Posted: February 24th, 2022

The DNP Project: PICOT Question, Purpose And Evidence-Based Intervention

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The DNP Project: PICOT Question, Purpose And Evidence-Based Intervention

Practice Question
The following practice question will serve as the basis for the proposed DNP project “For caregivers of children, on an acute pediatric medical-surgical unit at a tertiary Children’s Hospital, does the implementation of ‘Commit to Sit’ integrative nurse rounding, compared with current practice, improve caregiver satisfaction, over 8-10 weeks?”

Purpose

The purpose of the proposed DNP project is to improve the caregiver satisfaction scores in an acute pediatric medical-surgical unit at a tertiary Children’s Hospital by implementing ‘Commit to Sit’ integrative nurse rounding which supports patient and family engagement by sitting during the interaction, at eye level, and maintaining eye contact. Nurses will be empowered and supported to include the ‘Commit to Sit’ integrative nurse rounding intervention to daily rounds to improve satisfaction. The project’s primary aim is to answer the PICOT question about whether the inclusion of ‘Commit to Sit’ integrative nurse rounding can impact patient satisfaction on an acute medical-surgical unit in 8-10 weeks.

The primary aim will be supported by the following objectives: (a) educate the acute medical-surgical unit nursing staff at a tertiary Children’s Hospital about ‘Commit to Sit’ integrative nurse rounding through a PowerPoint presentation to reinforce and support the outcomes of the project, (b) measure the compliance of the nurses’ incorporation of commit to sit integrative nurse rounding as it was intended which will be verified by the DNP student’s audit and observation, (c) assess the nurses’ adherence to the commit to sit nurse rounding which will be recorded by the DNP student through observation spot checks, rounding, and chart audits, (d) identify barriers and comfort level of nurses in using commit to sit nurse rounding, which will be queried and recorded by the student during scheduled daily huddles, staff meetings, and 1:1 interviews.

Evidence-Based Intervention
In the early 2000’s the Centers for Medicare and Medicaid Services (CMS) Value-Based Purchasing Program established by the Affordable Care Act, shifted compensation from volume of services to the overall quality of care provided (Centers for Medicare, and Medicaid Services [CMS], 2018; Mazurenko et al., 2017). As part of this change, person and community engagement or consumer satisfaction constituents a large component for reimbursement, and innovative strategies were developed to improve satisfaction.

The intervention to improve patient satisfaction of the hospitalized patient is the daily inclusion of ‘Commit to Sit’ to daily nurse rounding (CTS-R) (Pattison et al., 2017). This evidence-based intervention consists of the nurse performing daily rounds in a sitting position, using eye contact at an appropriate eye level during each interaction (Pattison et al., 2017). The intervention focuses on therapeutic communication, enhancing attentiveness, and improved perceptions of care without increasing the actual time spent at the bedside (Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017). This intervention has been supported and associated with The Beryl Institute Experience Framework as it aligns with the person-centeredness theme for patient experience (Silvera et al., 2017). The ‘Commit to Sit’ integrative rounding has been nationally recognized as a best practice that focuses on delivering patient and caregiver-centric communication to improve satisfaction (Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017).

As a best practice recognized by The Beryl Institute, CTS-R fosters a harmonious dialogue between the nurse, patient, and caregiver that supports a trusting, safe, and caring environment (Lidgett, 2016; Silvera et al., 2017). Placing control in the patient and caregiver’s hands, the nurse prompts the CTS-R with the question, “Do you mind if I sit and talk with you?” (Lidgett, 2016). Having the nurse in a sitting position at eye level, maintaining eye contact, evokes mutual interest and builds a rapport that has been seen to improve the experience and overall satisfaction of both the caregiver and patient without increasing time spent at the bedside and no additional costs (Lidgett, 2016; Merel et al., 2016; Orloski et al., 2019; Pattison et al., 2017).

The DNP student as a project manager has identified a Project Team of CTS-R champions who have agreed to Help in the implementation of this change project. The CTS-R Project Team consists of medical-surgical registered nurses from both day and night shifts.

References

Centers for Medicare & Medicaid Services. (2018). Hospital consumer assessment of healthcare providers and systems (HCAHPS) Survey. Retrieved November 4, 2021, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS (Links to an external site.)

Lidgett, C. D. (2016). Improving the patient experience through a commit to sit service excellence initiative. Patient Experience Journal, 3(2), 67-72. https://doi.org/10.35680/2372-0247.1148 (Links to an external site.)

Mazurenko, O., Collum, T., Ferdinand, A., & Menachemi, N. (2017). Predictors of hospital patient satisfaction as measured by HCAHPS: A systematic review. Journal of Healthcare Management, 62(4), 272-283. https://doi.org/10.1097/JHM-D-15-00050 (Links to an external site.)

Merel, S. E., McKinney, C. M., Ufkes, P., Kwan, A. C., & White, A. A. (2016). Sitting at patients’ bedsides may improve patients’ perceptions of physician communication skills. Journal of Hospital Medicine, 11(12), 865-868. https://doi.org/10.1002/jhm.2634 (Links to an external site.)

(Links to an external site.)Orloski, C. J., Tabakin, E. R., Shofer, F. S., Myers, J. S., & Mills, A. M. (2019). Grab a seat! Nudging providers to sit improves the patient experience in the emergency department. Journal of Patient Experience, 6(2), 110-116. https://doi.org/10.1177/2374373518778862 (Links to an external site.)

Pattison, K. H., Heyman, A., Barlow, J., & Barrow, K. (2017). Patient perceptions of sitting versus standing for nurse leader rounding. Journal of Nursing Care Quality, 32(1), 1-5. https://doi.org/10.1097/NCQ.0000000000000214 (Links to an external site.)

Silvera, G. A., Haun MPH, C. N., & Wolf PhD, J. A. (2017). Patient experience: The field and future. Patient Experience Journal, 4(1), 7-22. https://pxjournal.org/journal/vol4/iss1/3

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