[ANSWERED 2023] In the Hospital Hope scenario, what do you think was the most important factor that led to the change in practice in the SICU?

Written By: Dan Palmer, RN

In the Hospital Hope scenario, what do you think was the most important factor that led

A Culture of Patient Safety

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Sammer, C. & James, B. (2011, September 30). Patient safety culture: The nursing unit leader’s roleOJIN: The Online Journal of Issues in Nursing,16(3), Manuscript 3.

In the Hospital Hope scenario, what do you think was the most important factor that led to the change in practice in the SICU?

If you worked in a facility that needed a practice change, what framework would you use and why? my facility is Acute and long-term rehabilitation

In the Hospital Hope scenario, what do you think was the most important factor that led to the change in practice in the SICU?

Expert Answer and Explanation

A Culture of Patient Safety

As patient advocates, nurses must ensure that they develop a culture of patient safety when caring for patients in the hospital. Although there have been many improvements done over the years to ensure that the quality of care improves in the hospital setup, there are still an alarming number of avoidable hospital infections and other aspects that compromises patients’ safety in the hospital.

Through evidence-based care, several frameworks have been created to improve patients’ experience, reduce their hospital stay and generally improve their health. Some frameworks include building a culture of care and incorporating a patient-centered care system. According to Sammer & James(2011), other factors that can effectively improve patients’ outcomes include leadership, teamwork, and a learning environment.

As nurses devote themselves to improved patient care, it is paramount to understand how the factors can affect the wellbeing of patients in their care.

Most Important Factor That Led to Change in Practice in SICU Hospital Hope

In Hospital Hope, nurses were frustrated that most of their patients suffered from hospital-acquired infections and had a high mortality rate (Sammer & James, 2011). Therefore, they vowed to change their practice mode to improve the patients’ experience. The most important factor that led to change in practice is the change of culture.

It was clear that the culture in the hospital was not supportive of patient-centered care, making it necessary for a different framework to be enacted. By identifying that the culture was inappropriate for patient care, the hospital’s leadership was able to ensure that there were positive changes that eventually improved the patients’ outcomes.

As a center of patient excellence the hospital leaders felt that they need to research more on the causes of hospital infections and come up with an issue that would reduce their occurrence. Through good leadership, it was clear that the hospital was able to identify several factors affecting patients’ wellness; therefore, to improve the culture, they must be addressed.

The leaders were not only ready to accept their responsibility in the current situation but were also focused on positively ensuring their followers as they sought to improve the patient’s experience in the hospital (Braithwaite et al. 2017). By developing this culture, it was clear that the nurses enjoyed their leaders’ support throughout the process, evidenced by their ability to talk about their mistakes and work on finding a solution.

The framework of cultural change also incorporates the use of the evidence-based practice. Notably, in contemporary society, medical practitioners are more drawn to evidence-based practice as it involves current tested methods of improved care.

The nurse manager researched evidence-based practice and came across a comprehensive Unit-Based Patient Safety Program (CUSP), which was integral in ensuring patients’ safety in the hospital. Following the framework, the nurse manager became more aware of what needs to be done to reduce hospital infections.

By focusing on cultural change, the hospital encouraged learning in the hospital. It is clear that after the leaders discovered that some of the nurses had experience and were studying what they were currently affecting them, they could be integral to enhancing the needed change in the system. Therefore, they asked them to make reports on the progress, which increasingly showed what was wrong in the system, giving them a chance to improve on their experience.

Moreover, the nursing manager went ahead and challenged some of the nurses to research the current operations of the hospital and how they can be improved, and this offered a wide perspective of care and encouraged learning amongst the nurses. Moreover, it encouraged the nurses’ to participate in decision-making as their opinions were welcome and valid.

It is also clear that the culture adopted focused on fostering teamwork in the nursing team. According to Sammer & James (2011), the nurses were able to support each other by enhancing transparency in the department. They were all encouraged to report their performance even though it appeared that it would report negatively on their work.

Additionally, they increased their cooperation as they communicated effectively and updated each other well during the end of their shifts. As a result, there was no gap in patient care, which improved the patients’ recovery time (Mannion & Davies, 2018).

It is also notable that communication among the nurses greatly improved as the nurses were able to consider the input of both patients and other stakeholders in providing the care needed in the hospital ad encouraging transparency. Through the change of culture, it became possible to improve patients’ outcomes and the quality of work life.

