reduction of Ventilator-Associated Pneumonia (VAP) for patients admitted in the Intensive Care Unit (ICU)

reduction of Ventilator-Associated Pneumonia (VAP) for patients admitted in the Intensive Care Unit (ICU)

The selected practice problem entails the reduction of Ventilator-Associated Pneumonia (VAP) for patients admitted in the Intensive Care Unit (ICU). The problem is relevant because VAP presents a significant burden to the healthcare system by increasing the period of hospitalization and the associated costs (Tinset et al., 2017). As with other healthcare concerns, it is possible to evaluate the issue from a systems approach perspective — micro-, meso-, and macro- levels. According to Zaccagnini and White (2017), the systems approach is necessary because it provides the basis for the incorporation of scientific evidence and the evaluation of healthcare from a broad perspective. Consequently, stakeholders obtain detailed insights into factors that influence the quality of healthcare.

The micro-system entails the direct provision of care to the affected patient. It highlights the most basic level in the healthcare system, and it reflects the urge for patient-centeredness in care provision. For this practice problem, it involves the ICU setting, including the related equipment, as well as the members of staff providing care to the patients. To improve this level, a DNP practice scholar may undertake quality improvement studies to assess how the structural designs of the ICU setting may be altered to lower VAP rates.

The meso-level serves as the point of interface between the micro- and macro-levels. Zaccagnini and White (2017) assert that this level serves as the point of intersection between elements of direct provision of care and those concerned with the continuum of care. Therefore, factors such the management, providers, and a healthcare facility’s accreditation fall under this level. Given the practice problem highlighted above, a DNP practitioner may improve on this level by developing comprehensive guidelines with which to educate patients and providers on how to reduce instances of hospital-acquired infections, including VAP.

The macro-level is the highest within the hierarchy of a system approach. Nonetheless, it is merely the sum of the other levels combined. Consequently, the totality of a macro-level cannot exceed that of the systems below it. Accordingly, stakeholders need to ensure that the management of all aspects of healthcare is appropriate from the basic level. This outcome would guarantee the integrity of the entire system. For the practice problem, the macro-system refers to federal and state healthcare policies that regulate hospital standards to reduce the prevalence of VAP. A DNP practice scholar may improve on this level by advocating for increased public funding for research on the issue. Such action is consistent with the perspective by Chism (2019). She contends that a DNP scholar should be able to improve the overall framework of healthcare by advocating for progressive policy changes.

All three systems are complementary. This assertion implies that they build into each other. Essentially, the lower level acts as a building block to the higher one. For instance, if a nurse is not available to offer care to a patient (micro-system), then the application of hospital policy on VAP control and management (meso-system) would not be possible. Similarly, in the absence of two, macro-level decisions on aspects like funding from Medicare and Medicaid would be irrelevant.

A systems approach is beneficial for improving patient safety and quality. According to Zaccagnini and White (2017), it achieves this outcome by providing an objective means of evaluating healthcare delivery systems. Consequently, it offers stakeholders an opportunity to assess the weaknesses and strengths of the entire process, a factor that creates a basis for corrective action and improvements where necessary.

References

Chism, L. A. (2019). The doctor of nursing practice: A guidebook for role development and professional issues (4th ed.). Burlington, MA: Jones and Bartlett.

Timsit, J.-F., Esaied, W., Neuville, M., Bouadma, L., & Mourvllier, B. (2017). Update on ventilator-associated pneumonia. F1000Research, 6, 2061. doi:10.12688/f1000research.12222.1

Zaccagnini, M. E. & White, K. W. (2017). The Doctor of Nursing Practice essentials: A new model for advanced practice (3rd ed.). Burlington, MA: Jones & Bartlett Publishers