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Case Study 1- Medical
3-year-old “Thomas”, has just been transferred to the Paediatric Ward, presenting with a 2-day history
of reduced oral intake, reduced wet nappies, tachypnoea, cough and wheeze. He has been diagnosed
with acute asthma. Thomas’ older brothers have also been unwell with a cold. His mother, Tanya,
has primary care of Thomas and his siblings, with his father caring for the children on weekends.
Thomas is up to date with his immunisations. Thomas was born at 32 weeks’ gestation via c- section.
He was hospitalised in Special Care Nursery until 34 weeks, for hyperbilirubinaemia and poor feeding.
After many hospital and doctors’ visits during his life so far, Thomas has been diagnosed recently with
Cerebral Palsy. Thomas currently has moderately increased work of breathing and requires 1 litre of
oxygen via nasal prongs for oxygen saturation of 88%. Thomas is irritable and keeps pulling the
oxygen tubing off. He has been ordered a once-only medication of Salbutamol via MDI, spacer and
mask, every 20 minutes for 1 hour STAT. He cries and pushes the mask off each time the nurse tries
to administer it. His mother cries and leaves the room when the nurses administer the salbutamol,
saying she is too upset to watch, which makes Thomas more distressed.

Case Study 2- Surgical
16-year-old Alex is an inpatient on the Paediatric Surgical Ward, and presented with signs and
symptoms of appendicitis. He is now 1-day post-op open appendectomy. The Paediatric Surgeon
discovered that his appendix was perforated intra-operatively. Alex presented with a 3-day history of
right sided abdominal pain, nausea, vomiting and fever. Alex is otherwise normally well, and was
conceived through IVF. He is in Year 11 at school and is an only child. Currently, both parents and
several visitors, including young children, are visiting and eating take-away at Alex’s bedside. Alex is
currently nil by mouth, on full IV maintenance fluids, and a morphine PCA. He has an IDC and nasogastric tube (NGT) on free drainage with 4-hourly aspirates. Alex is presenting as quiet and withdrawn,
but frequently asks the nurse to remove the NGT. He denies having any pain despite having several
bad tries on the PCA, and is refusing to be moved for pressure area care or to be washed by the nurses.
He rates his nausea as 10/10 most of the time. 

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In 500‐750 words (not including the
title page and reference page), apply a change model to the implementation
plan. Include the following:

1. Rogers’ diffusion of innovation theory is a
   particularly good theoretical framework to apply to an EBP project.
   However, students may also choose to use change models, such as Duck’s
   change curve model or the transtheoretical model of behavioral change.
   Other conceptual models presented such as a utilization model (Stetler’s
   model) and EBP models (the Iowa model and ARCC model) can also be used as
   a framework for applying your evidence‐based intervention in clinical
   practice.
2. Apply one of the above models and carry your
   implementation through each of the stages, phases, or steps identified in
   the chosen model.
3. In addition, create a conceptual model of the project.
   Although you will not be submitting the conceptual model you design in
   Topic 5 with the narrative, the conceptual model should be placed in the
   appendices for the final paper.

SECOND part: Evidence-Based Practice Proposal – Section F: Implementation
Plan

My project proposal topic is CAUTI (catheter associated
urinary tract infection) prevention. It is a continuous paper. Please maintain that continuity in
this assignment. Please let me know if you need more information.

PICOT question is :

Among hospitalized adult patients with indwelling catheter (P) how does the
implementation of CAUTI prevention bundle (I) when compared with no specific
measures (C) reduces CAUTI (O) during the hospitalization period (T)?

In 500‐750 words (not including the
title page and reference page), provide a description of the methods to be used
to implement the proposed solution. Include the following:

1. Describe the setting and access to potential subjects.
   If there is a need for a consent or approval form, then one must be
   created. Although you will not be submitting the consent or approval
   form(s) in Topic 5 with the narrative, the consent or approval form(s)
   should be placed in the appendices for the final paper.
2. Describe the amount of time needed to complete this
   project. Create a timeline. Make sure the timeline is general enough that
   it can be implemented at any date. Although you will not be submitting the
   timeline in Topic 5 with the narrative, the timeline should be placed in
   the appendices for the final paper.
3. Describe the resources (human, fiscal, and other) or
   changes needed in the implementation of the solution. Consider the
   clinical tools or process changes that would need to take place. Provide a
   resource list. Although you will not be submitting the resource list in
   Topic 5 with the narrative, the resource list should be placed in the
   appendices for the final paper.
4. Describe the methods and instruments, such as a
   questionnaire, scale, or test to be used for monitoring the implementation
   of the proposed solution. Develop the instruments. Although you will not
   be submitting the individual instruments in Topic 5 with the narrative,
   the instruments should be placed in the appendices for the final paper.
5. Explain the process for delivering the (intervention)
   solution and indicate if any training will be needed.
6. Provide an outline of the data collection plan.
   Describe how data management will be maintained and by whom. Furthermore,
   provide an explanation of how the data analysis and interpretation process
   will be conducted. Develop the data collection tools that will be needed.
   Although you will not be submitting the data collection tools in Topic 5
   with the narrative, the data collection tools should be placed in the
   appendices for the final paper.
7. Describe the strategies to deal with the management of
   any barriers, facilitators, and challenges.
8. Establish the feasibility of the implementation plan.
   Address the costs for personnel, consumable supplies, equipment (if not
   provided by the institute), computer related costs (librarian
   consultation, database access, etc.), and other costs (travel,
   presentation development). Make sure to provide a brief rationale for
   each. Develop a budget plan. Although you will not be submitting the
   budget plan in Topic 5 with the narrative, the budget plan should be
   placed in the appendices for the final paper.
9. Describe the plans to maintain, extend, revise, and
   discontinue a proposed solution after implementation.

