| Course | NURS 4106 Patient Safety and Quality Improvement |
|---|---|
| Week | Week 6 |
| Paper type | Evidence appraisal table |
| Length | About 640 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Bachelor of Science in Nursing (BSN) |
| Updated | October 2026 |
Free sample paper for NURS 4106 Week 6
Evidence Appraisal Table: Eight Sources on Nurse-Driven Urinary Catheter Removal for a CAUTI Project
Student Name
College of Nursing, Walden University
NURS 4106: Patient Safety and Quality Improvement
Instructor Name
Month Day, Year
Evidence Appraisal Table: Eight Sources on Nurse-Driven Urinary Catheter Removal for a CAUTI Project
Purpose
The project on a composite medical-surgical unit aims to reduce catheter-associated urinary tract infections (CAUTI). The cause analysis found that catheters often stayed in place after their indication had ended, because removal depended on a provider order that was rarely written early. The intervention under consideration is a nurse-driven removal protocol, which lets nurses remove a catheter without a new order once standard criteria show it is no longer indicated. Each source below is placed by design, evidence level, and quality before its finding is recorded, using the Johns Hopkins evidence hierarchy, in which Level I is experimental research and its reviews and Level V is quality improvement reports and expert opinion (Dang et al., 2022).
The Table
Table 1
Appraisal of Evidence on Nurse-Driven Catheter Removal
| Source | Design | Level | Quality | Finding relevant to the project |
|---|---|---|---|---|
| Meddings et al., 2010 | Systematic review and meta-analysis of 14 interventional studies | II | Good | Reminders or stop orders to prompt removal reduced CAUTI rates by 52% and catheter duration by 37% |
| Meddings et al., 2014 | Updated systematic review and meta-analysis | II | Good | Reminders or stop orders reduced CAUTI rates by 53% across 11 studies; no significant harm reported |
| Durant, 2017 | Systematic review of 29 nurse-driven protocol studies, all pre-post | II | Low: high risk of bias, average of 4.9 of 11 quality indicators met | Nurse-driven protocols reduced catheter use and CAUTI rates in nearly all studies |
| Saint et al., 2016 | National multicenter improvement program, 926 units | V | Good for its type; large, but no control group | Unadjusted CAUTI rate fell from 2.82 to 2.19 per 1,000 catheter-days |
| Gould et al., 2010 | National clinical practice guideline | IV | High | Recommends removal once the indication ends, supported by system prompts such as reminders and stop orders |
| Oman et al., 2012 | Pre-post quality improvement on two units | V | Moderate | Catheter days fell on both units; CAUTI numbers too small to test |
| Parry et al., 2013 | Hospital-wide intervention in one community hospital | V | Moderate | Catheter use fell 50% and CAUTI 70% over 36 months, with wide variation by unit |
| Blodgett & Sheets, 2021 | Small mixed-methods acceptability study, 13 questionnaires | III | Low: small sample, 52% completion | Nurses found the protocol acceptable in intensive and intermediate care but less so on medical-surgical units |
Synthesis
The strongest evidence, two meta-analyses rated Level II, consistently shows that prompting timely catheter removal, by reminders or stop orders, cuts CAUTI rates roughly in half (Meddings et al., 2010; Meddings et al., 2014). A nurse-driven removal protocol is a form of stop order, placed in nursing hands. The systematic review of nurse-driven protocols points in the same direction, but its studies were all pre-post designs with a high risk of bias, so its agreement adds confidence in the direction of effect more than in its size (Durant, 2017). The national guideline recommends prompt removal supported by system-level prompts, the category a nurse-driven protocol belongs to (Gould et al., 2010), and the national improvement program showed that reductions can be achieved at scale (Saint et al., 2016).
The quality improvement reports from single hospitals show large reductions but also show variation by unit (Oman et al., 2012; Parry et al., 2013). The one study of nurses' acceptance is small, but its finding that medical-surgical nurses were less convinced the protocol was needed is directly relevant to this project, because it is a medical-surgical unit (Blodgett & Sheets, 2021).
What the evidence can support: adopting a nurse-driven removal protocol, with confidence that it is likely to reduce catheter days and CAUTI. What it cannot support: a specific expected size of reduction on this unit, since the largest reported effects come from lower-quality studies. The acceptance finding suggests the rollout should include education on why removal matters, not only the protocol itself.
