Capella FPX 4025 Assessment 2

Capella FPX 4025 Assessment 2

Student Name

Capella University

NURS-FPX4025 Research and Evidence-Based Decision Making

Prof. Name:

Date

Applying an EBP Model

Older adults often do not drink enough water, which can lead to urinary tract infections (UTIs). This happens because they might not feel thirsty or may have trouble remembering to drink (Bruno et al., 2021). Nurses can miss early signs, so UTIs get worse. This project used the Iowa Model to find ways to help nurses watch for dehydration and keep patients well hydrated. The goal was to see if a simple hydration program could lower the number of UTIs in older patients. The team tested fluid checks and nurse-led care to help prevent infections and improve patient health.

EBP-Relevant Issue Associated with UTI Secondary to Dehydration

An issue commonly associated with UTIs secondary to dehydration is delayed recognition and management of hydration status in older adults, which contributes to recurrent infections and increased hospitalization rates. In 2019, UTIs caused around 236,790 deaths worldwide. This was a significant increase of about 140% compared to 1990 when there were roughly 98,590 deaths (Yang et al., 2022). Older adults often experience diminished thirst perception and can suffer from cognitive impairments, making it challenging for them to maintain adequate fluid intake.

Nurses overlook early signs of dehydration or urinary tract infection due to subtle symptom presentation in this population (Tan et al., 2025). Timely assessment and prevention of dehydration is a crucial concern that could be effectively addressed through an Evidence-Based Practice (EBP) approach. Implementing a standardized hydration protocol in at-risk populations, especially in long-term care settings or acute medical units, can enhance early identification and reduce UTI incidence. Evidence suggests that improving oral fluid intake and hydration monitoring, along with nurse-led interventions such as scheduled voiding and fluid rounds, can decrease UTI frequency.

An EBP approach would help determine the most effective interventions for preventing UTIs related to dehydration and tailor strategies to specific populations. The use of an EBP model provides a structured method to identify relevant interventions, assess outcomes, and guide nursing practice (Dusin et al., 2023). Addressing this issue not only improves patient safety and comfort but also reduces costs associated with hospital admissions, antibiotic use, and complications such as urosepsis. By focusing on the relationship between hydration and infection control, nurses can advocate for system-level improvements in patient care. 

Selected EBP Model and UTIs

The Iowa Model of Evidence-Based Practice is well-suited to address the issue of UTIs secondary to dehydration. This model emphasizes problem identification, interdisciplinary collaboration, piloting changes, and evaluating outcomes. It supports using both research and professional experience, promoting sustainable practice change within healthcare systems. Firstly, the Iowa Model begins by noticing a problem that needs fixing or realizing there is something new to learn (Cullen et al., 2022). In this case, recurrent UTIs in older adults due to dehydration show a trigger that points to a specific problem.

Secondly, once the trigger is identified, a team evaluates the issue’s relevance to organizational priorities. Given that hospital-acquired infections and preventable readmissions are key concerns for most institutions, this issue aligns well with strategic goals. Thirdly, a team of stakeholders, including nurses, dietitians, physicians, and infection prevention staff, is formed to examine and synthesize current research on hydration protocols and UTI prevention. Fourthly, if sufficient evidence supports the intervention, a pilot test is implemented. For example, this could involve introducing a structured hydration program with daily fluid intake monitoring and staff education (Duff et al., 2021). Fifthly, outcomes such as UTI incidence, hydration status, and patient satisfaction are measured to see how well the intervention worked.

Sixthly, based on the results, the team refines the process and disseminates findings across units. Finally, the strength of the Iowa Model lies in its cyclical nature and focus on organizational applicability, making it ideal for translating research into practice for common and preventable diagnoses like UTIs. By following this model, nurses can lead systematic change efforts that enhance patient outcomes, reduce healthcare costs, and improve care quality. According to Cullen et al., (2022), the Iowa Model is appropriate for addressing UTIs because it emphasizes evidence-based, collaborative approaches to solving common clinical problems. The model also supports the implementation of preventive strategies like hydration protocols across healthcare settings.

Application of Iowa Model Steps and Resource Identification

The Iowa Model was applied which helped in identifying the high incidence of UTIs linked to dehydration in older adults in my medical-surgical unit. As this was a problem-focused trigger, it justified an EBP inquiry. A small interdisciplinary team was gathered including a nurse educator, a dietitian, and a quality improvement specialist. Together, we formulated a clinical question: “In (P) hospitalized elderly patients, does (I) implementing a structured hydration program, compared to (C) standard care, reduce the (O) incidence of UTIs (T) during hospitalization?” A literature search was then conducted using databases such as PubMed, CINAHL, and Cochrane Library, focusing on studies from the last five years. After selecting three resources, we critically appraised the evidence and designed a pilot intervention involving daily hydration monitoring and fluid rounds every two hours.

