A Qualitative Study of Factors Facilitating Clinical Nurse Engagement in Emergency Department Catheter-Associated Urinary Tract Infection Prevention.
OBJECTIVE
The aim of this study was to explore the actions of nurse leaders that facilitated clinical nurses' active involvement in emergency department (ED) catheter-associated urinary tract infection (CAUTI) prevention programs.


BACKGROUND
Hospitals face increasing financial pressures to reduce CAUTI. Urinary catheters, often inserted in the ED, expose patients to CAUTI risk. Nurses are the principal champions of ED CAUTI prevention programs.


METHODS
This was a qualitative analysis from a multisite, comparative case study project. A total of 52 interviews and 9 focus groups were analyzed across 6 enrolled EDs. Using a conventional content analysis, members of the research team coded data and developed site summaries to describe themes that had emerged across transcripts. Subsequently, all codes and site summaries were reviewed to identify the actions of nurse leaders that facilitated clinical nurses' engagement in CAUTI prevention efforts.


RESULTS
Nurse leaders were the principal champions of CAUTI prevention programs and successfully engaged clinical nurses in CAUTI prevention efforts by (1) reframing urinary catheters as a source of potential patient harm; (2) empowering clinical nurses to identify and address CAUTI improvement opportunities; (3) fostering a culture of teamwork, which facilitated interdisciplinary communication around urinary catheter appropriateness and alternatives; and (4) holding clinical nurses accountable for CAUTI process and outcome measures.


CONCLUSIONS
The prevention of CAUTI is an important opportunity for nurse leaders to engage clinical nurses in meaningful improvement efforts. Clinical nurses are best positioned to examine urinary catheter insertion workflow and to suggest improvements in avoiding use and improving placement and maintenance. To engage clinical nurses in CAUTI prevention, nurse leaders should focus on how urinary catheters expose patients to potential harm, involve nurses in designing and implementing practice changes, and provide local data to show the impact of nursing practices on patient outcomes.
Author Affiliations: New York-Presbyterian Hospital; and Columbia University School of Nursing, New York, New York (Dr Carter); and Department of Emergency Medicine, Brigham and Women's Hospital, Boston (Drs Pallin and Schuur and Ms Sinnette); School of Nursing and Health Sciences, Regis College, Weston (Dr Mandel); and Harvard Medical School, Boston (Dr Schuur), Massachusetts.
Eileen J
EJ
Carter
Daniel J
DJ
Pallin
Leslie
L
Mandel
Corine
C
Sinnette
Jeremiah D
JD
Schuur
D055499:Catheter-Related Infections / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000009:adverse effects; D003428:Cross Infection / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control; D017144:Focus Groups; D006801:Humans; D016357:Infection Control Practitioners; D009720:Nurse Clinicians / Q000458:organization & administration*; D024802:Nurse's Role; D009730:Nursing Assessment; D010043:Outcome and Process Assessment, Health Care; D036301:Qualitative Research; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control