Category: Intensive Care

Introduction

Nursing is a profession that is responsible for providing essential health care services to patients. This enables the sick to deal with, cope, and live with illnesses to lead everyday lives. The intensive care unit in a health institution provides life support and critical care for acutely injured patients. The nurses play critical roles in the ICU by monitoring patients progress, administering treatments, and maintaining patients records. Additionally, they identify changes in patients conditions and act immediately. This article summarizes the nursing workflow in the intensive care unit among the enlisted nurses in research conducted in mainland China.

Reasons for Choosing the Article

Firstly, this article was chosen because it provides knowledge in the nursing workflow. This information is helpful in human allocation and nursing management. Allocation involves the reassigning of nursing staff on a day-to-day basis. An account of staff insufficiency, time fluctuations in patients requirements, and staff absence is taken. Management in nursing requires the assignment of nurses to various patients. By doing this, the patients needs are given the needed attention. Nurse Managers play the overall role of supervising the nursing staff in a hospital.

There was ethical consideration taken into consideration during the research. This was done after the approval of the ethics committee of Xuanwu Hospital in Capital Medical University. The targeted population was informed of the research, and they were given freedom of determination of the research if it made them unsafe and insecure. The design method applied during the research was observational, time, motion, and perspective. It allows the researcher to watch an individual continuously and record their conduct. The time taken by a person to complete each behavior from a start to the end is noted. Ones different manners are assessed according to direction and flow.

Study Area

The study was conducted in a hospital in China with nine ICUs units. It had 159 beds and 40 patients admitted with various illnesses (Han et al., 2020). The workflow of all the nine ICUs was analyzed. Each ICU was assigned one nurse manager responsible for primary nurse tasks. Information technology has cooperated into the workflow of nurses, where most activities are done by a personal digital assistant and an intensive care information system. The patients privacy has been protected by ensuring the systems have strong passwords. The publications review method was adopted to recover data from the China National Knowledge Infrastructure and Wanfang databases to identify nursing activities.

Nursing Activities

Nurses were found to perform both direct and indirect roles in the hospital. Direct care services came from a nurse spending time with the patients family. Indirect nursing care refers to preparations done by the nurse before interacting and treating the patient (Chipps et al., 2021). To ensure data reliability, a panel of experts comprising the ICU managers discussed the activities assigned to nurses. This ensures that information given at the end of the research is relevant and authentic. Twenty-seven researchers specializing in nursing acted as observers in data collection (Han et al., 2020). Nursing activities were recorded in paper form, including columns indicating the start and finish times. They recorded 107 groups of nursing activities, 6 categories, and 20 subcategories.

Nursing documentation includes assessment, planning, implementation, and evaluation of care. Data records include the patients name, address, age, and next of kin. This information is critical in the diagnosis process in addition to avoiding confusion. Similarly, the health personnel can be able to do follow-up quickly. The communication process in the hospital enables the treatment process to be conducted with ease (Happ, 2021). Good communication skills should be used during the interaction to understand the patients experiences and concerns. Positive interaction will make the patients accessible and be able to give out truthful information. Doctor-nurse communication is critical for treating the patient and should be on good terms.

Nurses personal affairs in the hospital include free time for eating and relaxing. Following shifts can facilitate this is followed so that patients always have caregivers. Order of activities should be observed to ensure a smooth transition from one task to another. The training was conducted before research to elaborate on the purpose, significance, and research tools. The researchers arrived at the working station 10 minutes before time. One nurse was identified for observation, and 30 nurses on duty were examined 79 times during that research period. The nursing work activities and time were written down for analysis purposes. Grading was done on a grade of 1-9 according to their experience and expertise (Happ, 2021). It was noted that most nurses consume their time in direct care, communication, and documentation activities.

Research Limitations

There were many limitations during the research aimed at studying nurses workflow. Firstly, lack of data before coming up with the online databases, hence the need for future comparison to verify existing information. The research was only conducted in one hospital, and no comparison was made with other facilities. There is insufficient time to collect, analyze, and verify data since the calculations are complex and time-consuming. Lastly, the nurses may have changed their behavior during the research, and the data might give a negative impression.

Conclusion

The main objective of the study was to observe and analyze workflow for ICU nurses. It was concluded that most nurses spend plenty of their time in direct care services. Nursing managers play a major role in ensuring time management and smooth flow of activities in the hospital. Patients data were kept confidential through the use of electronic records. Patients are able to interact with healthcare givers via online.

References

Chipps, E. M., Joseph, M. L., Alexander, C., Lyman, B., Mcginty, L., Nelson-Brantley, H., Parchment, J., Rivera, R. R., Schultz, M. A., Ward, D. M. & Weaver, S. (2021). Setting the research agenda for nursing administration and leadership science.JONA: The Journal of Nursing Administration, Publish Ahead of Print 51(9), 430-438. Web.

Han, B., Li, Q., Chen, X., & Zhao, G. (2020). Workflow for intensive care unit nurses: A time and motion study. SAGE Open, 10(3), 1-10. Web.

Happ, M. (2021). Giving voice: Nurse-patient communication in the intensive care unit. American Journal of Critical Care, 30(4), 256-265. Web.

The management of burns is one of the critical questions to be discussed by nurses who have enough experience of working in burn centers. In the article “Management of Burns in Intensive and Acute Care,” Rowley-Conwy (2013) discusses the aspects of the care that should be provided for patients with major burn injuries in order to prevent the development of complications. The purpose of the article is to describe what procedures should be performed not only by specialists in intensive care units but also by general nurses in emergency departments. Therefore, much attention should be paid to discussing the article’s features and its contribution to the nurses’ practice.

The article can be viewed as the review of the currently used practices to cope with burns in intensive care units, and the author describes procedures that are necessary in order to provide the respiratory care, cardiovascular care, renal care, pain management, wound care, required nutrition, and psychosocial care (Rowley-Conwy, 2013). The target audience of the article is general nurses who need to improve their knowledge regarding burn care. The article can also be interesting to specialists working in burn centers. Still, although Rowley-Conwy (2013) refers to results of the studies conducted in the United States in the 1980s, it is important to note that, being a staff nurse in King Abdulaziz Medical City in Saudi Arabia, the author synthesizes the global experience in burn care to present it in the article.

The information presented in the article can be discussed as easy for understanding by nurses and specialists in burn care because the text includes many terms and descriptions of procedures that should be performed by nurses in order to guarantee high-quality care. Therefore, the article’s content is focused on the target audience, and the information is appropriate to be understood by the reader. It is also important to pay attention to three interesting details that are described in the article. First, the author points out that nurses need to provide cardiovascular care in order to avoid oedema and the associated tissue hypoxia, as well as possible myocardial dysfunction. Furthermore, the focus should also be on renal care, especially when the electrical injury is observed because of the risks of developing acute necrosis. In addition, Rowley-Conwy (2013) pays attention to the fact that burn centers often use the out-of-date approaches to providing wound care because of certain limitations. Thus, healthcare providers can have the limited access to the modern dressings and other required resources.

While referring to the article’s content, it is possible to state that the detailed information regarding procedures to take in order to provide different types of care can be actively used in clinical settings. If a nurse needs to provide the care for a patient with burn injuries, she can use the recommendations proposed in the article to ensure the provision of respiratory care, wound care, and pain management (Rowley-Conwy, 2013). Therefore, the presence of many practical notes regarding burn care and pain management at different levels allows for recommending the article for students who need to improve their basic skills in providing the care for patients with burn injuries.

Still, in spite of the fact that the article provides the detailed and well-structured information on the delivery of the systemic burn care, it is possible to improve the presentation of data and add more information about rehabilitation and psychosocial care. Thus, Rowley-Conwy (2013) provides only a few sentences about psychosocial care and available rehabilitation services for patients with burn injuries, but the problem is in the fact that, in some cases, nurses and other healthcare providers who do not work in burn centers need to spend much time while working with patients and their families. As a result, they need to know how to conduct the psychological assessment and what strategies are effective to support patients. However, the article is written in such a manner that the reader can find oneself searching more details about the described procedures in order to be prepared for providing the acute care in those situations when the immediate reaction is expected to save the patient’s life.

From this perspective, the article includes many details regarding the burn care in intensive and acute care units. However, the review of the article allows for concluding that the detailed and specific information presented in the work is organized effectively in order to provide the reader with an opportunity to select the section of interest and learn the information that can be easily applied to practice. Furthermore, the author provides the discussion of the most efficient procedures with reference to peer-reviewed studies in the field, and the reader can easily utilize the recommendations for the evidence-based practice. Therefore, the article can be discussed as important to be reviewed not only by nurses working in intensive care units but also by general nurses. They will be able to improve their skills in providing burn care.

Reference

Rowley-Conwy, G. (2013). Management of burns in intensive and acute care. Nursing Standard, 27(45), 63-68.

Introduction

The aim of this paper is to present an implementation plan for the research problem that deals with the use of physical restraints in the intensive care unit. The steps and resources that will be used in the plan will also be presented. The paper also acknowledges the importance of evaluating any plan put in place to solve a problem.

Towards this end, the paper will present the evaluation plan of the proposed solution and the anticipated outcomes. Lastly, the paper will touch on the dissemination of evidence for nursing practice.

Description of Solution: Best Practice Staffing

Best practice staffing is defined by the Emergency Nurses Association as “that which provides timely and efficient patient care and a safe environment for both patients and staff, while promoting an atmosphere of professional nursing satisfaction,” (Robinson, Jagim & Ray, 2004).

Based on best practice, staffing will be done taking into consideration the following factors: patient census, patients’ acuity, length of stay of patients, nursing time for interventions and activities by patient acuity, and the mix of registered nurses versus non-registered nurses’ skills.

The Implementation Plan and the Steps and Resources that will be Used

An automated tool (in this case an Excel workbook) will be used to calculate the number of fulltime equivalent (FTEs) that is needed to provide quality care to patients in the intensive care unit. The tool will then split the FTEs into a skills mix of registered nurses (86%) and non-registered nurses (14%). The ratio of RN to non-RN needed in intensive care units was determined by the Nursing Interventions Classification (NIC) system (Robinson et al., 2004).

