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Applying Principles of Advanced Practice Nursing 

Applying Principles of Advanced Practice Nursing 

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Applying Principles of Advanced Practice Nursing

A central line refers to a tube that doctor places in a large vein in the neck administer fluids, blood, drugs, or perform a medical test. The former is also indicated for pulmonary artery catheterization and monitoring central venous pressure. Failure to accord appropriate care to the central lines by the medical team predisposes the patient to infections attributed to lack of knowledge, poor nurse engagement, poor leadership, and a high nurse-patient ratio. The doctor diagnoses a patient with CLABSI after manifesting with erythema, pain, swelling, foul odour emanating from the central line site, and warmth around the area. The following paper presents an overview of a project aimed at understanding if the implementation of education sessions for nurses twice-weekly reduces the rate of central line infections.

SMART Goals and Objectives

SMART Goal: To ensure that 100% of full-time nurses working with hospitalized patients with central lines complete education sessions on preventing CLABSI in three months.

SMART Objectives:

  1. To ensure there are brief regular meetings for leaders and nurses to discuss the current problems and existing concerns to find a solution.
  2. To ensure the patient outcome is improved within three months since the prevalence of infections would be decreased.
  3. To establish a culture of clinical excellence for communication between leaders and nurses, thus ensuring they participate in all discussions.

SMART Goal: Within three months, professional leaders manage 100% of full-time nurses and demonstrate compliance in all nursing activities that affect the quality of care given to patients with central lines.

SMART Objectives:

  1. To ensure there is a standard guideline with activities for all nurses who work in particular units after a thorough examination of the achievements and findings.
  2. To ensure nurses have a clear plan of how to organize their activities

Literature Review and Gap Analysis


There are visual barriers to providing quality care to patients from clinical practice, thus predisposing patients to central line infections. As mentioned earlier, poor nurse engagement, ineffective leadership, and lack of knowledge hinder the provision of quality care to clients. Eliminating them would directly lead to the prevention of cases of CLABSI among patients. Nurses are the critical caregivers for hospitalized clients; hence for the success in infection prevention, all the interventions should be centered around them. Awareness is key to the realization of success in the hospital; consequently, nurses would demonstrate effective infection prevention strategies through education.

Literature Review

The quality of care accorded to patients determines their speed of recovery. CLABSI prevention is essential in reducing morbidity and mortality rates among inpatients. According to Hussain et al. (2020), central line infections can be prevented by nurses using CPP, which focuses on evidence-based practices such as hand washing, hygienic line insertion, empowering nurses, and care for central lines. A study conducted by Myatra (2019) suggests that hand hygiene is the most convenient and cost-effective method of infection prevention among hospitalized patients. The former should be performed before contact with the patient, before aseptic techniques, after touching the patient, and after handling their immediate surroundings. This prevents the transmission of pathogens from the nurse to the clients. After reviewing several studies assessing the effectiveness of insertion and maintenance of the package, it is evident that effective implementation of the bundle would prevent central line infections.

However, evidence-based protocols for central line insertion and maintenance alone may not prevent infections. The latter calls for a multi-faceted methodology that necessitates behavior change for nurses that can be achieved through teamwork, assessment of performance, improving safety culture, and creating awareness. Alp et al. (2019) suggest that a multi-faceted methodology can be used to control and reduce device-associated ICU-acquired infections. However, according to Wasserman et al. (2018), bundle intervention is an effective way to implement change and improve the “culture” of patient safety by promoting teamwork, measuring compliance, and providing feedback. Safety culture ensures that catheters are inserted utilizing aseptic techniques.

Learning Needs and Gaps

The learning needs of stakeholders based on practice gap include lack of knowledge of the importance of infection prevention, lack of practice in real life, and lack of practice in managing CLABSI. There is an identified gap in compliance by hospitals with interventions aimed at preventing central line infections (Aloush et al., 2018). A high obedience rate to the protocols would lower central line infections and mortality among patients. Also, adherence to the protocols can be increased by reducing the nurse-patient ratio and organizing education and practice sessions for nurses to identify their worth learning infection prevention strategies.



The need to change the guidelines to be followed by the medical team stimulated the research. The other gap is the engagement of nurses with their activities which may affect the quality of care. According to Flint (2020), the presence of a unit-based quality nurse dedicated to performing infection prevention activities may be an effective strategy for infection reduction. Lack of knowledge and low confidence hinder nurses from completing their functions and maintaining their competencies (Troughton et al., 2019). The need to change the confidence and competence level stimulated the demand for the project. The desired state is to demonstrate its competencies and follow the guidelines to promote infection prevention.

