Mika Kimura, a registered nurse working in the neurosurgical intensive care unit (NSICU), observes that many of the patients under her care need to be transferred from their beds to wheelchairs. However, most of these patients have very lile motor control and are unable to assist the nurses with transfers. As a result, she observes more absences among her coworkers aributable to back injuries. Mika realizes there is a need for change and is curious about how other similar units address this issue. She asks her coworkers who have worked in other units if they have seen a solution to this problem. No one reports a satisfactory solution. Mika turns to the evidence from the published literature to determine if anyone has conducted a study to address this problem. The question she develops is, “In intensive care units, specifically neurosurgical ICUs, is there a method of transferring patients that does not cause injury to the nurse?” She starts her search in the PubMed database and types in the key words “neurosurgical icu,” “patient transfers,” and “nurses.” This yields a few hits but nothing very useful. Thus she decides to broaden her search to include any ICU, and this time spells out “intensive care unit” and tries the key word of “lift*.” By using an asterisk, Mika retrieves articles that use the word lift or lifts or lifting or lifted. She omits the word “nurse” because she can still use the information if the article refers to other healthcare employees. She finds a few articles that she wants to examine in more depth, so she links to the full text of those articles and prints them. Later that evening, when it is quieter on the unit, she reads the articles. Mika learns that many hospitals have developed “no lift” policies and have also purchased moveable lift devices. One article discusses the cost-effectiveness of using a lift versus dealing with staff absences aributable to back injuries and workers’ compensation claims. Mika then determines how many employees in her unit in the past year have missed work because of injuries caused by transfers. Armed with this information, she approaches the unit manager to request that the hospital purchase a lift that can be rolled from room to room. Based on the evidence that she provided to prove her point—both from the literature and from hospital injury reports—Mika’s request is approved and a lift is purchased. Not only has she won the thanks of her coworkers but also she has saved the hospital substantial money in lost time from occupational injuries.
Case Analysis Questions
1. Mika exemplifies the idea of nurses as consumers of evidence. Consider the steps in a systematic approach outlined early in this concept presentation. In what way is this consistent with what Mika did?
2. The last step in a systematic approach is evaluating outcomes. How should it be determined if the acquisition of a lift has made a difference?