Once the tool determines the total number of FTEs needed for the ICU patients, they will be distributed throughout the day according to the trends of the patient volume. This staffing technique based on best practice will enable the unit to acquire the appropriate number of nurses as well as support staff needed to provide utmost care to the ICU patients.

It is hoped that by having adequate nursing and support staff, the need to use physical restraints would be reduced drastically (Kielb, Hurlock-Chorostecki & Sipprell, 2005). Moreover, having adequate number of nurses and support staff will ensure that physically restrained patients do not go for hours without being checked.

In addition to best practice staffing, the solution will include a thorough observation of the patients. One important aspect of the action plan is the assertion that restraints or their alternatives should not be used as a substitute for observation. To enhance observation, the patients considered to be high-risk will be located in rooms that are closest to the nurse’s station.

Safety rounds and patient checks will then be done after every one hour, with more frequent safety rounds at highly risky times (for instance during shift change). Documentation will be part and parcel of the assessment procedure. The documentation of the patient’s physical, emotional and psychological state will be done after every assessment.

The records will be inserted in each patient’s folder and placed at the bedside for easy access by the nurse. As a result, the number and severity of injuries that often result from physical restraints’ use would also decline (Winston, Morelli, Bramble, Friday & Sanders, 1999).

Evaluation Plan

The effectiveness of the action plan can be evaluated through quality assurance indicators that include the attitudes of the medical staff towards physical restraints use, types and number of patients’ injuries, and number of patients who have been restrained before and after the program.

The attitudes of the medical staff towards restraint use will help to gauge the effectiveness of the education program offered within the program. The number of staff who favored the use of restraints before the program will be compared with the number of staff favoring restraint use after the program.

The evaluation plan will be conducted through data collection using questionnaires as well as from medical records of the patients. As a result, the resources needed include human resources to carry out the actual data collection and statistical tools to analyze the data.

The projected outcomes from this plan are many. First and foremost, it is expected that the attitudes of the nurses towards ICU patients will be more positive than was the case before the plan’s implementation. This is due to reduced work load resulting from an increase in the number of staffs in the organization.

Second, it is expected that fewer patients will be physically restrained because physical restraints will be used only in extreme circumstances. Third, it is expected that the number and severity of injuries that result from physical restraints will reduce.

Dissemination of Evidence

Dissemination of evidence for nursing practice can be done in a number of ways. First, conferences organized for the nursing professionals are a great channel of disseminating evidence as they allow for extensive discussion of the evidence and criticism from peers.

Second, the evidence can be disseminated through publications in professional journals, periodicals, organizations’ newsletters, books, newspapers and magazines. Publication in peer-reviewed journals is the best option because experts in the field can criticize and appraise the evidence thus making it more credible.

The evidence can be published in various journals including: The Journal of Aging & Social Policy, Pre-hospital Emergency Care, Journal of Nursing Scholarship, and Journal of Nursing Practice to mention but a few. I would choose the Journal of Nursing Practice to disseminate the evidence. This is because this journal covers a wide range of topics in the nursing field practice and is therefore not as limited as the rest. As a result, the journal has a higher readership rate than the rest.

Conclusion

Based on evidence from the literature, this paper has provided a solution for the problem of physical restraints in the intensive care units. The paper has also presented an implementation plan of the solution as well as the means through which the evidence can be disseminated.

Reference List

Kielb, C., Hurlock-Chorostecki, C., & Sipprell, D. (2005). Can minimal patient restraint be safely implemented in the intensive care unit? Canadian Association of Critical Care Nurses, 16(1), 16-19.

Robinson, K., Jagim, M., & Ray, C. (2004). Nursing workforce issues and trends affecting emergency departments. Topics in Emergency Medicine, 26(4), 276-286.

Winston, P. A., Morelli, P., Bramble, J., Friday, A., & Sanders, J. B. (1999). Improving patient care through implementation of nurse-driven restraint protocols. Journal of Nursing Care Quality, 13(6), 32-46.

Introduction

The present essay will consider the topic of constructive alignment (CA) and apply it to the education of nurses working in Intensive Care Units (ICUs). CA can be viewed as a specific approach to developing educational programs, and it has been evidenced to have some positive outcomes, especially for the quality of said programs (Biggs, 2014; Croy, 2018; Duff et al., 2017). For ICU nurses, education is particularly important because ICU settings have their specific features that require appropriate training (Innes & Calleja, 2018). Consequently, ICU nurses need programs that would facilitate their work by providing them with the necessary knowledge and skills. Given the potential benefits of CA for education, CA needs to be considered in terms of ICU nurse training to determine if it applies to the settings of ICU.

To achieve this outcome, the present paper will begin by presenting the background of CA with particular attention paid to the key features of the approach, its history, and relevance for healthcare education. It will then proceed to critically examine the scope of the literature on the topic and the stakeholders relevant for this review. The impact of CA on ICU nurse education (ICUNE) will be considered next; the related benefits, challenges, and limitations will also be reviewed. Finally, the solutions to the challenges will be proposed. Based on the presented information, a conclusion will be made that due to its benefits and applicability to the ICU context, CA is worth the effort of overcoming its challenges.

Background

Topic Description

Biggs (2014) defines CA as an “outcomes-based approach to teaching.” In practice, it means that learning outcomes are viewed by CA as the first stage of planning. They are the first element of a teaching plan to be stated, and they are used to determine the methods that will be employed. In turn, the methods are viewed as the means of achieving related outcomes and measuring progress. Importantly, the planning must occur before teaching.

Thus, it is apparent why CA is termed as “alignment”: it involves the alignment of teaching and assessment methods with the desired outcomes. However, CA is not limited to outcomes and methods; climate and environment are similarly important (Leigh, Rutherford, Wild, Cappleman, & Hynes, 2013; Turjamaa, Hynynen, Mikkonen, & Ylinen, 2018), as well as the rules and procedures of educational institutions that host the teaching activities (Croy, 2018). Paskevicius (2017) also points out the significance of learning materials. Thus, CA may be defined as the approach to teaching that focuses on the alignment of the various components of the teaching process to create the best and most useful learning experience.

Consequently, it should also be mentioned that the first part of the term CA refers to constructivism. Constructivism can be defined as a specific student-centered approach to education, in which knowledge is viewed as something that a learner “builds” or “constructs” based on their experiences (Joseph & Juwah, 2012; Paskevicius, 2017). From this perspective, a teacher is tasked with designing the learning experiences that would facilitate the process of knowledge construction (Joseph & Juwah, 2012). CA adopts this perspective: it is learner-centered and constructivist, which determines the types of outcomes and methods that it aligns (Biggs, 2014; Dames, 2013). Also, an important aspect of CA is the difference between “surface” and “deep” learning: the former is concerned with a limited understanding of a studied topic, and the latter involves a more thorough investigation of the relevant content (Larkin & Richardson, 2013; Vanfretti & Farrokhabadi, 2013). This is a summary of the key elements of CA that should be considered when describing it.

History and Relevance to Nursing and Midwifery Education

CA is not a very new idea; supposedly, it was offered in 1949 by Ralph Tyler (Biggs, 2014, p. 6). However, Biggs (2014) notes that traditional teaching is not learner-centered. In particular, the author suggests that traditional curricula are typically centered on the activities of a teacher and the requirements that should be applied to them. This factor also reflects itself in the use of similarly traditional teaching methods (for instance, lectures). Consequently, as Biggs (2014) suggests, the spread of CA was slowed down because it could not exist in an environment that would not support learner-centered approaches.

Joseph and Juwah (2012) also report that the curricula employed in nursing education are often traditional and lack the innovative nature that is required for the field which has to correspond to the changes in the modern world. As a result, even though CA has been employed in education for many years (Ahlin, Klang-Söderkvist, Johansson, Björkholm, & Löfmark, 2017), it is not clear how often it is encountered in nursing education (Joseph & Juwah, 2012). Still, it should be noted that CA can be of use in multiple areas, including nursing and midwifery education.

In this regard, it is appropriate to mention several real-life examples. For instance, Croy (2018) discusses the application of CA to a mental health nursing course. The author reports positive outcomes which are evidenced by the students’ feedback. Similarly, Sunnqvist, Karlsson, Lindell, and Fors (2016) used CA to create a virtual patient simulation program and stated that the approach was well-suited for the task, even though they do not discuss its role in detail. Duff et al. (2017) applied CA to an oral health module in a midwifery program. The latter project was only reviewed by an expert panel, which is why there is not much evidence of the program’s effectiveness; also, the panel’s feedback cannot be attributed to CA exclusively. Still, the examples illustrate the fact that CA applies to nurse and midwifery program development, and the developers state that it can be beneficial for the two fields of education. Thus, it can be concluded that CA is relevant to the topic.

Stakeholders and the Scale of the Topic

The present paper considers the use of CA in ICUNE, which limits the relevant stakeholders to the specialists working in ICU and ICU patients. Indeed, patients may be ones who are most likely to benefit from the actions of well-trained nurses. However, CA would also have a positive impact on ICU nurses’ preparedness and ability to interact with other specialists and engage in teamwork (Croy, 2018), which is particularly important for ICUs. Finally, for nurses, enhanced skills and abilities are also most helpful in their performance, confidence, and career growth. Thus, all the stakeholders of the ICU can be affected by the use of CA in nursing education. The fact that CA can enhance the learning experience is evidenced below.

CA is relatively well-researched and represented in modern literature, but the present paper considers a more specific topic. While there is some research on the use of CA in the field of nursing education, it is not very extensive (Joseph & Juwah, 2012). Furthermore, modern literature does not offer the coverage of the usage of CA in the development of curricula for ICUNE; the present investigation could not find an article that would focus on this topic. Some papers that are devoted to ICUNE mention CA, but they typically do not consider it as one of their primary themes and do not provide any substantial coverage for it or its role in ICUNE (Innes & Calleja, 2018). Thus, the topic is not very frequently explored by modern literature, and the size and scale of the research devoted to it are rather small. Still, the existing studies that cover similar topics can be used to infer some conclusions about the impact of CA on ICUNE.

