Developing and Evaluating New Practice Approaches

Summary of the Practice Issue and Proposed EBP Strategies

It is the role of nurses to identify practice issues and develop evidence-based solutions to improve the quality of care (White, Dudley-Brown & Terharr, 2016). One of the issues that affects nursing practice is long intensive care unit (ICU) admission of critical care patients. Extended stay in intensive care is a significant practice problem in health care. There are many risks that face patients who are admitted in ICU for an extended period of time. Longer hospital admission in the ICU has been associated with negative patient outcomes and experiences. The longer patients are admitted in intensive care, the higher the chances of mortality and hospital readmission (Denehy, Lanphere & Needham, 2017). Patients’ personal experiences in care are also more negative when they stay in ICU for a long period of time. Therefore, it is important to use EBP solutions to improve the experiences and outcomes of these patients.

The proposed solution for this practice issue is the mobilization of patients. Research shows that early mobilization of critical care patients can have a positive effect on their healthcare experiences and outcomes. Therefore, it is recommended that nurses increase their frequency of mobilizing patients from time to time to speed up their recovery. The theoretical foundation for this solution is the theory of planned behavior. This is a psychological theory arguing that people’s perceptions and beliefs influence their behavioral reactions to certain phenomena. Mobilizing the patients will help them to have a positive view of their recovery; hence, this will enhance their attitudes towards their health and help to speed up their recovery process.

The Potential Economic Impact of the Suggested Strategies

            The main economic impact of the recommended EBP strategies for improving ICU experiences and outcomes is the need for new personnel. According to Lord et al. (2013), early mobilization of the critical care patients may generate substantial clinical improvements in ICU patients and reduce costs to hospitals, payers, and capitated health care delivery systems. Even when the expected clinical effectiveness of an early mobilized program is reduced by 20% the estimated net present value was positive by the second year of the program. The ICU I work for has 32 beds which equals 32 patients who do require early mobilization to improve their health outcomes. This procedure, on the other hand, will require the nurses to spend a lot of time with the patients to help them. This, on top of the low nurse to patient ratio in many hospitals as well as my unit, means that nurses will experience more burnout or be unable to perform the procedures effectively, especially the minimum of three times a day per patient per twelve-hour shift. Therefore, for my hospital to implement the procedures will need to invest in more personnel, which will mean that more financial resources will be spent on managing the workforce.

How can the new Strategies Improve Healthcare Quality?

            However, the new strategy of mobilization has the potential to improve the quality of care for intensive care patients. First, mobilization helps to reduce muscle fatigue. The patients who are critically ill spend a lot of their time in bed, which increased their muscle atrophy (Denehy et al., 2017). Early mobilization of the critical care patient will also help with the reduction in airway, pulmonary, and vascular complications; their early mobility can also significantly reduce certain complications such as re-intubation rates, pneumonia, pneumothorax, and DVT (Denehy et al., 2017). Most importantly, the early mobilization of patients has the potential to reduce the rates of mortality and hospital readmissions (Denehy et al., 2017). Longer hospital stays have been associated with these two factors. Therefore, if the mobilization is done, patients will have a chance to experience positive outcomes. Generally, these strategies will help to enhance the experiences of patients admitted in intensive care.

References

Denehy, L., Lanphere, J., & Needham, D. M. (2017). Ten reasons why ICU patients should be mobilized early. Intensive care medicine43(1), 86-90.

Lord, R. K., Mayhew, C. R., Korupolu, R., Mantheiy, E. C., Friedman, M. A., Palmer, J. B., & Needham, D. M. (2013). ICU early physical rehabilitation programs: financial modeling of cost savings. Critical care medicine41(3), 717-724.

White, K. M., Dudley-Brown, S., & Terharr, M. F. (2016). Translation of evidence into nursing and health care practice (2nd ed.). New York, NY: Springer.