Introduction
As Dr. White and Dr. Stanley suggest, engagement in the policy process, regardless of the site of change’s hierarchical level, is a worthy investment of time. Keeping in mind this takeaway’s implications for ICU physicians’ and nurses’ collaboration, this presentation will address the opportunity for policy-making at the organizational level. The presentation explores how to maximize ICU nurses’ potential to prevent the incidence of ICU-AW at discharge from a fifty-bed facility.
The clinical practice issue incorporates the increased incidence of ICU-AW cases. The condition is a subtype of muscle dysfunction that often involves new-onset myopathy or polyneuropathy, increases morbidity and mortality risks in the post-discharge period, and promotes long-term reductions in limbs’ functional health, thus affecting the quality of life in various age cohorts (Zhang et al., 2019). Excessive immobility and co-operating patients’ prolonged bed rest time contribute to the issue, and the facility lags behind the field’s leaders in instrumentalizing early mobilization (EM) programs and policies based on assessing the clinical appropriateness of EM daily and inducing moderate physical activity starting from the second day after the condition’s onset. Level-I evidence, including a systematic review of RCTs conducted by Zhang et al. (2019), suggests EM interventions’ positive influence on ICU patients’ balance, the ability to stand, walking endurance, and ventilator-free days along with reductions in ICU-AW diagnoses at discharge. Despite the need for additional training, nurse-led EM interventions are effectively incorporated at academic medical facilities (Fazio et al., 2021). These could be feasible for the organization of interest as ICU nurses outnumber physicians and physical therapists.
Stakeholder Identification
Centered on the facility’s internal patient assessment policies, the issue might require contributions and support from two stakeholder groups. The first group provides the DNP-prepared advocate with unique opportunities for motivational and advocacy work. The ICU’s management, involving the CEO and chief financial, operating, and medical officers, could be interested in the prospective policy’s quality-enhancing results and implications for funding, word-of-mouth marketing, and value-based purchasing programs. Non-nursing ICU staff, including critical care physicians and a few physical therapy professionals, could support policy change and ICU nurses’ inclusion in EM activities based on the considerations of better mobility restoration results and workload improvement through the delegation of some mobility assessment and EM initiation responsibilities to ICU nurses. For the latter, participation in EM would become an additional skill improvement opportunity and prophylaxis of high-stress facility overload scenarios stemming from increases in the average length of stay.
The pioneers of critical care research and leaders in the medical technology market represent the external stakeholders to support the DNP professional’s advocacy efforts through informational assistance. In particular, Medtronic advocates for the ubiquitous adoption of the ABCDEF Bundle, with E representing early mobilization, in ICUs and offers comprehensive materials on culture change that justify EM’s financial viability and address practitioners’ misconceptions of EM through case study dissemination (Marach, n.d.). Similarly, the SCCM offers education on the mentioned evidence-based six-component guide while also promoting recent EM-focused research, such as Liu et al.’s (2021) review of the bundle’s sub-optimal implementation. These stakeholders’ inclusion will promote culture and mindset changes to encourage the entire multidisciplinary workforce to advocate for organizational policy improvement.
Nursing Advocacy Strategy Proposal
As opposed to state- or federal-level advocacy, a more inductive approach to organizational change that fosters practice improvement at the institutional level to inspire a self-supporting chain reaction at the local level appears a more promising approach in the selected case. The proposed strategy borrows orientation at the SDOH factors from the large-scale HiAP advocacy framework, including structuring the proposal around healthcare quality as one determinant of interest (Williams et al., 2018). Having sufficient research appraisal skills, the DNP-prepared nurse can engage in evidence collection, including EM interventions’ general helpfulness for addressing ICU-AW, and, in collaboration with financial and medical managers, assess the policy change’s cost realism, appropriateness, and ICU nurses’ skillsets.
Conclusion
Having achieved a clearer facility-specific proposal, the nurse can then proceed with promoting the right mindset in the clinical staff by employing persuasive evidence dissemination. This could involve various communication methods, including educational presentations and meetings with external advocates for EM. The step, if completed successfully, will foster an interdisciplinary team establishment that would assess the new policy’s feasibility concerning both financial data and external EM facilitators’ success cases.
References
Fazio, S. A., Doroy, A. L., Anderson, N. R., Adams, J. Y., & Young, H. M. (2021). Standardisation, multi-measure, data quality and trending: A qualitative study on multidisciplinary perspectives to improve intensive care early mobility monitoring. Intensive and Critical Care Nursing, 63, 1-8. Web.
Liu, K., Nakamura, K., Katsukawa, H., Elhadi, M., Nydahl, P., Ely, E. W., Kudchadkar, S. R., Takahashi, K., Inoue, S., Lefor, A. K., Kesecioglu, K., & Nishida, O. (2021). ABCDEF bundle and supportive ICU practices for patients with coronavirus disease 2019 infection: An international point prevalence study. Critical Care Explorations, 3(3), 1-16. Web.
Marach, M. (n.d.). Overcoming a culture of immobility in the ICU. Medtronic. Web.
Williams, S. D., Phillips, J. M., & Koyama, K. (2018). Nurse advocacy: Adopting a health in all policies approach. Online Journal of Issues in Nursing, 23(3).
Zhang, L., Hu, W., Cai, Z., Liu, J., Wu, J., Deng, Y., Yu, K., Chen, X., Zhu, L., Ma, J., & Qin, Y. (2019). Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PloS One, 14(10), 1-16. Web.