Total Length: 3219 words ( 11 double-spaced pages)
Total Sources: 15
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Introduction
The progressive care unit (PCU) is a practice setting in which the researcher’s health care team is often failing to meet quality care objectives according to patient reporting on the hospital consumer assessment of healthcare providers and systems (HCAHPS). Opportunities for growth in quality care based on the HCAHPS of the PCU include topic areas related to patient inclusion as well as communication skills of the members of the healthcare team. Patient perception of quality is that the healthcare team in the PCU is unable to explain the care process in a way that the patient and family members feel comfortable with or that allows them to understand the care that is being provided to them. The researcher has first-hand experience with this challenge in the PCU and has heard first-hand from patients there that the care seems disjointed, that continuity is lacking, and how problematic it is for patients to hear different answers or explanations from different members of the team. Care providers do not seem to be on the same page according to patient responses, and patients and family members, as a result, report feeling helpless and feeling that they are not included in their own care processes.
In order to empower patients, make them feel more engaged with the care process, and increase quality of care in the PCU with regard to the specific areas of involving the patient and patient’s family in the care process, this study identifies specific procedures and processes in the PCU that can be altered in order to positively impact care providers’ approach to promoting the inclusion of the patient. Specifically, it looks to address the issue with EBP, which is vital for helping nurses and care providers to implement quality care practices based on research and evidence (Melnyk, Fineout?Overholt, Giggleman & Choy, 2017).
EBP applies to the problem of a lack of patient inclusion in the following ways, which indicate the nature of the problem: 1) the PCU nursing team conducts bed shift reports among nursing staff; 2) case management, respiratory therapy, physical therapy, occupational therapy, and the hospitalist group also conduct separate rounds on patients and family members; 3) the teams all have a designated meeting time for interdisciplinary meetings in which patient care issues are discussed; 4) however, the teams do not conduct rounding together in a way that incorporates the patient and or family; 5) this lack of interdisciplinary team work may contribute to patients’ experiences of disjointedness in terms of care that they receive while in the PCU. EBP is needed to clarify whether involving the interdisciplinary teams in an approach to make the patient feel more included in the care process can increase the sense of quality of care experienced by the patient while in the PCU. This issue is important because currently the PCU team is not scoring well with patients in terms of providing consistent, quality care.
In this proposal, the main problem and PICOT question to be examined will be identified. A literature review will follow that provides a summary of the relevant literature on the subject of interdisciplinary team work in promoting patient satisfaction. The sample, practice setting and clinical context of the study will be provided; a plan for implementation will follow, and the main points of the paper will be summarized in the conclusion.
Identification of Problem
The PICOT for this proposal is: For progressive unit patients (P), how does interdisciplinary rounding with patient/family inclusion (I) compared to individual rounding by team members (C) affect patient satisfaction and family anxiety (O) during their hospital stay (T)?
PICOT questions are useful for addressing clinical practice issues as they represent an effective way to conduct an evidence-based clinical inquiry. The PICOT acronym helps the researcher to organize the focus of the clinical inquiry (Melynk & Fineout-Overholt, 2015). The P stands for population of interest, the I for intervention or issue of interest, the C is for the comparison of interest, the O is the outcome expected and T is for the time for the intervention to achieve the outcome. For the PICOT format not, all components are necessarily based on the presented clinical scenario.
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Hypothesis
It is expected to be found that rounding exercises in which the patient and the patient’s family are included with the interdisciplinary team will increase patient satisfaction scores on the HCAHPS, reduce patient anxiety and possibly facilitate the decrease in the length of stay for patients, if the interdisciplinary team, working together, can collectively identify barriers to discharge.
Literature Review
To obtain evidence for this study, online peer-reviewed journal databases were searched using the appropriate key words. Databases include CINHAL, MEDLINE, and Dynamed, and key words utilized to examine what researchers have documented in the literature about this topic included “interdisciplinary teamwork healthcare,” “patient inclusion interdisciplinary,” “evidence based practice” and “patient inclusion rounding.” A variety of research was found to be available on aspects of this topic.
Selection criteria for the PICOT question included: the study had to be published within the past five years in a peer-reviewed journal or on a professional health care organization website, such as the Institute of Medicine (IOM) or the Centers for Disease Control and Prevention (CDC); the studies had to be of Level III or higher in terms of evidence-based research: this included non-experimental studies such as systematic reviews, qualitative analysis, quasi-experimental studies, and experimental studies (randomized control trials).
McCaffrey and McConnell (2015) provide a systematic review of literature in their Level III study regarding how interdisciplinary team work can help nurses and care providers to better communicate and provide compassionate care (aka a high level of quality care) to patients. The interdisciplinary approach fosters a sense of shared governance among care providers, as Kutney-Lee, Germack, Hatfield et al. (2016) indicate in their Level III cross-sectional observational study that in hospitals where there is a substantial sense of shared governance among nurses, the outcomes for patients is much higher than in facilities where is less sense of shared governance. Unfortunately, there is a lack of strong evidence on the subject of interdisciplinary rounding and patients’ sense of inclusion in their own care process. The Level III study by Bhamidipati, Elliott, Justice, Belleh, Sonnad and Robinson (2016) is a systematic review of 22 qualitative studies, which found that there were few high quality research articles on the topic of interdisciplinary rounds and their impact on patients’ quality of care.
