Improving collaborative efforts between physicians and nurses in the intensive care unit may decrease the risk of ventilator-associated pneumonia, suggest the authors of a new study presented at the American Thoracic Society 2016 International Conference.
According to the study's authors, better nurse work environments and ICU physician staffing models in which the care of all patients is managed by a critical care physician have been independently linked to lower rates of patient mortality. However, not much is known about how these factors conjointly influence VAP.
For the study, researchers analyzed critical nurse survey data from 25 ICUs collected in 2005 and 2006. Researchers examined the impact of closed physician models — models in which all ICU patients are the responsibility of an intensivist instead of multiple physicians — and the quality of the nurse work environment as measured by the Practice Environment Scale-Nurse Work Index on VAP both unilaterally and jointly.
The research found that better nursing environments were linked to a nearly six-fold increase in VAP risk. However, the authors clarified that this finding may be attributable to the way different roles of nurses and physicians in the ICU influence care.
"Nurses provide preventive VAP care once a patient is intubated, but patients are intubated by physicians. Without taking into consideration the physician staffing model, we are misattributing greater risk to nurses alone when in clinical practice, and as our results suggest, both nursing and medicine have the potential to influence VAP risk," said lead study author Deena Kelly Costa, PhD, RN, of the University of Michigan School of Nursing in Ann Arbor.
While a closed ICU physician staffing model did not display a significant association with VAP risk when scrutinized independently, there was a significant effect on VAP when examining interaction between nurse work environment and ICU physician staffing models.
Researchers found that in the open ICU model — in which care is managed by several physicians — the variety of physicians and better work environments may encourage nurses to standardize VAP preventive care thereby minimizing VAP risk. However, in a closed ICU and a strong nursing environment, nurses may likely contribute less prominently in VAP prevention care since there is more focused oversight from the ICU physicians.
The authors concluded, "These findings highlight a novel view that minimizing VAP depends on cultivating organizational collaboration between ICU nursing and medicine."
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