The University of Lahore

Lahore School of Nursing

Management in Nursing

Presented by: Saqib

Student: Post RN, BSN (Year-II, Semester-II)

Presented To: Mr. Muhammad Afzal

Date: 26-06-12

“The world hates change, yet it is the only thing that has brought progress.”

Charles Kettering

“However beautiful the strategy, you should occasionally look at the results.”

Winston Churchill

Urinary Catheterization

Objectives

At the end of this session the learners will be able to get worthwhile knowledge about:

Express understanding about the strategic planning.

Develop personal philosophy that will guide the plan.

State the vision and mission.

Formulate long term and short term goal.

Enlist what improvements want to make at work place.

Utilize Change theory as change agent.

Integrate the literature related to the topic.

References .

Strategic Planning

Strategic planning is a tool for organizing the present on the basis of the projections of the desired future. That is, a strategic plan is a road map to lead an organization from where it is now to where it would like to be in five or ten years.

(1) Where are we now? (The Situation)

(2) How did we get there? (Our Momentum)

(3) Where are we going? (The Direction)

(4) Where should we be going? (Desired Direction)

(5) How will we get there? (The Strategic Plan)

Strategic Planning process

Personal philosophy

The nurses have key role to prevent the clients from the hospital acquired infections. E.g. Catheter acquired urinary tract Infections. (CAUTI)

By adopting best practices, nurses can play their role in health promotion and disease prevention.

As a member of health care team, a nurse can identify the CAUTI’s and take measures to deal the situation accordingly.

MISSION & VISION

• Is to help clients by recognizing CAUTI’s, develop strategies, and use their God-given intuitive abilities of nurses to ease sufferings of clients.

•To prove a favorable learning environment that will stimulate the minds of nurses at work place to achieve their full potential to save the clients from CAUTI.

Philosophy

By collaborating with the patients, families, and other health team members to plan and provide nursing care that will achieve an optimal level of health and wellness, and prevent the clients from CAUTI.

• Setting goals to achieve the objectives by directing the efforts of nurses to adopt new standards of care in the catheterized patients.

• Short term goal• Long term goal

Objectives

The nurses at the clinical site will be able to:

Demonstrate relevant anatomy.

Discuss the methods of urinary catheterization and their indications.

Identify catheter-associated complications,

Assess and manage the client with CAUTI’s. Elaborate strategies those home healthcare practitioners can employ to ensure best patient outcomes and minimize complications.

GOALS

Short Term goal

• Nurses will adopt correct techniques for catheter insertion and care to ensue the objectives within one year.

Long Term Goal

• Nurses will get Education and training about catheterized patients and convey it to their caregivers to play an integral role in the practitioner's efforts to ensure best patient outcomes and reduce the complications.

Improvements I want to initiate….

• Nurses have the knowledge about indications of catheterization.

• adopt the sterilize method for indwelling urinary catheter.

• Nurses acquainted about the complications of catheterization.

• Nurses prevent the client from urinary tract infections.• Nurses update the relevant anatomy of Genitourinary

system. • Nurses can identify the risks.• Evidence based practice in clinical area.• Lectures arrange for the clinical nurses.• Update knowledge by holding the seminars, symposiums

and workshops. .

Catheter-related Urinary Tract Infection

Many hospitalized patients require the placement of indwelling urinary catheters for days or even weeks at a time.

Urinary tract infections (UTIs) account for up to 40% of nosocomial infections, with urinary catheter-related infections causing the vast majority of nosocomial UTIs.

Nurses can take measures to reduce the ratio of UTIs by practicing standardize procedures.

LEWIN’S CHANGE THEORY

Unfreezing Stage

Reducing the forces that are striving to maintain the status quo and dismantling the current mindset.

By doing a survey of attitude, it will show the morale of people.

Deliver information regarding the adaptation of new standardize procedures.

Build up a trustful relationship among people.

Change or Transition

This phase can be lengthy and almost certainly will not happen as a matter of few days.

Continual Communication with the health team members, they will feel more involvement and connected with the process.

Address the barriers of negative people, inform them how can we reduce the percentage of UTI by adaption of change.

Be open to negotiate with the team members.

Refreezing

In this last phase, when the team members have adopted the sterilized techniques of catheterization, now need to be sure that improvements are stick.

Celebrate the success as a standard part of change process.

Establish performance and reward system by the collaboration of management to monitor the change consistency.

Train personal where necessary and invite continued involvement in the procedures.

Literature

• Catheter-associated infection is also a problem in long-term care, such as care homes, where elderly residents are catheterized for prolonged periods and are at risk of acquiring recurrent UTI and the subsequent long-term complications associated with the infection. The risk of infection with routine catheterization is 1-2% per procedure. The risk with an indwelling catheter is 5% risk per day accumulating

(Tambyah et al, 2002)

Each hospital-acquired UTI results in an increased length of stay of 5-6 days in hospital and costs £1,327 to treat.

(Plowman et al, 1999).

Patients who have catheters and develop UTIs in primary care settings have greater contact with their GP, visit the hospital more frequently for outpatient appointments and receive more visits from district nurses.

(Plowman et al, 1999)

• The risk of UTI is associated with the method and duration of catheterization, the quality of catheter care and host susceptibility.

(EPIC, 2001)

• The duration of catheterisation is also variable within healthcare settings and is often related to the reason for catheterisation. For example, it can be of short duration (1-7 days) for postoperative patients, intermediate duration (7-30 days) for the measurement of urine output in critically ill patients, or of long duration (more than 30 days) for those patients with complications related to intractable incontinence.

(Glynn et al (1997)

Each silver alloy urinary catheter tray costs about $5.30 more than a standard, non coated urinary catheter tray. However, a recent economic evaluation indicates that when all the clinical and economic costs are accounted for, silver alloy urinary catheters may provide both clinical and economic benefits in patients receiving indwelling catheterization for 2 to 10 days.

(Saint S, Veenstra DL, Sullivan SD, 2000)

References:

Integrating Issues Management Into Association Strategic Planning. Michael T. Pfeiffer,

in A Sharing of Expertise & Experience, 2: 312-320. ASAE, Washington, DC, 1984 Developing a Strategic Marketing Planning and Monitoring System. John R.

McKenzie and Alan R. Shark, in A Sharing of Expertise and Experience, 5: 322-328. ASAE, Washington, DC, 1987. Five Characteristics of Effective Planning in Associations. Glenn H. Tecker, in A Sharing of Expertise and Experience, 5: 269-272. ASAE, Washington, DC, 1987. The Strategic Management Process: as Model for Associations. Paul S. Forbes, in

A Sharing of Expertise and Experience, 6: 278-286. ASAE, Washington, DC, 1987. Hunt, Gillian M., Pippa Oakeshott, and Robert Whitaker. "Intermittent

Catheterization: Simple, Safe, and Effective but Underused." British Medical Journal 312, no. 7023 (Jan. 1996): 103-7.