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Evidence Based Practice
--- to improve ICU nurses’
acceptance of Tele-ICU
Ling Li, RN, MSN student
Supervisors: Prof. Nick Hardiker; Dr. Angela Cotton
University of Salford, UK
Outline
Aim: To improve ICU nurses’
acceptance of Tele-ICU
Barriers to the acceptance of Tele-ICU
Acceptance Improvement strategy
• ICU Mortality
• ICU length of stay (LOS)
• Evidence-Based Practice
Effects of Tele-ICU
--- (Lilly et al., 2011; Mackintosh et al., 2016; Ward, Jaana, & Natafgi, 2015; Wilcox & Adhikari, 2012; Young et al., 2011)--- Pictures are retrieved Fromnhttps:// www.google.co.uk/ search?biw=1440&bih=775&tbm=isch&sa= 1&q=intensive+patients&oq=intensive +pa tients&gs _l=img.3..0i8i30k1.145208.145208.0.146021.1.1.0.0.0.0.150.150.0j1.1.0....0...1c.1.64.img..0.1.149.TOl9SNwIbqQ#imgrc=4Rdi9vwYJANa-M:
The needs and preferences
of health service users
The nurses’ expertise, skills, and
clinical judgement
The best available evidence
--- (International Council of Nurses, 2012)
Aim: to improve ICU nurses’ acceptance of Tele-ICU
Three Key
elements to
successful
evidence-based
practice
• Electronic database---
MEDLINE(Ovid), Cochrane Library,
CINAHL, Scopus, PubMed.
• Hand searching--- related
organizations，websites, Journals,
references, citations.
Search Strategy
1 systematic review
10 qualitative studies
5 others
(Miller & Forrest, 2001; Deslich, & Coustasse, 2014)
Findings:
Barriers and Facilitators influencing acceptance
and utilization of Tele-ICU
(Moeckli, Cram, Cunningham, & Reisinger, 2013)
• Confused how to use
• Week training
• Tele-ICU understanding
• Perceived need
• Organizational factors
Pre-implementation
• Weak collaboration
• Unmet expectations
• Discomfort with being monitored
• Impact on work systems
• Tele-ICU understanding
Post-implementation
Barriers to Tele-ICU acceptance
(Moeckli, Cram, Cunningham & Reisinger, 2013)
Acceptance Improvement strategy
Barriers
Barriers solutions
Cost appraisal
Evaluation
Force-field analysis
Stakeholder analysis
Adopters analysis
---(Martin, 2005; Lukas et al., 2007)
Force Field Analysis
Driving Forces Restraining Forces
1 Quality improvement
needsLeadership concerns 1
2Increasing evidence of
the value of Tele-ICU Conservatives 2
3 Organizational
Acceptance of Tele-ICU
Lack of competency and
knowledge of Tele-ICU
3
4Innovation reform
policy in ICU
Different
perceived needs 4
--- (Lewin, 1946)
Stakeholder Analysis
High
Power
Satisfy
• Hospital Ethic Board
• Trade Unions
• The director of Nursing
Department
Manage
• Senior leaders of ICU Department
• ICU staff
• The director of IT Department
• The suppliers or contractors of Tele-
ICU settings
Low
Power
Monitor
• Financial Department
• Equipment Department
Inform
• ICU patients and their relatives
• General Affairs Department
Low impact / Stake holding High Impact/Stake holding
--- (NHS Institute for Innovation and Improvement, 2008)
Recognizing Different Adopters
• Innovators : Tele-ICU project team
• Early adopters: Tele-ICU nurses, nurse managers
• Early majority: advanced practice nurses, clinical nurse specialists
• Late majority: most bedsides nurses (nurse practitioners, junior nurses)
• Laggards: some senior nurses
(Rogers, 2010)
(American Association of Critical-Care Nurses, 2013)
AACN Tele-ICU Nursing Practice Guidelines
Objectives
To improve nurses’ understanding of Tele-ICU
To gain support from organization
To improve nurses’ competency towards Tele-ICU
To design more efficient Tele-ICU workflows and system
(Moeckli, Cram, Cunningham & Reisinger, 2013)
Barriers Solutions Accountability
AssignmentActions contents
Organization
Leaders
Support Tele-ICU nurses in achieving and maintaining
certification to work in Tele-ICU environment
Develop networks and IT technology support for
sharing and spreading knowledge and refection on
practice.
Develop structures that support education and training
Appropriate staffing
Facilitate change management to support evidence-
based practice
(American Association of Critical-Care Nurses, 2013. American Telemedicine Association, 2014, Moeckli, Cram, Cunningham & Reisinger, 2013)
Barriers Solutions
Accountabilit
y AssignmentActions contents
Tele-ICU
Leaders
Be engaged in measuring and analyzing outcomes and
report them for gaining organizational support
Create policies, and framework to better standardize Tele-
ICU procedures and practice;
Convene innovators and early adopters to build a
quality improvement team, and set a Journal Club for them
Set a workshops for experience sharing (focus on early
majority and late majority)
(American Association of Critical-Care Nurses, 2013. American Telemedicine Association, 2014, Moeckli, Cram, Cunningham & Reisinger, 2013)
Barriers Solutions
Accountability
AssignmentAction contents
Tele-ICU
Leaders
Knowledge Training designed for late majority
and laggards (evidence-based practice of Tele-ICU,
role understanding, Tele-ICU Guidelines learning)
Skill training curriculums for all nurses (skilled
communication, true collaboration, collegiality, effective
decision making)
Provide opportunities for joint team meetings (quality
meetings, research participation, and joint celebrations)
(American Association of Critical-Care Nurses, 2013. American Telemedicine Association, 2014, Moeckli, Cram, Cunningham & Reisinger, 2013)
Evaluation
Outcome Audit: ICU patients’ average Length of Stay
Incidence of Complications of ICU
patients ICU patients’ Mortality Rate
Interviews: to collecting nurses’ perception and
satisfaction towards Tele-ICU
(Coustasse, Deslich, Bailey, Hairston, & Paul, 2014)
Cost Appraisal
Process Expense Type $ Amount
Action Executing Action planning supplies $50
Network and Infrastructure Costs $1,000
Tele-ICU work system & procedures &
flow files improvement costs $500
Staff Training costs $1,000
Miscellaneous (supplies) $100
Control & Evaluation Outcome audit $50
Staff interview costs (for collecting staff
perception & satisfaction towards Tele-ICU) $100
Contingency costs $100
Total Costs $2,900
(Fifer, 2010)
Outline
Aim: To improve ICU nurses’
acceptance of Tele-ICU
Barriers to the acceptance of Tele-ICU
Acceptance Improvement strategy
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References:
Ling LiSupervisors: Prof. Nick Hardiker; Dr. Angela Cotton
School of Nursing, Midwifery, Social Work and Social ScienceUniversity of Salford.Manchester.M5 4WT. UK
Email: [email protected]