References
Blodgett, T. J., & Sheets, C. (2021). Perceptions of a nurse-driven urinary catheter removal protocol in a hospital setting. Clinical Nurse Specialist, 35(2), 73-79. https://doi.org/10.1097/NUR.0000000000000579
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review. American Journal of Infection Control, 45(12), 1331-1341. https://doi.org/10.1016/j.ajic.2017.07.020
Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2010). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control & Hospital Epidemiology, 31(4), 319-326. https://doi.org/10.1086/651091
Meddings, J., Rogers, M. A. M., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review. BMJ Quality & Safety, 23(4), 277-289. https://doi.org/10.1136/bmjqs-2012-001774
Meddings, J., Rogers, M. A. M., Macy, M., & Saint, S. (2010). Systematic review and meta-analysis: Reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clinical Infectious Diseases, 51(5), 550-560. https://doi.org/10.1086/655133
Oman, K. S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-directed interventions to reduce catheter-associated urinary tract infections. American Journal of Infection Control, 40(6), 548-553. https://doi.org/10.1016/j.ajic.2011.07.018
Parry, M. F., Grant, B., & Sestovic, M. (2013). Successful reduction in catheter-associated urinary tract infections: Focus on nurse-directed catheter removal. American Journal of Infection Control, 41(12), 1178-1181. https://doi.org/10.1016/j.ajic.2013.03.296
Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A. M., Ratz, D., Fowler, K. E., Edson, B. S., Watson, S. R., Meyer-Lucas, B., Masuga, M., Faulkner, K., Gould, C. V., Battles, J., & Fakih, M. G. (2016). A program to prevent catheter-associated urinary tract infection in acute care. The New England Journal of Medicine, 374(22), 2111-2119. https://doi.org/10.1056/NEJMoa1504906
NURS 4106 Week 6 instructions, in plain terms
Week 6 of NURS 4106 commonly asks for an evidence appraisal table supporting a quality improvement intervention. You state the purpose, rate each source by design, sample, findings, level and quality, then state what the set supports. Faculty reward discrimination between sources, so a table without levels reads as an annotated bibliography. Cite each source in APA 7 and name the evidence hierarchy used. Quality improvement reports may be included but should be rated as lower-level evidence. Six to ten sources is common. The synthesis should state an overall recommendation strength. NURS 4106 faculty want each row to carry design, sample, finding, level, quality and relevance. Label the hierarchy used. The synthesis should judge the sources together.
How this NURS 4106 Week 6 example is built
A wide table spanning two pages, followed by about a page and a half of synthesis. Columns hold the full citation, study design, evidence level, quality rating, setting and sample, the key finding in one sentence, and relevance to the project's cause analysis. Levels follow the Johns Hopkins nursing evidence model, from experimental studies and their systematic reviews at the top to expert opinion at the bottom, with each source rated high, good or low for quality. The eight rows include two systematic reviews, three quasi-experimental studies, one guideline, one quality improvement report and one expert opinion piece. Key findings are stated in words, with no percentages the author cannot verify. The synthesis groups findings by intervention type and ends with the recommendation carried into the next stage.
NURS 4106 Week 6 rubric: what earns full marks
Evidence appraisal rows reward discrimination between sources. A table that lists sources with summaries but no level or quality rating reads as an annotated bibliography, and the appraisal rows go unclaimed. The sample's level and quality columns, applied consistently under a named model, answer those rows. Currency is usually its own line, and sources outside the rubric's window cost points individually. Synthesis carries heavy weight: instructors look for a paragraph saying what the body of evidence supports, not a restatement of each row. The relevance column and the recommendation connect the stage to the project, which many rubrics score as alignment. Honesty about limitations is rewarded, and overstating weak evidence is penalized. APA formatting applies to the table itself, including its number, title and note.
Common NURS 4106 Week 6 mistakes, and how to avoid them
Appraisal tables lose credit when they summarize sources without rating level and quality. Rate each one. Another common gap is mixing guidelines, trials and QI reports without distinguishing them. Label the type. Writers also skip the synthesis. Say what the body of evidence supports. Avoid old sources when newer ones exist. Name the hierarchy, such as Johns Hopkins. Connect each source to the protocol. Close with the strength of the overall recommendation. Writers also forget to note conflicting findings between sources. Address them. Another frequent slip is a table too wide to read. Keep cells short. Check that the guideline year is current. Name the protocol's key steps.
Get a NURS 4106 Week 6 example written to your instructions
The appraisal template, the rubric, the intervention topic your project is weighing and any sources already found are what to send. A custom appraisal table comes back in 24-48h, the first one free, rated by the evidence model your course uses and synthesized toward your project's next stage.
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NURS 4106 Week 6 questions, answered
Which evidence hierarchy should the table use?
The one your course specifies. The Johns Hopkins nursing model is common in BSN programs and pairs a level for study design with a quality rating, which suits a table well. Other hierarchies rank designs slightly differently. Consistency matters most: every row should be rated by the same model, and the model should be named and cited in the table note.
Can a quality improvement report count as evidence?
Yes, at a lower level than research, and it is labeled that way. QI reports show what worked in a particular setting, which can be highly relevant to a project even when the design is weaker. The sample includes one and rates it honestly. A table built only from QI reports would struggle on the appraisal rows; one or two among stronger studies adds practical relevance.
What source count does the table carry?
Whatever your prompt sets, and prompts commonly ask for five to ten. The sample uses eight because that number allows two strong reviews, several studies and a guideline without crowding the synthesis. Fewer sources make the synthesis thin; many more tend to produce shallow rows. Quality and relevance count for more than volume in how these tables are scored.
Where can I find a free NURS 4106 Week 6 sample paper?
The CAUTI evidence table is reproduced here with eight sources rated by level and quality and a synthesis on nurse-driven catheter removal.
How many sources does the NURS 4106 Week 6 table rate?
Eight, each with design, sample, finding, Johns Hopkins level and quality rating for a nurse-driven catheter removal protocol.