NSG 324 · Unit 4 · sample paper

NSG 324 Unit 4: sample paper, in real form

Reviewed by Cecily Vandenberg, MSN, RN Herzing University True APA form Annotated

This page holds a complete NSG 324 Unit 4 example in true form: a finished evidence appraisal written for Evidence Based Practice in Nursing in the RN to BSN program at Herzing University. A working nurse takes one problem from a composite medical surgical unit, asks a searchable question, and then judges six sources on design and fit instead of summarizing them.

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Judging the Evidence for a Nurse Driven Catheter Removal Protocol on a 28 Bed Medical Surgical Unit

Student Name

Department of Nursing, Herzing University

NSG 324: Evidence Based Practice in Nursing

Unit 4 Assignment

Instructor Name

Month Day, Year

What this page is doingThe title names the intervention, the setting, and the act of judging, which tells a grader in one line that this is an appraisal and not a summary. Naming the bed count makes the paper specific before the first paragraph, and specificity is what a relevance row rewards. The block carries the course line and the unit line the classroom expects, and it claims no grade and no official name for the work, because a model document has neither.
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The Practice Problem on a Composite Medical Surgical Unit

I work as a registered nurse on an adult medical surgical unit, and the unit described here is a composite: the bed count, the staffing, and every number below are assembled from ordinary practice so that no employer, no ward, no colleague, and no patient can be identified. The composite is a 28 bed adult medical surgical unit staffed at one nurse to five patients on days and one to six at night. Across a six month record it logged 8,100 patient days and 1,480 indwelling urinary catheter days, a device utilization ratio of 0.18. Nine catheter associated urinary tract infections were recorded in the same six months, which is 6.1 infections per 1,000 catheter days.

A review of those nine records produced the pattern behind this paper. In seven of the nine, the catheter stayed in place after the documented indication had ended, with a median of two extra days between the last recorded indication and removal. Removal required a written order in every case, and the order was requested on rounds rather than at the hour the indication expired. The practice question follows from that finding rather than from a general interest in infection: in adults on a medical surgical unit, does a nurse driven removal protocol, compared with removal on a written order alone, lower catheter days and the infection rate per 1,000 catheter days across six months?

The search covered CINAHL, PubMed, and the Cochrane Library from 2014 forward, using the terms catheter associated urinary tract infection, nurse driven protocol, and catheter removal. It returned 61 records, of which 6 were retained after full text reading. A source was kept only if it reported an outcome this unit can measure. Each retained source is graded below for design, sample, directness to the question, and risk of bias, using the levels described by Melnyk and Fineout-Overholt (2023). A source that cannot change what a nurse does on this unit at 0200 is not evidence for this problem, however often it is cited.

What this page is doingThe rate arrives with its denominator and its window, so 6.1 per 1,000 catheter days across six months can be checked rather than believed. The problem is then local before it is general, which is what separates a real practice question from a library exercise. The privacy boundary is stated once, in plain terms, and never repeated. Search terms, databases, date limit, and the 61 to 6 screen let a reader reproduce the search, which most papers at this level leave out.
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Judging the Retained Sources One at a Time

Meddings et al. (2014) is the strongest of the retained sources for this question, and it is still not strong. The integrative review covers reminder and stop order interventions and reports a pooled reduction in infection rate of roughly half. That pooled estimate deserves less confidence than its size suggests, because most contributing studies used before and after designs at single sites with no concurrent control, so ordinary improvement in catheter care over the same years cannot be separated from the intervention itself. What the review supports is a direction and a plausible magnitude. It does not support a promised percentage, and quoting one to this unit would misrepresent the design that produced it.

Saint et al. (2016) carries more weight on design and less on directness. It reports a national prevention program across a large number of hospitals, and in non intensive care units the infection rate fell from 2.40 to 2.05 per 1,000 catheter days. The scale is the reason to take the result seriously, and the multi component bundle is the reason for caution: removal authority was one element beside training, competence checks, and daily review, so the study cannot tell this unit what the protocol alone would deliver. Its baseline also sits well below the composite unit's 6.1 per 1,000 catheter days, which ordinarily means more room to improve here rather than less.

The two agency sources do different work and are cited for different claims. The CDC guideline (Gould et al., 2019) is the standard the current practice is measured against, since it states removal as soon as the indication ends; it is a consensus document, so it sets the target rather than proving an effect size. The AHRQ toolkit (2015) supplies implementation structure, including the daily review and the measure definitions, which is what a unit level change needs and what journal articles usually leave out. The Cochrane review by Lam et al. (2014) was retained on the first pass and then set aside, because it compares types of catheter rather than duration of use. It is high quality evidence for a question this unit is not asking, and using it as support here would be a citation working as decoration.

