Meddings et al 2014 p 284 these staff members may be

“just not how we were trained.” (Meddings et al., 2014, p. 284). These staff members may be
active resisters for reasons such as feeling reluctant to remove the catheter since it is a doctor
order or perception that patients need catheters for skin protection related to incontinence.
Some staff may even be attempting to avoid the inconvenience of increased patient care due to
incontinence.
Formal education for protocol changes as well as revalidation for practice may be
difficult in some settings if the facility does not have appropriate staff for education, procedures

11
EBP and Applied Nursing Research: Task 2 – Bundles for CAUTI Prevention
for implementing new protocols, or interdisciplinary teams within the hospital to facilitate these
protocols. This lack of resources could be a major barrier to translate the research into change.
F3. Strategies to Barriers
Although barriers to change exist, there are several strategies that can be used to
overcome the barriers to change. In the context of the barrier of “active resisters”, those nurses
who feel reluctant to removal of the catheter would benefit from the initiation of “nurse-
initiated urinary catheter discontinuation” which is part of the Keystone Bladder Bundle
Initiative launched in Michigan hospitals in 2007. (Saint et al., 2013, p. 875). If nurses feel
empowered to remove catheters without a physician order this would be a huge step in the goal
towards CAUTI prevention. To address those resisters that utilize catheters for incontinence or
convenience, there should be education regarding the indications for catheter use. Catheter
reminder or stop orders every shift would have the nurse re-assess the need for the catheter
and remove if necessary. CAUTI champions can act as catheter “patrol” and facilitate the
removal of a catheter if not indicated.
Lack of educational resources and process improvement teams could be a barrier to
translate the research into reality. Encouraging the participation in committees could facilitate
this change and give nurses a sense of autonomy to feel like they have direct contribution to
change. Initiating a CAUTI committee to educate and facilitate the bundle protocols as well as
to do audits and monitor progress is a way to overcome the educational barrier. Having a
volunteer nurse champion will help more easily facilitate the change if a nurse colleague is
providing coaching and rounds on the unit.

12
EBP and Applied Nursing Research: Task 2 – Bundles for CAUTI Prevention
F4. Indicator to Measure Outcome
An indicator to measure the outcome of decreased CAUTIs would be to monitor the rate
of CAUTIs before and after the implementation of the bundle bladder protocols. Devising a
CAUTI “team” and utilizing them to develop a catheter use implementation protocol as
applicable to the setting being used, to educate staff and implement the protocols into place.