NURS 491 Week 6 Evidence-Based Practice Project: Part 2 Example

Teaching a Unit to Remove Catheters Sooner: Audience, Change Theory and Constraints Behind a Staff Teaching Tool

Introduction

On our medical-surgical unit, indwelling urinary catheters usually stay in until a provider orders their removal, even though the hospital approved a nurse-driven removal protocol two years ago. In Part 1, I created a twelve-slide staff presentation explaining the HOUDINI criteria, the protocol's steps and the monitoring after removal. This paper explains the thinking behind that tool from a nurse manager's perspective: who the audience is, what the change will mean for them, the change theory that guides the plan, the organizational constraints and why a short presentation with text reminders was chosen.

The Audience

The audience is the unit's 42 registered nurses and 14 nursing assistants across three shifts. Roughly one nurse in three is within two years of licensure, while several senior nurses have worked on the unit for more than fifteen years. Most staff know catheters cause infections, but few know the protocol exists, and many believe removing a catheter without an order would be overstepping. Huang et al. (2023), reviewing 34 studies of health care workers' knowledge, attitudes and practices around catheter infections, found that staff generally held positive attitudes but had uneven knowledge and practices that fell short of guidelines. That matches our unit, where caring is not in short supply; the habit of waiting is simply stronger than staff knowledge of the protocol.

Newer nurses tend to follow what they see experienced nurses do, so the senior staff are the most important part of the audience. Assistants matter too, because they empty drainage bags, measure output and often notice first when a patient wants the catheter out.

Impact of the Change

For nurses, the change adds a HOUDINI check to every shift assessment and gives them authority to remove catheters without calling. That autonomy is a benefit but also a new responsibility, since a nurse who removes a catheter must monitor voiding and bladder scan if needed. Some nurses will worry about blame if a patient goes into retention. For assistants, there will be more measured voids to record in the hours after removal. For providers, there will be fewer calls about catheters but also less control, which some may resent. For patients, the change should mean fewer catheter days, less discomfort, fewer falls from being tethered and fewer infections.

Change Theory

Finkelman (2016) presents Lewin's approach, which treats change as a sequence: first people are helped to let go of the current way (unfreezing), then they learn and try the new practice (moving), and finally the new practice is locked in as the norm (refreezing). I chose Lewin because three stages fit easily into a huddle conversation and because our unit's last attempts at change failed at the refreezing stage.

Unfreezing begins with the unit's own data. The first slide shows that 22 of 31 patients with catheters past day three had no documented reason to keep them. Borrowing from Kotter's emphasis on urgency, this local evidence is meant to make the problem feel real. McDonnell et al. (2026), reviewing 17 studies of structured change in health care, found Kotter's eight-step model the most frequently used framework and identified strong communication and leadership as the main enablers.

Moving involves the presentation itself, practice with the HOUDINI checklist on real patients during the first two weeks and a charge nurse available to answer questions. Two senior nurses who have agreed to champion the change will remove the first catheters under the protocol on each shift, so newer nurses see respected colleagues doing it.

Refreezing depends on reminders and feedback. An electronic HOUDINI prompt, a running count of catheter days posted where the team gathers and a monthly report of infections and reinsertions are meant to make the new practice the default. McDonnell et al. (2026) identified the absence of ways to monitor progress as a common barrier, which is why measurement is built into the plan from the start. Kotter's idea of short-term wins applies here as well: the first month in which catheter days drop will be celebrated at the huddle.

Organizational Constraints

Several constraints could limit the change. Staffing is the first. On nights, nurses often care for six patients, and Huang et al. (2023) identified heavy workload and understaffing as barriers to catheter infection prevention. The HOUDINI check is designed to take less than a minute for each patient, and removal is scheduled for day shift when possible.

Provider habits are the second constraint. A few physicians routinely write "keep catheter" orders without a reason. I will ask the unit's medical director to remind providers that the protocol applies unless a specific indication is documented.

The electronic record is the third. Adding the HOUDINI prompt requires approval from the informatics team, which may take several weeks. Until then, the charge nurse's midday check will serve as the reminder. Supplies are the last constraint: bladder scanners must be available and working, so the unit's single scanner will be checked daily, and I have requested a second one through the capital budget.

Choice of Media and Its Effect on Learning

I chose a short slide presentation delivered at huddles because huddles are the only time all staff on a shift are together, and a ten-minute session fits there without pulling nurses away from patients. Each slide has three or four bullets and a single message, with the unit's own numbers, so nurses can absorb it quickly. Speaker notes allow charge nurses to deliver the same content on every shift.

To keep the learning from fading, the presentation will be followed by brief text reminders sent to staff every other day for two weeks, each with one HOUDINI criterion or one protocol step. Danaee et al. (2026) found that ICU nurses who received text message reminders of key points every other day for two weeks after a training session showed significantly greater gains in knowledge and performance than nurses who received the lecture alone. Short, repeated messages fit the way busy nurses actually learn on a unit. A presentation starts the change; repetition is what makes nurses act on it at 3 a.m.

Conclusion

The teaching tool from Part 1 is meant to move a unit from waiting for orders to acting on evidence. Understanding the audience, anticipating how the change affects each group, applying Lewin's model with Kotter's urgency and short-term wins, planning around staffing, provider and system constraints and choosing a medium that fits a nurse's day all make that move more likely. The real measure will be whether, six months from now, catheters on our unit come out on day two because nurses checked HOUDINI and acted.

References

Danaee, F., Rostamnia, L., Abbasi, P., & Salari, N. (2026). Effect of short messages on ICU nurses' knowledge and performance regarding ventilator-associated pneumonia prevention: A quasi-experimental study. Nursing in Critical Care, 31(4), e70540. https://doi.org/10.1111/nicc.70540

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Pearson.

Huang, A., Hong, W., Zhao, B., Lin, J., Xi, R., & Wang, Y. (2023). Knowledge, attitudes and practices concerning catheter-associated urinary tract infection amongst healthcare workers: A mixed methods systematic review. Nursing Open, 10(3), 1281-1304. https://doi.org/10.1002/nop2.1384

McDonnell, R., Chauhan, A., Adams, C., Cardenas, A., Moscova, M., Walsan, R., Sina, M., Munro, A., Manias, E., Mitchell, R., Gust, A., Sabesan, S., & Harrison, R. (2026). Applying change models and methods during a period of vast digital transformation: A systematic review of practice in healthcare. International Journal of Health Planning and Management, 41(5), 1032-1053. https://doi.org/10.1002/hpm.70092