Page 130 - Encyclopedia of Nursing Research

CRITICAL CARE nURSInG RESEARCH n 97

the likelihood of research utilization, Halm to five interventions that, when performed
(2010) concluded that several factors were collectively and reliably, have been proven
critical to the practice of EBn: (1) the transfor- to improve patient outcomes (Resar et al., C
mational leadership behaviors, particularly 2005). A bundle has the effect of conceptu-
among nurse executives in Magnet hospitals; ally and behaviorally linking idiosyncratic
(2) the positive impact of the local unit culture; and seemingly unrelated nursing interven-
and (3) the quality of the unit leader–nurse tions into a package of interventions that
interactions with staff nurses. An interesting clinicians know must be followed for every
aspect of successful transformations to EBn patient, every single time. Compared with a
is in the redefinition of “real work” from that checklist, the bundle is based on and deter-
of a “doing” culture, that is, that values the mined by Level 1 evidence. Examples include
practical busyness of accomplishing tasks, to the Central Line Bundle and the ventilator
that of a “being” culture, that is, reflecting on Bundle (IHI, 2010).
practice, integrating research into practice. Critical care has been a research-inten-
Collaborative projects in critical care sive discipline, both in medicine and in nurs-
are valued more explicitly, as the contribu- ing. The initial narrow focus on maintaining
tions from the disciplines of psychology, physiological stability of the cardiopulmo-
medicine, gerontology, respiratory care, nary system undoubtedly contributed to the
and social work often overlap with those early commitment to research-based prac-
of nursing. In 2009, the AACn’s Evidence- tice. Critical care nurse scientists have been
Based Practice Resource Work Group pub- extraordinarily productive, creative, and
lished an updated evidence-leveling system sophisticated in their investigations. A recent
used to grade scientific studies and other search of grants currently funded in 2010 by
sources of information for application to the national Institute of nursing Research
critical care practice (Armola et al., 2009). yielded 592 federally funded studies of pedi-
The intent of this review was to evaluate atric and adult patients. This author identi-
grading systems adopted by other specialty fied 33 studies (6%), which were focused on
organizations, to consider the quality of the critical care patient population (Project
prioritized research design in the leveling Reporter, 2010). The low percentage of funded
process, and to evaluate the inclusion of grants for the critically ill patient popula-
meta- synthesis as an additional research tion may be underestimated because nurse
design. The new system ranks meta-analysis researchers do apply to other Institutes for
and meta- synthesis as the highest level in funding. Studies were focused on end-of-life
the hierarchy of evidence for recommenda- decision making for dying and chronically
tion. AACn’s future priorities for 2010–2011 critically ill patients, identification of cellu-
focus on concerns related to topics essential lar biomarkers of critical illness and patient
to excellence in practice, including medica- outcome, improvement of nursing assess-
tion management, hemodynamic monitor- ment of patient symptoms and symptom
ing, healing environments, palliative care management, relationship among mechani-
and end-of-life issues, mechanical venti- cal ventilation, oral care, and infection, and
lation, monitoring neuroscience patients, facilitation of communication, learning, and
and noninvasive monitoring of critically ill practice improvement in the ICU (Project
patients (AACn, 2010). Reporter, 2010).
Increasingly, nursing care interventions Clinical research in intensive care set-
in the ICU are bundled. A bundle is a struc- tings presents multiple challenges because
tured way of improving the processes of of the ethical concerns of obtaining informed
care and patient outcomes. It consists of a set consent, the demands of time and availabil-
of evidence-based practices, usually three ity at the bedside, the need for institutional