| Course | NUR 682 Generalist Nursing Capstone |
|---|---|
| Module | Module 5 |
| Paper type | capstone milestone literature review and synthesis |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 682 Module 5
Milestone Two: Literature Review on Reducing Urinary Catheter Use and Catheter-Associated Infections
[Student Name]
Southern New Hampshire University
NUR 682: Generalist Nursing Capstone
Module Five Milestone Two
[Instructor Name]
[Date]
Milestone Two: Literature Review on Reducing Urinary Catheter Use and Catheter-Associated Infections
A literature review for a capstone is an argument, not a catalog. Its job is to show what is known about a problem and its solutions, where the knowledge is thin and why the proposed project is a reasonable next step. This review supports a project to introduce a nurse-driven urinary catheter removal protocol on a 30-bed general medical floor with a high rate of catheter infections. It is organized by theme: preventing unnecessary placement, prompting timely removal, the role of unit culture and teamwork and the questions that remain. Studies were located through CINAHL, PubMed and the Cochrane Library pairing terms for indwelling catheters and catheter infection with terms for removal, reminders and protocols led by nurses, limited to English-language work on adult inpatients.
Theme One: Fewer Catheters at the Door
The simplest way to prevent a catheter infection is to avoid placing a catheter that is not needed. On many medical floors, catheters arrive with the patient from the emergency department, placed for convenience or out of habit. Fakih et al. (2010) introduced written guidelines listing acceptable reasons for catheter placement in one hospital emergency department. After the guidelines, fewer patients received catheters and a larger share of the catheters placed had an accepted reason. The study was a single-site before-and-after comparison, so its results may not transfer everywhere, but the change required no new equipment and relied on clinicians agreeing on indications.
The capstone unit cannot change emergency department practice directly. What this theme offers the project is a data point: if many catheters arriving on the unit lack indications, the removal protocol will catch them on the first daily review, and sharing those counts with the emergency department may start a separate conversation.
Theme Two: Prompting Timely Removal
The largest body of evidence concerns removal. Catheters tend to outlive their purpose because nobody is prompted to reconsider them. Meddings et al. (2014) gathered strategies that reduce unnecessary catheter use and found that interventions prompting removal, whether reminders, stop orders or nurse authority to act, were associated with lower infection rates and less catheter use, without a measurable increase in harm. They argued that reducing use should come before device-based solutions such as coated catheters, whose benefits are uncertain.
Durant (2017) narrowed the lens to protocols that allow nurses to remove catheters when criteria are met. Most of the studies reported fewer catheter days, fewer infections or both. The protocols differed in their criteria, in whether a physician was notified and in how they were introduced, and almost every study combined the protocol with education or feedback. The reviews agree on direction but cannot isolate the protocol's share of the benefit.
Read together, these sources suggest that the delay between when a catheter stops being needed and when it is removed is the key target, and that giving nurses authority to close that gap is a reasonable way to do it. They also suggest that the protocol should arrive with education and feedback rather than alone.
Theme Three: Culture and Teamwork
Technical fixes depend on people. Saint et al. (2016) evaluated a national program across hundreds of hospitals that paired technical elements, including daily assessment of catheter need and prompt removal, with a structured approach to safety culture, teamwork and engagement of unit leaders. Units outside intensive care reduced catheter use and lowered infection rates by roughly a third, while intensive care units did not show significant improvement. The authors suggested that differences in patient acuity and in who controls decisions may explain the gap.
For a medical floor, this is encouraging. It also warns that the protocol will succeed only if physicians accept it, nurses feel safe using it and unit leaders keep it visible. The national program's attention to these factors, rather than the checklist itself, may be what separated successful units from the rest.
Synthesis Across Themes
Table 1 draws the themes together. Across studies with different designs and settings, the pattern is consistent: fewer catheters placed, faster removal and supportive culture each move catheter days and infections in the right direction, and none shows a signal of harm. The strongest and most directly relevant evidence concerns removal, which is also where nurses have the most influence.
Table 1. Evidence by Theme
| Theme | Key sources | What they show | Main caution |
|---|---|---|---|
| Avoid unneeded placement | Fakih et al. (2010) | Written indications reduced placement | Single site, before and after |
| Prompt removal | Meddings et al. (2014); Durant (2017) | Fewer catheter days and infections, no rise in harm | Mostly uncontrolled designs; bundled interventions |
| Culture and teamwork | Saint et al. (2016) | Medical units improved when technical and culture work were paired | No significant change in intensive care units |
Note. The capstone draws most heavily on the removal theme.
What Remains Unsettled
Four gaps matter for the project. First, few studies followed units beyond a year, so it is unclear how long gains last once attention fades. Second, the literature cannot say which removal criteria are best or how much nurse independence is needed. Third, patients' own experience of earlier removal, including comfort, continence and mobility, is rarely measured. Fourth, most studies come from units with stable staffing, and it is not known how a protocol fares when nurses are stretched.
