Association of Catheter-Associated Urinary Tract Infection (CAUTI) With the Practice Environment at the Unit Level

2.50
Hdl Handle:
http://hdl.handle.net/10755/621626
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Association of Catheter-Associated Urinary Tract Infection (CAUTI) With the Practice Environment at the Unit Level
Other Titles:
Health Promotion of Patients With Catheters
Author(s):
Ballard, Nancy; Bott, Marjorie J.; Park, Shin Hye; Gajewski, Byron; Miller, Peggy A.
Lead Author STTI Affiliation:
Mu Phi
Author Details:
Nancy Ballard, PhD, RN, NEA-BC, Professional Experience: Experience includes: 40+ years in practice in progressive leadership roles. More than a decade of practice supporting professional practice. Publication and presentations on shared governance and professional practice environments. Dissertation focus on the practice environment and clinical outcomes. Author Summary: Dr. Ballard is currently an assistant professor at Kennesaw State University after practicing in community hospitals for 40+ years and has been an appraiser for the ANCC Magnet designation program for 10+ years. Her passion for shared governance and professional practice has guided her research interest in the practice environment with presentations at regional & national conferences and publications in American Journal of Critical Care, Western Journal of Nursing Research, JONA, Journal of Emergency Nursing.
Abstract:

Purpose:

Identification of elements of the practice environment that influence both nurse satisfaction and patient outcomes is an important area for nursing research. Several valid and reliable tools to measure the components of the practice environment have been developed by nurse researchers. The Practice Environment Scale and Job Enjoyment Scale are included in the National Database of Nursing Quality Indicators® (NDNQI®) RN Satisfaction Survey. In addition the NDNQI provides a database for participating hospitals to collect nurse-sensitive quality outcome data including catheter-associated urinary tract infection rates (CAUTI) for internal use and external benchmarking. All data are collected at the unit level providing opportunity for researchers to explore associations between the nurse work environment and measured quality outcomes.

Leiter and Laschinger (2006) posited the Nursing Worklife Model (NWLM) to explain how the elements identified in the practice environment are interrelated in the complex system of the nurse practice environment with subsequent work that extended the model to include association of nurse perception of patient adverse events. To date, researchers have primarily evaluated the impact of the practice environment on clinical outcomes using administrative data at the hospital or individual nurse level using nurse perceived adverse patient outcomes.

Exploration of the practice environment using the NWLM with catheter-associated urinary tract infections (CAUTI), an identified never event, is an important area for research. Care occurs at the work unit level where practice environments may vary. Study of relationships at the unit level with a measured clinical outcome extended previous hospital-level NWLM research. The purpose of this two-phased study was to fit the NWLM to unit level data, validate the fit of a modified NWLM from the first phase and extend the model to evaluate the association with CAUTI rate at the work unit level in acute care settings.

 Methods:

A secondary data analysis of a national sample (N= 3,023) of critical care, step-down, medical, surgical, and combined medical-surgical units from the 2011 NDNQI® was used to fit the NWLM to the unit level data. The modified NWLM was then validated using a national sample, (N=1,106), of medical, surgical, and combined medical-surgical unit level data from the 2012 NDNQI® data. Using structural equation modeling (SEM), a modified NWLM of job enjoyment was confirmed and extended to include a unit level outcome measure, the annualized CAUTI rate from the matched units in the 2012 NDNQI® data.

 Results:

Following indicated modifications to the NWLM pathways in the analysis of the 2011 data, additional significant paths were added to job enjoyment, staffing and resource adequacy, and foundations for quality care resulting in good model fit to the unit level data (CFI=.999; RMSEA=.059 [95% CI=.034 -.089]; SRMR=.002). Using the a priori model from 2011 data analysis, the modified NWLM at the unit level showed an excellent model fit (CFI =.995, RMSEA=.041 [95% CI=.028-.056]; SRMR=.020) to the 2012 NDNQI® unit level data. The results of the extension of the model to include the clinical outcome revealed a significant (p= <.01) negative pathway from job enjoyment to CAUTI rates (β= -.08). There were significant positive association of CAUTI rate with hospital characteristics that included Academic Medical Centers (β=.13) and hospitals greater than 500 beds (β=.07), indicating both had higher CAUTI rates.

 Conclusion:

The validated model using unit level data supported the importance of the nurse practice environment in reducing negative clinical outcomes (i.e., CAUTI rates). The results demonstrated the importance of the unit practice environment based on the NWLM, for improving quality of care. In addition to emphasis on best clinical practice, strategies to support a culture of professional practice are indicated.

