Poor Glycemic Control in ICU Patient - Research Paper Example

? Poor Glycemic Control in ICU Patient DHT2 TASK Ambika Chacko Western Governors Topic Diabetic patients admitted to the ICU must have their blood sugar carefully monitored as part of their treatment. Implementing the existing clinical protocol includes assessing the clients’ health upon admission and consulting with the electronic medical records to identify their medical histories of glycemic control. However, the admitting diagnosis, whether stroke or heart attack or major injury, can take precedence over the diabetes, and then blood glucose levels rise unchecked, thus complicating the initial condition. When glycemic control is not a priority, medical conditions can worsen within a few hours. When blood sugar levels rise, risk of infection increases, and organs can fail. Morbidity and mortality result. Careful glycemic control is crucial to a diabetic’s survival and recovery. Nurses can take the lead in improving the implementation of ICU clinical protocol, and their critical thinking skills are invaluable for determining such protocol (Plost, Nelson, 2007, p 155). What obstacles prevent ICU nurses from full compliance with protocol for glycemic control during the first 48 hours of a diabetic patient’s stay in the ICU, and what steps will raise compliance? A2.Participants The participants in this study are registered nurses with bachelor’s degrees and at least two years of experience in the ICU, and they work together in the ICU of a community hospital. Most work full time, but several are part time. Nurses with less than two years of experience in the ICU are excluded. They range in age from 25 to 59; older nurses have been in the ICU for decades and younger ones seem poised for long careers, as well. Such longevity produces expertise, but also precludes innovation. These nurses come from different nationalities and ethnicities. Although their educational level are similar, their learning styles differ markedly. Also, what motivates each of them has an impact on the implementation of protocol. They have not been involved in developing protocol. The researcher observed a lack of compliance with protocol for glycemic control in the ICU. B1. B . Outline the problem: During the first 48 hours after ICU admittance, patients have poor glycemic control because the policy and protocol for blood glucose monitoring is not followed. In this community hospital, it has been observed the patients’ blood glucose level during the first 48 hours of their admission is high and is not being managed according to the national standard. The main problem is to identify the reasons nurses do not comply with the treatment plan. What causes nurses to not follow the protocol? And how can we improve the compliance? B3.Causes of the problem Compliance with new legislation costs money. Examining and tracking the quality of care is a financial concern. In facilities with strict budgetary restraints like this one, pressures are enormous to delay or deny compliance. The facilities many not be able to comply in every aspects of patient’s care. This ICU does not have an internal audit nurse which could have been befitted to compliance program. Before something has become a clinical concern, compliance programs are especially ineffective. “ The better trained the staff, the better the quality of care and the more compliant a facility will be (Abell,T,2011)”. All staff members need to respect compliance with regulations, a fact which is not observed in this ICU. Staff nurses are not sure if the protocol and previous training they have received was effective. How was the follow up? Staff is not aware of any. This ICU must ensure qualified educators are performing the training, and the protocol has to take into account the nurses’ level and the needs of the community. Interventions always have to be meaningful which is not observed in this ICU. Another concern nurses feel is that they are very busy in ICU with the acute care needs of the patient; there is not enough time, or not enough staff. Nurses believe glycemic control is not a priority because patients come in with other diagnoses. Nurses are not sure when protocol was last reevaluated. B3.proposed solution: When it comes to compliance in ICU or any health care area, nurses need to give a higher priority to development and implementation of regular education. Training programs can be focused on compliance behaviors of nurses, and the effectiveness of protocol can be documented and assessed (7 steps to Health care compliance, 2002). The proposed solution can include researching to try to find an evaluative format by using the nursing process. Instead using compliance, the researcher can use the problem-solving method for managing poor glycemic control in ICU. Using the nursing process, what is the rational for not following the protocol in the ICU? There can be innovative ways to view the ICU as a team project instead of as a duality of an educator trying to implement the compliance. Include nurses in all committee and evaluation processes before a protocol is presented to the ICU. Let the nurses take their role as inventors. Empowering them to take an active role in their ICU will have an impact on how we can deliver compliance. The researcher also uncovers the relation of ruling health care with equalizing research relations which include the nurses in all educational activities and inform them in advance so they can participate in many ways to improve compliance in the ICU( Murphy,N.,Canales.M.,2001). C. Research questions The research will try to answer the question: What are the perceptions of ICU nurses in relation to compliance with existing glycemic protocols versus exclusively with physician’s orders? D1.Data The research shall use primary data. Primary data is data obtained directly from respondents based on their views. The data in this case is collected