F. Advancing Clinical Quality and Safety Through Nursing-Led Evidence and Decision-Making: From bedside protocols to systems-level care improvement
An Oral Care Protocol for Non-Ventilated ICU Patients to Address NV-HAP - presented by Dake Wang
This evidence-based practice (EBP) project was conducted to improve oral care within adult non-ventilated ICU patients to reduce the occurrence of non-ventilator hospital-acquired pneumonia (NV-HAP). NV-HAP is associated with lengthened ICU stays, increased morbidity, and hospital costs. Using the Iowa Model of EBP, we developed a nurse-driven oral care protocol and implemented it across three ICUs within a large metropolitan hospital.
Oral care is a modifiable risk factor for HAP caused by aspiration of oral microorganisms. A randomized cluster study suggests that performing oral care twice daily contributed to a reduction in NV-HAP. The combination of an applicable protocol with targeted staff education had positive patient care outcomes evident by a reduction of NV-HAP of 85% on medical units and 56% on surgical units. Although many hospitals have initiatives to address ventilated hospital-acquired pneumonia, many lack similar protocols to address NV-HAP. Therefore, addressing NV-HAP and exploring interventions for reduction would significantly reduce hospital expenses and improve patient outcomes.
First, a pre-survey of attitude, knowledge, and behaviors were assessed amongst ICU nurses to help identify necessary implementation strategies. From this, a standardized, nurse-driven oral care protocol was created. Besides, tailored education with information regarding the protocol, proper oral care mechanics, and information on NV-HAP were distributed to ICU nurses. In addition, tools such as patient education flyers and more efficient suction toothbrushes were supplied to each unit. Project team members led nurses through the implementation by rounding on the ICUs to support questions and reinforce usage the protocol.
Within two months of implementation, we have already observed a 9% increase in oral care frequency amongst non-ventilated ICU patients. Our post implementation survey also suggested a significant increase in ICU nurses’ knowledge, improvement of oral care frequency as well as a favorable attitude towards the newly development oral care protocol.
The Evolving Science of Rural Stroke Care: Nursing Leadership and Evidence Translation - presented by Renee Colsch
Introduction
Rural populations experience disproportionately higher stroke incidence, mortality, and long-term disability despite advances in cerebrovascular science. Persistent disparities are driven by geographic isolation, limited access to specialized stroke services, workforce constraints, and challenges across the continuum of prevention, acute care, and recovery. The American Heart Association's recent scientific statement on targeted nursing interventions for improving stroke care in rural settings represents a significant advancement in the science of rural stroke care by synthesizing emerging evidence and explicitly recognizing the central role of nursing leadership in addressing these inequities.
Purpose
The purpose of this presentation is to describe the current state of the science informing rural stroke care and to examine the contributions of nurses serving on scientific writing committees in shaping evidence-based, implementable recommendations.
Methods
As first author of this scientific statement, evidence was identified through structured literature review, interdisciplinary expert consensus, and iterative synthesis focused on rural stroke prevention, acute recognition and treatment, care transitions, and recovery. Nursing perspectives were integrated throughout the writing process to ensure recommendations reflected clinical realities, population health considerations, and implementation feasibility in resource-limited settings.
Results
The scientific statement highlights nursing-led strategies that improve stroke outcomes in rural environments, including risk factor management, early recognition and triage, coordination of tele-stroke services, transitional care, and patient and caregiver education. Nurse authorship on scientific writing committees strengthened the translation of evidence into actionable guidance by aligning scientific rigor with real-world care delivery, workforce capacity, and health system constraints.
Conclusion
Nurses play a critical role in advancing the science of rural stroke care not only as clinicians, but as knowledge synthesizers and leaders in guideline development. Meaningful nurse representation on scientific writing committees is essential to producing scalable, and sustainable stroke care recommendations that improve outcomes for rural populations and inform nursing education, practice, and policy.
Pressure Injury Prevention in Critical Care: How Nurses Make Decisions - presented by Kristin Honer
Hospital-acquired pressure injuries (HAPI) remain a significant problem in critical care. While previous research has described factors critical care nurses considered when determining HAPI risk, more research is needed on the information and process nurses use to reach a judgment about the patient’s risk of HAPI development. Similarly, more research is needed on how critical care nurses select actions to mitigate the risk (particularly when the patient does not tolerate the intervention), and to what extent a risk assessment tool informs their decisions. Therefore, the purpose of this study was to describe critical care nurses’ decision making related to pressure injury prevention. Methods: A descriptive qualitative design was used, conducting virtual focus groups with nurses working in an adult intensive care unit (ICU). Maximum variation sampling was used to recruit a heterogeneous sample with diverse perspectives based on unit/patient population, years of ICU experience, and sex. Thematic analysis is in progress and will be completed by February 2026. Results: RNs (n=16) from 2 ICUs and the critical care float pool participated in the study. The majority were female and had bachelor’s degrees in nursing; years of ICU experience ranged from 1 to more than 10 years. Preliminary analysis suggests that nurses conduct a holistic assessment, considering risk factors specific to each patient; and incorporate standard interventions common to ICU patients, with additional interventions individualized to the patient’s risk factors. When making decisions for a patient whose clinical instability precludes implementation of some interventions, nurses do as many interventions as possible while continually reassessing clinical priorities. Conclusions: Findings from this study highlight strategies and conditions that enable nurses to make the best possible decisions to prevent pressure injuries in critical care. They also inform future research on strategies to facilitate this decision making in clinical practice to improve patient outcomes.