Identification of a Practice Issue for the EBP ProjectVivibelle
Running head: EBP Project 1
EBP Project 4
Evidence-based Practice Project: PIICOT Statement
Evidence-based Practice Project: PIICOT Statement
Delayed patient transfers from the intensive care unit (ICU) is a significant practice problem that affects the quality and safety of healthcare delivery as well as the costs and efficiency of service delivery in a healthcare institution. It is nurses’ role to identify issues and develop strategies for quality improvement (Stillwell, Fineout-Overholt, Melnyk & Williamson, 2012). The following PIICOT Statements seeks to develop an intervention to reduce the rates of delayed transfers to enhance patient experiences and outcomes.
In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?
P: Adult patients
I: in extended intensive care within an urban acute care facility
I: increased mobilization of the patients
C: minimal mobilization of the patients
O: early transfers of the patients from intensive care
T: 6 months
Salient Elements that Inform the Research Question
The research question above has been developed based on observations in clinical practice of patients in intensive care, who overstay their admission in the ICU. Past research shows that delayed transfers of patients from the ICU to non-intensive care wards or the community settings have a negative effect on patient experiences and the patient outcomes. Some of the common negative effects of delayed patient transfers that have been identified by past researchers include an increased risk of infection, a higher rate of readmission, and increased costs of care, which may cause issues for the patients and their families in the future (Schneider et al., 2012). Therefore, this research seeks to determine methods that can be used to help speed up the process of discharging patients from intensive care to the regular units or the community settings when applicable.
The intervention of increasing patient mobility has been developed based on the theory of Dorothea Orem's Self Care Deficit Nursing Theory. Orem's theoretical model puts forward three major theories: self-care, nursing systems, and self-care deficit theory. In the self-care theory, Orem emphasizes behaviors, deliberate actions, and knowledge that help the patients to care for themselves. This theory links a person's beliefs to their behaviors. A person's attitudes towards something affects their controlled behaviors related to it (Holdsworth et al., 2015). For ICU patients, increasing mobility enhances their attitudes towards recovery and in turn, increases the progression of their recovery process; thus, speeding up the process of discharge from the ICU.
The intervention of focus in this research is increasing patient mobility to enhance their recovery process. Literature reveals that mobilization of ICU patients is an effective method of increasing the chances of achieving positive outcomes. The mobilization can be done in various ways depending on the patient characteristics. Some of the benefits associated with mobilization, which are expected to contribute to the early discharge include reduced risks of pressure ulcers, reduced risks of muscle atrophy, and decreased inflammation among others (O'Mahony et al., 2011). Therefore, based on this research, it is likely that nurses can enhance patient recovery and reduce the length of ICU stay by improving the mobility of patients.
Concerns Related to the Research
The primary concern with conducting this research is the critical nature of most of the ICU patients. It will require a lot of collaboration with other healthcare professionals and approval from relevant authorities to implement increased mobility on ICU patients to enhance their recovery and reduce their delay of transfer from the ICU. Other than that, there is adequate research demonstrating the safety and quality issues associated with over staying in ICU, which make this research project an essential tool for improving the quality of care delivery. The research will be beneficial not only for nursing practice but also for other health care professionals and the efficiency of healthcare institutions. Most importantly, it will help to improve the outcomes and experiences of ICU patients.
Holdsworth, C., Haines, K. J., Francis, J. J., Marshall, A., O’connor, D., & Skinner, E. H. (2015). Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior. Journal of critical care, 30(6), 1243-1250.
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61.
O'Mahony, R., Murthy, L., Akunne, A., & Young, J. (2011). Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Annals of internal medicine, 154(11), 746-751.
Schneider, E. B., Hyder, O., Brooke, B. S., Efron, J., Cameron, J. L., Edil, B. H., ... & Pawlik, T. M. (2012). Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. Journal of the American College of Surgeons, 214(4), 390-398.
Klopper, H. C., Coetzee, S. K., Pretorius, R., & Bester, P. (2012). Practice environment, job satisfaction and burnout of critical care nurses in South Africa. Journal of Nursing Management, 20(5), 685-695.