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Developing a sustainable implementation of practice change in the ICU
Abstracts ances and vital signs. There was a perception that ICU nurses have a lack of understanding of what the ward nurses can actually manage. Ward nurses also needed to know about the patient’s family. Communication is the essential component for a ‘smooth transition’ for ward nurses. This research may provide better understanding of the multifaceted issues linked with transitional care. doi:10.1016/j.aucc.2007.12.009 Developing a sustainable implementation of practice change in the ICU Ben Hackwood1* , Debbie Carney1 , Leanne Aitken1,2 1
Princess Alexandra Hospital, Australia; 2 Research Centre for Clinical Practice Innovation, Griffith University, Queensland, Australia Critical care practitioners face the constant challenge of implementing evidence into practice. Factors that influence the success of such a process include time, knowledge and skills and environmental culture. Patient positioning to reduce ventilator-associated pneumonia (VAP) is an area of practice that should be influenced by evidence. This project was designed to achieve sustainable practice change in the area of patient positioning based on available evidence. Working within the framework of the Iowa Model of Practice Change five intensive care nurses in clinical roles examined practice in this area. Four relevant articles were located, and critique of the evidence indicated 30◦ head up positioning of mechanically ventilated patients was associated with reduced incidence of VAP. A multidimensional change strategy incorporating education, random audits of bed height elevation, prominent reminders and installation of inclinometers on each bed was implemented. Prior to implementing practice change, 29/100 (29%) patients assessed during six audits were positioned ≥30◦ head up. The change strategy was implemented progressively over 5 months commencing with an education and information program, followed by the installation of inclinometers and posting of reminders. The proportion of patients positioned ≥30◦ head up increased to 12/27 (44%) during three audits after education and 57/109 (52%) during eleven audits after implementation of all aspects of the change strategy. Sustainable practice change is able to be achieved by clinicians working together. Important elements of a successful change strategy include a
55 systematic approach, multidimensional education and practice initiatives, adequate resources and commitment by team members. doi:10.1016/j.aucc.2007.12.010 Partnerships in intensive care unit (ICU): A new model of care delivery Sue Brack The Alfred, Australia In the context of an aging nursing workforce, challenges around retention problems, and an increased acuity of patients, current care delivery models in critical care are not sustainable. To maintain quality care delivered by an all nursing workforce in a dynamic complex environment, new models of care are needed. The aim of this study was to develop a new model of care that incorporated Division 2 Registered nurses working under the direction and supervision of a Division 1 critical care nurse. In this exploratory descriptive study, a partnership model of care was implemented in a 26 bed ICU. This model involved two Division 2 Registered nurses providing essential nursing care to patients under the supervision of one Division 1 critical care nurse. Data were collected using surveys, focus group interviews, and audit to determine standards of essential nursing care, staff satisfaction, and acceptance of the partnership model. Data were analysed using content analysis. Ethics approval was granted. Findings showed essential nursing care quality was equivocal. Staff accepted the notion of trialing new models of care; however, this partnership model was not sustainable in this high acuity population. Geographical limitations and staffing issues led to suspension of the study project 8 months into the intended 12-month period. This partnership model has merit for maintaining an all nursing workforce, and professional development for experienced nurses. However, issues of unit context, patient acuity, geographical layout, and specific nurse selection criteria must be addressed for this model of care to be successful. doi:10.1016/j.aucc.2007.12.011
Princess Alexandra Hospital, Australia; 2 Research Centre for Clinical Practice Innovation, Griffith University, Queensland, Australia Critical care practitioners face the constant challenge of implementing evidence into practice. Factors that influence the success of such a process include time, knowledge and skills and environmental culture. Patient positioning to reduce ventilator-associated pneumonia (VAP) is an area of practice that should be influenced by evidence. This project was designed to achieve sustainable practice change in the area of patient positioning based on available evidence. Working within the framework of the Iowa Model of Practice Change five intensive care nurses in clinical roles examined practice in this area. Four relevant articles were located, and critique of the evidence indicated 30◦ head up positioning of mechanically ventilated patients was associated with reduced incidence of VAP. A multidimensional change strategy incorporating education, random audits of bed height elevation, prominent reminders and installation of inclinometers on each bed was implemented. Prior to implementing practice change, 29/100 (29%) patients assessed during six audits were positioned ≥30◦ head up. The change strategy was implemented progressively over 5 months commencing with an education and information program, followed by the installation of inclinometers and posting of reminders. The proportion of patients positioned ≥30◦ head up increased to 12/27 (44%) during three audits after education and 57/109 (52%) during eleven audits after implementation of all aspects of the change strategy. Sustainable practice change is able to be achieved by clinicians working together. Important elements of a successful change strategy include a
55 systematic approach, multidimensional education and practice initiatives, adequate resources and commitment by team members. doi:10.1016/j.aucc.2007.12.010 Partnerships in intensive care unit (ICU): A new model of care delivery Sue Brack The Alfred, Australia In the context of an aging nursing workforce, challenges around retention problems, and an increased acuity of patients, current care delivery models in critical care are not sustainable. To maintain quality care delivered by an all nursing workforce in a dynamic complex environment, new models of care are needed. The aim of this study was to develop a new model of care that incorporated Division 2 Registered nurses working under the direction and supervision of a Division 1 critical care nurse. In this exploratory descriptive study, a partnership model of care was implemented in a 26 bed ICU. This model involved two Division 2 Registered nurses providing essential nursing care to patients under the supervision of one Division 1 critical care nurse. Data were collected using surveys, focus group interviews, and audit to determine standards of essential nursing care, staff satisfaction, and acceptance of the partnership model. Data were analysed using content analysis. Ethics approval was granted. Findings showed essential nursing care quality was equivocal. Staff accepted the notion of trialing new models of care; however, this partnership model was not sustainable in this high acuity population. Geographical limitations and staffing issues led to suspension of the study project 8 months into the intended 12-month period. This partnership model has merit for maintaining an all nursing workforce, and professional development for experienced nurses. However, issues of unit context, patient acuity, geographical layout, and specific nurse selection criteria must be addressed for this model of care to be successful. doi:10.1016/j.aucc.2007.12.011