ABSTRACT
Innovation in health care requires leaders to influence the development of positive environments that accelerate innovation and produce better outcomes for patients, the workforce, and organizations. Given the multifaceted changes in today's health care system, nursing leaders must utilize opportunities for innovation to focus on enhancing practice environments. In this article, nursing leaders who oversee personnel on direct care delivery units report on how they worked within existing organizational structures to influence improvement in practice environments while accelerating innovation.
Subject(s)
Decision Support Systems, Clinical/standards , Nurse Administrators , Nursing Care/organization & administration , Organizational Innovation , Advisory Committees , Hospitals, General , Humans , Massachusetts , Quality Assurance, Health CareABSTRACT
AIM: This paper is a description of a protocol for studying the impact of a patient/family-centered, evidence-based practice change on the quality, cost and use of services for critically ill patients at the end of life. BACKGROUND: International attention currently is focused on the quality and cost/use of intensive care services. Empirical literature and expert opinion suggest that early, enhanced communication among the clinical team and the patient and family results in higher quality and less costly care at the end of life. DESIGN: Our Medical Intensive Care Unit practice change involves three components: teaching sessions for all Registered Nurses and physicians assigned to the unit; patient/family meetings held in 72 hours of the patient's admission to the unit; and formal documentation to support communication among clinicians. Ethical approval was obtained in April 2009. A two-group post-test design is used, with one group comprising patients hospitalized before the practice change and their families, and the second group of patients/families after the practice change. Data comprise medical record information and families' responses to surveys. Final analytic models will result from multivariable regression techniques. DISCUSSION: The study represents translational research in that interventions are brought to the bedside to reach the people for whom the interventions were designed. The practice change is likely to endure after the study because our research team is composed of both clinicians and scientists. Also, direct care clinicians endorse and are responsible for the practice change.
Subject(s)
Critical Care/organization & administration , Evidence-Based Medicine , Patient-Centered Care/organization & administration , Professional-Family Relations , Research Design , Adult , Aged, 80 and over , Attitude to Health , Clinical Nursing Research , Clinical Protocols , Communication , Critical Care/economics , Critical Care/standards , Education, Continuing/organization & administration , Family , Health Care Costs , Humans , Length of Stay , Medical Records , Patient-Centered Care/economics , Patient-Centered Care/standards , Quality Assurance, Health Care , Terminal Care/economics , Terminal Care/organization & administration , Terminal Care/standards , Young AdultABSTRACT
We summarize the key interventions and general findings from a 3-yr project titled, "Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit." This multifaceted demonstration project was designed so palliative care and intensive care clinicians would share their expertise and develop projects that promote end-of-life care in a medical intensive care unit (ICU) setting. A variety of interventions are described, including collaborating with ICU leaders, training nurses as "palliative care champions," opening visiting hours, educating house officers and other staff about relevant palliative practices, establishing the presence of a palliative care specialist during work rounds, teaching about and promoting family meetings, introducing a "Get to Know Me" poster, staff support efforts, and modeling of interdisciplinary teamwork. Additional problems were noted but not well addressed, particularly routine communication with families and continuity of care for complex patients leaving the ICU.