Impact

There is very little research on the use of CA in ICUNE. Innes and Calleja (2018) mention that CA is important for transition programs, which help new nurses get the necessary knowledge and skills for ICUs. The authors state that CA is essential for the structure of such programs. They also report that the programs, which they reviewed, seemed to have positive outcomes. However, it is not clear if such outcomes should be attributed to CA because the latter is not covered very extensively in the article. Other sources that would do more than mention CA in connection to ICUNE were not found, which is why it is difficult to discuss the impact of CA on this field of training. However, other sources on CA indicate that is can have a positive effect on educational programs, and it appears possible to infer that similar outcomes can be observed for ICUNE as well.

The primary consequence of CA is the improved quality of programs, which stems from their greater standardization, transparency, and coherence (Biggs, 2014; Croy, 2018; Duff et al., 2017). It is the result of the outcomes being aligned with teaching methods and assessment approaches (Croy, 2018; Higgins, Hogg, & Robinson, 2017). Additionally, evidence suggests that CA can improve students’ performance (Larkin & Richardson, 2013). This result is similarly believable because the outcomes-based approaches to education tend to have such effects (Tan, Chong, Subramaniam, & Wong, 2018). Also, learners are shown to change their learning approaches because of the influence of CA; in particular, they adopt “deeper” strategies that enable “deeper” learning (Wang, Su, Cheung, Wong, & Kwong, 2013). This outcome can also be viewed as a positive one. Finally, learners can be more satisfied with CA-based programs, which is shown in the study by Larkin and Richardson (2013). In summary, the benefits of CA are numerous and significant for a model of program development; ICUNE could use them.

Additionally, it should be mentioned that CA is well-suited for nursing education in general and ICUNE in particular. Indeed, nursing education has a very strong focus on practice and skills acquisition (Ahlin et al., 2017), which makes a constructivism-based approach to it very appropriate (Croy, 2018; Leigh et al., 2013). Also, since skills are the desired outcomes, they can be easily integrated into the CA model of teaching (Joseph & Juwah, 2012). CA is also viewed as an appropriate approach for practice-based learning (Wang et al., 2013). Thus, the focus of nursing education on skills and practice makes CA suitable for it.

Furthermore, CA is supportive of collaborative learning, which is particularly important for ICU nurses who need teamwork skills (Croy, 2018). The “deep learning” approach is applicable as well: ICU nurses need a comprehensive and deep understanding of the topics that they study due to the importance of their job for human lives (Berggren et al., 2016; Joseph & Juwah, 2012; Wang et al., 2013). CA is also helpful for nursing education, especially in ICU, because the nurses have prior experiences which they can use to construct knowledge (Tan et al., 2018). Additionally, it can be noted that learner-centredness should be viewed as a beneficial feature for students in any area, which is another positive feature of CA (Higgins et al., 2017). Overall, CA is suggested for the use of nursing education (Stott & Mozer, 2016), and it is recommended for ICUNE as well (Fitzgerald, Wong, Hannon, Tokerud, & Lyons, 2013). All the above-presented factors can be viewed as the benefits of CA that can be helpful in ICUNE.

At the same time, CA has some notable challenges. First, even though CA can be used at every educational level, which is one of its advantages, Biggs (2014) highlights the fact that it is more difficult to implement it at a grander scale because CA requires an institutional climate that supports learner-centered education. Additionally, the author concedes that other elements of CA education can conflict with the specific rules of an institution, including, for instance, particular approaches to evaluation or course content structures. Overall, the traditional features that may be present in an institution can undermine the use of CA in individual and especially institution-wide practice.

Furthermore, if CA is being introduced in new settings, resistance to change can be a problem (Biggs, 2014). In general, the implementation of CA needs to include more than surface compliance; it requires the support of the educators involved in the process (Larkin & Richardson, 2013). A major challenge in this regard is that CA needs a notable amount of work, especially for the achievement of the best quality of teaching. The process of the development of the CA curriculum can be particularly time- and resource-consuming, especially when a large-scale implementation is concerned (Biggs, 2014; Croy, 2018). This issue can be connected to another problem: the process of achieving alignment can be problematic and difficult, especially for an unprepared person (Trigwell & Prosser, 2013). In general, it can be suggested that CA-based programs are not easy to develop and implement, which is its main challenge.

It should also be noted that CA leaves room for variations, which can be a positive feature because it enables educators to search for the approaches that would fit their learners the best. However, it is also a problem since the quality of the chosen elements might differ because of this variation, which results in the possibility of developing well-aligned but ineffective programs (Trigwell & Prosser, 2013). As a result, it can be suggested that while alignment may be crucial for a program’s quality, the choice and management of the elements are similarly important, which further complicates the challenge of program development. Thus, the primary limitation of CA is that it does not guarantee the positive outcomes of programs; rather, it is one of the tools that an educator should employ to improve the quality of their work. In summary, CA has some challenges and limitations, which can be interrelated with its benefits, but CA’s positive features are particularly promising, which makes the approach noteworthy.

Solutions

The solutions to the above-presented issues are likely to target different audiences, but in the majority of cases, the cooperation of stakeholders will be required. For the implementation problem, the first dimension to be considered is the difficulty of CA use. In this regard, there are some common approaches to CA which can facilitate its application. An example is a one-verb method, in which the same verb is used in the phrasing of an outcome and the methods associated with it to ensure their alignment. Biggs (2014) views this strategy as integral to CA, and while it does not completely resolve the problem of CA’s complexity, it can facilitate the process of CA-based education program development. Similarly, the employment of specific steps that have been developed for CA can guide one’s practice of program development (Berggren et al., 2016; Croy, 2018). Based on this information, it can be suggested that the primary strategy for the facilitation of CA use is the investigation of the existing literature on the topic and its study by the educators to get ready to employ CA effectively.

This approach would also help to manage CA’s limitations. Since the methods of a well-aligned program also need to be high-quality, the integration of various modern evidence-based approaches to education may be helpful, and educators need to be aware of them. Overall, the preparation of educators to employ CA is important; it is necessary to ensure that they have a good perspective on all the relevant elements (Turjamaa et al., 2018). By enhancing their knowledge of teaching methods, especially those compatible with constructivism, nurse educators will be able to improve the quality of their work, and this strategy is perfectly applicable to the ICU context.

Indeed, the first solution is the improvement of educators’ knowledge, which is an activity that should be performed by ICU nurse educators themselves. However, other stakeholders can also assist them in this process. For instance, the managers and administrators can provide the resources necessary for this endeavor and otherwise encourage educators’ professional development. Thus, the cooperation of stakeholders in this regard would be particularly promising.

On the other hand, the strategies for removing the CA-conflicting elements from an institution’s system and the reduction of resistance to change are mostly meant for the administration, but educators can provide important advice on the matter. Regarding the issues that can hinder CA, they can be numerous, but examples might include the time allocated for ICUNE or the specific approaches to measuring ICUNE progress (Biggs, 2014). An educator would be particularly good at detecting such problems. The matter of the time which is consumed by CA can also fit into this category: ICU educators need to detail the data on the requirements of the process, and managers need to provide the relevant resources. As for the resistance to change, both educators and other stakeholders (including the nurses in training) can assist by providing the leadership which is necessary to eliminate the issue. Thus, both key strategies can be employed in ICU settings.

The anticipated drawback of the mentioned solutions is that they are going to consume resources (funds, time, and effort). However, their main limitation is that they can only be fully effective if the collaboration of stakeholders is present. While individual educators can work to improve their knowledge, they might be held back by the lack of institutional support. While managers can allocate extra resources for educators’ CA efforts, they are unlikely to be able to do that effectively without any input from the educators. Thus, the challenges that are connected to CA can be resolved only through active collaboration, which should be aimed at the preparation of educators for their work with CA and the development of an institutional support system for CA. As a result, ICU nurse educators need to ensure the engagement of the relevant stakeholders. Given the benefits of CA, dedicating the efforts to resolving the mentioned issues is worthwhile.

Conclusions

CA is an approach to educational program development that aligns teaching and assessment methods, as well as other components of teaching, with learning outcomes. The concept has been present for over 60 years, but its use in ICUNE is not explored. Still, it can be assumed that CA fits ICUNE because it is practice- and learner-oriented; it is also good for collaborative and deep learning. CA is evidenced to have beneficial outcomes, including improved performance and learner satisfaction; it enhances the transparency and coherence of educational programs, which is why it should be applied to ICUNE. Admittedly, CA is associated with notable challenges because it is resource-consuming and difficult to implement; also, CA cannot guarantee the high quality of resulting programs. However, the mentioned issues can be resolved through the collaboration of stakeholders with the help of the strategies aimed at improving educators’ preparedness to use CA and institutions’ ability to support it.

References

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Berggren, E., Strang, P., Orrevall, Y., Ödlund Olin, A., Sandelowsky, H., & Törnkvist, L. (2016). Evaluation of ConPrim: A three-part model for continuing education in primary health care. Nurse Education Today, 46, 115-120. Web.

Biggs, J. (2014). Constructive alignment in university teaching.HERDSA Review of Higher Education, 1(1), 5-22. Web.

Croy, S. (2018). Development of a group work assessment pedagogy using constructive alignment theory. Nurse Education Today, 61, 49-53. Web.

Dames, G. (2013). Enhancing of teaching and learning through constructive alignment. Acta Theologica, 32(2), 35-53. Web.

Duff, M., Dahlen, H., Burns, E., Priddis, H., Schmied, V., & George, A. (2017). Designing an oral health module for the Bachelor of Midwifery program at an Australian University. Nurse Education in Practice, 23, 76-81. Web.