Al Danaf et al. (2017) showed by way of the case study approach how proactive rounding can facilitate patient oriented care and increase the positive feeling that the patient experiences regarding their care process. Other studies that have reached the same conclusion support the overall research hypothesis, which is that if teams work together across disciplines to take a more united, proactive and consistent approach to rounding, answering questions, and being mindful of the appropriate ways to educated patients on their care, patients will feel better about their care process overall (Pannick et al., 2015; Braus et al., 2016; Urisman, Garcia & Harris, 2018; Bright, Austin, Garn, Glass & Sample, 2017). The more that nurses, care providers and staff demonstrate a combined effort to put the patient first and foremost by displaying a consistent and unified approach to care, the better that patient’s experience has been shown to be.
However, just because the research has shown that when teams work together and communicate more effectively to promote a higher quality of care for patients, implementing EBP is not always easy, as Sadeghi?Bazargani, Tabrizi and Azami?Aghdash (2014) show in their Level III systematic review of barriers to EBP implementation. They find that one of the most common obstacles to EBP is a lack of cooperation among care providers in a facility. Their study illustrates the difficulty that care providers face when attempting to provide quality care for patients: there is little cooperation, communication, sense of shared governance, or continuity of care. Baird, Rehm, Hinds, Baggot and Davies (2016) find in their Level III qualitative research in which they conducted interviews with seven patients and twelve nurses that continuity of care as something that is very important to patients….....
Al Danaf, J., Chang, B. H., Shaear, M., Johnson, K. M., Miller, S., Nester, L., ... & Aboumatar, H. J. (2017). Surfacing and addressing hospitalized patients’ needs: Proactive nurse rounding as a tool. Journal of Nursing Management, https://doi.org/10.1111/jonm.12580
Baird, J., Rehm, R., Hinds, P., Baggot, C., Davies, B. (2016). Do you know my child? Continuity of nursing care in the pediatric intensive care unit. Nursing Research, 65(2): 142-150.
Bhamidipati, V. S., Elliott, D. J., Justice, E. M., Belleh, E., Sonnad, S. S., & Robinson, E. J. (2016). Structure and outcomes of interdisciplinary rounds in hospitalized medicine patients: a systematic review and suggested taxonomy. Journal of Hospital Medicine, 11(7), 513-523.
Braus, N., Campbell, T. C., Kwekkeboom, K. L., Ferguson, S., Harvey, C., Krupp, A. E., ... & Roberts, K. F. (2016). Prospective study of a proactive palliative care rounding intervention in a medical ICU. Intensive Care Medicine, 42(1), 54-62.
Bright, B., Austin, B., Garn, C., Glass, J., & Sample, S. (2017). Identification of interprofessional practice and application to achieve patient outcomes of health care providers in the acute care setting. Journal of Interprofessional Education & Practice, 9, 108-114.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4.
Kutney-Lee, A., Germack, H., Hatfield, L., Kelly, S., Maguire, P., Dierkes, A., ... & Aiken, L. H. (2016). Nurse engagement in shared governance and patient and nurse outcomes. The Journal of Nursing Administration, 46(11), 605-612.
Lin, P. Y., MacLennan, S., Hunt, N., & Cox, T. (2015). The influences of nursing transformational leadership style on the quality of nurses’ working lives in Taiwan: a cross-sectional quantitative study. BMC Nursing, 14(1), 33.
McCaffrey, G., & McConnell, S. (2015). Compassion: a critical review of peer?reviewed nursing literature. Journal of Clinical Nursing, 24(19-20), 3006-3015.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare. 3rd.
Pannick, S., Davis, R., Ashrafian, H., Byrne, B. E., Beveridge, I., Athanasiou, T., ... & Sevdalis, N. (2015). Effects of interdisciplinary team care interventions on general medical wards: a systematic review. JAMA Internal Medicine, 175(8), 1288-1298.
Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane Library. 6. Art. No.: CD000072. DOI: 10.1002/14651858.CD000072.pub3.
Sadeghi?Bazargani, H., Tabrizi, J. S., & Azami?Aghdash, S. (2014). Barriers to evidence?based medicine: a systematic review. Journal of Evaluation in Clinical Practice, 20(6), 793-802.
Urisman, T., Garcia, A., & Harris, H. W. (2018). Impact of surgical intensive care unit interdisciplinary rounds on interprofessional collaboration and quality of care: Mixed qualitative–quantitative study. Intensive and Critical Care Nursing, 44, 18-23.
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