PhD in Nursing Science Program

Organizational Domains Influencing Interprofessional protocol Implementation in Intensive Care 

Dissertation under the direction of Professor Lorraine C. Mion 

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 (r5 =0.44 -0.58), role clarity (r s =0 .42-0.59 ), training/understanding (sr =0.33-0 .46), coordination (r5=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 (r s =0.35) and confidence (sr =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=S.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.