Date Available

4-29-2020

Year of Publication

2020

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Melissa Thompson-Bastin

Committee Member

Dr. Amy Fisher

Committee Member

Dr. Cassondra Degener

Abstract

Abstract

BACKGROUND: Oversedation in the mechanically ventilated patient can cause long- and short-term adverse side effects. Light sedation practices provide patients with relief from agitation and pain and still allows them to actively participate in care. A light sedation protocol was introduced to bedside ICU registered nurses (RNs) at the University of Kentucky Medical Center (UKMC), but deep sedation is still commonplace. Reeducating bedside RNs and increasing their knowledge and confidence is a proposed strategy for increasing adherence to light sedation protocols.

PURPOSE: The purpose of this quality improvement project was to gain understanding of bedside RNs knowledge and perceived confidence regarding the established light sedation protocol before and after education to determine ways to increase adherence to the light sedation protocol.

METHODS: Pre and post-test surveys were distributed to the bedside registered nurses working in the Medicine Intensive Care Unit (MICU) at UKMC. The survey contained 5 knowledge questions, 5 confidence questions, and 1 “choose all that apply” question. Education sessions were provided to the bedside RNs with the use of educational outreach, change champions, and opinion leaders, between the pre and post-test survey that detailed the light sedation protocol. The knowledge question answers were compared to determine total answers correct. The confidence questions allowed the RNs to rate their perceived confidence using a 5-point Likert scale, and those responses were compared for changes. The “choose all that apply” question allowed RNs to choose what barriers they identified for using the light sedation protocol.

RESULTS: The total knowledge score for the pretest (n=83) had a mean(SD) of 3.98(0.86) and the total knowledge score for the posttest (n=57) had a mean(SD) of 4.05(1.06) which was not statistically significant with a p=0.64. Four of the five confidence questions showed a significant increase in the bedside nurses’ confidence level. There was no statistically significant change in what nurses determined as barriers to using the protocol from the “choose all that apply question.”

CONCLUSION: Knowledgeable and confident nurses are vital for improving patient outcomes. However, if multiple barriers are identified by bedside staff, implementation of a practice change will be difficult. When the practice change is multifactorial then a team approach may be better for success. Further research needs to be done to assess the knowledge and perceived confidence of other healthcare providers to understand the attitudes of the multidisciplinary team regarding the light sedation protocol. Reviewing the electronic health record for adherence to charting assessments and interventions would be pivotal for understanding nursing adherence to protocol.

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