NUR 682 Module 6 Stakeholder Paper Example

Who Must Say Yes: Stakeholders and Barriers for Nurse-Led Catheter Removal

[Student Name]

Southern New Hampshire University

NUR 682: Generalist Nursing Capstone

Module Six Stakeholder Paper

[Instructor Name]

[Date]

Who Must Say Yes: Stakeholders and Barriers for Nurse-Led Catheter Removal

The protocol at the center of this capstone changes who decides. Today, a catheter on the general medical floor at Harbor Point Medical Center comes out only when a physician writes an order. Under the protocol, a registered nurse will remove it after a structured daily review finds no guideline indication. That shift touches physicians' authority, nurses' workload and confidence, the emergency department's habits and patients' expectations. This paper identifies the stakeholders, describes the barriers reported in similar efforts, organizes them with an implementation framework and sets out how each group will be engaged before, during and after the change.

Who Has a Stake

Six groups matter most. Hospitalists write most admission orders on the unit and will need to accept that nurses may remove catheters they ordered. Emergency department physicians and nurses place most of the catheters that arrive, so the project's data will reflect their choices. Staff nurses will carry out the daily review and removals, and some will worry about being blamed if a patient needs a catheter reinserted. Infection prevention staff own the surveillance data and can lend credibility. The nurse manager and the chief nursing officer control time for education and can make the protocol a unit priority. Patients and families live with the catheter and occasionally ask to keep it for convenience.

A seventh group, the medical executive committee, must approve any protocol that lets nurses act without an individual order. Its approval is a formal gate rather than a relationship, but hospitalist support will largely decide it.

Barriers Reported in Similar Efforts

Krein et al. (2013) interviewed staff at hospitals taking part in a statewide effort to reduce catheter use. Several barriers recurred. Many clinicians saw catheters as a convenience, especially for patients who were incontinent or hard to move, and some doubted that catheter infections were serious enough to justify the effort. Physicians were frequently unaware that their patients had catheters at all. Some physicians resisted nurses removing catheters without an order, while some nurses were reluctant to take that responsibility. Catheters placed in the emergency department arrived on inpatient units without a clear reason, and patients or families sometimes asked for them. The researchers also noted that hospitals successful in reducing use often had a respected champion and leaders who kept the issue visible.

These findings closely match what staff on the capstone unit described informally: catheters kept for incontinence care, uncertainty about who may remove them and physicians who rarely think about catheters during rounds.

Organizing Barriers with CFIR

The Consolidated Framework for Implementation Research, described by Damschroder et al. (2009), gathers many theories of implementation into a single set of domains that shape whether a new practice takes hold. They cover features of the practice itself, pressures from outside the organization, conditions inside it, the knowledge and beliefs of the people involved and the steps taken to plan, engage, carry out and reflect. Sorting barriers into these domains shows where effort is most needed and prevents the project from treating every problem as a training gap.

Most of the unit's barriers fall inside the organization and among individuals. Physician authority and unclear responsibility are features of the internal setting; doubts about seriousness and fear of blame are individual beliefs. The protocol's own design matters too: if its criteria are long or vague, nurses will hesitate. Outside pressures, such as public reporting and payment rules, are supportive and can be used to explain why the change matters now.

Table 1. Barriers by CFIR Domain and Planned Response

Note. Domains are paraphrased from the framework.

Planning Change with Lewin

Lewin (1947) described group change as a sequence in which established habits must first be loosened, then moved to a new pattern and finally settled so the new pattern holds. He also argued that behavior in a group settles where the pressures toward a new way of working meet the pressures holding the old one in place, and that reducing the restraining forces is often more effective than adding pressure.

The project applies both ideas. Loosening will come from sharing the unit's own infection and device data at staff huddles and a hospitalist meeting, because local numbers are harder to dismiss than national statistics. Moving will come with education, the checklist and a two-week trial on one hall. Settling will come from building the daily review into the electronic record, adding the protocol to orientation and posting monthly results. Restraining forces, such as fear of blame, will be addressed directly with a written statement from nursing and medical leaders that nurses following the protocol are acting within policy.

Engagement Plan by Stakeholder

Hospitalists will be approached first through the physician who chairs the hospital's quality committee, with a short presentation of unit data and the evidence, and invited to co-lead. Emergency department leaders will receive monthly counts of catheters arriving without indications, framed as shared learning. Staff nurses will help write the checklist, and two respected night-shift nurses will serve as champions because most unneeded catheters are recognized overnight. Infection prevention will present baseline data alongside the student. The nurse manager will protect education time and include protocol use in rounding. Patients will receive a short explanation of why catheters come out early and how the team will help with toileting.

Conclusion

A nurse-driven protocol will succeed or fail on relationships more than paperwork. Mapping barriers with CFIR shows that the heaviest work lies in clarifying authority and addressing individual doubts, and Lewin's model gives that work a sequence. The next milestone turns this plan into an implementation and evaluation design.

References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50

Krein, S. L., Kowalski, C. P., Harrod, M., Forman, J., & Saint, S. (2013). Barriers to reducing urinary catheter use: A qualitative assessment of a statewide initiative. JAMA Internal Medicine, 173(10), 881-886. https://doi.org/10.1001/jamainternmed.2013.105

Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103