The impact of nighttime intensivists on medical intensive care unit infection-related indicators

In 2013, a before-and-after intervention study was conducted to evaluate the effect 24-hour intensivist coverage on length of stay and rates of catheter-associated urinary tract infection, central-line associated blood stream infection, and ventilator-associated events. Intensivist coverage for 24 hours did not decrease length of stay or result in a decrease in any specific infection rate.Infect. Control Hosp. Epidemiol. 2016;37(3):352–354</jats:p

Clinical components and associated behavioural aspects of a complex healthcare intervention : Multi-methods study of selective decontamination of the digestive tract in critical care

Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.Peer reviewedPostprin

Theories of behaviour change synthesised into a set of theoretical groupings: Introducing a thematic series on the Theoretical Domains Framework

Behaviour change is key to increasing the uptake of evidence into healthcare practice. Designing behaviour-change interventions first requires problem analysis, ideally informed by theory. Yet the large number of partly overlapping theories of behaviour makes it difficult to select the most appropriate theory. The need for an overarching theoretical framework of behaviour change was addressed in research in which 128 explanatory constructs from 33 theories of behaviour were identified and grouped. The resulting Theoretical Domains Framework (TDF) appears to be a helpful basis for investigating implementation problems. Research groups in several countries have conducted TDF-based studies. It seems timely to bring together the experience of these teams in a thematic series to demonstrate further applications and to report key developments. This overview article describes the TDF, provides a brief critique of the framework, and introduces this thematic series. In a brief review to assess the extent of TDF-based research, we identified 133 papers that cite the framework. Of these, 17 used the TDF as the basis for empirical studies to explore health professionals’ behaviour. The identified papers provide evidence of the impact of the TDF on implementation research. Two major strengths of the framework are its theoretical coverage and its capacity to elicit beliefs that could signify key mediators of behaviour change. The TDF provides a useful conceptual basis for assessing implementation problems, designing interventions to enhance healthcare practice, and understanding behaviour-change processes. We discuss limitations and research challenges and introduce papers in this series

The Patient as a construction and a non-participant member of a change-process.

The contribution of this paper is a discussion about how the patient as a phenomenon is constructed and used by employees for different purposes, enabling and inhibiting change. The results are based on a three year case study in which data has been collected with interviews and observations. They have then been analyzed and interpreted within a framework consisting of theories about thinking collectives, structuration, information and knowledge management. The findings indicate that “the patient” has implications for how project management is conducted and a patient record upgraded at the anesthesia and intensive care unit of a hospital.the patient; anesthesia information management; constructionism; thinking collectives; knowledge management; structuration.

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK)

Background: The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention. Methods: Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff. Results: Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision. Conclusions: We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes

Collaborative participatory research as a learning process: the case of CIP and CARE in Peru

Participatory research (PR) has been analyzed and documented from different points of view, but particularly taking into consideration the benefits that this process generates for farmers. Studies of the benefits of PR for other actors such as field staff, researchers and organizations have been limited, with organizational learning receiving the least attention. This paper analyzes the interaction between the International Potato Center (CIP) and CARE in Peru and makes the case that PR can also contribute to creating a collaborative learning environment that generates important lessons for the individuals and organizations involved. The paper describes the evolution of the collaborative environment of these two institutions for more than a decade. Three interactive learning periods are presented, namely the “information transfer period” (1993 –1996) the “action-learning period” (1997-2002), and the “social learning period” (on-going). Several lessons from each period, as well as changes in institutional contexts and perceptions, are described. The CIP-CARE case shows that research and developmentoriented organizations can interact fruitfully using PR as a mechanism to promote learning, as well as flexibility in interaction and innovativeness, and that a process of osmosis of information occurs between groups that use PR in a specific case to other groups within the organizations, influencing behavior. However, the paper also indicates that institutional learning should be promoted more specifically in order to extract guidelines from the lessons, which can influence the way organizations plan and implement their projects in a constantly changing environment

Perspectives on Pay for Performance in Nursing: Key Considerations in Shaping Payment Systems to Drive Better Patient Care Outcomes

Explores the advantages, obstacles, and risks of pay-for-performance systems in nursing and starting points for effective measurement. Makes recommendations including supporting research and reflecting nursing's complexity and centrality in system design