Two limits run through the retained set and belong in the appraisal rather than in a footnote. None of the studies blinded outcome collection, and infection surveillance depends on who orders a urine culture, so a unit that reduces culturing while reducing catheters can appear to improve twice on one change. None of them report sustained results beyond twelve months either, so the durability of a protocol is unknown across the group. Both limits shape what this paper is allowed to claim, and neither is a reason to discard the evidence.

What this page is doingEach source is judged, not reported. The strongest citation is called not strong, the largest study is credited for scale and faulted for bundling, and a Cochrane review is retained and then set aside for answering a different question. That last move earns more credit than an extra paragraph of agreement, because it shows the writer read for fit rather than for support. Naming two limits that run across the whole set is what a synthesis row is testing.
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What This Body of Evidence Supports on This Unit

Taken together the retained sources support a moderate strength recommendation, and the wording is chosen with care. Two independent bodies of work, one pooled and one national, point the same way on catheter days, and one consensus guideline already sets removal at the end of the indication as the standard of care. What is missing is a controlled comparison of removal authority by itself, which means the size of the effect on this unit is uncertain even where the direction is not. A proposal that states moderate strength and names the missing design is more defensible than one asserting evidence based practice and hoping the phrase does the work.

Fit is judged on three points before anything is recommended. The population matches, since the retained studies describe adult inpatients on general units rather than intensive care or long term care. The intervention is deliverable, because the composite unit has an electronic record able to carry a daily indication prompt and a standing order set a nurse practice council could revise inside one term. The comparison is real, because removal here waits on a written order today, which is the control condition in the retained studies. Where the fit fails, this paper says so: nothing in the evidence speaks to night staffing of one to six, which is the likeliest reason a signed protocol goes unused.

The outcomes this unit would track are the ones the agency sources already define, so the numbers stay comparable across settings: infections per 1,000 catheter days and the device utilization ratio, both reported monthly across the six months after adoption and set against the six month baseline of 6.1 per 1,000 and 0.18. One process measure sits underneath, the percentage of catheter days carrying a documented indication, sampled on 20 records a month rather than counted on all of them, because a measure a charge nurse cannot finish in an hour stops being collected by the third month. One balancing measure closes the set: unplanned recatheterization within 48 hours of a nurse initiated removal.

What this page is doingStrength of evidence is stated as moderate and the reason is given, which is safer and better rewarded than the word strong with nothing behind it. Fit is then tested on population, intervention, and comparison, and the one place the evidence says nothing is admitted rather than covered over. The measures reuse agency definitions so results stay comparable, and the sampling plan is sized to what a charge nurse can actually complete.
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References

Agency for Healthcare Research and Quality. (2015). Toolkit for reducing catheter-associated urinary tract infections in hospital units: Implementation guide. U.S. Department of Health and Human Services. https://www.ahrq.gov/hai/cauti-tools/index.html

Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practices Advisory Committee. (2019). Guideline for prevention of catheter-associated urinary tract infections. Centers for Disease Control and Prevention. https://www.cdc.gov/infection-control/hcp/cauti/

Lam, T. B. L., Omar, M. I., Fisher, E., Gillies, K., & MacLennan, S. (2014). Types of indwelling urethral catheters for short-term catheterization in hospitalized adults. Cochrane Database of Systematic Reviews, 2014(9), Article CD004013.

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.

Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.

Saint, S., Greene, M. T., Krein, S. L., Rogers, M. A. M., 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 infections in acute care. New England Journal of Medicine, 374(22), 2111-2119.

How this NSG 324 Unit 4 example is structured

In many sections this unit asks for an appraisal of evidence rather than a finished proposal, so the NSG 324 Unit 4 example below is written that way; your classroom's instructions decide the exact form. The first sheet establishes the practice problem in its own numbers, with each rate carrying its denominator and its window, and turns that problem into a question the literature can answer. The second sheet judges the retained sources one at a time, naming design, sample, directness, and the limit each source places on what may be claimed, including one high quality review that is set aside as off question. The third sheet states the strength of the whole body of evidence, tests fit against the unit, and defines the measures.

NSG 324 Unit 4 questions, answered

What does the NSG 324 Unit 4 assignment usually ask for?

In many sections this unit sits where appraisal begins, so the work is commonly a written judgment of several sources tied to one practice problem and a searchable question, rather than an implementation plan. Your classroom's instructions and rubric decide the exact form, including how many sources are required and whether a table is expected alongside the prose.

What is the difference between appraising a source and summarizing it?

A summary reports what a study found. An appraisal states what the study is allowed to prove: its design, sample, comparison group, and the claims that design cannot support. If your paragraph about a source would survive with the results removed, you are appraising. If it collapses, you are summarizing and a graded synthesis row will show it.

Can I write about my own hospital unit?

Write about a composite unit built from what you know, and say so once in the opening lines, as this paper does. Keep the bed count, staffing, and rates realistic but non identifying, and never name an employer, a manager, a colleague, or a patient. The appraisal is graded on reasoning, and a composite carries the reasoning without the exposure.

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