Best, best

Identifyand discuss the following:

· what is known/not known about the topic and the gap in knowledge the study is intended to fill.

· the research design, purpose of the study, and setting.

· information about the sample:

 

· method;

· size;

· inclusion/exclusion criteria,

· attrition/loss to follow up/response rate, if any;

· important characteristics of the sample

· Another question:

Viner and Gautam (2020) relied on anecdotal data about the population of the study. The study participants selected for the study were all the nursing staff in the two long-term care facilities selected as the setting for the study. Anecdotal data stated that there were potential 40 respondents but data was collected from 21 nurses who responded to the questionnaires issued. The response rate was 52.5 percent. The sampling method and the inclusion-exclusion criteria were inadequate to reduce sampling bias because the researchers used a convenience sample that included only the nursing staff who were direct care providers. There was selection bias since the sample was not randomly selected.

The sample was not representative of the target population. First, because of its size. The sample was small; thus, the findings cannot be generalized. Second, the researchers did not state the demographics of the study population, and they did not state the number of nurses who were full-time, part-time, or per diem employed. This means the characteristics of the sample could not be compared to that of the target population.

There was a decline in sample size because the researchers targeted 40 participants as indicated in the anecdotal data, but only 21 completed the study activities. The researchers identified the decrease late as they were compiling the data sets; thus, they did not make any attempts to reduce the decline. However, the decrease was not adequately explained by the researchers.

The sampling procedure is commonly use in nursing research, where researchers target a specific nursing unit. My problem is on the identification of the participant characteristics which is important for making comparisons between the sample and the target population. The sample was not representative of the population; thus, the findings derived from the sample cannot be generalized. As a result, I do not have confidence in drawing inferences to the target population.

 

Reference

Viner, S., & Gautam, R. (2020). Urinary tract infection knowledge of long-term care nursing staff: The effect of an educational intervention. Urologic Nursing, 40(1), 7-10, 21. https://doi.org/10.7257/1053-816X.2020.40.1.7

I need a response for this:

Nice start!  You stated, “Second, the researchers did not state the demographics of the study population.”  Is this true?  There might have been some information not collected, but was no demographic data at all provided? 

Also, “The sampling method and the inclusion-exclusion criteria were inadequate to reduce sampling bias because the researchers used a convenience sample that included only the nursing staff who were direct care providers. There was selection bias since the sample was not randomly selected.”  Interested to see your peers’ responses on this.

UROLOGIC NURSING / January-February 2020 / Volume 40 Number 1 7

Urinary

Sophia Viner, DNP, ANP-BC, is an Adult Nurse Practitioner, and a
DNP Student, the University of Massachusetts Lowell, Lowell, MA.

Ramraj Gautam, PhD, is an Associate Teaching Professor,
University of Massachusetts Lowell, Lowell, MA.

Urinary Tract Infection Knowledge of Long-Term Care
Nursing Staff: The Effect of an Educational
Intervention

Sophia Viner, DNP, ANP-BC; and Ramraj Gautam, PhD

Data from the Centers for Disease Control and
Prevention (CDC) (2018) identify the urinary system
as the most common site of health care-associated
infections among residents of long-term care facili-
ties. Urinary tract infection (UTI) is the second most
common infection among residents of long-term
care facilities (Genao & Buhr, 2012). Results from a
retrospective review using national emergency
department (ED) data by Caterino and associates
(2012) determined that roughly 5,000,000 ED visits
among those aged 65 years and over were for UTI
diagnosis and treatment. Communication barriers,
chronic genitourinary symptoms, and other health
comorbidities of the long-term care facility popula-
tion make the identification of a UTI challenging
(Genao & Buhr, 2012). Jeon and colleagues (2018)
determined that a delay in identification, diagnosis,
and treatment result in preventable hospital admis-
sions and mortality. Thus, early recognition and ini-

U r o l o g I C N U r s I N g

Research

© 2020 Society of Urologic Nurses and Associates
Viner, S., & Gautam, R. (2020). Urinary tract infection knowl-

edge of long-term care nursing staff: The effect of an
educational intervention. Urologic Nursing, 40(1), 7-10,
21. https://doi.org/10.7257/1053-816X.2020.40.1.7

Providing an educational intervention for long-term care
facility nursing staff improves knowledge and prevention
of urinary tract infections.