using a survey technique with questionnaires being the method of obtaining information from the respondents. Further data will come from the researcher’s observations of patients’ blood sugar levels and of the nurses’ interventions to lower it if necessary ( Nesbeth, Orskov, Rosenthall, 2009, p 30). Verbal inquiries of nurses will also provide primary data. The questions will concern nurses’ participation in protocol formation and revision, their knowledge of the protocol for glycemic control in the ICU, and about their thoughts and feelings on compliance with the protocol for glycemic control in the ICU. The data analysis technique to be used involves quantitative methods. Questionnaires are very good in obtaining data in a quantitative research. Computer statistical software such as SPSS is to be used in analyzing the results (Holloway, Wheeler, & Holloway, 2010). The analysis process will establish the quantitative trends in the data such as the mortality trend according to the collected data. D2 Instruments and methods: This research seeks to identify the areas that nurses overlook while attending to diabetics. In the medical field, very little information is required to raise an alarm, thus this research does not seek to obtain the real statistics but rather just the neglected requirements of the services in accordance with the accords of the profession. There will be three methods of collecting data. Electronic medical records from one hospital shall be consulted to collect data regarding glycemic control in the ICU during a patient’s first 48 hours. The researcher’s personal observations will be recorded. Several surveys, both formal and informal, will be conducted with the ICU nursing staff. The treatment of diabetics has no seriousness even when the disease happens to be the seventh killer of all the other diseases. The lack of seriousness is by the fact that there are several details left out in the protocols of administering the glycemic control. A researcher has a sole responsibility of fishing for the data and information needed for the research from the respective participants. The also researcher interprets the gathered data. Thus, quantitative research arbitrarily subsides to the biasness of the researcher although the information and results for this research are stated and interpreted without swaying a bit of it. D3 The researcher will compare the electronic data collected with pertinent information from the Inpatient Evaluation Center (IPEC). This software identifies episodes of care as well as diagnosis and readmission. All statistical analyses will be performed using SAS version 9.1 (SAS Institute Inc., Cary, NC). (Rosen, Kamal. Itani, Cevasco, Kaafarani, Hanchate, Shin, Shwartz, Loveland, Chen, and Borzecki, p. 3) The researcher will identify the compliance with protocol for glycemic control, or lack thereof, by ICU nurses. The researcher will quantify the nurses’ responses and establish outcome criteria according to the clinical standard. The response and action plan in this ICU will be compared with the practices in ICU. The researcher discourages relationships with the participants. This measure checks on the effects of emotions towards the tone of research methodology (Lincoln & Reason, 1996). Additionally, the part of discussion seems to be very prone to kind of tone discussed above. A picture of confusion or coherence comes up when discussing the findings of a research. He adds that the researchers’ mind loads with dynamicity, lifelessness, false, or truth and thus ends up documenting personalized statements. The researcher shall make all attempts possible to document the exact data and information gathered from during the interviews. The researcher considers all the ethical contemplation and shall seek for the informed consent from the relevant authority, including the officials from the University, hospitals and the dissertation authority. The researcher is also obligated to contact the nursing staff and the participants. The researcher handles the accessed patient data with ultimate confidentiality, but he or she modifies or customizes the filled questionnaire for any other respondent. D3.Data Analysis Techniques: The data analysis technique to be used involves quantitative methods. Questionnaires are very good in obtaining data in a quantitative research. Computer statistical software such as SPSS is to be used in analyzing the results (Holloway, Wheeler, & Holloway, 2010). The analysis process will establish the quantitative trends in the data such as the mortality trend according to the collected data. This is because the researcher will attempt to use medical records from hospitals’ Intensive Care Units in the first part of the study. The nurses are also interviewed by the researcher if they have adequate knowledge about ICU protocol in hyperglycemic patient. Evaluation include by demonstrating policy and procedures and how to follow insulin protocol in the ICU. Upon the approval of Institutional review board, data were retrieved from the ICU electronic medical record system and were identified for analysis. Demographics characteristics that is age, sex,race,marital status and educational level, body mass index and co-morbid conditions and base line of health history were retrieved. Researcher preconized the difficulties of changing behaviors and culture in ICU. This also proved noncompliant way of program until this ICU culture consistently demonstrated failure to engage in behaviors and would confirm the nurses noncompliant culture is a true challenge in ICU. (Chang, Davis, Birt, Castelluccio, Woodbridge, Marrero, 2007, pp. 377-385). This research employs Survey Questionnaire to collect data from the respondents and participants. The participants, who are nurses by default, shall be selected based on expertise and deployment in the Intensive Care Unit. The questionnaire shall contain a complete set of instructions