Exploring Factors Associated with Nurses' Adoption of an Evidence-Based Practice to Reduce Duration of Catheterization

Purpose:
To identify factors associated with Registered Nurses' adoption of an evidence-based practice to reduce the duration of indwelling urinary catheterization in hospitalized adults.

Background/Significance:
Critical to health care reform is the demand for high-quality, cost-effective, and safe health care. Inclusion of evidence-based practice (EBP) related to patient safety is vital for healthcare organizations, and nurses play a pivotal role in translating evidence into practice. Despite long-standing indwelling urinary catheter protocols, catheter-associated urinary tract infections (CAUTI) continue to rise and constitute the most common type of healthcare acquired infections.

Methods:
Pilot study using mixed methods and a two-group pre/post study design. Instruments used included the Evidence-Based Practice Questionnaire (EBPQ) and the Adoption of the Early Catheter Discontinuation Protocol Questionnaire (AECDPQ). Qualitative data were collected via focus groups. Additionally, quantitative data were collected on the incidence and duration of urinary catheterization among patients on both units pre/post intervention of a nurse-driven protocol. Descriptive statistics and analysis of variance were used.

Results:
The change in mean total scores on the EBPQ from pre to post intervention was statistically significant between the two groups (F = 6.15, p = 0.018). Additionally, the results for the practice (F = 7.74, p = 0.009) and attitude (F = 9.85, p = 0.004) subscales were also statistically significant. The mean score for responses to the AECDPQ was 5.82 (SD = 0.83), well above the mean score of 4.0 (neutral), t(19) = 9.76, p < 0.001. The difference in mean change for duration of catheterization between the groups was statistically significant, F(1,251) = 5.83, P = 0.016.

Conclusions and Implications for Practice:
Results indicated that learning about and implementing a nurse-driven protocol was a factor in the intervention group nurses' perceptions of practice and attitudes related to EBP. The focus group responses indicated motivation to adopt changes in practice when the rationale was understood.