1—— After speaking with my mentor, we came up with several different ways on how this practice change would affect our facility. For my project proposal of catheter-associated urinary tract infection (CAUTI) prevention, this change will impact each all of the areas seen here. From the financial aspect, quality aspect, and clinical intervention.

A systematic review of the literature identified only four studies that produced original estimates of the attributable cost of (CAUTIs) in the United States since the year 2000. In 2016 U.S. dollars, the reported attributable costs of CAUTIs are $876 inpatient costs to the hospital for additional diagnostic tests and medications. $1,764 inpatient costs to Medicare for non-intensive care unit (ICU) patients. $7,670 inpatient and outpatient costs to Medicare. $8,398 inpatient costs to the hospital for pediatric patients and $10,197 inpatient costs to Medicare for ICU patients. The prevailing notion of a CAUTI costing approximately $1,000 is an underestimate and an oversimplification of its true economic burden because many factors such as patient population, patient acuity, infection etiology, and cost perspective can increase the cost well above $1,000.Additional research is needed to accurately assess the full economic effect that CAUTIs have on hospitals and the U.S. healthcare system Hollenbeak & Schilling (2018).

A simple clinical intervention aimed at reducing the duration of catheterization may decrease the frequency of CAUTI and antibiotic use for CAUTI, even if the impact of the intervention is variable according to the type of unit. Indeed, we recommended the removal of unnecessary urinary catheters on the fourth day of catheterization because CAUTI incidence peaked on the sixth day of catheterization during the observational phase. A continuous daily review from the time of insertion intervention might likely be even more efficient, particularly in surgical units, where postoperative patients require catheters for a few days until all vital signs have stabilized, according to Crouzet (2007).

The CDC 2015 also reported 15%-25% of patients to receive urinary catheters during their hospital stays. CAUTI represents an estimated 40% of all hospital-acquired infections. More than 70% of CAUTIs are preventable; however, more than 500,000 nosocomial CAUTIs still are reported annually in the United States (Carr et al., 2017). Using inter-professional approaches to minimize catheter insertion days and maintaining appropriate care were keys to this project’s success. Strong collaboration among nurses, other providers, PCTs, therapists, and patient transporters supported the newly established CAUTI bundle. Consistent staff education during team huddles and weekly audits also helped sustain the project’s success. CAUTI prevention interventions now have become a sustained change in nursing practice embraced by PCU staff. There will be a need for continuous education brought to the staff. The initial training would need to be done at either the quarterly staff meeting or a special in-service. This would require paying the staff to come in over their expected work hours. One would also need to take into consideration the amount of time I would need to develop a plan for the continued annual competency training. On the other hand, this change will likely save the facility on expenses. This would decrease the amount of CAUTI in the hospital.

2———-After having a long discussion with my mentor about the issues related to nursing shortage and the factors causing it, we found that there are lots of changes going to take place in our facility, which would definitely improve our quality of care towards the patients, even affect the financial and clinical aspects for developing my capstone project.

a) Financially: It is true that much money is required to establish facilities conducive for both the patients and nurses. The problems which cause staff shortage in hospitals such as, work overload, nurse turnover, low insufficient wages, improper staffing etc., would create lots of problem in patient related care and safety. By providing enough ratio of staffs among patients will avoid certain serious negative outcomes, which directly or indirectly benefit the facility in financial aspect. The cost of nurse turnover can have a huge impact on a hospital’s profit margin. According to National Healthcare Retention & RN Staffing Report (2016), the average cost of turnover a nurse ranges from $37,700 to $58,400. Hospitals can lose $5.2 million to $8.1 million annually. The turnover rate for RNs continues to rise. Turnover statistics for bedside RNs in 2014 were 16.4 percent, and they rose to 17.2 percent in 2015.

b) Quality: Evidence-based practice needs high quality for correct performance. All steps are supposed to be designed in order to avoid low quality practices. Nurse staff shortage is a threat to quality of healthcare and safety of patients in hospital facilities. The quality aspect should be carefully considered as a very sensitive matter, as we deal with human life, and not with the objects. Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job (McHugh, M. D., & Ma, C. (2014). Definitely, with the sufficient number of nurses for the allotted patients will provide the best quality care to the patients and their safety as well.

c) Clinically: It is said that nurses’ important role becomes more visible during times of scarcity. Professional recognition for individuals and entire teams has grown through the years. A nursing shortage increases the spotlight on dysfunctional staff, and efforts to deal with them more earnestly. Investing in quality staff by divesting of poor role models supports quality care, retention, and morale (Lillee Gelinas, 2017). Personally, I believe that there will be well organized working environment in the facility when there is proper staffing and stress free zone, which contribute to positive outcomes.

3——-My EBP suggestion is to implement skin-to-skin contact (SSC) as a standard practice within all maternity facilities to help initiate breastfeeding as well as the additional health benefits of SSC for an infant.

