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Urinary Tract Infection: Clinical Practices Research Paper

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Updated: Aug 13th, 2020

Scope and Purpose of the Clinical Practice Guideline

Being one of the most common bacterial infections, the urinary tract infection (UTI) affects a large number of people, causing further health complications and leading to an overall drop in the quality of life among the patients (Prakash & Saxena, 2013).

A recent study on the subject matter addressing the specifics of catering to the needs of women with an uncomplicated UTI, the paper by Hooton (2012) sheds light on the nursing strategies that must be considered when facing the problem in question. Although the scope of the paper is quite small, addressing the issue of a thirty-year-old female patient, the purpose thereof can be deemed as rather broad. Specifically, the paper is aimed at determining the tools for managing recurrent episodes of UTI, as well as designing the framework that will help tend to the needs of patients with UTI in the most successful manner possible.

Furthermore, the author narrows the study down to analyzing the complications related to the recurrent instances UTI, especially recidivism, which is the case in point. Apart from elaborating on the concerns regarding the application of the necessary strategies to managing the needs of patients with UTI, Hooters also touches upon the issue of pyelonephritis; however, the author does not differentiate between the two diagnoses, providing the same combination of nursing strategies to manage the problem. Instead, he offers a general method of treatment, including the use of nitrofurantoin monohydrate macrocrystals (the firs-line therapy stage) and Fluoroquinolones (ciprofloxacin) (the second-line therapy stage) (Hooton, 2012).

Stakeholder Involvement

The stakeholder engagement level of the paper can be viewed as moderate. The paper was designed to promote awareness about the possible treatment methods primarily among nurses, which means that they are likely to be among the key stakeholders. Describing the means of managing the disease, the authors of the article contribute to the stakeholder engagement considerably, since the paper offers an extensive analysis of the available treatment methods.

As stressed above, the paper is aimed primarily at managing the issue of the UTI recidivism in women aged 30. Therefore, the identified population can be considered the key stakeholders. It could be argued that also mentioned the issue of disease prevention, the paper could address the needs of a slightly younger population, providing them with the required precaution strategies for preventing UTI development.

Similarly, slightly older women could consider themselves as the possible target audience since the article helps locate the means of managing UTI at its later stages. However, these are women in their 30s that the article targets primarily at: “Acute uncomplicated pyelonephritis is much less common than cystitis (estimated ratio, 1 case of pyelonephritis to 28 cases of cystitis),7 with a peak annual incidence of 25 cases per 10,000 women 15 to 34 years of age” (Hooton, 2012, p. 1028).

Rigor of Development

The concept of methodological rigor is often viewed as one of the building blocks of nursing guidelines. Although a range of articles claims to provide detailed guidelines for the treatment of a particular disease or address a specific problem, they often lack what is referred to as the methodological rigor (O’Brien, Harris, Beckman, Reed, & Cook, 2014). As a result, the instructions provided by the authors of such papers remain suggestions. Unless the element of rigor is incorporated into the article, it cannot warrant the title of a nursing guideline.

The rigor of the development of the instruction is at a quite appropriate level. Although the authors of the article do not detail the methodological approach that they adopt to study the problem, they provide a scrupulous account of the outcomes of the research. For instance, the study details the clinical efficacy of each medicine suggested for addressing the issue.

Furthermore, the authors of the study outline the crucial aspects of raising awareness among patients. Indeed, the target audience must be able to detect the symptoms of the disease and receive the necessary nursing services before the problem grows more significant. By managing the issue at the earliest stages, one is likely to prevent the instances of recidivism, thus, increasing the quality of life among the target members of the population. Therefore, the rates of the rigor of development can be considered moderately high.

Recommendations

It would be wrong to deny the study certain flaws, however. Even though it provides a detailed overview of the effects that certain tools can have on treating UTI and the related issue, it lacks a comparison with other techniques. The fact that the article adopts an EBP approach by considering the actual case and addressing the needs of a specific patient can be deemed as an obvious advantage also must be brought up. Nevertheless, since the study considers the case of only one patient, the outcomes of the analysis may turn out to be far too specific to view them as implications for the design of a more general approach.

To handle the issues mentioned above, one could suggest a follow-up study that will embrace a wider range of patients and, therefore, make its scope somewhat larger. Moreover, it is recommendable that the researcher should consider the patients of a different age range. For instance, the study could include women aged 20–50; in the identified scenario, it would be a good idea to separate the participants into several groups based on their age, the severity of the problem, the nursing strategy applied to address the issue, etc.