explaining the conducting process, filled then submitted to the Dissertation authority. The researcher shall also visit a single provincial hospital to reach the participating nurses of the same hospital. The researcher is required to conduct the participating nurses with the permission from the hospital head Authority. The researcher does this on every participating nurse in order to verify his or her willingness and availability for the survey. The research methods will be more fully explained in the upcoming tasks, and the appropriate documents presented. In considering human subject research, there will also be necessary documents and explanations. The position and biases of the researcher will be disclosed. A review of pertinent literature will follow. Reasons for choosing the research methods will be given, and the research design will be presented. Participant permissions will be included. Along with the data collected, figures and charts will show the research results. Data analysis then follows. Various summaries and variations of the project explore the topic thoroughly. Finally, conclusions based on the results will point to areas for further investigation. Task 2 IRB: Q1. Research methods This will be a qualitative research where surveys will be used as the method of research in seeking to identify the areas that nurses overlook while attending to diabetics. Q2. Research procedures The research will involve the use of medical records from hospitals’ Intensive Care Units in the first part of the study. Then the nurses will also be interviewed by the researcher if they have adequate knowledge about ICU protocol in hyperglycemic patient. Evaluation will include by demonstrating policy and procedures and how to follow insulin protocol in the ICU. Q3. Data collection tools The research will be a data survey monkey, nurses from USA online survey. Three methods will be used to collect data. Electronic medical records from one hospital shall be consulted to collect data regarding glycemic control in the ICU during the first 48 hours of stay in hospital by a patient. The personal observations of the researcher will also be recorded. Several online surveys, both formal and informal, will be conducted with the ICU nursing staff in the United States. Q4. Human subject participant population The participants are national online survey through survey monkey. The ages of participants will range from 25 to 59; older nurses have been in the ICU for decades and younger ones seem poised for long careers, as well. These nurses come from different nationalities and ethnicities. Although their educational level are similar, their learning styles differ markedly. Also, what motivates each of them has an impact on the implementation of protocol. Q5. Vulnerable or the protected population participants This study will involve only the registered nurses with bachelor’s degrees. In addition, they must have at least two years of experience in the ICU. Most work full time, but several are part time. However, the study will not include nurses with less than two years of experience in the ICU. Q6. Children under the age of 18 No child under the age of eighteen will take part in the study. Q7. Steps taken to minimize any risk to participants in the study The participants will be given freewill to give their views and their information will not be made public to protect them. Q8. Confidentiality of the participants and the research data The records of data collected shall not be accompanied by the identities of participants, and a password shall also be required in order to gain an access to the stored data. A copy of the data shall be stored in a hidden folder then written in to a compact disk. Only the researcher will be able to access the folders and disks where the information will be stored. Q9. Procedure for gaining the informed consent of the participants The researcher shall agree to all the requirements and terms of conducting a study on the poor glycemic control on the type 2 diabetics admitted in the ICU, and inform the participants about the research topic and rationale for the study as well as objectives and then assure them of confidentiality. References ABELL, T. (2011). Creating a compliance/QA culture. Long-Term Living: For The Continuing Care Professional, 60(5), 36-37. Amy K. Rosen, PhD, wz Kamal M.F. Itani, MD,zy8 Marisa Cevasco, MD, MPH,yz Haytham M.A. Kaafarani, MD, MPH,#** Amresh Hanchate, PhD,*z Marlena Shin, JD, (2011). Validating the Patient Safety Indicators in the Veterans Health Administration Do They Accurately Identify True Safety Events? Medical Care, Volume 00(00),1-12 2014 .ABELL, T. (2011). Creating a compliance/QA culture. Long-Term Living: For The Continuing Care Professional, 60(5), 36-37. Harrison, R., Stalker, S., Henderson, R., & Lyerla, F. (2013). Use of a clinical decision support system to improve hypoglycemia management. Medsurg Nursing: Official Journal Of The Academy Of Medical-Surgical Nurses, 22(4), 250. Holloway, I., Wheeler, S. & Holloway, I. (2010). Qualitative research in nursing and healthcare. Chichester, West Sussex, U.K: Wiley-Blackwell. Ingram, T. (2009). Compliance: a concept analysis. Nursing Forum, 44(3), 189-194. doi:10.1111/j.1744-6198.2009.00142.x Accessed February 15, 2014.Plost, G., & Nelson, D. (2007). Empowering critical care nurses to improve compliance with protocols in the intensive care unit.American Journal Of Critical Care, 16(2), 153-157. Sigg AC,, A, Fiorelli,P. (2014.) nd7 Steps to Health-care Compliance. Internal Auditor [serial online]. Available from: Health Business Elite, Ipswich, MA. Accessed February 15, February 2002;59(1):35. U.S. Department of Health and Human Services CfDCaP. (2011). National estimates and general information on diabetes and prediabetes in the United States. In National diabetes fact sheet. Retrieved January 16, 2014, from http://phrp.nihtraining.com/index.php Read More