Using institutional ethnography to understand how the ruling text organizes nursing performance related to catheter-associated urinary tract infections in the intensive care unit
- UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
- Robert L. Slaughter III (Creator)
- Institution
- The University of North Carolina at Greensboro (UNCG )
- Web Site: http://library.uncg.edu/
- Advisor
- Susan Letvak
Abstract: Introduction/Background: Catheter-Associated Urinary Tract Infection (CAUTI) is a healthcare associated infection that is associated with the placement of an indwelling urinary catheter. In the recent past, CAUTI and other HAIs have come under intense scrutiny since reimbursement policies were changed so health care organizations are not reimbursed for care associated with CAUTI or other HAIs. The participating health system has been able to reduce their number of CAUTI cases but unable reach the goal of zero CAUTIs. Methods: Institutional ethnography was the conceptual framework and methodology for this research. Field observations, interviews, and focus groups were employed in this research to understand how the ruling text of the health system organizes nursing practice related to CAUTI in these two intensive care units. A total of five field observations, 10 interviews, and two focus groups were conducted. Interviews and focus groups were recorded verbatim then transcribed. Analysis: Transcripts were coded and analyzed using thematic analysis. Three major themes were identified: Nursing Health Education and Training Varies, Foley Catheter Care Ruling Text and Realities of Care, and Complex and Dynamic Work Area and Environment of Care. Findings: Analysis of the focus group interviews revealed that although CAUTI nursing leaders had implemented CAUTI best practices, they acknowledged gaps in training and competency. Field observations were used to build a process map for nursing care observed. The care observed was consistent with the ruling text. The ruling text of the health care system organizes nursing practice related to CAUTI in the ICU setting but did not guarantee consistent behavior or performance. Nursing team members observed providing care did so in alignment with the ruling text. While nursing team members interviewed could speak with alignment to ruling text, they also reported instances where they observed nursing team members providing care that deviated from the ruling text. Nursing documentation in the EHR may result in hidden text and hidden care that potentially makes determining CAUTI root causes more difficult. The nursing team are aware of policies and procedures but not aware of the term ruling text and the potential implications of the ruling text. The ruling text allows for gaps in training, performance, and competency that need to be addressed in order to close care gaps related to CAUTI. Conclusions: The ruling text of the health system organizes nursing practice related to CAUTI in the ICU setting of the healthcare organization. The use of institutional ethnography in this study demonstrates its potential as an innovative conceptual framework and methodology for future nursing research.
Using institutional ethnography to understand how the ruling text organizes nursing performance related to catheter-associated urinary tract infections in the intensive care unit
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Created on 8/1/2021
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Additional Information
- Publication
- Dissertation
- Language: English
- Date: 2021
- Keywords
- CAUTI, HAI, Institutional Ethnography, Intensive Care, Nursing, Qualitative
- Subjects
- Urinary tract infections
- Urinary catheterization
- Intensive care nursing
- Hospital care