Fitzgerald, L., Wong, P., Hannon, J., Tokerud, M., & Lyons, J. (2013). Curriculum learning designs: Teaching health assessment skills for advanced nursing practitioners through sustainable flexible learning. Nurse Education Today, 33(10), 1230-1236. Web.

Higgins, R., Hogg, P., & Robinson, L. (2017). Constructive alignment of a research-informed teaching activity within an undergraduate diagnostic radiography curriculum: A reflection. Radiography, 23, S30-S36. Web.

Innes, T., & Calleja, P. (2018). Transition support for new graduate and novice nurses in critical care settings: An integrative review of the literature. Nurse Education in Practice, 30, 62-72. Web.

Joseph, S., & Juwah, C. (2012). Using constructive alignment theory to develop nursing skills curricula. Nurse Education in Practice, 12(1), 52-59. Web.

Larkin, H., & Richardson, B. (2013). Creating high challenge/high support academic environments through constructive alignment: student outcomes. Teaching in Higher Education, 18(2), 192-204. Web.

Leigh, J., Rutherford, J., Wild, J., Cappleman, J., & Hynes, C. (2013). The patchwork text assessment – an integral component of constructive alignment curriculum methodology to support healthcare leadership development. Journal of Education and Training Studies, 1(1), 139-150. Web.

Paskevicius, M. (2017). Conceptualizing open educational practices through the lens of constructive alignment. Open Praxis, 9(2), 125-140. Web.

Stott, A., & Mozer, M. (2016). Connecting learners online: Challenges and issues for nurse education – Is there a way forward? Nurse Education Today, 39, 152-154. Web.

Sunnqvist, C., Karlsson, K., Lindell, L., & Fors, U. (2016). Virtual patient simulation in psychiatric care – A pilot study of digital support for collaborate learning. Nurse Education in Practice, 17, 30-35. Web.

Tan, K., Chong, M., Subramaniam, P., & Wong, L. (2018). The effectiveness of outcome based education on the competencies of nursing students: A systematic review. Nurse Education Today, 64, 180-189. Web.

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Vanfretti, L., & Farrokhabadi, M. (2013). Evaluating constructive alignment theory implementation in a power systems analysis course through repertory grids. IEEE Transactions on Education, 56(4), 443-452. Web.

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Introduction

Even though the use of an evidence-based approach is actively promoted by healthcare providers, the application of this approach in clinical settings faces a range of obstacles. As a result, researchers and practitioners are interested in developing strategies and techniques that can be used in evidence-based practice (Friesen-Storms, Beurskens, & Bours, 2017; Jackson, 2016). In this context, evidence-based practice is an approach associated with applying research findings and the best clinical practices in healthcare settings to maximize the likelihood of positive outcomes for patients (Christensen, Carroll, & Josephson, 2014; Warren et al., 2016). The following discussion will focus on the specifics of using evidence-based practice in the context of an intensive care unit. The purpose of this paper is to identify challenges that are associated with the implementation of an evidence-based approach in a clinical environment and describe strategies that can be used for implementing this approach.

Challenges in Implementing an Evidence-Based Approach

Although the evidence-based practice is important in intensive care units as well as in other settings, there are certain challenges or barriers to the use of this approach by clinicians. It is possible to divide these challenges and barriers into individual and organizational obstacles. Individual challenges are connected with nurses’ inability to apply evidence to practice because of a lack of knowledge regarding relevant facts and data (Christensen et al., 2014). The problem is that nurses and other healthcare providers working in different clinical settings, including intensive care units, are often unaware of the latest findings relating to different problems and disease treatment.

Moreover, healthcare providers may lack the necessary skills that are required to identify the essential information in published research to guide their practice and implement the most effective problem-solving approach. Evidence-based practice is associated with making patient-oriented decisions concerning scientific evidence and the most effective findings in the clinical field (Hoffmann, Montori, & Del Mar 2014). However, nurses’ inability to review studies and propose decisions limits them in providing the most appropriate care. Furthermore, there may also be psychological barriers if nurses do not believe that their actions or decisions can change practice and improve patient outcomes.

Organizational challenges include a lack of support and resources from authorities in healthcare organizations, a lack of time, and a lack of training about evidence-based practice. Thus the problem is that the application of an evidence-based approach in clinical settings is often not supported by actual changes in the work of clinical units to provide nurses and other healthcare practitioners with opportunities to learn more about the available findings on various questions (Grant & Coyer, 2018; Hallum-Montes, Middleton, Schlanger, & Romero, 2016). Nurses are often not provided with training and time for searching for research studies and evidence to resolve a clinical problem. As a result, the lack of access to a clinician’s expertise negatively affects the quality of provided care as more efficient solutions could be proposed and applied. Therefore the principles of applying an evidence-based approach to different clinical settings should be taught to nurses and other healthcare providers at an organizational level (Tacia, Biskupski, Pheley, & Lehto, 2015). The reason is that practitioners need to know how to search for material, evaluate research results, and conclude concerning data.

Strategies for Implementing an Evidence-Based Approach

To guarantee the implementation of an evidence-based approach in a clinical setting, it is necessary to implement changes at an organizational level. The associated strategies include providing training and education for nurses to help them learn how to work with research and evidence, and how to apply them to practice (Melnyk, Gallagher‐Ford, Long, & Fineout‐Overholt, 2014). For this purpose, healthcare authorities often use online and interactive courses, as well as consultations with professionals in the field. After completing a training course, nurses and physicians can conduct searches of available databases and analyze findings most efficiently (Kristensen, Nymann, & Konradsen, 2015; Hallum-Montes et al., 2016; Grant & Coyer, 2018). Moreover, nurses should also be trained regarding the correlation between patients’ individual preferences and the latest research in the field to choose the most appropriate treatment in a specific case (Grant & Coyer, 2018; Friesen-Storms et al., 2017). As a result of these activities, it is reasonable to expect that evidence will begin to be applied to daily practice.

Other strategies are motivational, and they are associated with involving nurses in regular meetings and discussions of patient cases and searching for solutions to clinical problems. Leaders in healthcare settings are expected to stimulate nurses’ interest in learning more and finding the most efficient solutions to problems. Therefore, they need to provide access to the Internet, databases, and online libraries so that they do not limit nurses and other clinicians in their search for resources and discussions of the latest innovations in different medical spheres (Underhill, Roper, Siefert, Boucher, & Berry, 2015). In this context, the promotion of cooperation between nurses in finding solutions to clinical problems also should be one of the strategies that are used in healthcare facilities, including intensive care units, to improve patient safety and the quality of care (Black, Balneaves, Garossino, Puyat, & Qian, 2015; Melnyk et al., 2016; Underhill et al., 2015). From this perspective, the use of an evidence-based approach is possible when healthcare providers know how to implement it, and they have the required resources, including time and the support of leaders.

Conclusion

The application of an evidence-based approach is a requirement in a modern clinical setting, especially in an intensive care unit where the focus is on using the most effective methods that can provide immediate results. However, despite the obvious interest of researchers and practitioners in evidence-based practice and associated research, there are still challenges. The problem is that nurses often lack the knowledge and critical skills to effectively analyze studies or data about effective practices or to apply this information to their work, and they often lack resources to complete these tasks daily. Thus in many healthcare facilities and units, there are no opportunities provided for nurses and other healthcare workers to practice collecting data on diagnosis and treatment concerning recent trends in the field. However, it is possible to apply certain strategies to implement an evidence-based approach to practice. In a clinical setting, these are usually educational and motivational strategies at an organizational level. These strategies usually lead to positive changes in shifting nurses’ practice toward an evidence-based approach.

References

Black, A. T., Balneaves, L. G., Garossino, C., Puyat, J. H., & Qian, H. (2015). Promoting evidence-based practice through a research training program for point-of-care clinicians. The Journal of Nursing Administration, 45(1), 14-20.

Christensen, R. D., Carroll, P. D., & Josephson, C. D. (2014). Evidence-based advances in transfusion practice in neonatal intensive care units. Neonatology, 106(3), 245-253.

Friesen-Storms, J. H., Beurskens, A. J., & Bours, G. J. (2017). Teaching and implementing evidence-based practice in a hospital unit with secondary vocational trained nurses: Lessons learned. The Journal of Continuing Education in Nursing, 48(9), 407-412.

Grant, A., & Coyer, F. (2018). An exploration of the barriers and facilitators to evidence based practice and research utilisation in an Australian intensive care unit. Australian Critical Care, 31(2), 133-139.

Hallum-Montes, R., Middleton, D., Schlanger, K., & Romero, L. (2016). Barriers and facilitators to health center implementation of evidence-based clinical practices in adolescent reproductive health services. Journal of Adolescent Health, 58(3), 276-283.

Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA, 312(13), 1295-1296.

Jackson, N. (2016). Incorporating evidence-based practice learning into a nurse residency program: Are new graduates ready to apply evidence at the bedside? Journal of Nursing Administration, 46(5), 278-283.

Kristensen, N., Nymann, C., & Konradsen, H. (2015). Implementing research results in clinical practice-the experiences of healthcare professionals. BMC Health Services Research, 16(1), 48-56.

Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., & Fineout‐Overholt, E. (2014). The establishment of evidence‐based practice competencies for practicing registered nurses and advanced practice nurses in real‐world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing, 11(1), 5-15.

Melnyk, B. M., Gallagher‐Ford, L., Thomas, B. K., Troseth, M., Wyngarden, K., & Szalacha, L. (2016). A study of chief nurse executives indicates low prioritization of evidence‐based practice and shortcomings in hospital performance metrics across the United States. Worldviews on Evidence‐Based Nursing, 13(1), 6-14.

Tacia, L., Biskupski, K., Pheley, A., & Lehto, R. H. (2015). Identifying barriers to evidence-based practice adoption: A focus group study. Clinical Nursing Studies, 3(2), 90-96.

Underhill, M., Roper, K., Siefert, M. L., Boucher, J., & Berry, D. (2015). Evidence‐based practice beliefs and implementation before and after an initiative to promote evidence‐based nursing in an ambulatory oncology setting. Worldviews on Evidence‐Based Nursing, 12(2), 70-78.

