Running head: LEADERSHIP STRATEGY ANALYSIS
Nursing 440 Leadership Strategy Analysis
Samantha Fries, Heather Hulien, Kathryn Kaufman, Corrin Simon, Sara Staffen
Ferris State University
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LEADERSHIP STRATEGY ANALYSIS
Leadership Strategy Analysis
This strategy analysis provides an opportunity to create an interdisciplinary team that is
responsible for data collection and analysis of catheter associated urinary tract infections
(CAUTI), developing a goal, and implementing a plan for quality improvement. According to the
Centers for Disease Control (CDC) hospitals should implement effective quality improvement
programs that promote proper use, insertion, and maintenance of urinary catheters and assess
appropriateness and need for catheters often (2009).
Clinical Need for CAUTI Guidelines
Urinary tract infections (UTI) are caused by bacteria entering the urethra and traveling to
the bladder. Urinary tract infections are the single most commonly acquired infection during a
hospital stay, and account for more than 40 percent of infections reported by acute care facilities
(American Association of Critical-Care Nurses [AACCN], 2011). Indwelling catheter associated
urinary tract infections (CAUTI), account for the majority of nosocomial UTIs according to a
review by Trautner (2011). Prevention is the top priority because an untreated CAUTI can lead
to complications such as sepsis, cystitis, prostatitis, epididymitis, endocarditis, vertebral
osteomyelitis, septic arthritis, and endophthalmitis. Complications associated with a CAUTI can
also cause discomfort to the patient, prolonged hospital stays, increased healthcare costs, and
higher rates of mortality (AACCN, 2011).
Interdisciplinary Team
The care and prevention of CAUTI can involve more than just the nurse. It may take a
team of healthcare providers, also known as an interdisciplinary team. An interdisciplinary team
will need to be knowledgeable on catheter bagging, tubing placement, securement, and proper
hygiene. For patients who need indwelling catheters, the team may evaluate catheter insertion
LEADERSHIP STRATEGY ANALYSIS
and educate patients and family members on proper care to prevent infection, risks associated
with catheter use, and to be as independent as possible in managing bladder functioning. A team
for CAUTI may involve: patient care technician, nurse, charge nurse or nurse manager,
physician, social worker, infection control preventionist, the CEO of the hospital, and
stockholders (Oman et al., 201, p. 549).
A patient care technician will need education on how to care for catheters. This will
involve proper perineal care, sanitary emptying of the bag, and correct discontinuation of the
catheter if permitted. He or she may also take vitals, such as temperature, to watch for any
change due to the infection. A nurse will be required for insertion, care of, and the removal of the
catheter in either clean or sterile techniques. He or she may also be involved in medication
administration if a CAUTI does develop. An RN writes the plan of care for a patient, and this
may need to involve interventions based upon treatment of a CAUTI. The nurse manager or
charge nurse will need to organize educational meetings or seminars for the staff to attend
pertaining to CAUTIs and care. He or she may also need to develop a new policy regarding the
insertion of catheters and the care. A physician will be involved if a CAUTI develops by writing
orders for medications, normally a type of antibiotic, which will treat the infection. He or she is
will be the one to diagnose the patient with a CAUTI. Social workers may need to educate the
patient on healthcare workers’ roles in their plan of care, help with facilitating decisions on
behalf of the patient, promoting communication among healthcare workers, and arranging for
resource or funds for the patient. An infection control preventionist is licensed in the prevention
and care of infections. He or she is an expert in the prevention of infection, methods to stop the
spread of infection, education, and research. The CEO and stockholder for the facility will deal
with money and legal issues. If a patient receives an infection while in the hospital, the hospital
LEADERSHIP STRATEGY ANALYSIS
may be responsible for the cost of treatment. This will lose money for the facility which affects
stakeholders because the stock they hold for the company begins to lose its worth.
Establishing CAUTI Outcomes
Catheter use in hospitals is leading to urinary tract infections which cause longer hospital
stays for patients and potential long term health complications. Catheter acquired urinary tract
infections are the most common type of healthcare associated infections (Gould, C., 2009). In
every hospital, outcomes must be established in order to prevent these costly infections.
