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 (rs=0.44-0.58), role clarity (rs=0.42-0.59), training/understanding (rs=0.33-0.46), coordination (rs=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 (rs=0.35) and confidence (rs=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=5.47, 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.
| Identifer | oai:union.ndltd.org:VANDERBILT/oai:VANDERBILTETD:etd-03162016-114734 |
| Date | 04 April 2016 |
| Creators | Boehm, Leanne Marie |
| Contributors | Nancy Wells, Mary S. Dietrich, Eduard E. Vasilevskis, Lorraine C. Mion |
| Publisher | VANDERBILT |
| Source Sets | Vanderbilt University Theses |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.vanderbilt.edu/available/etd-03162016-114734/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Vanderbilt University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
Page generated in 0.0025 seconds