Warren, J. I., McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence‐Based Nursing, 13(1), 15-24.

Course Overview

This course prioritizes cross-professional collaboration and mutual knowledge exchange to enhance the professional diversity and foster versatility among the ranks of nurses. The core course constituents include care for critically ill clients as well as condition assessment and provision of quality assistance under stress and time pressure (Pun et al., 2019). Such a course will benefit the overall practical proficiency of nurses and improve their decision-making expertise. In addition to that, it will advance their theoretical knowledge of the ICU setting and contribute to the base knowledge of nursing concepts and theories.

Course Objectives

The students who took this course will exhibit the mastery of:

1. Assessment of the need for care under time constraints and in adverse conditions;
2. Provision of assistance to critically ill individuals with precision, speed, and proficiency;
3. Effective use of modern machinery and equipment utilized daily in ICU setting;
4. Collaboration with other professionals in the unit with a maximized synergy;
5. Mastery of knowledge related to the theoretical side of care provision in the ICU unit.

Course Requirements

The main requirements are attendance and participation in all course activities. The intricate connection between all course modules does not allow for easy stand-alone learning without sufficient damage to understanding of the course material. Participation is critical for hands-on learning as well as stable progression and acquisition of key concepts of the program.

Course Outline

• Unit 1: Nursing diagnosis in ICU setting
  • Critical components of diagnosing a patient;
  • Working under pressure;
  • Searching for the best possible criteria;
  • Implementing guidelines and evidence-based practice (Robertson & Al-Haddad, 2013).
• Unit 2: Provision of assistance to critically ill patients
  • Approaches and frameworks of care for critically ill patients;
  • Importance of monitoring as methods of prevention of urgent situations;
  • Stabilization of airway and berating circulation;
  • Hemodynamic support and other methods of care.
• Unit 3: ICU equipment and electronics
  • Practical functioning and importance of ICU tools;
  • Development of techniques and need for knowledge update.
• Unit 4: Teamwork and collaboration in ICU setting
  • Value of collaboration and practical use;
  • Differences between other nursing positions and ICU;
  • ICU roles.
• Unit 5: ICU theory and practice
  • Nursing models of care applicable to ICU;
  • Critical knowledge base update for other settings;
  • Making use of one’s background.

Teaching Strategies

The course will employ all audio-visual materials available in class to effectively translate knowledge and practical wisdom. As such, handout materials, presentations, videos, oral speech, and practical demonstrations will be used to teach students. After the material is delivered, it will be assessed on the exam.

Attendance and Participation

Students will assume responsibility for attendance and participation in its entirety. All materials and topics discussed during classes and practical demonstrations will be requested to produce at the exam (Center for Teaching and Learning, n.d.).

Course Evaluation Strategies

Participation and attendance as well as depth and fullness of knowledge will be the core constituents of a final grade. Thus, the final exam will be worth 50% of the grade, take-home projects – 15%, participation – 15%, unit mini-exams – 20%.

Evaluation Methods

References

Center for Teaching and Learning. (n.d.). Course and syllabus design. Web.

Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., … Ely, E. W. (2019). Caring for critically ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative in over 15,000 adults. Critical Care Medicine, 47(1), 3-23.

Robertson, L. C., & Al-Haddad, M. (2013). Recognizing the critically ill patient. Anaesthesia & Intensive Care Medicine, 14(1), 11–14.

While medications are offered to patients around the world for treating their health problems, such a substantial use suggests that risks of harm could increase. It is essential to understand that the delivery of healthcare to patients is not an infallible process and errors do occur; moreover, they represent the seventh most common cause of death among patients (Moyen, Camire, & Stelfox, 2008).

A medication error refers to an incorrect decision made at any point of the medication use process, which consists of such stages as “prescription, transcription, preparation, dispensation, and administration” (Hussian & Kao, 2015, p. 92). Causes of such errors in Intensive Care Unit (ICU) settings can vary from factors related to health care professionals (lack of training, poor communication with patients, etc.) to factors associated with the overall work environment (lack of resources, confusing medication packaging, etc.). The majority of medication errors take place at the stage of administration (53%); however, mistakes also occur during prescription (17%), preparation of medication (14%), and transcription (11%) (Krahenbuhl-Melcher et al., 2007). Medication errors appear in around six percent of ICU episodes associated with medication use. Among adults diagnosed with critical conditions, the rate or errors in medication can vary from 1.2 to 947 mistakes per thousand patient ICU days (with a median of 106 mistakes per thousand patient ICU days) (Moyen et al., 2008). It is also important to mention that medication errors have adverse consequences, with a fifth of them being life threatening and almost a half problematic enough to require additional treatment.

With regards to the strategies implemented to reduce medication errors, different institutions had different approaches. For instance, the FDA required the use of bar codes and biological product labels placed on medication packaging so that healthcare providers could use scanning equipment. World Health Organization proposed such solutions as medication reviews, automated information systems, and multicomponent interventions.

List of Sources

Aronson, J. (2009). Medication errors: Definitions and classifications. British Journal of Clinical Pharmacology, 67(6), 599-604.

Cho, I., Park, H., Choic, Y., Hwang, M., & Bates, D. (2014). Understanding the nature of medication errors in an ICU with a computerized physician order entry system.PLoS One, 9(12), Web.

Cohen, M. (2007). Medication errors. Washington, DC: American Pharmacists Association.

Dalal, K., Barto, D., Smith, T. (2015). Preventing medication errors in critical care. Nursing Critical Care, 10(5), 27-32.

di Muzio, M., Marzuillo, C., de Vito, C., La Torre, G., & Tartaglini, D. (2016). Knowledge, attitudes, behavior and training needs of ICU nurses on medication errors in the use of IV drugs: A pilot study. Signa Vitae, 11(1), 182-206.

di Simone, E., Tartaglini, D., Fiorini, S., Petriglieri, S., Plocco, C., di Muzio, M. (2016). Medication errors in intensive care units: Nurses’ training needs. Emergency Nurse, 24(4), 24-29.

Donaldson, M. (2008). An overview of to err is human: Re-emphasizing the message of patient safety. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Chapter 3). Rockville, MD: Agency for Healthcare Research and Quality.

El Haj, H., Lamrini, M., & Rais, N. (2013). Quality of care between Donabedian model and ISO9001V2008. International Journal of Quality Research, 7(1), 17-30.

Garrouste-Orgeas, M., Philippart, F., Bruel, C., Max, A., Lau, N., & Misset, B. (2012). Overview of medical errors and adverse events. Annals of Intensive Care, 2(2), 1-9.

Garrouste-Orgeas, M., Timsit, J., Vesin, A., Schwebel, C., Arnodo, P., Lefrant, J.,… Soufir, L. (2010). Selected medical errors in the intensive care unit. AJRCCM, 181(2), 1-17.

Hussain, E., & Kao, E. (2005). Medication safety and transfusion errors in the ICU and beyond. Critical Care Clinician, 21, 91-110.

Kiekkas, P., Karga, M., Lemonidou, C., Aretha, D., & Karanikolas, M. (2011). Medication errors in critically ill adults: A review of direct observantion evidence. American Journal of Critical Care, 20(1), 36-44.

Krahenbuhl-Melcher, A., Schlienger, R., Lampert, M., Haschke, M., Drewe, J., & Krahenbuhl, S. (2007). Drug-related problems in hospitals: A review of the recent literature. Drug Safety, 30, 379-407.

Kruer, R. M., Jarrell, A. S., & Latif, A. (2014). Reducing medication errors in critical care: a multimodal approach. Clinical Pharmacology: Advances and Applications, 6, 117-126.

Kunkel, S., Rosenqvist, U., & Westerling, R. (2007). The structure of quality systems is important to the process and outcome, an empirical study of 386 hospital departments in Sweden. BMC Health Services Research, 7, 104-112.

Liu, S. W., Singer, S. J., Sun, B. C., & Camargo, C. A. (2011). A conceptual model for assessing quality of care for patients boarding in the emergency department: Structure-process-outcome. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 18(4), 430-435.

MacFie, C., Baudouin, S., & Messer, P. (2015). An integrative review of drug errors in critical care. SAGE Journals, 17(1), 63-72.

Moore, L., Lavoie, A., Bourgeois, G., & Lapointe, J. (2015). Donabedian’s structure-process-outcome quality of care model: Validation in an integrated trauma system. Journal of Trauma and Acute Care Surgery, 78(6), 1168-1175.

Moyen, E., Camiré, E., & Stelfox, H. T. (2008). Clinical review: Medication errors in critical care. Critical Care, 12(2), 208-218.

Velo, G. P., & Minuz, P. (2009). Medication errors: prescribing faults and prescription errors. British Journal of Clinical Pharmacology, 67(6), 624-628.

Introduction

This essay presents a report of a project dedicated to the assessment of the learning needs of a group of nurses in an intensive care unit (ICU). It will offer a definition and explanation of learning needs assessment, describe the target group and predictions for the project and detail the methods used during it. After that, the results of the project will be presented, analysed and used to propose recommendations in the form of an educational program plan. Additionally, the implications of the project and associated problems will be considered and a conclusion will be made. The project demonstrates the importance of educational needs assessments and provides sufficient data for the development of an educational program for the studied ICU.

Background

Education Needs Assessment: An Explanation and a Rationale

Education, learning and training needs assessment (ENA) can be defined as the procedure which aims to determine the areas of study that a particular group should focus on (Aw & Drury,2016,p219; Gaspard & Yang,2016,p1-2). Additionally, the ENA can consider other elements of the educational experience, for instance, the preferred teaching methods and approaches of the target group (Abyad & Banday,2016,p8-9; Fox et al.,2015,p73).

