NURS 6052 Week 4 Sample Paper

A Nurse-Driven Catheter Removal Protocol on a 36-Bed Medical-Surgical Unit: An Evidence Matrix and Critical Appraisal

Student Name

College of Nursing, Walden University

NURS 6052: Essentials of Evidence-Based Practice

Instructor Name

Month Day, Year

What this page is doingThe title names the intervention, the population, and both deliverable genres the paper carries, so a grader reading the title alone knows the scope. It does not restate the assignment as a name, which matters here because Walden does not publish week-by-week deliverable titles and a paper that titles itself after an assignment tells the reader nothing about its own content. The unit is a composite built to carry the analysis, not a scrubbed real case. The block is plain APA 7 student format, no running head.

Practice Question and Search Strategy

The question in this paper comes from a 36-bed adult medical-surgical unit inside a 240-bed community hospital. Over the twelve months ending June 30, the unit recorded 11 catheter-associated urinary tract infections across 2,920 indwelling catheter days, a rate of 3.8 per 1,000 catheter days against a comparable medical-surgical benchmark near 1.4. The device utilization ratio over the same window was 0.25, which means a urinary catheter was in place for one of every four of the unit's 11,680 patient days. Chart review of the 11 events found that 8 involved a catheter left in place beyond 72 hours with no documented indication that still met criteria on the day of the infection.

Stated in PICOT form, the question asks whether, among adult inpatients on a medical-surgical unit with an indwelling urinary catheter, a nurse-driven removal protocol that authorizes discontinuation against standing criteria, compared with removal only on a new physician order, reduces the catheter-associated urinary tract infection rate and mean catheter days over a six-month implementation window. The intervention was chosen because it is modifiable at the level of the unit rather than the level of the system. The two outcomes were chosen because both are already collected under existing surveillance definitions, so a change can be measured without standing up new data work.

The search ran in CINAHL Complete, MEDLINE through PubMed, and the Cochrane Library, using catheter-associated urinary tract infection, indwelling urinary catheter, nurse-driven protocol, and removal reminder as search terms with Boolean operators and truncation. Filters were English language, peer reviewed where applicable, and publication from January 2014 through the search month. The strategy returned 486 records once duplicates were removed, title and abstract screening left 41 for full-text review, and 5 sources were retained. Two agency documents that predate the date filter were kept deliberately, because standing national guidance is not superseded by recency and an appraisal has to say where practice authority actually sits.

What this page is doingThe local rate arrives before the PICOT question on purpose. A practice question with no numbers behind it reads as a topic, and topics do not earn the problem-significance rubric row. Notice that every figure carries its denominator and its window: 11 infections, 2,920 catheter days, twelve months ending June 30. The search paragraph then reports yields at each screening step, which is what turns a claim of a search into a reproducible one, and it defends the two sources kept outside the date filter instead of hoping nobody notices.

The Evidence Matrix in Narrative Form

The matrix carries seven columns for every retained source: citation, purpose, design, sample and setting, findings with the numbers as the authors reported them, limitations, and level of evidence with the tool used to assign it. Columns are filled from the full text rather than from the abstract, because abstracts routinely report an effect without the denominator that makes the effect readable. What follows is that matrix in narrative form. Design is named exactly as each author named it, since the distance between a randomized trial and a prospective collaborative with no control group is the distance between what this body of evidence can and cannot claim.

Meddings et al. (2014) is an integrative review of interventions to reduce unnecessary catheter use, pooling reminder and stop-order studies drawn largely from non-randomized before-and-after work in adult acute care. The pooled estimates are a reduction in infection rate of roughly half and a reduction in catheter duration of about a third, and the authors themselves flag heterogeneity across settings and the publication bias a before-and-after literature invites. Saint et al. (2016) is a national prospective collaborative across 926 units in 603 hospitals, with no concurrent control group. In non-intensive-care units the infection rate fell from 2.28 to 1.54 per 1,000 catheter days; in intensive care units the change was not significant.

The two agency sources sit at a different altitude and do different work. The Healthcare Infection Control Practices Advisory Committee guideline (Gould et al., 2019) is systematically developed guidance whose central recommendations are to insert a catheter only for an accepted indication and to remove it as soon as that indication ends. Its value is in the grading attached to each recommendation, not in an effect size. The Agency for Healthcare Research and Quality (2015) toolkit is an implementation guide built on collaborative experience and expert consensus, which makes it weak as evidence of effect and strong as evidence of feasibility. The fifth retained source, the surveillance manual (Centers for Disease Control and Prevention, 2025), supplies the case definition and the denominator rule that make the unit's 3.8 comparable to anyone else's number.

What this page is doingThis is the matrix without a table, and it still behaves like a matrix because the columns are declared first and then filled in the same order for every source. The paragraph on the two studies keeps the reported numbers attached to the design that produced them, including the detail that one collaborative had no control group. Drafts lose points here by summarizing findings and skipping design, which leaves the appraisal section with nothing to appraise. Naming the surveillance manual as the source of the case definition is what makes the unit's own rate comparable.

