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Sacred Cow in Nursing

Nursing as a practice plays a fundamental role in ensuring patients are protected from infection and that they get the best care approach possible while undergoing treatment. Nursing thus functions to achieve three primary objectives; patient advocacy, infection control, and physical care of the entire body, not just the disease or signs and symptoms. In nursing, “sacred cows” refer to long-standing practices founded on deeply-held beliefs that are rich in history and are consequently difficult to change (Yancey & Hamilton, 2022). Among them are methods that have stood the test of time but for which scientific or empirical proof is lacking. Misconceptions, outmoded habits, and the inability to confront and manage change all contribute to the prevalence of these problems, which have been documented in settings as diverse as critical care units, emergency rooms, and operating rooms. However, ideal patient-centered nursing set to meet the above objectives should be based on evidence.

Implementing evidence-based practice is a highly efficacious approach to challenging entrenched beliefs in nursing care. However, it is not uncommon for healthcare practitioners to resist change, akin to the immovability of the megaliths at Stonehenge, when it comes to upholding certain practices that lack empirical support. As per the findings of Correa et al. (2020), a significant proportion of patients, specifically 30% to 40%, are not provided with care that aligns with the latest scientific evidence. Modifying habits can present challenges due to several factors, such as the temporal requirement to attain noticeable outcomes, the potential mismatch between expended resources and benefits derived, and the possibility of conflicting evidence with practitioners’ fundamental principles or values. One practice for a sacred cow I have witnessed in my institution corresponds to managing and controlling Catheter-Associated Urinary Tract Infections (CAUTIs). It is believed that this can be reduced when nurses perform routine meatal care with soap and water during daily bathing. Of course, this is a factual claim, but any evidence does not support it. CAUTIs are a prevalent type of healthcare-associated infection that can be avoided through proper preventative measures. According to Mitchell et al. (2021), these microorganisms constitute approximately 70% to 80% of urinary tract infections acquired in hospital settings. They are linked to extended hospitalization periods and heightened susceptibility to morbidity and mortality. The significance of mitigating healthcare-associated infections, particularly CAUTIs, is underscored by their adverse impact on patients and healthcare systems.

There have been several suggested methods for lowering the likelihood of CAUTIs. Urinary catheters should be removed immediately, adequately inserted and maintained, and used only when required. Urinary catheter care, including meatal washing, has been linked to a lower incidence of CAUTIs. However, the existing data on the efficacy of this treatment is mixed, as shown by research.

The sacred cow identified above can be mitigated through collaboration and the establishment of evidence-based practices. One of the evidence-based practice management of CAUTI is using the Houdini protocol. This is a systematic process of catheterization with positive results when timely and effectively used (Blackmore et al., 2019). The control and management of CAUTI require a system-wide change with regular education sessions with the staff. These endeavors require full cooperation in order to be successful. Thus, the need for collaboration with colleagues. To achieve this, I could introduce talking chats and fliers among colleagues and attend conferences to educate the intensive care unit on these evidence-based practices.


Blackmore, A. R., Leonard, J., Madayag, R., & Bourg, P. W. (2019). Using the trauma quality improvement program metrics data to enhance clinical practice. Journal of Trauma Nursing| JTN26(3), 121–127. DOI: 10.1097/JTN.0000000000000436

Correa, V. C., Lugo-Agudelo, L. H., Aguirre-Acevedo, D. C., Contreras, J. A. P., Borrero, A. M. P., Patiño-Lugo, D. F., & Valencia, D. A. C. (2020). Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: A systematic metareview. Health Research Policy and Systems18, 1-11.

Mitchell, B., Curryer, C., Holliday, E., Rickard, C. M., & Fasugba, O. (2021). Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: An updated systematic review and meta-analysis. BMJ Open11(6), e046817.

Yancey, N. R., & Hamilton, T. (2022). Sacred cows in nurse education: Are faculty scared to dream? Nursing Science Quarterly35(4), 411–415.


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