ENA is typically carried out for the development of tailored educational programs (Goudreau et al.,2015,p5; Kilic et al.,2014,p3). To ensure their success, they should take into account the specific knowledge gaps and various forms of educational preferences of the targeted groups (Abyad & Banday,2016,p3; Gaspard & Yang,2016,p1-2). In other words, to make a program learner-centred, which is a requirement for the modern approach to teaching (Waltz, Jenkins, & Han, 2014,p392), ENA is necessary. Thus, the present project focused on establishing the needs of the target group before proceeding with the development of an educational program.

Target Group

The target group consists of the nurses of the ICU of the King Fahad Hospital (KFH) in Almadinah, Saudi Arabia. The reason for choosing this target group is the affiliation of the researcher: since the researcher is a nurse who works in the ICU of KFH, the analysis of the educational needs of the nurses of this establishment is required. Additionally, the target group defined the topics that were presented to the participants as potential options for consideration and the knowledge of the specifics of the work of an ICU nurse assisted the researcher in developing the data collection tool. Thus, the determination of the target group was a crucial element of the project.

Predictions

The predictions were rationalised by the researcher’s knowledge of the specifics of the training of nurses in the ICU. Most nurses of the KFH’s ICU are not provided with direct training on X-ray interpretation. The issue may be related to the fact that the orientation department of the hospital does not seem to consider chest X-ray as a particularly important area of knowledge for ICU nursing.

However, the experience of ICU nurses who have been working with the researcher suggests that chest X-ray is helpful in the settings; for instance, it can be used to determine the correct place for the endotracheal tube. Thus, the topic should be of interest to the respondents and the lack of training on it is likely to result in them reporting a shortage of skills in this field. As a result, the importance of and the lack of knowledge on chest X-ray was the main prediction of the educational needs of the ICU nurses in KFH.

Method

Tool Design and Justification

For the present project, a questionnaire was used as the tool for the ENA. Questionnaires are capable of gathering the perspectives of rather large groups in a resource-efficient manner (Timmins,2015,p42), which are their major advantages. These tools are very widely employed (Rowley,2014,p308) and they can be used in nursing research as well (Timmins,2015,p42). Additionally, questionnaires are commonly applied to ENA (Abyad & Banday,2016,p11-12; Barratt & Fulop,2016,p1-2; Gaspard & Yang,2016,p2; Hennessy & Hicks,2011,p11-13). It is apparent that the purpose of questionnaires suits the aim of the project, which is to gather the nurses’ reports about their educational needs. Therefore, the method fits the project and its advantages justify its use.

The questionnaire of this project includes four major sections: one is targeted at demographics, one considers the topics that the participants want to study, one reviews their self-reported skill levels and one focuses on their educational preferences. These sections used the Likert scale, which is a commonly employed scale that helps to gather the perspectives of participants (Bishop & Herron,2015,p279; Harpe,2015,p838).

Also, its use makes the process of working with questionnaire simpler, which can encourage the participants to complete the procedure (Rowley,2014,p314). Two more questions were open-ended; they invited the participants to list the skills that they would like to train and make any further comments. The latter questions were added to avoid restricting the participants’ options.

It is important to consider the existing questionnaires, which can also be modified as required, before developing a new one (Aw & Drury,2016,p216; Kilic et al.,2014,p3; Timmins,2015,p45). This project’s questionnaire was based on the Hennessy-Hicks Training Needs Analysis Questionnaire and the CME Needs Assessment. Both of the tools consider the perceived importance and level of skills, and both use the Likert scale and open-ended questions (Abyad & Banday,2016,p 11-12; Hennessy & Hicks,2011,p11-13). The idea of an extensive demographics section was taken from Hennessy and Hicks questionnaire (2011,p11).

However, neither of the questionnaires were devoted to ICU; as a result, the topics which they used did not fit the needs of the present project. Thus, the tools were modified to include the questions that are of interest to ICU nurses. The choice of the topics was guided by relevant literature (Guilhermino, Inder, Sundin, & Kuzmiuk,2014,p2; Fleming, Brady, & Malone,2014,p55; Larkin & Zimmanck,2015,p334; Silva et al.,2015,p438.e8). It should be noted that the change of topics is not expected to significantly affect the tools’ reliability or validity (Maher et al.,2017,p308).

The resulting questionnaire was piloted in Melbourne and Saudi Arabia with three nurses in total. The first pilot (in Melbourne) implied that some changes were required, mostly those related to the phrasing of the questions; in particular, the Likert scale was better explained. The second pilot was conducted with no problems identified, after which the tool was deemed ready. All the pilot group nurses supported the chosen topics and did not suggest any new ones.

Thus, the eventual questions covered the arterial blood gas (ABG) interpretation, 12 lead electrocardiography (ECG), central venous pressure (CVP), modes of ventilator, chest X-ray, drug calculation, wound care, tracheostomy care, endotracheal tube care, management of intercostal catheters (ICT) and computer usage based on the literature and the expertise of the developer and testers of the tool.

Implementation Phase

The implementation of the needs assessment project involved the distribution and collection of the questionnaires. First, the questionnaire was sent to one of the KFH workers who printed 33 copies and provided them to the head nurse of ICU. The head nurse proceeded to distribute the copies to the ICU nurses, informing them about the project, its duration (two days) and the fact that the participation in it was voluntary. Additionally, the head nurse placed a box in her office, which was used to gather the filled-out questionnaires. The questionnaires were then sent to the researcher by the same worker who had printed them.

The pen-and-paper approach to questionnaires is a well-established and valid one, even though it is more costly and time-consuming than online versions (Maher et al.,2017,p308; Timmins,2015,p48). The reasons for choosing it were concerned with the lack of researchers’ experience in the development of online questionnaires and the opportunity to use the pen-and-paper version provided by the ICU.

A total of 30 copies were successfully distributed and 25 of them were returned, which constitutes an 83% response rate. This response rate is quite high because questionnaires are typically associated with very low response rates; basically, a response rate above 75% would be considered sufficient for making conclusions (Timmins,2015,p48). The implementation procedures were designed in a way that would ensure their ethical nature.

Ethical Considerations

The ethical considerations of the project were not very extensive because the needs assessment questionnaire did not hold any significant risks. Indeed, the questions could not be considered insensitive and were unlikely to cause any discomfort; other issues, for instance, economic or physical ones, were inapplicable to the project. This situation is common for anonymous questionnaires because they are almost risk-free (Barratt & Fulop,2016,p5). Also, none of the questionnaires that were used to develop the tool showed significant ethical issues; they were anonymous and not insensitive. As a result, no significant ethical concerns were associated with the choice and modification of the tools.

However, the project needed to ensure the voluntary nature of the respondents’ participation and take into account the confidentiality concerns. The nurses were made aware of the fact that they could refuse to participate by the head nurse during the distribution of the copies of the questionnaire; there were no repercussions for not taking or submitting the copy. Furthermore, the design of the tool and the procedure ensured that it would be impossible to determine who returned the questionnaire and who did not.

The tool did not gather any personal information; as a result, the participants remained anonymous. The materials of the project will be kept in a safe location (the researcher’s place) for as long as they are required to prepare the report.

It is also important that the researcher contacted the head nurse of KFH to obtain the permission to conduct the ENA, which was officially granted. Similarly, the nurse director of the researcher also agreed to the questionnaire project with the condition that the results would be provided for the use in ICU. Since the results of the project do not include any personal or identifying information, the condition was deemed appropriate.

Results

After the data collection, it was transferred to the researcher’s computer and analysed with the help of MS Excel, which allows making the following conclusions. The majority of the respondents (more than 83%) were female (see Figure 1); also, most of them (70%) were between 21 and 29 years old (see Figure 2). Additionally, most of the participants (almost 71%) had a diploma, although some of them had a bachelor’s (4%) or master’s (25%) degree (see Figure 3). Furthermore, the majority of the respondents had less than one year of experience in ICUs (see Figure 4) and the same is true for their experience with KFH (see Figure 5).

The second section of the questionnaire required considering ICU topics and reporting the importance of receiving some training related to them. The question used a Likert scale, in which number 1 corresponded to the least important topic and number 5 indicated the most important one. The results are presented in Figures 6-16. The topics that were ranked as most important by the majority of the participants (more than 10 people) include ABG interpretation (Figure 6), chest X-ray (Figure 10), drug calculation (Figure 11) and ICT management (Figure 15).

In another section, the participants were asked to report their level of skill with respect to the same topics. The process used a Likert scale again; in it, number 1 corresponded to basic skills and number 5 implied the highest level of skill. Figures 17-28 report the relevant results. The participants were most skilled in tracheostomy care (Figure 24), ETT care (Figure 25) and computer use (Figure 27). They seemed to be the least sure about their skills in chest X-ray interpretation (Figure 21).

For this topic, five nurses reported a low level of skill, 14 nurses suggested that their skills were below the medium level and none indicated a high level of skills. Furthermore, for ABG results interpretation, five nurses used number 2, which can be interpreted as rather low skills and 12 nurses used number 3, which indicates medium skills. The picture was similar for drug calculation (Figure 22) and ICT catheters (Figure 26). With the rest of the topics, more participants reported being skilled in them.

The next section considered the educational preferences of the participants. It also used Likert scales: 1 indicated the least preferred answer and 5 was used to label the most preferred one. 22 participants ranked bulletin boards as the best approach to informing them of educational opportunities and 18 of them considered e-mails to be very convenient. Also, the nurse director possibility was ranked as the best by five people and two people chose flyers. One person listed e-mails as the least convenient option and one also marked the nurse director variant in the same way (Figure 29).

The final question asked the participants to consider different learning methods. 22 people noted that they would prefer classroom lectures and no people labelled this option as the worst one. Also, 16 people viewed bedside training as the best learning opportunity. The handouts were preferred by four respondents and three of them would rather choose online learning. Only online learning was labelled as the least convenient method of learning (Figure 30).

Only three answers to open-ended questions were received. In one of them, one participant explained that they wanted to study chest x-ray; another cited ECG and CVP as important topics. In the final one, a participant thanked the researcher for conducting the needs assessment.

