Date of Award
4-1-2018
Embargo Period
1-1-2019
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College
College of Nursing
First Advisor
Gayenell S. Magwood
Second Advisor
Lynne S. Nemeth
Third Advisor
Emily Johnson
Fourth Advisor
Donna Lee Armaignac
Abstract
Background: Telemedicine Intensive Care Unit (tele-ICU) nursing is a relatively new dimension of critical care. Tele-ICU nursing practice leverages surveillance technology to facilitate and expedite patient care. Despite the growing number of critical care nurses practicing in this environment, little is known about tele-ICU nursing practice influence on ICU patient outcomes including avoiding failure to rescue (FTR). Preventing FTR in ICU patients with a diagnosed hospital acquired condition (HAC) is an important measure of quality of care. This dissertation is the first research to report a comprehensive analysis of the influence of tele-ICU nursing interventions to prevent FTR. The purposes of this study were 1) to characterize tele-ICU nursing interventions related to the prevention of FTR through qualitative exploration, 2) to determine which combination of documented tele-ICU nursing interventions (DTNIs) best predicts prevention of FTR in patients with HACs, 3) to triangulate qualitative and quantitative findings in order to provide a comprehensive understanding of tele-ICU nursing practice. Methods: The American Association of Critical Care Nurses (AACN) tele-ICU model of success (MOS) was used as the framework for this parallel convergent mixed methods study. An integrative review of the literature (n = 17) was first used to identify gaps related to tele-ICU nursing practice (Manuscript 1). Next, tele-ICU nurses’ characterizations of their interventions to prevent FTR were explored using qualitative interviews (n=19) using an integrated (inductive-deductive) approach to thematic analysis (Manuscript 2). Concurrently, secondary analysis of the electronic health records of ICU patients (n=861) diagnosed with a HAC was used to examine the extent to which DTNIs were predictors of prevention of FTR. Finally, triangulation was used to assess the extent of agreement, expansion and discordance in the study findings (Manuscript 3). Findings: Several gaps identified in the literature review provided the basis for this mixed methods analyses of the phenomena of tele-ICU nurse interventions to prevent FTR. Qualitative inquiry produced four themes (fundamental tele-ICU nurse attributes, proactive clinical practice, effective collaborative relationships, and strategic use of advanced technology) that characterized tele-ICU nurses’ interventions to prevent FTR. DTNIs related to hemodynamic instability were predictive of FTR. Mixed analyses found that DTNIs were consistent with tele-ICU nurses’ account of their interventions to prevent FTR. Conclusion: Tele-ICU nursing interventions to prevent FTR involve systems thinking and integration of complex factors. Prevention of FTR in the tele-ICU setting is influenced by tele-ICU nurses’ view of their role in preventing FTR, their ability to build effective collaborative relationships, and strategic use of technology to drive their proactive clinical practice. The information presented in this dissertation provides a foundation for future research to develop evidenced-based quality indicators for tele-ICU nursing practice that positively influences patient care outcomes.
Recommended Citation
Williams, Lisa-Mae, "Tele-ICU Nursing Interventions to Prevent Failure to Rescue of Patients in Critical Care with a Diagnosed Hospital Acquired Condition" (2018). MUSC Theses and Dissertations. 914.
https://medica-musc.researchcommons.org/theses/914
Rights
All rights reserved. Copyright is held by the author.