Key Words
Urinary tract infection, educational intervention, long-
term care facility, nursing staff, longitudinal data
collection.

tiation of appropriate treatment is paramount. Imple –
mentation of an educational program for nursing
staff on early recognition and treatment of UTI can
promote quality of care and reduce hospital readmis-
sion.

Background/Purpose
Long-term care facilities provide post-acute care

to individuals who do not require acute care but are
unable to care for themselves at home (Horney et al.,
2017). It is estimated that 4 million Americans are
admitted to long-term care facilities annually, with
these facilities providing care to nearly 1 million
Americans daily (CDC, 2019). Specific health risks,
specifically a UTI, are associated with residing in a
long-term care facility. This risk has been correlated
to a weakening of one’s immune system, which is
expected with aging, and the tendency to have mul-
tiple health-related comorbidities (High et al., 2009).
For females, decreased levels of estrogen, expected
in post-menopause, increases the risk for developing
a UTI (Grover et al., 2009). For males, UTI preva-
lence increases because of age-associated benign
prostatic hypertrophy and associated urinary reten-
tion (Girard et al., 2017).

Juthani-Mehta and associates (2005) posit that
an uncertainty surrounds the diagnosis of UTI
because there are no universally accepted criteria for
the diagnosis, treatment, or surveillance of this con-
dition among residents of long-term care facilities. In
non-acute care health settings, consensus is absent
between the diagnosis of UTI and asymptomatic bac-
teriuria. A diagnosis of UTI is dependent upon the
growth of bacteria in a urine culture, yet in the
absence of clinical symptoms, treatment may be
unwarranted (Benton & Nixon-Lewis, 2007).

1.3 contact hours

Instructions for CNE Contact Hours
UNJ 2001

Continuing nursing education (CNE) contact hours can be
earned for completing the learning activity associated with this

article. Instructions are available at suna.org/library
Deadline for submission: February 28, 2022

8 UROLOGIC NURSING / January-February 2020 / Volume 40 Number 1

Bacteriuria represents colonization of the bladder by
organisms acquired from flora of the gut and peri-
urethral area. Treatment of asymptomatic bacteri-
uria is not recommended, and is associated with
antibiotic overuse and an increase in rates of antibi-
otic resistance (Juthani-Mehta et al., 2005). Adults
over 65 years of age do not often present with the
typical symptoms of a UTI, such as fever, urinary
burning, or frequency. A UTI among this population
may present with nonspecific symptoms, such as
decreased appetite, poor oral intake, decreased
physical activity, and/or increased agitation (Jump
et al., 2012). Nonspecific symptoms, such as mental
status changes and behavioral changes, are often
attributable to UTIs in this population.

Early identification of UTI and timely initiation
of appropriate treatment are important in successful
management of the infection. Early intervention sta-
bilizes conditions and established approaches to
care to initiate best management of conditions can
occur (Rantz et al., 2014). All members of the health
care team play an important role in providing qual-
ity care to patients in skilled and long-term care
facilities. Nursing staff education on prevention and
early identification of UTI can reduce incidence of
an infection among older adults. The purpose of this
research was to determine if an educational inter-
vention improved UTI knowledge among nursing
staff employed in a long-term care facility.

Literature Review
The Preferred Reporting Items for Systematic

Review and Meta-Analysis (PRISMA) report was
used to identify relevant articles for this review.
Limiting publications to the years of 2005-2017;
available in English; published in peer-reviewed
journals; the search engines of CINAHL, Medline,
and Ovid; and the key words of urinary tract infec-

tion, knowledge, nursing staff, and education, 120
articles were initially identified. These articles were
further limited based on the presence of UTI, data
collected in long-term care facilities, the provision
of an educational intervention, full-text availability,
and documented health outcomes. Once this refine-
ment was completed, 22 articles remained; all were
included in the review and used to develop the
planned educational intervention. The activities of
this research were guided by the article that devel-
oped, implemented, and evaluated a UTI-specific
educational intervention for long-term care facility
nursing staff (Freeman-Jobson et al., 2016).

