Stages of Adoption Concern and Technology Acceptance in a Critical Care Nursing Unit.

OBJECTIVE: The aim of this study is to examine the stages of concern (self, task, and impact) and usability (trust, perceived usefulness, and ease of use) shifts experienced by nurses adopting new technology. BACKGROUND: Patient care processes in critical care units can be disrupted with the incorporation of information technology. New users of technology typically transition through stages of concern and experience shifts in acceptance during assimilation. METHODS: Critical care nurses (N = 41) were surveyed twice: (1) pre, immediately after training, and (2) post, 3 months after implementation of technology. RESULTS: From presurvey to postsurvey, self-concerns decreased 14%, whereas impact concerns increased 22%. Furthermore, there was a 30% increase in trust and a 17% increase in perceived usefulness, even with a 27% decrease in ease of use. CONCLUSION: Adoption of new technology requires critical care nurses to adapt current practices, which may improve trust and perceived usefulness yet decrease perceptions of ease of use.

Exposing Compassion Fatigue and Burnout Syndrome in a Trauma Team: A Qualitative Study.

Compassion fatigue (CF) and burnout syndrome (BOS) are identified in trauma, emergency, and critical care nursing practices. The purpose of this qualitative study was to measure CF and BOS in a trauma team and allow them to share perceptions of related stress triggers and coping strategies. Surveys to measure CF and BOS and a focus group allowed a trauma team (12 practitioners) to share perceptions of related stress triggers and coping strategies. More than half scored at risk for CF and BOS. Stress triggers were described as situation (abuse, age of patient) versus injury-related. Personal coping mechanisms were most often reported. Both CF and BOS can be assessed with a simple survey tool. Strategies for developing a program culturally sensitive to CF and BOS are provided.

Acceptability and implementation of debriefings after trauma resuscitation.

Postresuscitation debriefings allow team members to reflect on performance and discuss areas for improvement. Pre-/postsurveys of trauma team members (physicians, mid-level practitioners, technicians, pharmacists, and nurses) were administered to evaluate the acceptability of debriefings and self-perceptions after multidisciplinary trauma resuscitations. After a 3-month trial period, improvements were observed in perceptions of psychological and patient safety, role on team, team communication, and acceptability of the debriefing initiative. Regrouping for a debriefing requires organizational change, which may be more easily assimilated if team members recognize the potential for process improvement and feel confident about success.

Treatment provider is most predictive of ED dismissal in minimally-injured trauma patients: a retrospective review.

BACKGROUND: Secondary triage protocols have been described in the literature as physiologic (first-tier) criteria and mechanism-related (second-tier) criteria to determine the level of trauma activation. There is debate as to the efficiency of triage decisions based on mechanism of injury which may result in overtriage and overuse of limited trauma resources. Our institution developed and implemented an advanced three-tier trauma alert system in which stable patients presenting with blunt traumatic mechanism of injury would be evaluated by the emergency department (ED) physician rather than the trauma surgeon. The American College of Surgeons Committee on Trauma (ACSCOT) requires that operational changes be monitored and evaluated for patient safety and performance. The primary aim of this study was to evaluate the process, as well as outcomes, of patient care pre and post implementation of the new triage protocol. The secondary aim was to determine predictor variables that were associated with ED dismissal. METHODS: A retrospective blinded pre/post process change implementation explicit chart review was conducted to compare process and outcomes of minimally injured trauma patients who were field triaged by mechanism of injury. Generalized linear modeling was performed to determine which predictor variables were associated with ED dismissal. RESULTS: There were no significant differences in minutes to physician evaluation, CT scan, OR/ICU disposition, readmission rates, safety or quality. Significant differences only occurred in time to chest x-ray, length of stay in ED, and ED dismissal rates. Trauma surgeon and ED physician patient groups did not differ on ISS, age, or sex. The only significant predictor for ED dismissal was treatment provider, with ED physicians 3.6 times more likely to dismiss the patient from the emergency department. CONCLUSIONS: ED physicians provided compble care as measured by safety, timeliness, and quality in minimally-injured patients triaged to our trauma center based only on mechanism of injury. Moreover, ED physicians were more likely to dismiss patients from the ED. A three-tiered internal triaging protocol can redirect resource usage to reduce the burden on the trauma service. This may be increasingly beneficial in trauma models in which the trauma surgeons also serve as critical care intensivists.

Trauma patient perceptions of nursing care: relationships between ratings of interpersonal care, technical care, and global satisfaction.

Interpersonal care is positively associated with patient satisfaction; however, patients may not be able to appreciate their caregivers' technical skills. This cross-sectional telephone survey of trauma patients examined the relationships between patient perceptions of interpersonal care (PIC) and perceived technical care (PTC) and global satisfaction (GS). Structural equation modeling indicated a significant direct effect of PIC on PTC and PTC on GS. Fit indices showed the hypothesized paths significantly improved the model. Strong positive relationships exist between patients' PIC and PTC and GS. Patients unacquainted with technical aspects of health care may make judgments based on satisfaction with perceived interpersonal care.

Trauma performance improvement and patient safety committee: fostering an effective team.

Trauma programs that are verified by the American College of Surgeons are required to have a multidisciplinary committee that examines trauma-related patient care operations. To facilitate a potentially large number of issues relevant to patient care, the Trauma Performance Improvement and Patient Safety Committee can apply team principles to promote success. A literature review concerning effective teams was conducted. Eleven principles were identified as essential for developing an effective committee that can properly respond to and resolve performance issues in complex trauma care. This article describes and applies these 11 principles to the Trauma Performance Improvement and Patient Safety Committee.