Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Unit-Based Strategies for the Serious Organization

Changing the Work Environment in ICUs to Achieve Patient-Focused Care: Unit-Based Strategies for the Serious OrganizationWhat interdisciplinary strategies could a critical care unit put into action to indicate its seriousness in implementing the AACN standards for healthy work environments with a strong focus on patients and patients’ families? Here are some suggestions for making skilled communication and true collaboration the norm:
•    Use techniques such as SBAR to guide interdisciplinary communication. Link
•    Assemble a small group of nurses, physicians, respiratory care practitioners, pharmacists, and other health-care providers to develop processes for organizing truly collaborative interdisciplinary rounds. Set a 6-month goal by which time no patient will be discussed on rounds without the contribution of the full team.
•    Plan educational programs about new and interesting care strategies that are taught jointly by representatives from at least two disciplines. Invite representatives from every discipline with a role in patients’ care, and students, not just medicine and nursing, to participate and contribute their perspectives.
•    Although acute care and critical care units are often considered the home base of nurses, ensure that other team members are considered and are not treated as visitors or interlopers. Invite team members from all disciplines to attend and contribute to unit-based social events, such as potluck meals, and be sure to invite everyone, not just the most collaborative members, who already know and appreciate the valuable input of others. Getting to know each other as people can set or reinforce the tone for true collaboration.
•    Invite the ethics committee chair to a unit staff meeting and discuss how the committee can offer guidance when tough disagreements happen. Do not focus solely on the familiar issues of discontinuing treatment and end-of-life care; also consider dilemmas such as providing quality care despite limited resources and verbal abuse, which carry equally serious ethical implications. Inviting the unit’s medical director and other team members to participate will create a climate of shared learning.
•    Develop a welcome-to-our-unit program so that all new caregivers including physicians, nurses, respiratory care practitioners, pharmacists, and others can learn how to contribute in a culture of true collaboration and patient-focused care. Ensure that the unit’s nurse manager and medical director speak with all new care providers about how true collaboration is the standard.

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