Guided by reports from the CDC (2018), the
uniqueness of assessing and identifying UTI in resi-
dents of long-term care facilities, and a paucity of
research describing nurses’ ability to identify this
health condition, a research study was formulated.
The purpose of the study was to determine the
impact an educational program had on UTI-specific
knowledge among nursing staff employed at either
study site. Results of the study may be used to
ensure that any educational program is evidence-
based and addresses the specific knowledge gaps of
the nursing staff.

Study Methodology
Using a longitudinal study design, a knowledge

quiz was administered prior to and after the educa-
tional program. In addition, demographic data were
collected and used only to describe the study popu-
lation.

Study knowledge quiz. The questionnaire was
composed of 11 items: 9 multiple choice and 2
dichotomous items. The content of the question-
naire assessed knowledge in management and pre-
vention of UTIs. Responses were anonymous, and
the questionnaire required 5 to 7 minutes to com-

Research

research summary
Introduction

Urinary tract infections (UTIs) occur frequently among
residents of long-term care facilities. Early identification of
this health condition leads to prompt treatment, which pre-
vents complications.

Objectives
To determine if an educational intervention improved

UTI knowledge among nursing staff employed in a long-term
care facility.

Methods
Using a longitudinal study design and a previously

developed questionnaire, data were collected prior to and
after a UTI-specific educational intervention. Data were
received from 21 participants, all nursing staff who were
direct care providers in a long-term health care facility.

Results
Using paired sample t test, knowledge and prevention

of UTI scores improved. While not statistically significant,
these data reflect a benefit from the educational intervention.

Conclusions
Reviewing clinical indicators for, assessment variables,

and benefits of early diagnosis and treatment may improve
the ability to decrease hospital admissions and mortality
from this health condition.

Level of Evidence: III-B
Source: Johns Hopkins Hospital/Johns Hopkins University
(2016).

UROLOGIC NURSING / January-February 2020 / Volume 40 Number 1 9

plete. The questionnaire was administered prior to
and after the study intervention. This provided a
forum to determine the effect of the intervention.

Study educational program. The educational
program was presented orally and guided by
PowerPoint slides. An educational content was
adopted, with permission from Freeman-Jobson and
colleagues (2016). Learning objectives of the pro-
gram were:
• Define UTI.
• Describe characteristics of symptomatic UTI.
• Discuss risk factors for UTI.
• Describe key factors required for the treatment of

UTI.
• Describe physical changes associated with UTI.
• Describe the laboratory testing for UTI.
• Discuss characteristics of asymptomatic bacteri-

uria and identify the difference between asymp-
tomatic bacteriuria and UTI.

The educational program was in the form of a
PowerPoint presentation, discussion, and questions.
A modified version of the study questionnaire was
used with permission from Freeman-Jobson and col-
leagues (2016) to measure participants’ pre- and
post-knowledge of UTI. Project activities included
completing the pre-intervention survey and provid-
ing a demographic description, participating in the
educational presentation, and completing the post-
intervention survey. The post-intervention survey
was conducted immediately after an educational
program.

Institutional Review Board (IRB) approval was
secured from the academic institution of the
researcher. Guided by 45 CRR44.101(2), the activi-
ties associated with this study were deemed to align
with exempt status. Thus, identifying information
was not collected, and consent was implied upon
submission of study materials. The administrator at
each study site agreed to allow the study to occur
during worktime. That, together with the ability to
provide continuing education contact hours, when
appropriate, increased study participation rates.

Study Sites
Two long-term care facilities served as study

sites. Each facility was located just outside a major
Eastern metropolis in the United States and were
dedicated to post-hospital care. Each facility has 40
post-acute short-term care rehabilitation areas and
80 long-term care beds. The educational interven-
tion was provided in a staff conference room, which
is located within the patient care area and has a
door. This prevented disruption during the session
and allowed staff to concentrate on the activity. Data
from a retrospective chart review at both facilities
performed over 3 months prior to this study identi-
fied UTI as a diagnosis for 53% of residents.

Study Population
Anecdotal data indicated there was a total of 40

potential participants. Complete data sets were
received from 21 participants, which calculates to a
52.5% response rate. Since both sites received the
same intervention and study inclusion criteria were
consistent, one data set was developed.

Results
Study population. Study participants included

18 registered nurses (RNs) and 3 licensed practical
nurses (LPNs), with an average work experience of 6
years. Each participant completed all study activi-
ties. These individuals were employed as direct care
providers either full-time, part-time, or per diem.
These individuals are described in Table 1.

