NURS 6052 Week 6 Sample Paper

From Appraised Evidence to Practice Change: A Nurse-Driven Urinary Catheter Removal Protocol for a 36-Bed Medical-Surgical Unit

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 announces the move, which is translation, and then names the protocol and the setting. A translation paper titled after the evidence it reviewed reads as a second appraisal and loses the recommendation rubric row before the first page. Nothing here claims an official assignment name, since Walden does not publish week-by-week deliverable titles, and the unit is a composite built to carry the plan. Standard APA 7 student title block, no running head, affiliation on its own line.

The Recommendation and the Evidence It Rests On

This paper recommends that a 36-bed adult medical-surgical unit adopt a nurse-driven urinary catheter removal protocol as a six-month pilot, with removal authorized against standing criteria and without a new patient-specific order. The problem has not changed since the appraisal that produced the recommendation. 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-unit benchmark near 1.4, and 8 of those 11 catheters had been in place beyond 72 hours with no indication that still met criteria. The gap is not knowledge of when a catheter should come out. The gap is who is permitted to take one out.

The appraised evidence supports this recommendation at the level of association, and the recommendation is written to match. Meddings et al. (2014) reports pooled reductions in infection rate and catheter duration drawn from a literature built mostly on before-and-after designs. Saint et al. (2016) reports a fall from 2.28 to 1.54 per 1,000 catheter days in the non-intensive-care units of a national collaborative that had no concurrent control group and found no significant change in intensive care. Those are consistent findings across settings, not demonstrations of cause. The Iowa Model Collaborative (2017) supplies the decision structure that fits evidence of this strength: pilot the practice change, then ask whether it is appropriate for adoption, rather than writing permanent policy off a promising body.

Two conditions have to hold before a nurse removes a catheter without an order. The protocol has to be approved as a standing order set by the medical executive committee and by nursing administration, and delegated removal has to be permitted by the board of nursing that licenses the unit's staff, since that authority is defined at state level rather than nationally. Both conditions are procedural rather than clinical, and both are where a protocol like this usually stalls. The clinical content is not in dispute: national guidance already directs that catheters be placed only for accepted indications and removed as soon as the indication ends (Gould et al., 2019). The protocol converts standing guidance into an action someone at the bedside is allowed to take.

What this page is doingThe recommendation is the first sentence of the paper. Drafts that build to a recommendation on the last page leave graders hunting for it, and a rubric row that asks for a clear practice recommendation rewards the paper that states one immediately. The evidence paragraph then does something unusual and worth copying: it matches the strength of the claim to the strength of the designs, and it uses the change model to justify a pilot rather than a policy. The authority paragraph names the approval that a nurse-driven protocol actually requires.

Implementation Plan: Criteria, Owners, and Dates

The protocol keeps a catheter in place only while one of five conditions is documented: acute urinary retention or obstruction, need for accurate output measurement in a critically ill patient, selected perioperative use inside the surgeon's stated window, an open sacral or perineal wound in an incontinent patient, and comfort at end of life (Gould et al., 2019). A registered nurse reviews the indication once per shift inside the safety huddle that already happens. When no condition on the list is documented, the nurse removes the catheter within that shift and records the removal time and the first void or bladder scan result. Anything outside the list, including a request to keep a catheter for convenience, requires a patient-specific order entered by the ordering clinician.

Ownership is assigned by named role rather than by committee. Weeks 1 and 2 belong to the unit practice council chair, who carries the protocol through the medical executive committee and nursing administration for standing-order approval. Week 3 belongs to the clinical nurse educator: thirty minutes of education for all 36 unit nurses, delivered in four sessions across day and night shifts, with teach-back on the indication list and on bladder scanning after removal. Week 4 is go-live, with the nurse manager and two charge nurses as the daily point of contact. Months 2 through 6 belong to the quality nurse, who audits 20 charts a week and reports monthly. Month 6 is the adoption decision, not a celebration.

The resource line is small and should be stated anyway, because a plan with no cost attached reads as a wish. Education costs 36 nurses at half an hour of replacement time, roughly 18 hours in total; the audit costs about four hours of quality nurse time per month; the bladder scanner and the electronic record fields already exist and need no purchase. The predictable barrier is not equipment. The implementation toolkit reports that removal protocols fail on clinician resistance and on nurse reluctance to exercise delegated authority far more often than on technique (Agency for Healthcare Research and Quality, 2015). Rogers (2003) is the reason two respected staff nurses are recruited as early adopters and asked to model the first removals in front of their peers.