Attaching rubrics as well Rubric copy feb 9a for part 1 and rubric copy feb9b for second part

I preparing my assignments with calltutors so far.it consist of two separate sections.please prepare the assignment as two parts.please contact me if you need more information.One more request i getting corrections each time i am submitting the assignment,please prepare according to the rubrics and instruction.

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Proposed
Solution

The implementation of the catheter
associated urinary tract infection (CAUTI) prevention bundle is the proposed
solution. The problem states that the population is adult patients with an
indwelling catheter. A near sterile system with a catheter and a ball retention
device implanted either through the urethra for bladder draining is an occupied
urinary catheter(Davies, et al., 2018).
The urine storage catheter is associated with external collecting instruments
(e.g., drainage pipe and bag). Urinary catheters for indwelling are only
recommended for short-term use, defined less than 30 days. Throughout two
specific bladder dysfunctions, Urinary Incontinence (UI), and urinary
retention, the bladder emptying by the catheter(Dehghanrad,
et al., 2019).

The definition of a CAUTI
Prevention Package strategy is a collection of straight forward, evidence-based
interventions that have an interconnected and preferably synergistic impact.
Avoid unnecessary urinary catheters, attach urinary catheters using aseptic
procedures, manage urinary catheters dependent on instructions, assess urinary
catheters on a daily basis, and eliminate as quickly as possible. The package
method includes the following(Davies, et al.,
2018).

In particular, CAUTI prevention
is primarily targeted at the use of urinary catheters with a particular focus
on continuous catheter evaluation and elimination, especially for those
patients for whom no clear indication is appropriate. The bladder kit,
therefore, focuses primarily on the “method” of urinary catheter
reduction(Sorour, et al., 2016). In CAUTI
prevention, Bladder Bundle is the first defense line. This helps healthcare
clinicians to have an effect on results by assessing the bladder role and then
using the right alternatives. The bulk of patient care starts and ends with the
bladder kit. The opportunity for contamination is one of the significant risks
involved with urinary catheters. Reasonable care will mitigate this risk(Monina Hernandez, PGDipHSc, Stewart, & PGDipHSc,
2019).

Organization
Culture

The bladder bundle approach also
reflects the culture and resources of the community. In the corporation[DD1] , it could quickly be enforced.
For a number of essential factors, CAUTI avoidance has been difficult. Careful
use of urinary catheter and CAUTI rates monitoring will help to maintain
urinary catheter interventions. Most specifically, changing procedures of
placing and removal of urinary catheters will also include steps to improve
nurses, doctors, and patients ‘ needs for urinary catheters(Elkbuli, et al., 2018).To help organize and
prioritize the many options for CAUTI prevention, the conceptual model of the
“Urinary Catheter Lifecycle” highlights the fact that the
best-performance interventions to prevent CAUTI will be directed at least one
of the four “stages” of catheter “life.” Urinary catheter
bags need to be emptied to a clean container daily at regular intervals to
prevent pull on the catheter.It must be occur every 3to 4
hours or whenever the bag is about half to three-quarters full. Hand hygine is the effective method to prevent all
the infections(Monina Hernandez, PGDipHSc, Stewart, & PGDipHSc, 2019).

Expected
Outcomes

The expected result of the PICOT
is that the CAUTI levels would be rising.[DD2]  
The solution of the bladder kit lowers the CAUTI output efficiently.
Nevertheless, the correct urinary catheter placement procedure is also
essential. Ensure that catheters are inserted using the right technique only by
trained individuals. Using the aseptic technique and sterile tools, insert the
catheter, and protect it correctly after injection to avoid friction and
urethral movement. Velcro moves and also slipping in and out can lead to
irritation as well as micro-organism transmission to urinary meatus(Elkbuli, et al., 2018). It is crucial to take
the protection. There are various types of protections available for the skin
care of the patient. It is also critical to resist the products which can hurt
the skin of the patient (Elkbuli, et al., 2018).

Hand hygiene is the most
important method to prevent transmission of infection. The maintenance of a
correct protocol of hand hygiene is the only significant means to avoid
infectious agents’ transmission. Make the use of antimicrobial / antiseptic
impregnated catheters if the CAUTI threshold for your company is not lowered
with the aid of a specific strategy (Davies, et
al., 2018).

Method
to Achieve Outcomes

The first phase in the
development is participating and preparation. Involving and educating the
bladder package program, encourageparticipating in presentations, through
material conference calls. In turn, each location will be provided a packaging
toolkit outlining prevention strategies, interventions, and helpful guides
through face-to-face sessions(Davies, et al.,
2018).

In order to lead the effort and
to assemble a bladder package squad that usually often involves a surgeon, the
facility will recognize and welcome at least one nurse champion (for example,
case manager, child supervisor, professional nurse expert). Members are invited
to participate in regular face-to-face workshops by the bladder bundle team.
The conference calls include all material calls of experts concerned with a
specific subject matter as well as coaching calls. These calls are recorded so
that participants who do not participate can listen to the debate at any time(Dehghanrad, et al., 2019).

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