Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Two Critical Standards

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Two Critical StandardsWe embrace the adoption of all six AACN standards as crucial for transforming the work environment. Yet, two of the standards, skilled communication and true collaboration, seem particularly necessary to achieve the goal of patient-focused care, because communication as well as continuity and concordance with the patients’ wishes are foundational premises of patient-focused care.
Some individuals may achieve some level of genuine patient-focused care even when they practice in a toxic work environment because they are gifted communicators who embrace true collaboration. However, we contend that, at best, their efforts will be hit-or-miss, and such heroic efforts will be impossible to sustain if the environment is not transformed into a model that reflects the AACN standards. The barriers to transforming a toxic environment are indeed massive, but if those barriers are not overcome, Pronovost et al’s notion of “interdependence without integration,” will prevail.
Imagine, then, working in an environment where skilled communication and true collaboration form the foundation from which to promote patient-focused care. This would be an environment that embodies the following:
•    The current, common practice of totally separate medical and nursing schools would change. Physicians and nurses have selected classes and clinical experiences together as students so that each group enters practice with a respectful, accurate knowledge of the other’s clinical contribution.
•    Interdisciplinary patient care rounds are the norm, and each discipline’s contribution is considered so essential that decisions are not made without all care providers weighing in.
•    Each patient, when able, and the patient’s family are integral members of the decision-making team so that the patient’s values and wishes are key components of the planning process.
•    All team members feel comfortable and supported in challenging care processes when the processes are perceived to be inaccurate, not evidence-based, or inconsistent with professional values or the patient’s values.
•    All team members actively seek and engage in educational programs that improve their communication and collaboration skills. Colleagues support each other in skill development and hold each other accountable for correcting lapses in respectful communication and collaboration patterns.

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