What this page is doingA plan earns points when someone could execute it. Five documented indications come straight from national guidance with the citation attached, so the criteria are not one student's opinion. Every action carries a role and a week, which is what separates a plan from a wish list, and the cost line appears even though it is small. The last paragraph names the barrier the implementation literature actually reports, clinician resistance rather than equipment, and answers it with early adopters instead of with more education.

Measurement and Dissemination

Three outcome measures carry baselines from the same twelve-month window, so that every later number has something to sit against. The infection rate starts at 3.8 per 1,000 catheter days, calculated from 11 events over 2,920 catheter days under the surveillance case definition already in use. The device utilization ratio starts at 0.25, or 2,920 catheter days over 11,680 patient days. Mean catheter duration starts at 4.1 days per catheterized patient. The pilot aim is a rate at or below 2.0 per 1,000 catheter days by month six, and that figure is a local target chosen to make progress visible, not an effect size borrowed from a study that ran somewhere else.

Two process measures and one balancing measure keep the pilot honest. The first process measure is the proportion of catheter days carrying a documented indication that still meets criteria, audited on 20 charts per week and reported monthly. The second is the proportion of catheters removed within one shift of the indication ending. The balancing measure is unplanned recatheterization within 24 hours of a nurse-driven removal, reported per 100 removals, because a protocol that trades infections for retention and reinsertion has moved harm rather than removed it. All three are plotted as change over time on a run chart. The pilot has no control unit, so a fall in the rate is a result to interpret, not an effect to claim.

Dissemination is planned as part of the work rather than as an afterthought, because a practice change that stays inside one unit's binder changes nothing outside it. Internally, monthly run charts are posted in the unit break room and reviewed in the practice council, the quality nurse presents to the nursing quality and safety committee at months three and six, and a one-page criteria card sits at every supply station. Externally, month-six results go to the hospital's evidence-based practice day as a poster and to the infection prevention committee as a written summary with the limitations stated in it. The Iowa Model Collaborative (2017) makes dissemination a numbered step for this reason, and the adoption decision depends on what that reporting shows.

What this page is doingEvery measure here carries a numerator, a denominator, a data source, a reporting frequency, and a baseline from a stated window. The balancing measure is the row most drafts miss: without it, a paper cannot tell improvement from displaced harm. The paragraph then refuses to claim causation from a pre-post pilot with no control unit, which reads as confidence rather than weakness. Dissemination closes the paper with audiences, formats, and dates, because unreported work is indistinguishable from work never done.

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

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/

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

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

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.

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 6 example is structured

This NURS 6052 Week 6 example picks up the same clinical question an evidence matrix answered earlier in the term and does the one thing an appraisal by itself never does, which is commit. The first body section states the recommendation in its opening sentence, then shows the evidence it rests on and the authority a nurse needs before removing a catheter without an order. The second section is the protocol itself: five documented indications, a named role against every action, and a cost line. The third attaches measures with baselines and denominators, adds a balancing measure, and plans dissemination as part of the work. In many sections of Essentials of Evidence-Based Practice at Walden University, this week asks master's students for a translation piece of this kind; your classroom's rubric decides the exact form.

NURS 6052 Week 6 questions, answered

How is the NURS 6052 Week 6 paper different from the evidence matrix earlier in the term?

The matrix judges evidence; this one spends it. Same clinical question, different job: a stated recommendation, a protocol someone could follow on Monday, measures with baselines, and a plan for telling people what happened. If your classroom pairs the two weeks, reuse the appraised sources rather than searching again, and cite them the same way.

Do I have to name a change model in a practice recommendation?

Most rubrics award points for one, and the model earns its place only if the paper visibly uses it. Naming the Iowa Model and then ignoring its pilot-and-decide step is decoration. Use the model to justify the size of the commitment: a pilot with a decision point when evidence is associative, a fuller rollout when it is not.

How specific do the outcome measures need to be?

Specific enough that a stranger could calculate them. Each measure needs a numerator, a denominator, the data source, how often it is reported, and a baseline from a named window. Add one balancing measure so the paper can distinguish real improvement from harm that moved somewhere else, and label any target you set as a local aim rather than a projection.

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 6: sample paper, in real form