learning. The “Skills” are the activities that occur throughout the clinical experience. The “Attitude” component is assessed during post-conference verbally through discussion. This is one of the most important aspects of implementation, as it allows the students to apply the knowledge acquired during the pre-planning and clinical experience. Additionally, it allows the faculty to pose questions for discussion which incorporate systems thinking, as opposed to focusing on the task that was performed on their assigned patient(s). It is during post-conference debrief and the written self reflection that follows where the instructor can observe/assess the students’ “attitude”. I recommend a structured self-reflective model to organize the students’ thinking process. In our program we utilized Dr. Christine Tanner’s Model for Clinical Judgment (2006) to assess clinical judgment and competency in the affective domain. The students can use this worksheet in any clinical setting to guide their experience. Instructors can likewise define this worksheet as a performance measurement or evaluation criteria.

**Note: Please also refer to the “Universal Template” strategy on the QSEN website for additional instructions on designing and implementing the template.

References:

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). *Educating nurses: A call for radical transformation.* San Francisco: Jossey-Bass.

Institute of Medicine. (2011). *The future of nursing: Leading change, advancing health. *Retrieved from the National Academies Press website: http://www.nap.edu/catalog.php?record_id=12956

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. *Journal of Nursing Education, 45,* 204-211.

Submitted Materials

119.EBP_.CAT_.N20-Rv-8.16.11.doc

Additional Materials

As stated in the strategy description, this strategy was designed utilizing the “Universal Template” (also submitted to QSEN.org). Please see the description for the Universal Template for detailed instructions on designing additional Clinical Activity Templates (CATs). Numerous “Clinical Activity Templates” (CATs) have been designed within all six QSEN categories utilizing this template structure.

For questions, comments, feedback, assistance in completing the Universal Template, or to request additional resources, please contact Ruth Zimmerman (Project Manager) at: Ruth.K.Zimmerman@kp.org.

Evaluation Description

This Clinical Activity Template has not yet been formally evaluated. We welcome further implementation and evaluation of this activity and would love to receive feedback on learning outcomes and satisfaction.