In the modern health care facilities, different challenges exist and necessitate the establishment of long-lasting solutions. Such remedies will help offset the imbalance caused by the institutionalized problem. A case in point of a health care problem facing many organizations is the Catheter-Associated Urinary Tract Infection (CAUTI). For instance, at Kaiser San Jose Hospital, an organization of choice for this study, CAUTI prevalence rate is at 2.55 per 1000 Foley catheter days in the medical-surgical unit as compared to the national requirement of <1.5 per 1000 Foley catheter days (Keyhani, 2016). The effect of such infection rates to the quality of care provided by this hospital is so devastating and necessitates a quick fix if the current situation is to change for the better. A widely used approach for addressing such institutional issues is the systems theory. In essence, this paper aims at analyzing this issue using the systems way of thinking. Finally, it will propose solutions that an institution with the CAUTI problem might consider in its attempt to better the quality of care. In light of such information, it is beyond question that the medical facilities will have improved patient outcomes.
Systems Theory
In this systems way of thinking, the theorists posit that the world is a system composed of subsystems, which are in a constant interaction of one another. In a health care facility context, the hospital is the system, and its subsystems constitute the input, processes, and output (Ziegler, 2005). As such, the unit that is worth analysis in the Kaiser San Jose hospital, medical-surgical unit, is a subsystem of the hospital system. Similarly, in this unit, there exists inputs, throughputs, output, a cycle of events and negative feedback that make it up as a subsystem and are worth noting.
Inputs
Inputs refer to the processed resources, energy, and raw material to produce outputs for the institution (Meyer, & O’Brien‐Pallas, 2010). In this context, the inputs for the medical-surgical unit include but not limited to the nurse’s effort to inserting, changing and removal of the Foley catheter, time spent in inserting, changing and removal the catheter, and guidelines for catheter insertion.
Throughput
According to Meyer, and O’Brien‐Pallas, (2010) throughput is the processes utilized by a system to convert the input to an output. In this case, the processes constitute assessing for the indication for inserting or removal of the catheter, planning for the insertion or removal of the catheter and teaching the patient on the need for maintaining high hygiene standards.
Output
The expected product or service from a processed input is the output of a system (Meyer, & O’Brien‐Pallas, 2010). A good patient outcome epitomized by being infection free is the output for the medical-surgical unit of Kaiser San Jose hospital.
Cycle of Events
Meyer and O’Brien‐Pallas, (2010) are of the idea that cycle of events means the cumulative/repeated process of exchange and transformation of energy that renews the system. In the medical-surgical unit, the cycle of events is the continual reliance on catheter due to the observed positive results.
Negative Feedback
Negative feedback is the internal information about the system operations and is a counteracting device that seeks to harmonize the used energy with the energy intake (Meyer, & O’Brien‐Pallas, 2010). In this context, the negative feedback would be revisiting of the guidelines of catheter insertion and removal due to increased rates of CAUTI.
Open Systems Approach to a Patient Care Problem
The identified and most common patient care problem for this unit was CAUTI. That is the case given that it accounted for the highest proportion CAUTI among all the units of this hospital. According to Keyhani, (2016) the CAUTI prevalence rate was approximately 2.55 per 1000 Foley catheter days for patients hospitalized in this medical-surgical unit. Central to the comprehensive description of the factors that may have contributed to this patient care related problem is the open systems approach.
Primarily, at the input stage, the nurses at this unit have knowledge deficit on the indication for proper catheter use. Such is the case given that most of the patients with incontinence in this unit regardless of the mobility status are on catheter even without the proper indication of the use of the catheter. Moreover, patients in the medical-surgical units have indwelling catheters for long periods before their removal (Keyhani, 2016). For instance, a surgical patient with improved consciousness 24 hours post-operatively is subject to catheter removal, but in this case, they stay with the catheter for an extended period causing a high risk of developing CAUTI.
Furthermore, this problem is also evident at the throughput stage of this system. That is a fact given that most of these infections were due to the failure of nurses to observe the aseptic technique when inserting, maintaining or removing of the catheter (Keyhani, 2016). For instance, the nurses in this unit rely on soap and water for wiping the catheter on a daily basis instead of using chlorhexidine whose use in other settings has proven to be an effective practice for the prevention of CAUTI (Noto, 2015).