Questionnaire results. Data were evaluated
using paired sample t test. There was no statistical
significant UTI knowledge difference from pre- to
post-intervention. Participants pre-presentation
evaluation achieved a mean knowledge score of 9.0
(SD = 1.06), which increased to 9.47 (SD = 0.87) post
intervention (t = -1.817, p = 0.088). Individual item
paired sample t tests were performed to find content
that was most improved after the educational pro-
gram. Results from this analysis identified a signifi-
cant improvement in knowledge related to how
UTIs are prevented (p = 0.003).

Discussion
There have been few reports on the effect of an

educational program on knowledge and manage-
ment of UTIs in long-term care facilities. The lack of
significance in pre- and post-test scores was a posi-
tive finding in this project. This demonstrated that

Urinary Tract Infection Knowledge of Long-Term Care Nursing Staff: The Effect of an Educational Intervention

Table 1.
Study Population Demographics

Job classification n %

RN 18 85.7

LPN 3 14.3

Gender n %

Male 4 19.0

Female 17 81.0

Age in years n %

18 to 26 3 14.3

27 to 35 2 9.5

36 to 50 6 28.6

Years of experience Cumulative

< 5 years 57.1

> 5 years 42.9

10 UROLOGIC NURSING / January-February 2020 / Volume 40 Number 1

participants in the two study settings were profi-
cient in an understanding of signs and symptoms of
UTI, as well as UTI management strategies. Post-
program assessment showed an increase in knowl-
edge related to the question regarding knowledge in
UTI prevention. Furthermore, there was a reduction
in documented UTIs and antibiotic use for treatment
of UTIs in two nursing facilities where this interven-
tion was carried out. Following the program, there
was a demonstrated 5% reduction in documented
UTI and antibiotic use associated with UTI, which
means the number of diagnosed and treated UTIs
decreased after the program.

Results of how UTIs are diagnosed and managed
were not statistically significant. The most likely
explanation for this finding is that most project par-
ticipants were experienced health care providers.
Thus, it is possible the content of the program on
diagnosis and management of UTIs was well known
to these individuals. Therefore, for effective results
in future studies, education must be tailored to par-
ticipant educational and experience level. This can
be achieved by including an interprofessional team
in the development and assessment of material for
educational interventions. Furthermore, with the
support of nursing leadership, more programs can
be implemented to embrace a wider audience, such
as nursing assistants, physical therapists, occupa-
tional therapists, and speech therapists. This could
help diagnose UTIs in a timely manner.

Although nursing staff were supportive of the
program, attendance was identified as a barrier.
Among those who did not attend, “being too busy”
was one reason. A solution to this barrier could be
addressed through collaboration with nursing man-
agement (e.g., shifting schedules so staff could
attend the program).

In conclusion, UTIs are associated with aging.
Studies have demonstrated that education for health
care providers specific to the prevention and manage-
ment of UTIs in the older adult population can
improve knowledge and awareness of symptoms, and
thus, reduce the number of patients diagnosed with
UTIs. Frequent reviews on prevention and manage-
ment of UTIs can help avoid re-hospitalization.

Limitations
The project had several limitations. First, the

study population was a small sample, and thus,
results cannot be generalized. Comparison of the
pre-intervention level of knowledge to job classifica-
tion was not feasible without compromising study
data confidentially. The ability to describe residents
of study sites was not possible. The health condition
of residents and their risk of UTI may affect policies
related to routine assessment for UTIs. Finally, the
educational program was developed based on the
published research literature. Assessment of nursing

staff knowledge, then developing and presenting an
intervention guided by these results, would provide
a data-specific educational program.

Implications for Practice
Results of this study emphasize an importance

of an educational program for health care providers
employed in long-term care facilities. Improved
knowledge and awareness results in early and effec-
tive recognition of UTIs, thus decreasing the neces-
sity of inpatient hospital care and mortality from
this health condition.

References
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Centers for Disease Control and Prevention (CDC). (2018).
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Centers for Disease Control and Prevention (CDC). (2019).
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continued on page 21

Research

UROLOGIC NURSING / January-February 2020 / Volume 40 Number 1 21

Urinary Tract Infection
continued from page 10

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