It is expected that the follow-up study should consider the issues related directly to different nursing strategies that can be used to improve the quality of care. Furthermore, the problems regarding organizational behavior and the factors that inhibit the nurses’ positive performance will have to be incorporated into the analysis. Thus, a more detailed overview of the existing alternatives will be delivered.

Application

Much to the author’s credit, one must admit that the framework suggested in the study has a lot of potentials as far as its application in the nursing setting is concerned. Particularly, the outcomes of the study indicate that the patient must be instructed carefully on the issue of detecting the disease symptoms, as well as using the services of the nursing facilities.

Indeed, according to the author, identifying the problem at the earliest stages of its development is vital to the success of the further treatment process. For example, Hooton declares that the early identification of the problem will ultimately lead to a less convoluted process of treatment and, therefore, a faster recovery: “Given the accuracy of a diagnosis that is based on the patient’s symptoms, in selected women with symptoms of cystitis, the infection can be successfully managed without in-person assessment” (Hooton, 2012, p. 1031).

Arguably, the current framework could use some improvements. For example, the author could have made better use of the application of the EBP approach. Although the current study includes a detailed analysis of a UTI case, a more detailed and generally all-embracive study involving a group of participants and an experiment could be considered.

Therefore, at present, the application of the strategy designed by the author of the study should be viewed as an addition to the currently existing approach. Thus, the framework can be tested successfully, and the opportunities that it provides can be used to enhance the effect of the therapy and promote better information management among nurses and patients alike. Particularly, the latter should be offered the tools for accessing the relevant instructions and pieces of advice so that they could detect the problem at the earliest stage and manage it in an appropriate manner (Gupta et al., 2011).

It should be borne in mind, though, that the application will require substantial costs. For instance, it will be necessary to design a new therapy approach that will help address the needs of the target audience more efficiently. Furthermore, the schedule of the nurses involved in the therapy will have to be rearranged to avoid the instances of workplace burnouts. Finally, the resources for increasing the availability of the relevant information to the target audience will have to be considered as a part of the expenses list (Chaurasia, Shrivastava, Shrivastava, Dubey, & Songra, 2015).

Editorial Independence

The article in question touches briefly upon the conflicting interests of healthcare staff members and the patients. For example, Hooton (2012) never brings up the fact about the workplace burnouts rates among healthcare employees, in general, and nurses, in particular. Therefore, the information supplied by the author can be considered as rather one-sided, being primarily the guide to managing the issue of UTI in female patients.

In light of the characteristics described above, the article cannot be considered independent in the editorial context. By considering the needs of other stakeholders, such as nurses, healthcare facilities, the patients’ family members, etc., Hooten (2012) would have made a very powerful statement and redesigned the existing guidelines significantly. However, as is, the article has a rather low editorial independence rate.

Nevertheless, claiming the article to be useless would be inappropriate. It provides a detailed overview of the effects that the suggested treatment provides. More importantly, it outlines the unique needs of the patients, therefore, setting premises for a follow-up study. Finally, it can be described as an EBP study, which means that its results can be used to model an efficient strategy (Kelly, Kutney-Lee, Lake, & Aiken, 2013).

Summary

Hooten (2012) focuses on the means of treating UTI by using traditional treatment tools. Calculating the amount of medicine that the patient will have to consume regularly to recover and outlining the stages of the therapy that the woman will have to undergo, it can be viewed as the framework for designing a unique EBP approach that will help manage the UTI-related issues. Furthermore, the author implicitly views the issue of a patient-centered approach as the essential area that further studies should be focused on. Providing extensive guidelines, the article can be viewed as a rather efficient guide.

Reference List

Chaurasia, D., Shrivastava, R. K., Shrivastava, S. K., Dubey, D., & Songra, M. C. (2015). Bacterial pathogens and their antimicrobial susceptibility pattern isolated from urinary tract infection in a tertiary care centre. International Journal of Pharmacy & Bio-Sciences, 1(1), 1-4.

Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B. I., Colgan, R.,… &. Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Practice Guidelines, 53(1), 103-120. DOI:10.1093/cid/ciq257

Hooton, T. M. (2012). Uncomplicated urinary tract infection. The New England Journal of Medicine, 366(11), 1028–1037.

Kelly, D., Kutney-Lee, A., Lake, E. T., & Aiken, L. H. (2013). The critical care work environment and nurse-reported health care-associated infections. American Journal of Critical Care, 22(6), 482-488. DOI:10.4037/ajcc2013298

Prakash, D., & Saxena, R. S. (2013). Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of Meerut City, India. Microbiology, 2013(749629), 1-13. DOI:10.1155/2013/749629

O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1-7. DOI:10.1097/ACM.0000000000000388

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