The first outcome to decrease CAUTI’s includes limiting the amount of catheters being
inserted in the hospital and decreasing duration of use. Indwelling catheters should only be
inserted by nurses for appropriate purposes, and catheters should only be left in as long as
needed (Healthcare Infection Control Practices Advisory Committee [HICPAC], 2009).
Indwelling catheters for incontinence purposes should be avoided especially for high risk
populations that include women and elderly. Use of catheters in operative patients should be
used only as needed, instead of routine practices. If a catheter must be placed during surgery,
removal within 24 hours will cut down on the risk of infection (HICPAC, 2009, p.10).
Nurses must be properly trained in inserting catheters using aseptic technique with sterile
equipment (HICPAC, 2009, p.12). Hand hygiene should always be performed before and after
catheterization. If sterile technique is broke, a new catheter kit will be obtained and the process
restarted. After insertion, the catheter should be properly secured to prevent movement of tubing
and reinsertion of bacteria (HICPAC, 2009, p.11). Technique should be evaluated once a year to
determine if nurses are maintaining sterile catheter guidelines.
Aseptic technique must be used throughout urinary catheter maintenance. Following a
closed drainage system during emptying will decrease chances of introducing bacteria into the
LEADERSHIP STRATEGY ANALYSIS
catheter (HICPAC, 2009, p.13). The drainage bag must remain attached to the bed frame and be
placed below the patient at all times. When emptying the bag, gloves will be used, and urine will
be placed into a clean container.
Catheter associated urinary tract infections can be significantly reduced by decreasing the
amount of catheters being placed and teaching nurses and doctors the appropriate situations
when a catheter is indicated. If a catheter must be placed, it is crucial to use aseptic technique
with sterile equipment and maintain this technique when maintaining catheter care. With these
techniques, hospitals can decrease the number of CAUTI’s leading to costly infections,
decreased long-term complications, and hospital stays.
Implementation
In order to effectively create a change, a process for implementing a change must be
identified and utilized. The rate of catheter associated urinary tract infections is high, and making
changes in nursing care is necessary for decreasing the problem. The most effective method for
implementing the changes that will reduce CAUTI is the process of engaging staff members,
educating the staff, executing the change, and evaluating intended and unintended consequences
of the change (Saint, 2011). This process is likely to be successful because staff members will
understand the reasons for making changes. According to Roger’s innovation-decision process
theory, encouraging the use of an idea and providing information about its benefits and
disadvantages promotes change (Yoder-Wise, 2014). Furthermore, a study reported by Scott et
al. suggests that incorporating staff into the implementation of a change will lead to long-term
acquisition of knowledge and longer-term results (2014).
The step of engaging others includes discussing the importance of the intervention. This
will be done by giving hand-outs that address the issue of CAUTI to all the nurses. Education is
LEADERSHIP STRATEGY ANALYSIS
completed when specific expectations of the intervention are discussed. Education will be
provided for the staff nurses through mandatory training classes. Once the team is engaged and
educated, the change must be executed by providing the necessary tools to carry out the
intervention. After the change has been employed, evaluation of the new intervention is essential
to determining if the change has been successful in decreasing the occurrence of CAUTI.
Evaluation
The purpose of evaluating change is to ensure that the problem is improving. One method
used for measuring improvement in staff performances in preventing CAUTI is to calculate the
percent of personnel who insert urinary catheters and who have proper training before, during,
and after the changes are implemented (Centers for Disease Control and Prevention [CDC],
2009). One-hundred percent of personnel need to be trained after the change is implemented. If a
staff member is not trained, he or she will be required to immediately complete the training
courses. Staff performance can also be evaluated by conducting random audits. The audits can be
used to calculate compliance rate of documentation of catheter insertion and removal dates, and
documentation of indication for catheter placement. By the end of the implementation process,
documentation is expected to be completed accurately in all of the charts that are reviewed.
The outcome of the interventions can be evaluated by calculating rates of CAUTI before,
during, and after the implementation of the nursing interventions (CDC, 2009). According to the
Centers for Disease Control and Prevention (2009), measurement of rates allows facilities to
determine the longitudinal impact of implementation of prevention strategies. Assessing the
improvements in staff members’ performances and changes in rates of CAUTI throughout the
change process allows the leader to determine if corrections need to be made in the process of
implementing change. According to Yoder-Wise (2014), the cybernetic theory proposes that,
LEADERSHIP STRATEGY ANALYSIS
“negative feedback, or information indicating a correction must occur within the system, informs
the change agent where problems exist” (p. 332). After being informed of the problems that
continue to exist, additional changes can be made in order to continue decreasing the rate of
CAUTI.
