My workplace is a mixed Intensive Care Unit or ICU. It is a relatively large unit with 12 beds. The unit stations high-risk, low-risk, and rising-risk trauma, medical, and surgical patients. The unit has three central nursing stations, two separate utility rooms (one clean and one dirty), and two medical rooms. The staff in the unit includes nurses, nurse educators, and break nurses. The nurse-to-patient ratio of the unit follows the standard for ICUs that requires a minimum of one nurse per two patients. Junior nursing staff is available as well. In addition, there are nurses focused on specific tasks such as dialysis and perfusion. Break nurses come to the unit during the break hours so that the staff of the unit could rest.
As for the EBP practices, according to the decision of the institution leadership, the unit was expanded not so long ago. In turn, since more patients had to be stationed, the leaders also decided to add the second nursing station – this way the nurses can observe all patient rooms at any time and respond to the ones who need help right away. Among the EBP practices employed in the unit, it is possible to recognize the moderation of noise in the area and reevaluation of the demand for the medical supplies required for the unit operations. Improvements are introduced quite often these days; however, I have heard that it has not always been the case. Today, the nurses in the unit are encouraged to educate themselves and read nursing journals and news in order to learn about the latest trends in the field.
There is one clinical guideline that is currently practiced in the unit. It refers to the management of pain in critically ill adult patients. According to the guideline, the depth of sedation in the patients who require pain management is to be light (to the degree that is allowed by the individual’s condition). In that way, the depth of sedation and the brain function of the patients are monitored carefully by means of Richmond Agitation-Sedation Scale (RASS). This is done because research finds that the deeper levels of sedation aggravate the psychological response to the stress of a patient’s brain (Barr et al., 2013). In addition, the sedation strategies for the mechanically ventilated adult ICU patients are developed with reliance on nonbenzodiazepine sedatives such as dexmedetomidine and propofol; these sedatives are preferred to the ones that use benzodiazepine.
In my opinion, the current leadership of the unit is oriented towards improvement and education. The only complication is that the resources of the unit and facility, in general, do not always allow implementing innovations and change.
Resources Available at Work Unit/Space
Cell phones used to be forbidden in my unit. However, the modern policy is more liberal. In particular, the patients are allowed to use them when they are set on vibrate mode. This is the policy regarding landline phones as well because the noise they make tends to add to the overall stress of the patients when it is combined with the sound produced by all the other types of equipment used in the territory of the unit. At the same time, in some cases, the use of cell phones inside of a patient’s room is disallowed because the frequencies the phones produce may interfere with the work of some devices. For example, one of such devices is syringe pump (when it is placed close to a cell phone set on the talking mode) (Hans & Kapadia, 2008). The staff members are allowed to use their phones when they are on a break and outside of the patients’ rooms. In that way, EBP information can be accessed on a daily basis.
When it comes to the accessibility of the printed copies of scholarly research articles and hard copies of journals, there is a small library room in the territory of the unit that contains versatile materials that can be accessed by the staff at any time. However, it is important to note that many of them (about 70%) are from the 1990s and the beginning of the 2000s, so the information in them is not new.
Yet, the current journals and books can be accessed online in the databases such as PubMed Central and NCBI. I can access scholarly research articles using these databases and a computer at the workplace library during my breaks. Besides, I can research the required materials at home. In my opinion, the journals are easy to access and are available at work. For a willing professional, it is possible to consult the literature and carry out the search several times a week. I tend to access journals at least once a week when I feel the need to backup or strengthen my knowledge. The library staff is responsive and can direct me to the materials on the subjects I need.
I have several recommendations concerning the EBP practices and attitudes in my workplace. First of all, funding is one of the core issues in this regard. Innovative ideas and new practices require investment. I think EBP needs to be encouraged from the top. Moreover, I think it would help if more computers were placed in the unit library for more staff members to access the latest literature.
Overall, I could evaluate the attitude to EBP at my workplace as positive and welcoming. However, insufficient funding sometimes slows down the change. I believe that the modern leaders in the unit are dedicated to keeping up with the progress in the field and follow the most recent trends.
Barr, J., Fraser, G. L., Puntillo, K., Ely, W. E., Gelinas, C., Dasta, J., … Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine, 41(1), 263-306.
Hans, N. & Kapadia, F. N. (2008). Effects of mobile phone use on specific intensive care unit devices. Indian Journal of Critical Care Medicine, 12(4): 170–173.