Internal and External Forces of Change

It is commonly known that the usage of Foley catheters provides an opportunity to help patients on their way to recovery. Still, nowadays professionals tend to mention that it can also have an adverse influence on one’s health condition (Stickler, 2014). Love and Rodrigue (2013) noticed that urinary catheters may cause urinary tract infections. They conducted research at Memorial Sloan-Kettering Cancer Center (MSKCC) to find out whether such complications can be prevented in the oncology population. The scientists believe that a comprehensive educational program for the nurses is the best solution for this problem, as it can teach health professionals how to avoid severe complications of catheter use.

This research is useful for the project that deals with the complications prevention of Foley catheter use in surgical patients in the regional medical center. It provides an opportunity to see what kind of change is needed to improve the situation. The scientists identify guidelines that should be followed, resources that should be employed and define the population that should be approached. They point out the challenges that can be faced and the ways, in which they can be overcome.

The decision to implement a change was made because of the increased number of severe complications that occur due to the usage of Foley catheters. The necessity to deal with the problem was emphasized externally by the Centers for Disease Control and Prevention, the Joint Commission, and the Centers for Medicare and Medicaid Services. Internal driving forces included the desire to improve health outcomes that leaders of the MSKCC and the nurses had, which presupposes personnel’s readiness to change, decent financial reserves, capable management, and workforce.

The change could have faced external resisting forces such as lack of funding, collaboration with other organizations or prohibition from the government but there were no such problems (Stickler & Feneley, 2010). The only issues dealt with nurses’ knowledge and products provided by the suppliers. Internal challenges included personnel’s resistance and unpreparedness because of the interaction with the Materials Management and Nursing Informatics department, Products Evaluation Committee, the approval made by MSKCC’s Medical Board, new technologies, and streamlined improvement of nurses’ knowledge and skills.

Still, as the healthcare organizations of international and country’s significance emphasized the necessity to find a way to prevent such complications of catheter use as infection, MSKCC had to follow provided guidelines and implement changes to improve health outcomes. Nurses’ schedules were changed for them to get used to new technologies and enhance knowledge and practical skills. After the additional education, they became more efficient, which proved to MSKCC’s Medical Board that they were ready to make decisions regarding the necessity of catheter use. A realistic timeline for the project was designed, which allowed working with appropriate supplies and electronic documentation. Various departments cooperated successfully, as their work was planned and everyone realized the crucially of the problem not only for patients but also for the organization. All products provided by the suppliers were assessed by the Products Evaluation Committee. Shigemura, Takase, Osawa, Takaba, & Nomi (2015) also underline that even thorough surveillance can be extremely helpful in this perspective.

MSKCC’s responses are applicable to my topic, as they are devoted to the prevention of complications of Foley catheter use in the healthcare facility. Regional Medical Center, as well as MSKCC, can utilize an educational program for nurses focused on this issue to solve it. Still, this project will reveal the situation in surgical patients, which was not previously discussed. Thus, nurses who work with this population will know how to assist them and prevent infections and other severe complications caused by catheter use.


Love, N., & Rodrigue, D. (2013). Catheter-associated urinary tract infection prevention in the oncology population: an evidence-based approach. Clinical Journal of Oncology Nursing, 17(6), 593-596.

Shigemura, K., Takase, R., Osawa, K., Takaba, K., & Nomi, M. (2015). Emergence and prevention measures for multidrug-resistant Pseudomonas aeruginosa in catheter-associated urinary tract infection in spinal cord injury patients. Spinal Cord, 53(1), 70-74.

Stickler, D. (2014). Clinical complications of urinary catheters caused by crystalline biofilms: Something needs to be done. Journal of Internal Medicine, 276(2), 120-129.

Stickler, D., & Feneley, R. (2010). The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control. Spinal Cord, 48(11), 784-790.

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