Experience of Nurses in Caring for Patients with Short Term Indwelling Urinary Catheters During Hospitalization: A challenge to Reshape Caring Practices
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EXPERIENCE OF NURSES IN CARING FOR PATIENTS WITH SHORT TERM INDWELLING URINARY CATHETERS DURING HOSPITALIZATION: A CHALLENGE TO RESHAPE CARING PRACTICES Abstract by Alecia Isabella Nye, Ph.D. Washington State University May 2018 Chair: Gail Oneal Hospitalized patients with indwelling urinary catheters are at risk for developing a Catheter Associated Urinary Tract Infection (CAUTI). CAUTIs increase length of stay, readmission, costs, and ultimately, contribute to patients’ quality of life and mortality. Despite infection prevention strategies, CAUTI remains a pervasive healthcare associated infection (HAI) throughout hospitals. A qualitative, hermeneutic, phenomenological study was used to interpret the meaning of nurses’ experiences in caring for hospitalized patients with short term indwelling urinary catheters. The goal of this study was to better understand nurse factors impacting infection prevention practices in hospitalized patients with indwelling urinary catheters. Two overarching patterns emerged from the analysis, Pattern One, “Shortcutting the Care Based on Competing Priorities to Get Through the Shift” and Pattern Two, “Working Around Established Values, Rules, and Norms by Modifying Practice within an Oppressive Culture”. In Pattern One, two themes were uncovered, 1) struggle to meet the demands of practice and 2) nurses’ perception of catheters. In Pattern Two, there were four themes found: 1) challenge in keeping up with Evidence Based Practice (EBP), 2) issues of staffing inconsistency and adequacy 3) cultural consequences, including interaction with Licensed Independent Providers (LIP), and communication/collaboration within the healthcare team due to power differentials, and 4) professional apathy. These findings illuminate organizational opportunities for improving structures and processes in the quality of care delivered to patients with indwelling urinary catheters. Shortcuts and workarounds in practice lead to incomplete negative consequences to patients with indwelling urinary catheters. Nurse engagement in control over practice as well as leveling power differentials and improving collaboration between medical and nursing providers may reshape caring practices that align with nurse authenticity and improve patient outcomes. Quality care is only as good as the resources and system infrastructure that supports the nurses’ skills and knowledge of best practices.