Nursing is a profession that has been around for many years. Nurses are mandated to provide holistic care to the sick in society. Part of what nurses do to provide holistic care for patients is catheterization. There are many catheters that nurses can insert. However, the most common catheters in hospitalized patients which are inserted by nurses are urinary of Foley’s catheters (Jozwiak, et al., 2014). This type of catheters are indicated for patients who have difficulties in passing out urine naturally either because of disease or medical-surgical interventions prescribed to them (Jozwiak, et al., 2014). Even though this procedure is very important, catheterization has been associated with high incidence of urinary tract infections especially in women (Lo, et al., 2014). This paper is prompt that suggests a research among hospitalized women of reproductive age to confirm that catheterization increases the likelihood of one acquiring Urinary Tract Infection (UTI).
Research has shown that UTIs are more likely to occur in females than in males since females have a shorter urethra (Foxman, 2014). Additionally, Barber, et al. (2013) posit that genitourinary tract instrumentation increases the chances of one acquiring urinary tract infection by simply enhancing disease causing microorganisms to rise up into the tract. Lastly, hospitalization increases chances of one acquiring UTI because of the expected high concentration of causative microorganisms especially bacteria in a hospital environment (Barber, et al, 2013). Despite all this knowledge on the topic, the increased incidence of antibiotic resistance and UTIs caused by antibiotic-resistant hospital-acquired bugs warrants a deeper research into this area. The relevance of this area of study to the practice of nursing is drawn from the fact that it is nurses who are responsible for most urethral catheterization in hospital and they have the responsibility of caring for patients with UTIs. Nurses, therefore, have a primary role of researching in this area to ensure that incidence of hospital-acquired UTIs is reduced.
Feasibility Questions
The first question that this research seeks to answer is the question of the appropriate study design for the research. In this case, the research is only interested in knowing the extent of UTIs among hospitalized patients that can be attributed to antibiotic-resistant hospital-acquired bugs. A cross-sectional study will be the best to describe such phenomena.
A study design is incomplete when one has not specified the participants of their research. In this case, hospitalized women who have been catheterized are the best participants.
Having the study design, it is important to establish how and where the study will be done. The research is best done in a hospital environment. The best department for this kind of research is the obstetrics and gynecology department since all patients here are females and a good number of them will be catheterized at some point during hospitalization.
It is important for one to determine the research procedures with their complexity and technicality for them to determine the feasibility of a study. In this case, the main research procedure will be collection of urine from patients. The urine will be analyzed using urinalysis strips. The remaining sample will be cultured for bacterial identification and antibiotic sensitivity testing. The researcher will need five assistants and input from the laboratory for the success of this procedures.
Finally, it is prudent for one to look at the financial feasibility of the research. To conduct this research, finances are required for purchase of culture media, antibiotic patches, urinalysis strips, and urine sample collection containers. More finances are required to pay the personnel involved.
PICOT Question
This research hypothesizes that antibiotic resistant bugs acquired as a result of catheterization are more likely to be the causative agents of UTIs in hospitalized patients than in patients who have been admitted for UTI or have not been catheterized.
P – Hospitalized women
I – Catheterization
C – Women who have not been catheterized or are newly admitted for UTI
O – Increased incidence of antibiotic-resistant bugs in UTIs arising after hospitalization and especially catheterization while in hospital.
Keywords in Literature Search
- Catheterization – this procedure has been associated with higher incidence of urinary symptoms in patients who receive it (Hooton, et al., 2010).
- UTI – urinary tract infections are common infections in women. Many papers have been written before showing the association of such infection with hospitalization and catheterization (Hooton, et al., 2010).
- Hospital-acquired infections – this are also called nosocomial infections. Wagenlehner and Naber (2000) were able to show that most urinary tract infections are acquired in hospital environment.
- Antibiotic- resistant bugs – antibiotic resistance is becoming an issue of major concern in current health practice. A 2014 paper by NPS Medicinewise grouped UTI as diseases associated with most antibiotic resistance.
- Hospitalization – hospital stay exposes one to nosocomial infections including UTI (NPS Medicinewise, 2014).
- Dysuria – painful urination is a major symptom of UTI (NPS Medicinewise, 2014).
- Obstetrics and gynecology – the patients in this department are all female and catheterization is a common procedure in the department (NPS Medicinewise, 2014).
- Urethritis – inflammation of urethra can be caused by antibiotic-resistant bugs in UTI (NPS Medicinewise, 2014).
- Cystitis – inflammation of the urinary bladder can result from UTI (NPS Medicinewise, 2014).
- Pyelonephritis – fatal inflammation and pus formation in the kidney can result from hospital-acquired UTI (NPS Medicinewise, 2014).
References
Barber, A. E., Norton, J. P., Spivak, A. M., & Mulvey, M. A. (2013). Urinary tract infections: current and emerging management strategies. Clinical Infectious Diseases, 57(5), 719-724.
Foxman, B. (2014). Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious disease clinics of North America, 28(1), 1-13.
Jozwiak, M., ten Eikelder, M., Rengerink, K. O., de Groot, C., Feitsma, H., Spaanderman, M., … PROBAAT Study Group. (2014). Foley catheter versus vaginal misoprostol: randomized controlled trial (PROBAAT-M study) and systematic review and meta-analysis of literature. American journal of perinatology, 31(02), 145-156.
Hooton, T. M., Bradley, S. F., Cardenas, D. D., Colgan, R., Geerlings, S. E., Rice, J. C., … & Nicolle, L. E. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical infectious diseases, 50(5), 625-663.
Lo, E., Nicolle, L. E., Coffin, S. E., Gould, C., Maragakis, L. L., Meddings, J., … & Yokoe, D. S. (2014). Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S32-S47.
NPS Medicinewise. (2014). Antibiotic resistance and UTIs. Retrieved from http://www.nps.org.au/publications/health-professional/nps-news/2014/reducing-antibiotic-resistance
Wagenlehner, F. M. E., & Naber, K. G. (2000). Hospital-acquired urinary tract infections. Journal of hospital infection, 46(3), 171-181.