Appraisal of Strength, Quality, and Limits

Levels were assigned with the rating system in Melnyk and Fineout-Overholt (2023), and quality was judged on a separate axis, because a high-level source can be conducted badly and a lower-level source can be excellent. Meddings et al. (2014) does not earn the top level on form alone: it is an integrative review whose pooled studies are predominantly non-randomized, so it is rated as a systematic review of non-randomized and descriptive work, quality B for a clear method and an honest limitations section. Saint et al. (2016) is rated as a cohort without a control group, quality A for its size, prespecified measures, and adjusted analysis. The graded guideline is rated as systematically developed guidance, quality A. The implementation toolkit is expert consensus, quality B.

The strongest statement this body supports is associative. Every effect estimate in it comes from a design without a concurrent control: single-unit before-and-after studies, a national collaborative measured against its own baseline, and reviews that pool those designs. Secular trend, concurrent infection prevention work running in the same hospitals, and drift in how surveillance definitions are applied can each move a rate downward with no protocol doing any of the work. Consistency of direction across settings and years is meaningful, and weighing consistency is part of what appraisal is for, but consistency of association is not evidence of cause. Written honestly, the finding is that units adopting nurse-driven removal have generally reported fewer catheter days and lower infection rates, not that the protocol lowers them.

Two gaps decide what happens next. First, none of the retained sources isolates nurse-driven removal from the bundle it usually travels inside, so an effect credited to the protocol may belong to daily indication review, to insertion technique, or to the attention any collaborative brings with it. Second, the intensive care result in Saint et al. (2016) was null, which is direct evidence that this body does not transfer to every unit in a hospital and should not be presented as though it does. Applied to a 36-bed medical-surgical unit sitting at 3.8 infections per 1,000 catheter days, the appraised evidence supports a time-limited trial of the protocol with measurement attached, not an announced projection of how far the rate will fall.

What this page is doingTwo moves earn the appraisal rows. Level and quality are scored on separate axes, and the paper argues down from the obvious level assignment rather than accepting the flattering one, which is the clearest signal a student read the studies. Then it draws the line between association and cause in plain language and names three rival explanations for a falling rate. Ending on what the evidence supports doing next, a measured trial rather than a promised reduction, sets up the recommendation the course asks for later.

References

Agency for Healthcare Research and Quality. (2015). Toolkit for reducing catheter-associated urinary tract infections in hospital units: Implementation guide. https://www.ahrq.gov/hai/cauti-tools/index.html

Centers for Disease Control and Prevention. (2025). Urinary tract infection (catheter-associated urinary tract infection and non-catheter-associated urinary tract infection) events. In National Healthcare Safety Network patient safety component manual. https://www.cdc.gov/nhsn/

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2019). Guideline for prevention of catheter-associated urinary tract infections (2009, updated 2019). Centers for Disease Control and Prevention. https://www.cdc.gov/infection-control/hcp/cauti/

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

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

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. New England Journal of Medicine, 374(22), 2111-2119. https://doi.org/10.1056/NEJMoa1504906

How this NURS 6052 Week 4 example is structured

This NURS 6052 Week 4 example is ordered the way an appraisal has to be argued rather than the way sources happen to be found. The first body section fixes the practice question to a real unit with a rate, a denominator, and a window, then documents the search so a reader can judge whether this is a body of evidence or a convenience sample. The second section is the matrix in narrative form, with each design named exactly as its authors named it. The third does the work most drafts skip: levels and quality assigned separately, then a plain statement of what an associative body cannot support. In many sections of Essentials of Evidence-Based Practice, this week carries a matrix or appraisal assignment for master's students at Walden University; your classroom's rubric decides the exact form.

NURS 6052 Week 4 questions, answered

Does the NURS 6052 Week 4 matrix have to be an actual table?

Many classrooms supply a template with fixed columns, and if yours does, fill that template rather than writing prose. The narrative version above exists to show what belongs inside each cell: design named precisely, sample and setting, findings with denominators, limitations, and level with the tool used. Check the classroom for a template before choosing a format.

How many studies should go in an evidence matrix for this week?

Enough to answer one question, which in practice is usually four to six sources rather than a long list. A defensible search with reported yields and a handful of well-appraised sources scores better than a dozen abstracts skimmed for agreement. Your rubric may set a floor, so read it first and treat that floor as a minimum, not a target.

Can a clinical practice guideline count as one of the appraised sources?

Yes, and it usually should, as long as you appraise it as guidance rather than as a study. Say who developed it, whether recommendations carry grades, and what the grades rest on. A graded national guideline settles what practice authority requires; it does not supply an effect size, and an appraisal that treats it as one will lose points.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official Walden University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

NURS 6052 Week 4: sample paper, in real form