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Title page for ETD etd-03162016-114734


Type of Document Dissertation
Author Boehm, Leanne Marie
Author's Email Address leanne.boehm@vanderbilt.edu
URN etd-03162016-114734
Title Organizational Domains Influencing Interprofessional Protocol Implementation in Intensive Care
Degree PhD
Department Nursing Science
Advisory Committee
Advisor Name Title
Lorraine C. Mion Committee Chair
Eduard E. Vasilevskis Committee Member
Mary S. Dietrich Committee Member
Nancy Wells Committee Member
Keywords
  • interprofessional
  • adherence
  • intensive care
  • bundle
  • implementation
Date of Defense 2016-03-15
Availability unrestricted
Abstract
The objective of this dissertation was to understand the relationship between organizational domains and provider attitudes as well as the relationship between ICU provider attitudes and ABCDE bundle adherence. A one-time interprofessional electronic survey in ten ICUs across the United States was conducted to examine association of organizational domains with provider attitudes regarding the ABCDE bundle. Protocol attributes (rs=0.44-0.58), role clarity (rs=0.42-0.59), training/understanding (rs=0.33-0.46), coordination (rs=0.33-0.46), and peer advocates (rs=0.37-0.48) were positively correlated with provider ABCDE bundle confidence and perceived safety and strength of evidence. Task autonomy was positively correlated with provider attitudes of ABCDE bundle perceived safety (rs=0.35) and confidence (rs=0.47). For every unit increase in workload burden, there was a 53% decrease in adherence to the ABCDE bundle (OR=0.47, CI=0.28-0.79, p=0.004). Perceived difficulty carrying out the bundle, perceived safety, confidence, and perceived strength of evidence were not associated with ABCDE bundle adherence. ABCDE bundle adherence was greater on ventilator-free days compared to ventilator days (97% vs. 72%, z=5.47, p<0.001). There are organizational domains that positively influence provider attitudes. Protocol attributes, role clarity, coordination, peer advocates, and teamwork factors explain the most variance in provider perceived difficulty with carrying out the bundle. Focusing interventions on factors influencing these organizational domains may facilitate ABCDE bundle implementation.
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