Read this article: Sammer, C. & James, B. (2011, September 30). OJIN: The Online Journal of Issues in Nursing,16(3), Manuscript 3. In the Hospital Hope scenario, what do you think was the most important factor that led to the change in practice in the SICU? If you worked in a facility that needed a practice change, what framework would you use and why?
Title: Factors Leading to Practice Change in the SICU: A Critical Analysis
Introduction:
The Hospital Hope scenario presented in the article by Sammer and James (2011) sheds light on the intricacies of implementing practice change in the Surgical Intensive Care Unit (SICU). The scenario highlights several factors that collectively drove the change in practice. To identify the most important factor, it is crucial to analyze the dynamics surrounding the scenario. Additionally, envisioning a practice change in a different healthcare facility requires selecting an appropriate framework. This response critically assesses the factors contributing to the practice change in the SICU, and subsequently proposes a suitable framework for implementing practice change in a hypothetical facility.
Factors Leading to Practice Change in the SICU:
The most significant factor that led to the practice change in the SICU was the occurrence of preventable harm to patients. The Hospital Hope scenario describes how the deaths of two patients were attributed to a lack of coordination among the healthcare team, inadequate communication, and the absence of standardized protocols. The adverse outcomes cast a spotlight on the existing flaws in practice, prompting stakeholders to recognize the urgent need for change.
In healthcare, when patient safety is compromised, it often serves as a powerful catalyst for change. The deaths of the patients in the SICU served as a tragic reminder that the current practices were insufficient and required immediate intervention. The critical nature of the SICU setting accentuates the importance of a reliable system to prevent errors and mitigate harm. The realization of preventable harm, combined with the gravity of the situation, propelled the stakeholders to prioritize practice change as an essential step toward improvement.
Another contributing factor to the practice change was the recognition of the need for standardized protocols and consistent communication. In the Hospital Hope scenario, the lack of standardized protocols resulted in inconsistent care practices and communication breakdowns. The absence of clear guidelines impeded coordination among team members and led to errors. This realization prompted stakeholders to appreciate the value of evidence-based standardized protocols and the need for effective interprofessional communication.
Furthermore, the role of leadership in initiating and supporting the practice change cannot be underestimated. The participation of the SICU nurse manager, clinical nurse specialist, and respiratory therapist in identifying the problems and advocating for change was pivotal. Their commitment to improving patient outcomes, combined with their influence and clinical expertise, facilitated the adoption of the change. Leadership involvement in championing practice change empowers healthcare professionals and fosters a culture of accountability and continuous improvement.
Moreover, the engagement and collaboration of multidisciplinary teams greatly influenced the success of the practice change in the SICU. The scenario depicts how stakeholders from various disciplines, including nursing, respiratory therapy, and pharmacy, came together to address the root causes of the adverse events. By working collectively, they created a shared understanding of the problems, identified potential solutions, and developed standardized protocols. This collaborative approach fostered a sense of ownership among the team members, leading to increased buy-in and commitment to implementing the change.
The Proposed Framework for Practice Change:
If faced with the need for a practice change in a different healthcare facility, a suitable framework to consider would be the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The PARIHS framework provides a systematic approach that incorporates evidence, context, and facilitation to guide the implementation of evidence-based practice changes.
The PARIHS framework emphasizes the need for robust evidence to support the proposed change. It encourages healthcare professionals to critically appraise the available evidence and identify the best practices for implementation. By basing the practice change on sound evidence, the PARIHS framework ensures that the proposed change aligns with the principles of patient safety and quality improvement.
In addition to evidence, the PARIHS framework recognizes the importance of the local context in implementing practice change. It encourages stakeholders to assess the readiness for change, identify potential barriers and facilitators, and adapt the evidence to the specific organizational context. By considering the unique characteristics of the healthcare facility, the PARIHS framework promotes the customization of practice change strategies, thereby increasing the likelihood of successful implementation.
Furthermore, the PARIHS framework emphasizes the role of facilitation in implementing practice change. It highlights the importance of having individuals or teams who can support and guide the change process. These facilitators act as agents of change, assisting in overcoming barriers, building relationships, and ensuring the effective dissemination and uptake of the new practices. Their expertise and guidance are invaluable in driving practice change and sustaining it over time.
Conclusion:
In conclusion, the practice change in the SICU depicted in the Hospital Hope scenario was primarily driven by the occurrence of preventable harm, the recognition of the need for standardized protocols and communication, effective leadership, and multidisciplinary collaboration. These factors collectively influenced the decision to implement the change and ensure the provision of safe and high-quality care. For a practice change in a hypothetical healthcare facility, the PARIHS framework would be a suitable option. Its focus on evidence, context, and facilitation aligns with the principles of implementing evidence-based practice changes in diverse healthcare settings, thereby increasing the likelihood of successful implementation and sustained improvement in patient outcomes.