Hellyar Mary, Madani Catherina, Yeaman Sarah, OʼConnor Kelly, Kerr Kim M, Davidson Judy E
Jacobs Medical Center Medical/Surgical Intensive Care Unit (Mss Hellyar and Yeaman and Drs Madani and Kerr), Intensive Care Unit (Ms O'Connor), and Education Development and Research (Dr Davidson), University of California San Diego Health.
Crit Care Nurs Q. 2019 Jan/Mar;42(1):96-105. doi: 10.1097/CNQ.0000000000000243.
Prevention of burnout is a national imperative, and blame-free investigations of clinical events are advocated. Reflective inquiry techniques are helpful in processing adverse events while minimizing blame. The purpose of this project was to develop an interprofessional peer review program (Case Study Investigation) to process emotions, improve teamwork, and optimize patient outcomes. This evidence-based practice project was conducted in a 12-bed intensive care unit using reflective inquiry techniques to perform peer case review across disciplines. Significant improvements were seen in percent strongly agree to the 2 satisfaction questions asked: "I feel free to speak up regarding issues that may affect patient care" (increased from 37% to 73%, χ = 6.19, P < .05), and "There is open communication between physicians and nurses" (rose from 33% to 73%, χ = 7.53, P < .05). In total, 95% perceived improvement in interprofessional teamwork. Burnout decreased significantly at 6 months (n = 22, M = 18.40, SD = 3.36) from baseline scores (n = 27, M = 21.96, SD = 4.47), F2,72 = 4.48, P < .02. Central line-associated infections decreased from 3.6 per 1000 to 0 per 1000 catheter-days. Catheter-related urinary tract infections decreased from 2 per 1000 to 0 per 1000 patient-days. Both were sustained below benchmark. Reflective inquiry decreases nurse burnout while improving perceived interprofessional teamwork and employee satisfaction, and measurements of patient safety.
预防职业倦怠是一项国家要务，提倡对临床事件进行无指责调查。反思性探究技术有助于处理不良事件，同时尽量减少指责。本项目的目的是开发一个跨专业同行评审项目（案例研究调查），以处理情绪、改善团队合作并优化患者结局。这个基于证据的实践项目在一个拥有12张床位的重症监护病房进行，使用反思性探究技术跨学科进行同行案例评审。对于所问的两个满意度问题，强烈同意的百分比有显著提高：“对于可能影响患者护理的问题，我觉得可以自由表达意见”（从37%提高到73%，χ = 6.19，P < .05），以及“医生和护士之间有开放的沟通”（从33%上升到73%，χ = 7.53，P < .05）。总体而言，95%的人认为跨专业团队合作有所改善。职业倦怠在6个月时（n = 22，M = 18.40，SD = 3.36）较基线得分（n = 27，M = 21.96，SD = 4.47）显著下降，F2,72 = 4.48，P < .02。中心静脉导管相关感染从每1000导管日3.6例降至每1000导管日0例。导尿管相关尿路感染从每1000患者日2例降至每1000患者日0例。两者均持续低于基准水平。反思性探究可降低护士的职业倦怠，同时提高跨专业团队合作的感知度和员工满意度以及患者安全指标。
