Degree Name
Nursing Practice, DNP
Publication Date
4-20-2026
First Advisor
Lisa Drake
Second Advisor
Beatrice Bailey
Abstract
Urine specimen contamination in emergency department settings contributes to diagnostic inaccuracies, unnecessary antibiotic use, increased healthcare costs, and decreased patient satisfaction. This quality improvement project evaluated the impact of a simulation-based educational intervention on staff knowledge, self-efficacy, and urine specimen contamination rates among emergency department nurses and patient care technicians with less than six years of clinical experience in a rural Texas hospital. The aim of this project was to enhance knowledge and self-efficacy while reducing contamination rates over a six-week period. The project was guided by Knowles’ Adult Learning Theory as the theoretical framework, supported by Lewin’s Change Theory, and implemented using the Plan–Do–Study–Act framework. A quantitative pretest–posttest design was used with 31 participants. Data were collected using the Evidence-Based Practice Self-Efficacy Scale and an 8-item knowledge test on urine specimen collection. Self-efficacy scores increased from pre-intervention (M = 73.11, SD = 10.62) to post-intervention (M = 83.83, SD = 10.40), t(30) = −3.81, p < .001. Urine specimen contamination rates decreased from 40.7% to 13.0% following implementation. Knowledge scores also increased after the intervention. Limitations included a single-site design, a small sample size, and the use of aggregate contamination data. These findings suggest that simulation-based education enhances clinician confidence and supports adherence to evidence-based urine specimen collection practices. Integration of simulation-based training into orientation and competency processes may improve diagnostic accuracy and support antimicrobial stewardship in emergency department settings.
Rights Management
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Recommended Citation
Strong, Kimberley, "Quality Improvement Project: Enhancing Efficacy and Reducing Urine Contamination Through Simulation in the ED" (2026). Doctor of Nursing Practice Projects. 327.
https://arch.astate.edu/dnp-projects/327