Keywords:
Catheter associated urinary tract infections; Nurse Work Life Model; Practice Environment
Repository Posting Date:
30-Jun-2017
Date of Publication:
30-Jun-2017
Other Identifiers:
INRC17M08
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleAssociation of Catheter-Associated Urinary Tract Infection (CAUTI) With the Practice Environment at the Unit Levelen_US
dc.title.alternativeHealth Promotion of Patients With Cathetersen
dc.contributor.authorBallard, Nancyen
dc.contributor.authorBott, Marjorie J.en
dc.contributor.authorPark, Shin Hyeen
dc.contributor.authorGajewski, Byronen
dc.contributor.authorMiller, Peggy A.en
dc.contributor.departmentMu Phien
dc.author.detailsNancy Ballard, PhD, RN, NEA-BC, Professional Experience: Experience includes: 40+ years in practice in progressive leadership roles. More than a decade of practice supporting professional practice. Publication and presentations on shared governance and professional practice environments. Dissertation focus on the practice environment and clinical outcomes. Author Summary: Dr. Ballard is currently an assistant professor at Kennesaw State University after practicing in community hospitals for 40+ years and has been an appraiser for the ANCC Magnet designation program for 10+ years. Her passion for shared governance and professional practice has guided her research interest in the practice environment with presentations at regional & national conferences and publications in American Journal of Critical Care, Western Journal of Nursing Research, JONA, Journal of Emergency Nursing.en
dc.identifier.urihttp://hdl.handle.net/10755/621626-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>Identification of elements of the practice environment that influence both nurse satisfaction and patient outcomes is an important area for nursing research. Several valid and reliable tools to measure the components of the practice environment have been developed by nurse researchers. The Practice Environment Scale and Job Enjoyment Scale are included in the National Database of Nursing Quality Indicators® (NDNQI®) RN Satisfaction Survey. In addition the NDNQI provides a database for participating hospitals to collect nurse-sensitive quality outcome data including catheter-associated urinary tract infection rates (CAUTI) for internal use and external benchmarking. All data<strong> </strong>are collected at the unit level providing opportunity for researchers to explore associations between the nurse work environment and measured quality outcomes.</p> <p>Leiter and Laschinger (2006) posited the Nursing Worklife Model (NWLM) to explain how the elements identified in the practice environment are interrelated in the complex system of the nurse practice environment with subsequent work that extended the model to include association of nurse perception of patient adverse events. To date, researchers have primarily evaluated the impact of the practice environment on clinical outcomes using administrative data at the hospital or individual nurse level using nurse perceived adverse patient outcomes.</p> <p>Explor<strong>a</strong>tion of the practice environment using the NWLM with catheter-associated urinary tract infections (CAUTI), an identified <em>never event, </em>is an important area for research. Care occurs at the work unit level where practice environments may vary. Study of relationships at the unit level with a measured clinical outcome extended previous hospital-level NWLM research. The purpose of this two-phased study was to fit the NWLM to unit level data, validate the fit of a modified NWLM from the first phase and extend the model to evaluate the association with CAUTI rate at the work unit level in acute care settings.</p> <p> <strong>Methods:</strong></p> <p>A secondary data analysis of a national sample (<em>N</em>= 3,023) of critical care, step-down, medical, surgical, and combined medical-surgical units from the 2011 NDNQI® was used to fit the NWLM to the unit level data. The modified NWLM was then validated using a national sample, (<em>N</em>=1,106), of medical, surgical, and combined medical-surgical unit level data from the 2012 NDNQI® data. Using structural equation modeling (SEM), a modified NWLM of job enjoyment was confirmed and extended to include a unit level outcome measure, the annualized CAUTI rate from the matched units in the 2012 NDNQI® data.</p> <p> <strong>Results:</strong></p> <p>Following indicated modifications to the NWLM pathways in the analysis of the 2011 data, additional significant paths were added to job enjoyment, staffing and resource adequacy, and foundations for quality care resulting in good model fit to the unit level data (<em>CFI</em>=.999; <em>RMSEA</em>=.059 [<em>95% CI</em>=.034 -.089]; <em>SRMR</em>=.002). Using the <em>a priori</em> model from 2011 data analysis, the modified NWLM at the unit level showed an excellent model fit (<em>CFI</em> =.995, <em>RMSEA</em>=.041 [<em>95%</em> <em>CI</em>=.028-.056]; <em>SRMR</em>=.020) to the 2012 NDNQI® unit level data. The results of the extension of the model to include the clinical outcome revealed a significant (<em>p</em>= <.01) negative pathway from job enjoyment to CAUTI rates (<em>β=</em> -.08). There were significant positive association of CAUTI rate with hospital characteristics that included Academic Medical Centers (<em>β=</em>.13) and hospitals greater than 500 beds (<em>β=</em>.07), indicating both had higher CAUTI rates.</p> <p> <strong>Conclusion:</strong></p> <p>The validated model using unit level data supported the importance of the nurse practice environment in reducing negative clinical outcomes (i.e., CAUTI rates). The results demonstrated the importance of the unit practice environment based on the NWLM, for improving quality of care. In addition to emphasis on best clinical practice, strategies to support a culture of professional practice are indicated.</p>en
dc.subjectCatheter associated urinary tract infectionsen
dc.subjectNurse Work Life Modelen
dc.subjectPractice Environmenten
dc.date.available2017-06-30T20:02:30Z-
dc.date.issued2017-06-30-
dc.date.accessioned2017-06-30T20:02:30Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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