Goals, Outcomes, and Standards
Central to the correction of the current situation are certain goal and objectives that Kaiser San Jose hospital must adopt and translate them into policies or procedures. Primarily, the desired outcome is that patients admitted to the medical-surgical unit at Kaiser San Jose hospital will demonstrate good health free from CAUTI after the hospital stay.
Of the essence to the achievement of this outcome is the overall goal of reducing the incidence of CAUTI in the medical-surgical unit of Kaiser San Jose hospital. The specific objectives are that nurses in the medical-surgical unit will: demonstrate good utilization of catheter, and illustrate good maintenance practice of the catheter.
In the translation of the identified goals and objectives as policies and procedure, one of the policies of Kaiser San Jose Hospital will be to bathe all patients with indwelling catheters daily using chlorhexidine solution. Such a practice is of the essence in the proper maintenance of catheters since it has shown to reduce the incidence of CAUTI significantly in other settings (Noto, 2015). Another policy would be the early removal of catheters (24 hours post-operative) for patients that have regained consciousness. Such a policy will reduce the time that an individual has an indwelling catheter, which is a predisposing factor for developing CAUTI (Keyhani, 2016). Abiding with the aseptic techniques is also a procedure that emanates from the proposed goal and objectives.
Finally, professional standards that support these recommendations exist and are worth mention. A case in point is the professional standard that directs nurses to promote a safe environment for the patient (American Nurses Association, 2015). By putting the recommendations into practice, a nurse would have met this standard given that he/she would have sought to make the hospital an environment that is safe for the patient. Clearly, this is proof enough to suggest that the recommendations are in line with nurse’s professional standards.
Alignment with Mission, Vision, and Values
The mission of Kaiser San Jose Hospital is to improve the health of our members and the community members we serve. On the contrary, its vision is to become a consistent provider of high quality and evidence-based care. Lastly, its core values include quality, patient-centeredness, and equity. The proposed solutions envision the mission, vision, and value of the Kaiser San Jose Hospital (Cushing, 2013). That is the case given that institutionalizing these recommendations will ensure that San Jose Kaiser does not come short of improving the health of its recipients by causing CAUTI. Additionally, it will ensure that San Jose Kaiser remains on course in achieving its vision and core values. Evidently, this is proof enough for the commitment of the recommendations to uphold the mission, vision, and values of the Kaiser San Jose Hospital.
Summary
Concisely, this discussion aimed at analyzing a common health care problem within a health care setting using the systems approach. Also, it targeted at establishing strategies that will help solve the identified issue. Indeed, from the analysis, it is clear that CAUTI is the biggest health care challenge for most medical facilities. That is the case given that it has a prevalence rate of 2.55 per 1000 Foley catheter days for patients hospitalized in this medical-surgical unit in San Jose Kaiser. The highlighted remedies for this medical problem include but not limited to aseptic techniques and early removal of catheters. That said, it is apparent that the systems theory is a vital and effective tool that medical institutions must rely upon in their resolution of problems that are affecting them. As such, the implication drawn from this analysis is that going forward, health care institutions have an obligation of utilizing such an approach if they are to attain better outcomes. In the absence of such, however, resolution of hospitals’ problems will remain to be uneventful.
References
American Nurses Association. (2015). Nursing: Scope and standards of practice.
Cushing, L. (2013). Henry Kaiser set bar for sharing innovations with public. Kaiserpermanentehistory.org. Retrieved 12 March 2017, from http://kaiserpermanentehistory.org/tag/quality-of-care/
Keyhani, M. (2016). Implementing ways to reduce Catheter-associated Urinary Infections (CAUTIs).
Meyer, R. M., & O’Brien‐Pallas, L. L. (2010). Nursing services delivery theory: an open system approach. Journal of advanced nursing, 66(12), 2828-2838.
Noto, M. J., Domenico, H. J., Byrne, D. W., Talbot, T., Rice, T. W., Bernard, G. R., & Wheeler, A. P. (2015). Chlorhexidine bathing and health care–associated infections: a randomized clinical trial. Jama, 313(4), 369-378.
Ziegler, S. M. (2005). Theory-directed nursing practice. New York: Springer Pub. Co.