Conclusion
The occurrence of urinary tract infections due to the use of indwelling catheters has
become a problem in acute care facilities. In order to provide quality care and protect patients
from CAUTI, changes in nursing care need to take place. This quality improvement initiative
will help the nursing profession identify the issue, develop a team that will be involved in
solving the problem, establish goals for improvement, implement change, and evaluate
movement toward reducing CAUTI in hospitals.
LEADERSHIP STRATEGY ANALYSIS
References
American Association for Critical-Care Nurses. (2011). Catheter-Associated Urinary Tract
Infections. Retrieved from
http://www.aacn.org/wd/practice/content/practicealerts/cathassocuti-nov11.pcms?menu=
Centers for Disease Control and Prevention. (2009). Guideline for Prevention of Catheterassociated Urinary Tract Infections. Retrieved from
http://www.cdc.gov/hicpac/cauti/003_ImplementAudit.html
Gould, C. (2009). Catheter-associated urinary tract infection (CAUTI) toolkit. Center for Disease
Control. Retrieved from http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf
Healthcare Infection Control Practices Advisory Committee. (2009). Guidelines for prevention
of catheter-associated urinary tract infections. Center for Disease Control. Retrieved from
http://www.cdc.gov/hicpac/pdf/cauti/cautiguideline2009final.pdf
Oman, S., Makic, M., Fink, R., Schraeder, N., Hulett, T., Keech, T. & Wald, H. (2011). Nursedirected interventions to reduce catheter-associated urinary tract infections. American
Journal of Infection Control, 40(6), 548-53. doi: 10.1016/j.ajic.2011.07.018
Saint, S. (2011). Implementing change: The technical & socio-adaptive aspects of preventing
cauti. Informally published manuscript, VA Medical Center, university of Michigan, Ann
Arbor, MI. Retrieved from
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB8QFj
AA&url=http://www.mhaonline.org/File%20Library/Quality/CAUTI/07_CAUTI_Nov14-Kickoff_saint_11
1_11_syllabus_.pdf&ei=DqnQU5ysJ8ynyASur4KwCw&usg=AFQjCNGWQRPlSQrxF7NOD75nK5NlLt6NQ&bvm=bv.71667212,d.aWw
LEADERSHIP STRATEGY ANALYSIS
Scott, R. A., Oman, K. S., Flynn-Makin, M. B., Fink, R. M., Hulett, T. M., Braaten, J. S.,
Severyn, F., & Wald, H. L. (2014). Reducing indwelling urinary catheter use in the
emergency department: A successful quality-improvement initiative. Journal of
Emergeny Nursing, 40(3), 237-244. Retrieved from http://0www.sciencedirect.com.libcat.ferris.edu/science/article/pii/S0099176712003443?_rdoc=
1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92
ffb
Yoder-Wise, P. S. (2014). Leading and managing in nursing. (5th ed., pp. 330-332). St. Louis,
MO: Elsevier Mosby
Trautner, B.W., (2001). Management of Catheter-Associated Urinary Tract Infection (CAUTI).
National Institutes of Health, 23(1): 76–82.
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Appendix A
Guidelines for
Nursing Care
Aseptic technique
used?
Prompt removal after
need is gone? (once
order is put in)
Training of nurses in
watching for
symptoms?
Hand hygiene
performed properly?
(education given)
Appropriate uses of
catheters? (nurse
advocate)
Never
More no than yes
In between
More yes than no
Always
LEADERSHIP STRATEGY ANALYSIS
Appendix B
Methods of Gaining
Research
Direct observation of
nurse practices
Evaluation of charting
(ie. checking charting –
when DC orders
placed, how long till
catheter removed?)
Amount of patients on
floor who have
catheters, % that get
CAUTIs:
Assess from nurses the
amount of them that
use/break sterile
technique:
Assess nurse
knowledge of sterile
technique:
Education materials
available on unit:
Hand hygiene
performed by nurse:
More Education
Needed
Needs Improvement
Good Technique
Excellent Technique