Empowering ICU Nurses: A Quality Improvement Initiative for Post-ICU Syndrome Education and Prevention

Abstract

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement (QI) project was to enhance ICU nurses' knowledge regarding Post-Intensive Care Syndrome (PICS) and, secondarily, encourage ICU nurses to implement PICS prevention strategies, with a specific focus on ICU liberation practices, ICU diaries, and music therapy. The project aimed to address existing knowledge gaps, perceived barriers, and the intrinsic motivation necessary for ICU nurses to adopt evidence-based practices that reduce PICS risk among ICU patients. Background: PICS is a complication following intensive care, marked by physical, cognitive, and psychological impairments that can persist long after discharge. New physical impairments occur in 25-80% of patients, cognitive disabilities occur in 30-80% of patients, psychological illnesses occur in 8-57% of patients, and 80% of family members suffer from PTSD after ICU discharge. Evidence-based interventions, such as early mobility, sedation reduction, and family engagement, have shown promise in reducing PICS incidence. However, barriers to implementing these practices, including time constraints, resource limitations, and knowledge deficits, are prevalent. Methods: A descriptive quantitative study design was used for this QI project. The project coordinator employed a pre- and post-survey, involving 28 ICU nurses in a surgical ICU within a large academic medical center. Baseline surveys assessed nurses' knowledge of PICS, perceived barriers to implementation, and readiness to adopt PICS prevention strategies. Following an educational intervention that included content on PICS and preventative strategies, a post-survey evaluated changes in knowledge, barriers, and readiness. Data were analyzed via descriptive statistics to determine percentage changes in responses and shifts in confidence and readiness levels. Results: The educational intervention led to notable improvements in knowledge, with increases in correct responses on knowledge-based questions about PICS components and prevention strategies. Confidence and readiness to implement ICU liberation and ICU diaries improved significantly, with a 450% increase in the number of nurses reporting they felt “very confident” in adopting these practices. Perceived barriers, such as time constraints and lack of resources, saw reductions, with a 35.3% decrease in time-related barriers and a 63.6% decrease in perceived resource limitations. Additionally, openness to using music therapy, a new concept introduced during the session, was high, with over half of the nurses expressing strong receptivity. Conclusions: This QI project demonstrated that targeted educational interventions can effectively increase ICU nurses’ knowledge, reduce perceived barriers, and enhance readiness to implement PICS prevention practices. By fostering a proactive and informed approach to patient care, this project supports the integration of evidence-based strategies aimed at reducing the incidence of PICS and improving long-term outcomes for ICU survivors. These findings highlight the value of structured education and institutional support in promoting sustained improvements in critical care settings.