Staff should receive education on recognizing early signs of dehydration in order to deal with patients with UTIs (Dusin et al., 2023). Evaluation metrics included daily fluid intake logs, incidence of UTIs, and nursing staff compliance. Based on positive pilot results, we expanded the protocol to all high-risk patients on the unit. One challenge in applying the Iowa Model was navigating the initial evidence search, as limited high-quality studies specifically addressed structured hydration programs for preventing UTIs in hospitalized older adults. Additionally, subtle symptom presentation and varying hydration needs in this population made it difficult to define standardized intervention criteria. 

Analysis of Resource Credibility and Relevance

All three selected articles meet the CRAAP criteria (Currency, Relevance, Authority, Accuracy, and Purpose). Li et al. (2023) is a current and relevant source, published within the last five years in the peer-reviewed Nutrients journal, part of the National Library of Medicine. The authors possess academic and clinical expertise in gerontological nursing, making the source credible and authoritative. This article will help answer the PICOT question by providing hydration strategies tailored for older adults, a population highly susceptible to UTIs due to dehydration. Its focus on preventive hydration methods aligns closely with the diagnosis and management of UTIs in acute care settings, making it well-suited to address the issue in vulnerable older adult populations.

Bruno et al. (2021) conducted a nurse-led intervention study, also published in the Nutrients journal, indicating both high currency and credibility. The study demonstrated effective outcomes from hydration-focused nursing interventions that significantly reduced dehydration-related complications, including UTIs. This article supports the PICOT question by providing direct evidence of how proactive nursing care can lower UTI incidence in populations similar to those found in many hospital units. The relevance lies in its practical application to nursing protocols and its alignment with standard care objectives. Its credibility and direct applicability to real-world clinical settings make it an excellent resource for addressing UTIs in practice.

Saade et al. (2024) present a recent quality improvement initiative published in Antimicrobial Stewardship & Healthcare Epidemiology, a respected journal in the field. The study meets the CRAAP criteria through its focus on current best practices, detailed methodology, and professional authorship. Although centered on catheter-associated UTIs, the structured, nurse-driven prevention strategies are adaptable to non-catheterized patients, offering transferable insights for broader UTI prevention. This article contributes to answering the PICOT question by highlighting how standardized nursing protocols reduce infection rates. Its credibility and emphasis on evidence-based, sustainable changes in nursing practice make it highly suitable for addressing UTIs within healthcare environments.

Conclusion

Helping older adults stay well hydrated can lower their risk of getting UTIs. Nurses play a big role in watching for early signs of dehydration. Using an easy plan, like checking fluids and reminding patients to drink, really helps. The Iowa Model gave us clear steps to follow. With small changes, we can make a big difference in patient care. 

References

Bruno, C., Collier, A., Holyday, M., & Lambert, K. (2021). Interventions to improve hydration in older adults: A systematic review and meta-analysis. Nutrients, 13(10), 3640. https://doi.org/10.3390/nu13103640 

Cullen, L., Hanrahan, K., Edmonds, S. W., Reisinger, H. S., & Wagner, M. (2022). Iowa implementation for sustainability framework. Implementation Science, 17(1), 1–20. https://doi.org/10.1186/s13012-021-01157-5 

Capella FPX 4025 Assessment 2

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2021). Determinants of an evidence-based practice environment: An interpretive description. Implementation Science Communications, 1(1), 1–9. https://doi.org/10.1186/s43058-020-00070-0 

Dusin, J., Melanson, A., & Lawson, L. M. (2023). Evidence-based practice models and frameworks in the healthcare setting: A scoping review. British Medical Journal Open, 13(5), e071188. https://doi.org/10.1136/bmjopen-2022-071188 

Li, S., Xiao, X., & Zhang, X. (2023). Hydration status in older adults: Current knowledge and future challenges. Nutrients, 15(11), 1–15. https://doi.org/10.3390/nu15112609 

Saade, E. A., Thatcher, E. J., Lewis, T., Carr, S., Cornell, M., Arnold, R., Albar, Z., & Pronovost, P. (2024). Reducing catheter-associated urinary tract infections in a large health system: A quality improvement approach using a fractal management system. Antimicrobial Stewardship & Healthcare Epidemiology, 4(1). https://doi.org/10.1017/ash.2024.386 

Tan, S. L. L., Manickam, A., Abdullah, N., Chai, W. F., Subramaniam, S. G. E., Yuan, L. X., Ng, M. K. C., & Ng, R. Q. M. (2025). Improving hydration among hospitalized older adults in an acute geriatric ward with a bundled multi-component intervention. British Medical Journal Open Quality, 14(2), e002805. https://doi.org/10.1136/bmjoq-2024-002805 

Capella FPX 4025 Assessment 2

Yang, X., Chen, H., Zheng, Y., Qu, S., Wang, H., & Yi, F. (2022). Disease burden and long-term trends of urinary tract infections: A worldwide report. Frontiers in Public Health, 10(888205). https://doi.org/10.3389/fpubh.2022.888205