Data Analysis

Analysis and Discussion

The first and last sections of the questionnaire provided the information that can be useful for the development of the program. In particular, the majority of the target group are young and relatively inexperienced nurses with diplomas rather than bachelor’s or master’s degrees. Therefore, it would be better to provide the content in a way that would not prevent less experienced nurses from being able to grasp it. Regarding the educational preferences, bulletin boards and e-mails are the preferred options of informing the nurses about their educational opportunities and the KFH’s ICU needs to use this fact to its benefit. Also, classroom lectures and bedside training seem to be the preferred teaching methods, which is important for the educational program development.

The classroom lectures were an unexpected choice since it is an old-fashioned approach that is typically not very learner-centred (Waltz et al., 2014,p392). However, lectures have been shown to be effective in transferring knowledge, even though more interactive methods are more likely to result in student engagement, which is why the combination of various options can be particularly useful (Presti,2016,p255; Waltz et al., 2014,p394). It should also be pointed out that other learning methods were also chosen by a few people, which offers an opportunity for diversifying the approaches of the program.

As can be seen from the rest of the results, there is a connection between the topics that the nurses rated as important for them to study and the areas in which, according to the respondents, they lacked skill. For instance, only two people ranked chest X-ray as not very important for their study (number 2 in the Likert scale) and only one of the nurses described their skills as quite high (number 4 in the Likert scale) in this area (see Figures 10, 21). This tendency suggests that the responses of the participants are relatively consistent, which makes the results more credible.

The second section of the questionnaire suggests that the topic of X-ray is chosen as the most important one by the majority of the respondents, which implies that it is likely to be the most pressing learning need of the ICU nurses of KFH (Figure 10). Additionally, some other topics were also chosen by more than ten people as the most significant ones: drug calculation (Figure 11) by 20 people and ICT management (Figure 15) by 17 people, and ABG interpretation (Figure 6) by 13 people. The rest of the topics have fewer people indicating their particular importance.

It should be noted that very few nurses described their skills as low (number 1 or 2 in the Likert scale); most of them chose to use number 3. This tendency suggests that those of the areas which do have nurses reporting low skills need to be considered especially closely. In this respect, the topic of chest X-ray seems to be particularly important (Figure 21) as no other area has a similarly large number of nurses reporting low (number 1) or somewhat low (number 2) level of skills.

Other than that, the topics of ICT catheters (Figure 26) has seven people with low or somewhat low skills and ABG results interpretation (Figure 17) and drug calculation (Figure 22) have six nurses reporting similar issues. Thus, the topics which are ranked as the most needed in courses and training are also the ones that have the greatest number of nurses being unsure about their skills.

It should be pointed out that only one topic was not labelled as the most important one by anyone, which implies that for different participants other areas may also be very relevant. However, given the fact that the educational program which is going to be proposed needs to be feasible, it is necessary to choose the topics that are especially important for the majority of the target audience.

Furthermore, it should be acknowledged that the tool can only gather the subjective perspectives of the respondents. In other words, more objective measurements (for instance, their scores in a variety of tests dedicated to all the mentioned topics) might be different because the participants could be incorrect in their assessments or not fully truthful (Timmins,2015,p49). Still, the personal accounts of the nurses are important since their self-perceived educational needs should be satisfied.

Additionally, the structure of the data collection tool enabled checking the consistency of the participants’ responses and they did prove to be consistent, which implies that they are more likely to be truthful. The confidentiality of the procedure also did not encourage false responses. Thus, the presented data can be used for the development of an educational program despite all the mentioned limitations.

Implications for Future Practice

The present study had a very limited and specific sample, which is meant to study; its results are not applicable to other settings and target audiences. Additionally, the project did not have a 100% response rate and the perspectives of some of the nurses may not be taken into account. Still, the following implications can be considered. The nurses of the ICU of KFH are unsure about their skills in the field of interpreting chest X-rays, and most of them want to receive some training on this topic. The X-ray topic was chosen as an option for the ENA because the orientation department does not pay much attention to it. Therefore, this perspective may need to be reassessed.

Furthermore, this discovery indicates that the current ENA allowed uncovering an important issue. It may be helpful for the ICU to consider conducting similar ENAs periodically. The head nurse or randomly selected nurses can be recruited to propose the areas which might be similarly problematic. No other topic demonstrated a similar tendency to be overwhelmingly difficult for the nurses, but in general, the respondents seemed to be interested in training in a variety of areas, which should also be taken into account by the nurses of the ICU. Finally, the data about the nurses’ educational preferences should be employed in the ICU.

Recommendations

Proposed Educational Program Plan

Topics and their alignment with the data

The analysis of the presented data allows making conclusions about the educational needs and preferences of the studied group, which, in turn, can be used to develop an outline of a program that can correspond to said needs and preferences. Given the nurses’ wishes to study particular areas, their concerns about their skills and the specifics of the topics chosen, the following plan is proposed (see table 1). In it, the topics of drug calculation, chest X-ray interpretation, ICT management and ABG results interpretation are included.

The corresponding numbers of hours are based on the reported educational needs, as well as the specifics of the topics. For instance, X-ray interpretation and drug calculation were chosen by more people than ABG results, which is why they are provided with more time.

On the other hand, X-ray interpretation was chosen by more people than drug calculation, but given the relative volume of the content to cover and the time that would be required for the drug calculation problems, the latter is given more time in the plan. Additionally, the program proposes including a review of all the topics that will be considered during it and takes into account the time that will be needed for the evaluation of the results, evaluation of the program and the collection of the participants’ feedback.

As for the methods to be used, they are based on the reported nurses’ preferences. In particular, lectures supported by PowerPoint presentations and videos are the primary method; both mentioned types of supporting materials are widely and successfully employed in nursing (Presti,2016,p255). Also, for ICT management, bedside training can be feasibly introduced and the program intends to use this opportunity.

Additionally, problem-solving will be used for drug calculation and ABG results interpretation to help the nurses train relevant skills. Group discussions and presentations are the interactive methods that can be introduced in the project. While the participants did not mention them as their preferred options, they have been employed in nursing education to the benefit of students (Presti,2016,p255; Waltz et al., 2014,p393). To summarise, a variety of methods is employed by the plan, which will allow the use of the benefits of both traditional and more modern, learner-centred options (Waltz et al., 2014,p394). Thus, the program is based on the data from the learning needs assessments and literature on the topic.

Table 1. Educational Program Plan.

The similarities and differences with the predictions

It is apparent that the primary prediction of the project was supported by evidence: the fact that the orientation department is not very attentive to the topic of X-ray interpretation resulted in many nurses experiencing the need to study it to improve their skills. As for the rest of the areas, they were not predicted, but their choice is understandable. Indeed, most of the topics were selected by at least some participants, which serves to prove that in nursing, continuing education is a requirement for effective practice (Gaspard & Yang,2016,p1; Maher et al.,2017,p307).

Also, ABG interpretation (Larkin & Zimmanck,2015,p334), drug calculation (Fleming et al.,2014,p55), as well as ICT management (Guilhermino et al.,2014,p2), have been reported to be crucial and often problematic for nurses. Thus, the results of the ENA are not unpredictable and can be explained by the difficulty of the topics and the specifics of the orientation procedures in the ICU.

Encountered Issues

The majority of the issues which were encountered were concerned with the initial goal of developing an online questionnaire. It is established that online tools facilitate data collection, allow studying larger samples and are particularly cost-effective (Timmins,2015,p42). Some concerns could also arise; for instance, online questionnaires cannot be controlled for who completes them (Rowley,2014,p328). However, the development of an online questionnaire requires some understanding of the available tools. The researcher searched for potential options and was studying them, but the process proved to be lengthy. The lack of experience in the field was also troubling.

Eventually, the nurse who was later engaged in printing the questionnaires noted that online tools are not fully free-of-charge: they are associated with the costs of the Internet connection, which is not very cheap in Saudi Arabia.

As a result, the researcher chose to use printed questionnaires instead to use a data collection tool that is more common and less taxing for the participants. The problem of the printing procedures was resolved by the nurse who volunteered to perform the task. The head nurse also assisted with the distribution and collection of the questionnaires. In general, the support of the ICU nurses from KFH was the primary factor that facilitated and enabled the project.

Other minor issues were also present. The process of developing the tool was not simple, but it was facilitated by the study of relevant literature and the cooperation of the other nurses who were engaged in the piloting of the questionnaire. Furthermore, the analysis of the data and the preparation of this report was associated with minor difficulties, predominantly those connected to the transfer of the data and its appropriate management. The researcher has some experience in working with data, which is why the problems were resolved. Overall, the skills of the researcher, the use of available literature and (most importantly) the support of other contributors allowed the project to overcome any difficulties.

Conclusion

The present essay offers an overview of an ENA project that was carried out with the nurses of the KFH’s ICU. The ENA used a commonly employed tool (questionnaire) based on two well-established tools to gather the information about the educational needs of the nurses. The nurses reported the need for additional training and the lack of skills in the same areas. The topics that were most commonly chosen included chest X-ray, ABG interpretation, drug calculation and ICT management.

The data, along with the information about the nurses’ preferences, were used to develop an educational program that was specifically tailored for the ICU nurses. The project implies that the lack of attention to X-ray in ICU nurses’ orientation may be a problem. The issues encountered by the project were resolved with the help of the participating nurses and relevant literature.

References

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Barratt, H., & Fulop, N. (2016). Building capacity to use and undertake research in health organisations: A survey of training needs and priorities among staff. BMJ Open, 6(12), 1-10. Web.

Bishop, P. A., & Herron, R. L. (2015). Use and misuse of the Likert item responses and other ordinal measures. International Journal of Exercise Science, 8(3), 297-302. Web.

Fleming, S., Brady, A., & Malone, A. (2014). An evaluation of the drug calculation skills of registered nurses. Nurse Education in Practice, 14(1), 55-61. Web.

Fox, M., Butler, J., Persaud, M., Tregunno, D., Sidani, S., & McCague, H. (2015). A multi-method study of the geriatric learning needs of acute care hospital nurses in Ontario, Canada. Research in Nursing & Health, 39(1), 66-76. Web.