Developing an Intervention Plan

Facilitators and Barriers

The nurse-patient ratio is a significant barrier to the nurse’s care given to the patient. From clinical practice, it is observable that nurses lack knowledge of the prevention of central line infections and their importance (Aloush & Alsareireh, 2018). Facilitators for this barrier are the management, who include leaders within the hospital. Their role would be to ensure the nurse-patient ratio is adequate to the patient’s needs. Therefore, competent leaders would advocate for the employment of more nurses to provide the nurse-patient ratio is 1:1; hence they receive maximum care. Another barrier to caring for patients within the hospital to prevent CLABSI is increased nursing responsibilities. Nurses have several obligations and responsibilities related to nursing care that may fail to prevent infections among patients with central lines. Nurse leaders would be the facilitators for increasing the number of nurses and ensuring they have competent training.

Interprofessional Teams

Interdisciplinary care is vital in preventing central line infections. The team needs to ensure that all the services are patient-centered. For instance, the nurses and physicians should conduct thorough surveillance on patients with central lines. Prolonged catheter use is a risk factor for developing infections; thus, the nurses and physicians need to check and remove unnecessary catheters and those used for long hours. Another team’s responsibility is to ensure they understand the indications, contraindications, and procedure for insertion of catheters hence preventing CLABSI. The environment is key to improving the patient outcome, hence the need for interprofessional team collaboration.

Interim Results: Expected Outcomes and Conclusions


After implementing the intervention, the management is expected to draft the protocols and educate the health team, thus decreasing CLABSI after three months. The medical team would be expected to have acquired skills in identifying and analyzing the risk for CLABSI development, thus reducing mortality and morbidity rate. Since the nurses make the most contact with the patient, the expectation is that they should identify signs of infections and make early interventions learned through the education sessions and practice.

Formative Evaluation

An evaluation plan would include regular assessments by the management to ensure the nurses provide quality care to the patients hence preventing infections. Nurse leaders would need to make regular rounds to see how care is accorded to patients by nurses. Surveillance would ensure unnecessary catheters are removed since it would demonstrate compliance with instructions provided in the education session. Nurse leaders should ensure a standard guideline with protocols vital for preventing infections.

Summative Evaluation

In the last week, all nursing staff should have passed tests on high compliance with infection prevention protocols such as personal equipment, environmental cleaning, and hygiene in the manipulation of catheters. Nurses would demonstrate competence in catheter insertion in suitable sites using aseptic techniques through their assessment. Furthermore, they would indicate the need to remove unnecessary catheters and proper sterilization of catheter hubs, unnecessary connectors, and infusion ports before assessing the catheter.


Anxiety frequently develops in hospitalized patients since they constantly worry about their outcomes. While in the hospitals, they may be exposed to infections, particularly those with central lines. However, these infections can be prevented by the healthcare team. One of the strategies institutions can adopt is health education for nurses working in these hospitals. Through the creation of awareness, they are acquainted with the knowledge of the care for central lines and their indications. Additionally, addressing barriers that affect service delivery, such as a high nurse-patient ratio and increased nursing activities, is pivotal in preventing CLABSI. The facilitators to meeting the goal of prevention would be nurse leaders’ who would ensure there is a standard guideline that contains CPP, which would consequentially improve patients’ outcomes.


Aloush, S. M., & Alsaraireh, F. A. (2018). Nurses’ compliance with central line-associated bloodstream infection prevention guidelines. Saudi Medical Journal39(3), 273-279. Web.

Aloush, S. M., Al-Sayaghi, K., Tubaishat, A., Dolansky, M., Abdelkader, F. A., Suliman, M., Al Bashtawy, M., Alzaidi, A., Twalbeh, L., Sumaqa, Y. A., & Halabi, M. (2018). Compliance of Middle Eastern hospitals with the central line-associated bloodstream infection prevention guidelines. Applied Nursing Research43, 56-60. Web.

Alp, E., & Rello, J. (2019). Implementation of infection control bundles in intensive care units: Which parameters are applicable in low-to-middle income countries? Journal of Hospital Infection101(3), 245-247. Web.

Flint, J. M. (2020). Most Effective Nursing Interventions to Prevent Central Line-Associated Bloodstream Infections: A Critical Review of the Literature (Doctoral dissertation). Web.

Hussain, A. S., Ahmed, A. M., Arbab, S., Ariff, S., Ali, R., Demas, S., Zeb, J., Rizvi, A., Saleem, A., & Farooqi, J. (2020). undefined. Archives of Disease in Childhood106(4), 394-400. Web.

Myatra, S. (2019). Improving hand hygiene practices to reduce CLABSI rates: Nurses education integral for success. Indian Journal of Critical Care Medicine23(7), 291-293. Web.

Troughton, R., Mariano, V., Campbell, A., Hettiaratchy, S., Holmes, A., & Birgand, G. (2019). Understanding determinants of infection control practices in surgery: The role of shared ownership and team hierarchy. Antimicrobial Resistance & Infection Control8(1). Web.

Wasserman, S., & Messina, A. (2018). Bundles in infection prevention and safety. Guide to infection control in the healthcare setting, 1-15. Web.

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