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The Effect of Harmonizing and Standardizing the nursing tasks on the Intensive Care Units of the European Community

Objectif

I- To carry out an organisation based managerial intervention at intensive care units (ICUs) of the European Community aiming at increasing the nurses' level of skill discretion and decision making regarding the most relevant nursing activity, the "titrated therapy", while testing the hypothesis that the intervention will improve the cost-effectiveness of care and increase the effectiveness of team-work management and leadership, reducing the incidence of burnout and dissatisfaction of the nursing personnel II- To develop an auditing system which will check the performance and survey the outcomes of the nursing activities.

The Foundation for Research on Intensive Care in Europe (FRICE) designed a large research programme, called EURICUS (European ICU Study) to study ICUs as a health care sub-system in the countries of the European Community using a methodology based on the "general system theory" in which the relations between Inputs:Throughputs:Outputs come under analysis. The rational supporting the programme is that non-medical management variables may influence the outcome of ICU patients. The EURICUS programme was divided into various specific studies. EURICUS-I, makes an explorative survey of 94 ICUs of 12 European countries. EURICUS-II is a prospective randomised controlled organisation and management based intervention study. Two groups of 24 ICUs each (experimental and control) randomly extracted from the database of ICUs surveyed in EURICUS-I. A protocolled set of managerial changes, designed and prepared by a panel of experts, concerning the nurses' level of skill discretion and the nurses' participation in decision making regarding titrated therapy, will be implemented at the ICUs of the experimental group during a period of six months, after an expert action of training and indoctrination of leading personnel in this group of ICUs took place. Measurements will be done before and after the intervention: a) concerning the effectiveness of the intervention regarding "skill discretion" and "participation in decision making" regarding the task of titrated therapy. Variables collected at ICU staff level (questionnaires and interviews), such as the level of perceived skill discretion, decision authority and adequacy of communication will be included; b) concerning other beneficial consequences of the intervention, will be collected from the daily ICU data: 1) concerning effectiveness of care: rate of adverse events related to titrated therapy and mortality; 2) concerning efficiency of care: length of stay in the ICU, nursing workload at patient level and the consumption of variable resources related with adverse events. Besides the objectives indicated above, it is expected that the programme will: a) stimulate the inclusion, and the participation of nursing research on Health Services Research in the Countries of the European Community; b) contribute to the synergistic development of the nursing profession together with the other professionals working at the ICUs in the countries of the European Community; c) strengthen and extend the existing network of researchers, providing the EC member states with objective instruments for the harmonisation and standardisation of the nursing tasks on the intensive care units.

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Coordinateur

Akademisch Ziekenhuis Groningen
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Adresse
59,OOSTERSINGEL
9700 RB GRONINGEN
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