Gaspard, J., & Yang, C. (2016). Training needs assessment of health care professionals in a developing country: The example of Saint Lucia. BMC Medical Education, 16(1), 1-6. Web.

Goudreau, J., Pepin, J., Larue, C., Dubois, S., Descôteaux, R., Lavoie, P., & Dumont, K. (2015). A competency-based approach to nurses’ continuing education for clinical reasoning and leadership through reflective practice in a care situation. Nurse Education in Practice, 15(6), 572-578. Web.

Guilhermino, M., Inder, K., Sundin, D., & Kuzmiuk, L. (2014). Education of ICU nurses regarding invasive mechanical ventilation: Findings from a cross-sectional survey. Australian Critical Care, 27(3), 126-132. Web.

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Maher, B., Faruqui, A., Horgan, M., Bergin, C., Tuathaigh, C., & Bennett, D. (2017). Continuing professional development and Irish hospital doctors: A survey of current use and future needs. Clinical Medicine, 17(4), 307-315. Web.

Presti, C. (2016). The flipped learning approach in nursing education: A literature review. Journal of Nursing Education, 55(5), 252-257. Web.

Rowley, J. (2014). Designing and using research questionnaires. Management Research Review, 37(3), 308-330. Web.

Silva, A. P., Stephens, T., Welch, J., Sigera, C., De Alwis, S., Athapattu, P.,… Siriwardana, S. (2015). Nursing intensive care skills training: A nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting. Journal of Critical Care, 30(2), 438.e7-438.e11. Web.

Timmins, F. (2015). Surveys and questionnaires in nursing research. Nursing Standard, 29(42), 42-50. Web.

Waltz, C., Jenkins, L., & Han, N. (2014). The use and effectiveness of active learning methods in nursing and health professions education: A literature review. Nursing Education Perspectives, 35(6), 392-400. Web.

Ruth M. Kleinpell and Robert Grabenkort, the authors of the article under consideration, tell that nursing practitioners and physician assistants play a very important role in the intensive care unit, however, their participation is still not well known to the public. This is why the authors aim at indentifying and using different literature sources concerning advanced practitioners in acute care settings by means of nonquantitative methods. One more purpose of this article was to describe possible implications for future critical care practice and improve nursing care within different critical care settings.

In order to conduct this very research, the authors reviewed more than 145 articles and used PubMed, Cumulative Index to Nursing and Allied Health Literature database, and some other services. The searching were limited from 1996 to 2007. Such terms like nurse practitioners, physician assistants, acute care nurse practitioner, intensive and critical care, and midlevel provider were combined in order to find out the necessary information, reliable articles, and other appropriate sources. The major point is that sources published not on English were excluded because abstracts and studies were not published.

31 research studies mostly focused on the role of both nurse practitioners and physician assistants in the care of critically ill patients. To be more exactly, 5 sources were devoted to physician assistance care; 20 sources are all about nursing practitioner care only; and 6 sources presented reliable information about NP and PA, their cooperation, and common impact on care of ill patients. All information was classified according to such categories as education, narrative interviews, and research studies. The vast majority of the sources found concentrated on “the impact of care on patient care management.” (Kleinpell and Grabenkort, 2008).

The included studies were sufficiently valid for the topic under consideration. The idea of nurse practitioners and physician assistants’ care, their role and influence into the sphere of medicine and nursing in particular was perfectly described within this article. Several studies described the models of care from nurse practitioners and physician assistants’ sides; some of them present a clear picture of how patient care management influence the development of the chosen sphere. According to these studies, PA and NP care was closely connected to clinical and financial outcomes “for mechanically ventilated patients including ventilator duration, LOS, morality and cost savings, reduction in floor…” (Kleinpell and Grabenkort, 2008).

Of course, certain studies present quite different information on one and the same question, because any scientist has his/her own vision on the problem and presents various ways out to solve it. However, the studies, chosen for consideration, have a lot in common. As the studies were classified, the sources of the same group present homogenous information about patient care management. The sources of other groups cover the same topic, but concentrate on other heterogeneous details in order to analyze the topic properly from different perspectives.

The results of the research conducted are rather impressive. With the help of 31 studies, which analyze NP and PA care in critical care settings, it was proved that patient care management, education of patients, and reinforcement of practice guidelines play considerable roles in the development of the care of such type. 14 sources introduce the information about intensive care unit, and only 14 are about acute care. However, this information is enough to make sound conclusions and prove that nurse practitioners and physician assistants in the intensive care unit may depend on lots of things, and care management is one of them.

Reference List

Kleinpell, R. & Grabenkort, R. (2008). Nurse Practitioners and Physician Assistants in the Intensive Care Unit: An Evidence-Based Review. Critical Care Medicine, 36 (10), 2888-2897.

Introduction

The intensive care units (ICU) their preoperative settings are multifaceted environment that requires cautious administration. The settings comprise not only of a variety of teams of caregivers but also the adaptation of care processes (Michigan Health & Hospital Association’s, 2013). Notably, communication breakdowns coupled with poor teamwork normally results in damaging medical errors, inefficient operating rooms, and longer hospital stays. Therefore, such dangers call for the implementation of a quality improvement program with multidisciplinary approaches that involves the hospital critical illness team and the surgery team.

Therefore, the imminent objectives should be to look beyond the patient mortality and to focus on the effect of critical illness towards the ICU patient long-term effects. Hospitals require to redesign how it conveys care within the ICU since there are accounts of critical illness in which physical therapy and occupational therapy consultations have not been considered with the result being detrimental to the patient health outcomes. Thus, the problems arise to some extent from the typical practice include maintaining the hospital in critical-care patients intensely sedated and extensively under bed rest. However, latest studies reveal that early rehabilitation along with minimal application of sedation is not just reasonable but also safe.

Summary of the Project

This program contains five phases that aim at transforming the ICU into an effective and efficient unit of the hospital. To achieve this, the program will transform the work culture within the ICU to be more rigorous and goal oriented. In so doing, it produces considerable safety improvements (Johns Hopkins Health System, 2013). The program entails empowering ICU personnel to take on responsibility for safety within their environment. Such a move utilizes education, responsiveness, the right to use organizational resources as well as a toolkit comprising every intervention. This program targets numerous problems including patient falls, the ICU-acquired infections, and medication administration slip-ups. Furthermore, the program calls for the hiring of a full-time physical therapist and an occupational therapist specialists since the preoperative patients have a high record of muscle weaknesses, damaged physical function, and impairments in their cognition. Such problems have been induced and made worse due to the hospital policy of maintaining critical care as a part-time program with the lack of a full-time rehabilitation assistant (Johns Hopkins Health System, 2013).

Moreover, the program calls for the implementation of current sedation practices. This entails moving away from the application of existing incessant intravenous combinations of benzodiazepines with narcotics, to only of necessity bolus doses (Johns Hopkins Health System, 2013). The approach of this project focuses on endorsing a culture of safety through the use of daily basis patient goals-sheets. Currently, the ICU labor force of the hospital comprise of a combination of steady, recurring, and impermanent or temporary clinicians. Consequently, this program offers a modern category of permanent providers using a standardized approach of care. To achieve this, there will always be a unit of nurses and physicians who will be working around the clock within the ICU (Johns Hopkins Health System, 2013).

Purpose of the Program

The intention of this program is to decrease the mortality of ICU patients arising from septic shock from the present 38% to 20% (Johns Hopkins Health System, 2013). This program seeks to harmonize guidelines on physical and occupational therapy consultations. Consequently, it will determine the safest time for ICU patients to acquire such therapies. Therefore, this program will focus on weaning ICU survivors off sedation and ventilators. This will minimize the ventilator-related pneumonia in addition to cutting down on ICU and overall lengths of stay. This program will also seek to minimize central line-connected bloodstream infections as well as VAP. Furthermore, it will aim at enhancing clinician-to-clinician contact and communication using a checklist to ascertain observance to infection-management practices ( American Hospital Association , 2012).

The Target Population

This program will primarily target ICU survivors, the ICU workforce, and the hospital physical and occupational therapy staff.

The Benefits of the Program

This project will reduce healthcare-linked infections, which then eradicates deadly and expensive infections. Through this program, the hospital ICU can survive over a year without an infection.

The Cost or Budget Justification

It is estimated that $200,000 will be required to set up this project since the project will focus on training the existing ICU staff, hiring temporary personnel into permanent positions, acquiring facilities for the physical and occupational therapy, and then implementing the uniform standardization of medicine. In addition to the above, supplementary qualified but permanent physical occupational therapists are required. This will result in additional salary expenses. Thus, the hospital seeks partial sponsorship for this project and the remaining amount will be repaid partially on a monthly basis from the revenues generated from the hospital. The client relations department of the hospital will handle the cyclic maintenance of the critical-care physical medicine and the rehabilitation facility.

Basis of the Project Evaluated

The ICU survivors’ satisfaction- survey questionnaire will form the basis for assessing the program performance. Secondly, performance indicators which derive the length of stay of preoperative patients prior to this program and afterwards will be evaluated using the Donabedian Q1 Model is a process improvement methodology which is used to identify quality and safety issues in the ICU, as it also comprises a systematic means of implementing the changes (Curtis, 2006).

Conclusion

It is important that all of the hospital critical-care stakeholders to distinguish and enforce imperative ICU attribute. The most important attributes include quality, value, and most importantly access. Thus, the Comprehensive Unit-based Safety Program fundamental strategy is to push progress in changing ICU care to a highly reliable model that entails enforcing reliable clinical practices through predictable outcomes.

References

American Hospital Association. (2012). Pioneering Hospitals Are Reinventing Intensive Care Units. Web.

Curtis, J. R. (2006). Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team. Crit Care Med , 34(2), 2111–2118.

Johns Hopkins Health System. (2013). The Comprehensive Unit-based Safety Program (CUSP). Web.

Michigan Health & Hospital Association’s. (2013). Keystone project. Web.