How the Capstone Responds
The project's design answers each gap where it can. It uses the CDC indication list as its criteria, so results can be compared with other units using the same standard. It tracks results monthly for at least six months after the protocol starts, not only in the first weeks. It adds a brief question at discharge about catheter comfort and mobility for patients who had a catheter. And it records staffing levels on days the daily review is missed, so the effect of short staffing on use of the protocol can be described, even if it cannot be tested formally.
Conclusion
The literature supports a nurse-driven removal protocol, introduced with education and feedback and backed by unit leadership, as a reasonable way to reduce catheter days and infections on a medical floor. The evidence is moderate rather than definitive, which is why the next milestone builds a careful implementation and evaluation plan.
References
Durant, D. J. (2017). Nurse-driven protocols and the prevention of catheter-associated urinary tract infections: A systematic review. American Journal of Infection Control, 45(12), 1331-1341. https://doi.org/10.1016/j.ajic.2017.07.020
Fakih, M. G., Pena, M. E., Shemes, S., Rey, J., Berriel-Cass, D., Szpunar, S. M., Savoy-Moore, R. T., & Saravolatz, L. D. (2010). Effect of establishing guidelines on appropriate urinary catheter placement. Academic Emergency Medicine, 17(3), 337-340. https://doi.org/10.1111/j.1553-2712.2009.00677.x
Meddings, J., Rogers, M. A. M., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review. BMJ Quality & Safety, 23(4), 277-289. https://doi.org/10.1136/bmjqs-2012-001774
Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E., Edson, B. S., Watson, S. R., Meyer-Lucas, B., Masuga, M., Faulkner, K., Gould, C. V., Battles, J., & Fakih, M. G. (2016). A program to prevent catheter-associated urinary tract infection in acute care. New England Journal of Medicine, 374(22), 2111-2119. https://doi.org/10.1056/NEJMoa1504906
What the NUR 682 Module 5 instructions ask for
Milestone Two in NUR 682 usually asks for a review of the literature that supports your capstone: a description of your search, a synthesis of the key evidence, a discussion of gaps and a conclusion about what the evidence supports. Expect six to eight pages in APA 7, commonly with at least five to eight scholarly sources, some of them recent. Organize by theme rather than by study, and in each theme say what the sources show together, where they disagree and what that means for your project. Close with the gaps and the ways your design answers them. An evidence table can sit in an appendix if faculty want every study listed.
How this NUR 682 Module 5 milestone two example is built
This review supports a nurse-driven catheter removal protocol on a medical floor and is built around three themes and a set of gaps. Fakih and colleagues show that emergency department guidelines reduce unneeded placement. Meddings and colleagues and Durant show that prompting removal cuts catheter days and infections without harm, though designs are weak. Saint and colleagues' national program shows that medical units improved when technical steps met culture work. A table joins the themes, four gaps are named, including durability and patient experience, and the capstone's design responds to each with monthly tracking, a discharge question and staffing notes. It ends by stating that the evidence is moderate rather than definitive.
Where the NUR 682 Module 5 rubric puts the points
Literature review milestones in the NUR 682 capstone are generally graded on the search description, the quality and currency of sources, synthesis across studies, critical discussion of limitations, identification of gaps, relevance to the project and APA 7. Excellent reviews read as an argument in which each theme builds toward the proposed intervention and the gaps explain why the project is still worth doing. They acknowledge weak designs honestly instead of inflating the evidence. Reviews lose credit when they summarize one study per paragraph, when the search cannot be reproduced or when gaps are stated as a generic need for more research with no link to the project. Accurate reporting of each source's design is expected.
NUR 682 Module 5 help: the mistakes that cost points
Frequent deductions on this NUR 682 milestone come from study-by-study summaries, missing search details, sources that are old or mostly non-scholarly and a conclusion that simply repeats the findings. A second gap is ignoring evidence that complicates the story, such as the lack of improvement in intensive care units. Build themes, compare sources within each, state the limits and show how your project responds to the gaps. If your faculty set a minimum number of sources or a publication window, add those rules to your NUR 682 notes and the sample will meet them while keeping the synthesis tight and readable throughout. Recent sources carry extra weight.
Get NUR 682 Module 5 written to your instructions
Send the NUR 682 Milestone Two instructions, your intervention and the sources you have. The review you receive will be organized by theme, compare the sources within each, admit the weak spots, name specific gaps and tie each gap to a choice in your design, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 682 Module 5 questions, answered
Where can I find a free NUR 682 Module 5 Milestone Two sample?
The full literature review is published here: evidence on reducing catheter use organized by theme, with a synthesis table, gaps and design responses.
How should an MSN capstone literature review be organized?
By theme, comparing what several sources show together, rather than summarizing one study per paragraph.
Does reducing catheter placement in the emergency department help?
One hospital found that written placement guidelines led to fewer catheters and more placements with accepted reasons.
Why did catheter programs work better outside intensive care?
The national program's authors suggested differences in patient acuity and in who controls catheter decisions may explain it.
What gaps remain in catheter infection research?
How long gains last, which removal criteria work best, how patients experience earlier removal and how protocols fare when staffing is short.