Post a brief introduction of yourself to your colleagues. Include an explanation as to how Walden’s vision, mission, goals, and social change initiative

Practice Change Framework To Use In My Facility

I have been working in an acute and long-term rehabilitation facility, and while the performance has been admirable over the years, I still believe there is much room for improvement. The facility focuses on rehabilitating patients who have suffered from traumatic injuries that have affected their ability to lead a normal life (Santana et al. 2018).

Notably, patients are not only physically stressed but also emotionally vulnerable, especially if they suddenly become dependent on others’ help after leading a life of independence. As a result, some might be stubborn and refuse help, delaying their recovery. By changing the current framework, which focuses on excellence, it will be possible to understand further and support patients, improving the care outcome.

The best framework to incorporate is the patient-centered framework which focuses on working with what the patient need. The framework has several components, which include self-management, improved information and understanding, advancement of prevention and health promotion activities, and shared decision-making (British Columbia Ministry of Health 2015). As stated earlier, most patients in our department feel vulnerable, and by giving them the power to self-manage and make their own decisions, they are likely to be more cooperative, improving their outcomes.

In acute and long-term rehabilitation centers, the patient must take an active role in enhancing their health. While they might be with the nurse for a long time, it is their effort that ensures their quick recovery.

With this in mind, the patient-centered approach will ensure that they understand that they are in control of their body and can improve their situation even though they might feel trapped. Encouraging and noting minute progress will be important as they look forward to achieving better milestones.

Through the patient-centered framework, it will be the responsibility of the nurses to ensure that they offer sufficient health education to the patients. This is especially necessary for ensuring that patient understands their diagnosis and the best treatment options available. As a result, the patients can make informed decisions concerning their care.

Moreover, following the health belief model, they will feel more responsible for their recovery and therefore will work hard on their part and will not do anything that will jeopardize their wellbeing (Gartner et al. 2022). The patient-centered framework will also increase cooperation between the family members and the caregivers.

In acute and long-term recovery plans, it is important to understand that family members will be expected to help the patient in the rehabilitation program (Santana et al. 2018). Additionally, some patients whose independence will have been affected by their illness will have to depend on their family members or caregivers.

This includes understanding why the home needs to be adjusted to ensure patient safety and how to help the patient improve even from the home setting. The patient-centered framework can improve recovery as all parties will know what the patient needs to recuperate. Additionally, they will be willing to work together and support each other, which will greatly reduce the recovery time.


Quality improvement is crucial for patient care, and as patient advocates, nurses must encourage frameworks that improve patients’ safety. As seen from the case study in Hospital Hope, building a culture of patient safety can be enough to revolutionize healthcare delivery in delivery. After envisioning what is needed for high-quality care, good leaders must involve their staff in understanding the best care to ensure quality care.

Through cooperation, good leadership, teamwork, great communication, and continuous learning, it will be possible to ensure that the patient’s needs are met. As seen in the personal setup, it is also crucial to first understand the needs of the patient and the role that the patient needs to play in their recovery.

When working in an acute and long-term care facility, the patients need more autonomy over their decisions as they are highly responsible for care outcomes. Therefore focusing on a patient-centered approach will ensure that the healthcare professionals focus on the needs of the patients hence improving the care outcome and encouraging self-care.


British Columbia Ministry of Health. (2015). The British Columbia Patient-Centred Care Framework.

Braithwaite, J., Herkes, J., Ludlow, K., Testa, L., & Lamprell, G. (2017). Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ open7(11), e017708.

Gartner, J. B., Abasse, K. S., Bergeron, F., Landa, P., Lemaire, C., & Côté, A. (2022). Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review. BMC health services research22(1), 1-24.

Mannion, R., & Davies, H. (2018). Understanding organisational culture for healthcare quality improvement. Bmj363.

Sammer, C., & James, B. (2011). Patient safety culture: The nursing unit leader’s role. OJIN: The Online Journal of Issues in Nursing,16(3), Manuscript 3.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centred care: A conceptual framework. Health Expectations21(2), 429-440.

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What is the function of the SICU?

