Challenging Critical Attitudes

1
Challenging Critical Attitudes

• Jo Sumpton
• BACCN committee member
• Anglia Region

2
Critical care from the other side

• Still not fully integrated within the trust
• Untouchables
• No communal areas for integration
• Down a corridor behind closed doors
• CC not dealt with like the oncology department
• Appears more scientific then reality
• Too sexy for its own good
• I want to drop the patient and go
• CC provide educational opportunities because they
  are superior and wear a badge of respect
• Is it critical care without walls?

3
Critical care attitudes June 2006

• Recruiting vulnerable patients for sensitive
  research
• Job satisfaction, coping, moral discord in ICU
• End-of-life decisions, medical futility
• Staff experiences of early warning scoring and OR
• Low-health literacy challenge for CC
• Tobacco cessation in acute and CC
• Measuring workload, Handing over
• Introducing intensive insulin therapy
• CC competence

4

• CC Outreach and NC
• Family as a member of trauma rounds
• Unmet needs of families in ICU waiting rooms
• Providing a good death
• Does TV portrayal of medical outcomes influence
  perceptions of patient recovery?
• Mothers experience of ICU
• Surgeons attitudes to communication with patients
  and families
• ..

5
Prompts for consulting scientific evidence

• Uncertainty of the best course of action
• Controversy regarding a procedure/therapy
• Lack of knowledge about effectiveness of one
  thing over another
• unexpected patient outcomes
• Introduction of the new
• Traditional practices
• novel suggestions by anyone

6
Nurses attitudes toward research

• Important correlation between our attitudes and
  use of evidence in practice
• Involvement as collaborators or data collectors
  is a significant predictor of a positive attitude
• More influential still is inclusion in analysis
  and design
• Most experienced nurses tend to be more cautious
  to change
• Respect, clinical credibility and role model
  effect are powerful forces

7
The Case of the ELC Water pistol W100

• witnessing of a critical incident 15 years ago
  equipment failure
• Included in bedside check in ICU (ICU doors
  bolted at this time!)
• Others disputed there was a problem
• Changed position and the problem reoccurred
• Will not work if the O ring falls out

8
Present System
9
And again.
10
Again and again .
11
Not uncommon
12
Evidence Audit, nurse practice, patient
experiences, critical incident reporting, SUI

• Audit results
• 70 equipment failure
• Nursing knowledge incorrect 68
• Equipment does not do what it says on the tin

• Hospital Management board presentation
• 17,000 secured, change within 2 weeks
• MRHA report sent contacted within 24 hours
• Collaboration with manufacturers
• BACCN poster personal invitation by R and D
  executive to visit Tyco, Germany.

13
Wish to know more

• sue.chatterton_at_ipswichhospital.nhs.uk
• Practice Educator in Critical Care

14
In summary - A thinking culture

• Evidenced-based change is a national policy
  imperative
• Committed to balanced decisions giving equal
  weight to evidence
• Successful strategies are likely to be
  multifaceted and targeted
• There are barriers
• Theoretical models are useful, but evidence is
  lacking
• Audit and feedback alone has unpredictable impact
• Didactic study days, clinical guidelines which
  are passively disseminated have little or no
  effect on practice