Two-nurse Approach vs a One-nurse Approach

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two nurse approach

A growing number of patients require catheter insertion, which can result in urinary tract infections. Nurses should be competent and aware of the potential consequences of a negligent attitude to urinary catheter insertion to ensure the quality and accuracy of the procedure and prevent catheter-associated urinary tract infections (CAUTI). Therefore, the purpose of the given paper is to explore based on the literature review how in patients requiring urinary catheter insertion (P), a two-nurse approach (I) versus a one-nurse approach (C) affects the rate of catheter-associated urinary tract infections (CAUTI) (O). It is assumed that the two-nurse approach is more effective than the one-nurse approach because in reduces the rate of CAUTI.

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Synthesis of Articles

The analyzed articles focus on the analysis of the educational and teaching opportunities for growth. To begin with, the article by Pashnik, Creta and Alberi (2017) demonstrates that competency validation and peer-to-peer teaching is an effective method for nurses to be more engaged in quality improvement. The authors proved that “the CAUTI prevention bundle compliance improved from 79.6 % (2015) to 88 % (2016), a 9.9 % improvement” (Pashnik et al., 2017, p. 328). Hence, staff nurse auditors were more involved in the training and assisting nurses to improve daily safety routine. Finally, the post-education analysis involved the perception of the enhanced ability to identify the relevance of the bundle and catheter compliance variance.

The findings of the article by Parker et al. (2017) could improve patient safety through the assessment of practice change and clinical practice. The development of baseline information can also establish a firm ground for ensuring the constant improvement of best practices. The study can gives evidence of how better understanding of the intervention can lead to the reduction of the CAUTI rates. Through the adoption of the Template for Intervention Description and Replication (TIDieR) framework, the assessment of the implementation strategies has been highlighted to contribute to the greater replication of the implementation and intervention strategies. The utilization of the mixed-method approach can also establish a base for the thorough assessment of the current barriers in regards to the implementation of the practice change.

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In the article by Alexaitis and Broome (2014), the major emphasis was placed on the purpose of decreasing catheter-associated urinary tract infections through the use of a nurse-driven protocol. In the study, simulation and didactic testing was introduced to assess knowledge acquisition. Didactic tests emphasized the principles of bladder ultrasound and the protocol, whereas simulation testing was used for improving the competency in conducting bladder ultrasound procedures. It has been found that the proficiency of nursing staff in the procedure was significantly high. In terms of compliance monitoring, the scholars assume that overall compliance with the protocol increased from 86 % till 90 % in the course of the assessment process. Compliance with the documentation of processing of catheters also advanced from 89.3% to 98%. Daily control and weakly response of findings were successful in advancing documentation and protocol. Hence, the nurse-based protocol for urinary catheter management was successful, which also contributed to the improvement of the patient outcomes.

Finally, the results of the study by Giles et al. (2015) revealed that innovation can also advance the prevention mechanisms for catheter-related urinary tract infections. In the study, 178 patients presented with indwelling urinary catheters (IUC) in situ in the course of their admission to the two study wards. Nearly 31% of the patients received IUC. The major admission diagnosis involved femur of hip fracture and prostatic hyperplasia requiring surgery. Most importantly, it was assumed that the educational opportunities should embrace staff educational programs and specific feedback systems which can promote greater access to the health network.

Appraisal of Evidence

The articles under analysis focused on the mixed-method methodology that combines interventions and literature review. However, there are still specific differences between them. Thus, Pashnik et al. (2017) engaged nurses in the project to validate the competency and value of nursing care. The project also promoted the analysis of the educational dimension. Parker et al. (2017) used the pre-post control intervention design along with the phased mixed method to control the two Health Districts. Alexaitis and Broome (2014) resorted to the review of literature on the best evidence for effective urinary catheter management and prevention of CAUTI. The quality improvement (QI) project was carried in the neurosurgical intensive care unit containing 30 beds for adult patients. 183 patients were included into the sample along with 107 registered nurses. Using QI methodology, the scholars focused on the problem. Additionally, QI plans involved a nurse-driven protocol for urinary catheter management to reduce the threat of infection. Similarly, Giles et al. (2015) used the pre and post intervention study aimed at progressing in three stages of urology and orthopaedic wards of a tertiary facility. The first phase included collection of clinical data for pre-intervention of patients who received indwelling urinary catheters. The second stage involved the adoption and implementation, whereas phase three relied on the assessment of the primary outcomes and barriers to the use of IUC.

Giles et al. (2015) revealed that a standardized and consistent approach to the IUC care for inpatients and use of bundle care interventions can significantly decrease the use of IUC, which can also pave the road for nurse initiatives to remove the urinary catheter and reduce the consequent infections. Further, Alexaitis and Broome (2014) found that protocol implementation contributes to the reduction of the CAUTI rate along with the cost for supplies and medications. The other two studies were more focused on the analysis of the theoretical values supported by the comprehensive literature review.

The research methodology of each article differs significantly, but all of them include some numerical data that has been introduced either empirically or from observational research. Nonetheless, the research designs of the articles are sound enough to provide new knowledge for understanding the corresponding practical changes which can assist a specific campaign for management. The given findings do not provide direct support of the PICO question because they focus on the educational opportunities for nurses’ improvement rather than on the number of nurses involved in the treatment process.

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First of all, all of the articles focus on the educational dimension and introduction of practical changes in the nursing environment. Second, the research studies also provide some theoretical perspectives and discuss the role of innovation and interventions in advancing the quality of procedures and catheter management. However, some of the studies have been more consistent in explaining the PICO question. For instance, Giles et al. (2015) insist on the need of introducing innovative methods for treatment and the use of nurse-led protocols for control and proper management of CAUTI.

Organizational Process

There should be a guideline for nurses to expand their knowledge on catheter management procedures. In addition, new protocols as an intervention for nurses should be introduced to develop a network of physicians and nurses and enhance the quality of control of urinary catheter management at hospitals. Such an approach can integrate changes at all levels of hospital management, starting from nurses’ education and practice and ending with the overall quality and image of the hospital.

Educational Approaches

Two educational approaches should be introduced to implement the proposed change into nursing practice. The first one is a training program for nursing staff, which a nurse-driven educational approach. The second one is an educational program for patients suffering from urinary-related disorders, which can also simplify the process for nurses to deal with the patients. These initiatives can also simplify the communication process and improve the quality of nursing practice. As such, the introduction of online protocols with the cloud network can be the best option. The second educational approach should involve the management of the electronic methods and the use of new catheters.

Improvement of the Delivery of Care

As soon as the protocols are introduced, the delivery of care can be improved through better control of the urinary infections management, earlier detection of the problem and better communication skills among nurses. As a result of the improvements, the patient care and security will be increased because of the better access to new methods and technology.


With regard to the above-presented PICO question, it can be assumed that the two-nurse approach could become a much more effective method of coping with CAUTI because it can strengthen the communication network and increase the accuracy of handling the disorders. The guidelines in the form of the new electronic protocol for nurses should be introduced to regulate CAUTI rates. Additionally, a training program for nurses should be introduced, which should involve theoretical information and practical assignments. The patient’s training is essential as well to improve communication.

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