Financially there is little additional cost in the implementation of SSC, due to it being a natural, non-invasive form of medical treatment. SSC is a free intervention that all health care providers can easily implement and maintain. My mentor and I did discuss the possible cost of training and educating facilities and its colleagues on the benefits of SSC and how to properly initiate and monitor SSC safely. This could be accomplished with unit based educational readings and demonstration. Choosing specific members of management and nursing leadership to receive the initial training on how to implement SSC safely and then these employees can help to train the remaining staff. All new employees would receive the training as part of their orientation and unit-based training. This would be the most cost-efficient way to implement the suggested EBP change.

SSC is a medical intervention, that in our (mentor and me) opinion, helps to heighten the quality of care a medical provider gives to their patient. The birth of a child is a momentous moment that is beautiful and highly emotional for the parents. Allowing a mother to experience SSC with their infant has been proven to help enhance bonding, breastfeeding and assists the infant with the transition of being born. SSC allows the nurse to step back and allow the parents to enjoy and bond with their new baby instantly, rather than having to wait for the nurse to wrap the infant up and bring back to the parents. Also, mothers who receive SSC have even been found, a year later, to have a stronger connection with their infants than those that did not (Skin-to-Skin Contact., n.d.).

On a clinical level, SSC would just be a matter of educating the parents on the initiation, process, and benefits of SSC. There are many educational opportunities within the obstetric clinic, especially towards the end of a pregnancy, a mother typically needs to be seen on a weekly basis. Educating the mother on skin-to-skin and what this means for her and her infant can help to enhance the experience and expectation of care once the baby is born.

4——–Research implications suggest how the findings may be important for policy, practice, theory, or subsequent research. Recommendations about research suggest that a specific action needs to be taken on policy, practice, theory or subsequent other research. How could you use implications or recommendations of your research in the planning and development stages of your project.

5———-My proposed solution is to improve satisfaction among family members of patients in the Intensive Care Unit. In one study research showed that family was not satisfied with communication, and how staff worked together. Consequently, family gave a poor score on perceived quality of care. The researchers in the study developed a communication algorithm that was set up to put a higher focus on communication and teamwork between staff and family, and to evaluate its effect on family satisfaction. The results showed that by implementing this communication algorithm, they were able to improve family satisfaction and increase the perceived quality of care (Huffines, 2013). My project is similar to this as I want to implement an educational tool that helps to prepare family members on what to expect during their loved ones stay in the ICU. I want my handout to include information about the difference health care teams, special equipment, special bedside procedures, and general orientation of the unit including contact information. This is a very stressful time and they usually cannot remember all of the information given to them. I want them to be able to keep this handout so that they can refer to it and ultimately use it to facilitate communication with staff. I want them to gain confidence and understanding of their very unfamiliar and sometimes chaotic environment. I want them to not be intimidated by all of the big equipment such as ventilators, IV pumps, and dialysis machines. My hope is that they can use this to ask questions and learn more readily about the care their loved one is receiving.

6—–SBIRT (screening, brief intervention, and referral to treatment) is being used at the Indian Health Council, but it is not being performed consistently by all providers. Barriers are a common finding when providing SBIRT services, because there is no funding for this program. Providers may not have time to screen, may not be notified of abnormal screening results by the medical assistants, and may not have time to counsel patients. Referrals are written, but patients may wait a few weeks for an appointment or may not schedule. When a patient is ready to make a change, the intervention needs to happen now, not in three weeks. This nurse’s solution is to address the barriers the clinic has in providing SBIRT services. Patients who are seen in the medical department by behavioral health staff are more likely to schedule with behavioral health, once they meet the counselor in the medical department. Brief interventions can reverse risky behaviors in patients by helping patients see the risks associated with their actions.

This nurse did not realize how many patients were affected by substance abuse until she attended some interdisciplinary meetings with TFS (Tribal Family Services) and made some visits with the public health nurse to the hospital. Child abuse, neglect, patients with heart failure and liver disease, teens, and pregnant women are impacted by alcohol and substance abuse in this community. Something must be done to break this cycle. Research has shown that brief interventions can help patients reduce substance use, but many studies show that there are barriers to providing SBIRT in many facilities. “SBIRT has been shown to be an effective tool that can empower primary care providers to identify and treat this population before costly symptoms emerge” (Hargraves, White, Frederick, Cinibulk, Peters, Young, & Elder, 2017, p. 9). Educating staff can make a big impact. Making sure patients are screened correctly and are educated on the consequences of substance use may be able to change this community.

If SBIRT is not provided, more patients will end up dying from injuries, accidents, chronic diseases, overdoses, and more children will be removed from their parents. Some patients have grown up with their family and friends using alcohol or drugs, and they do not realize it is not a normal part of life. “Because substance use disorders are becoming more of a problem identified in primary care and community-based programs, it is important that counselors routinely screen for them, intervene when screens are positive, and have access to culturally diverse and reliable referral resources” (Hodgson, Stanton, Borst, Moran, Atherton, Toriello, & Maag Winter, 2016, p. 57). The goal is to provide patients with quality care and improve the quality of their lives. Medical and behavioral health staff need to have the tools, so that SBIRT can be used effectively at the Indian Health Council. Part of obtaining the tools is making sure staff are educated appropriately on SBIRT methods and removing barriers to providing SBIRT services.