The Surgical Intensive Care Unit (SICU) plays a critical role in the care and recovery of patients who have undergone surgical procedures, particularly those who require intensive monitoring and management post-surgery. The primary functions of the SICU are as follows:

  1. Intensive Monitoring: The SICU provides 24/7 monitoring of patients, especially those who have undergone complex surgeries or who have medical conditions that necessitate close observation. This includes monitoring vital signs, oxygen levels, and other critical parameters.
  2. Post-Operative Care: Patients in the SICU are typically in the early stages of recovery following surgery. The unit specializes in managing the immediate post-operative needs, ensuring patients are stable, managing pain, and addressing any complications that may arise.
  3. Critical Care: The SICU is equipped to provide critical care for patients who require interventions such as mechanical ventilation, hemodynamic support, and continuous organ system monitoring. This is essential for patients with severe medical conditions or those who have undergone high-risk surgeries.
  4. Pain Management: Managing post-operative pain is a crucial function of the SICU. Nurses and medical professionals work to ensure that patients are as comfortable as possible while maintaining their overall stability.
  5. Early Detection and Intervention: The SICU staff is trained to recognize early signs of complications or deteriorating health. Rapid response to changes in a patient’s condition is vital for positive outcomes.
  6. Nutritional Support: SICU teams ensure that patients receive appropriate nutrition, often through enteral or parenteral nutrition, to aid in the healing process.
  7. Wound Care: Patients with surgical incisions require meticulous wound care to prevent infection and promote healing. This is an important function of the SICU.
  8. Medication Management: Patients in the SICU may require a range of medications to manage pain, prevent infection, and support recovery. Medication administration and monitoring for adverse effects are key tasks.
  9. Multidisciplinary Care: The SICU is staffed by a multidisciplinary team, including intensivists, surgeons, nurses, respiratory therapists, and other specialists. Collaboration is essential to provide comprehensive care.
  10. Family Support: SICUs often provide support and education to the families of patients, helping them understand the patient’s condition, the recovery process, and what to expect.
  11. Transition to Step-Down or General Care: Once patients are stable and have sufficiently recovered, they may be transferred to a step-down unit or a general care floor for further rehabilitation and continued recovery.

The SICU serves as a bridge between the operating room and general patient care areas. It is designed to manage the critical, immediate post-operative period and ensure that patients are stable and on the path to recovery. The highly specialized care provided in the SICU is essential for patients who have undergone complex surgeries or have significant medical conditions that require intensive management.

What type of patients are in SICU?

The Surgical Intensive Care Unit (SICU) primarily cares for patients who have undergone complex surgical procedures or have medical conditions that require intensive monitoring and specialized care. The types of patients typically found in the SICU include:

  1. Post-Operative Patients: These are individuals who have recently undergone major surgical procedures. They may be in the SICU for close monitoring during the initial stages of recovery. This can include various types of surgeries, such as cardiovascular, neurosurgery, orthopedic, transplant, and trauma surgery.
  2. Critically Ill Surgical Patients: Some patients in the SICU may have pre-existing medical conditions that make them critically ill. They might require surgery to address or manage these conditions. Examples include patients with severe infections, acute respiratory distress syndrome (ARDS), or multi-organ failure.
  3. Cardiothoracic Surgery Patients: Patients who have undergone open-heart surgery, such as coronary artery bypass grafting (CABG), valve replacement, or heart transplant, are often admitted to the SICU. These surgeries require intensive post-operative care due to their complexity.
  4. Neurosurgical Patients: Individuals who have had neurosurgical procedures, including brain surgeries, spinal surgeries, or interventions for conditions like traumatic brain injury or brain tumors, may be cared for in the SICU.
  5. Trauma Patients: Patients with severe traumatic injuries, such as those resulting from accidents, falls, or violence, are often admitted to the SICU. Trauma patients may require immediate surgical interventions and intensive post-operative care.
  6. Organ Transplant Recipients: Individuals who have received organ transplants, such as heart, lung, liver, or kidney transplants, require close monitoring to assess organ function and prevent rejection.
  7. Orthopedic Surgery Patients: While many orthopedic surgeries are not typically considered high-risk, complex procedures like spinal surgeries, joint replacements, or fracture repairs may necessitate SICU admission.
  8. Vascular Surgery Patients: Patients who have undergone vascular surgeries, such as aortic aneurysm repair or vascular reconstructions, may require intensive care due to the potential for complications.
  9. Patients with Complications: Sometimes, patients who undergo routine surgeries may experience post-operative complications, such as bleeding, infection, or cardiac issues. These individuals may be transferred to the SICU for specialized care.
  10. Patients Requiring Mechanical Ventilation: Patients who need mechanical ventilation due to respiratory failure or compromised airway function are often managed in the SICU.
  11. Patients with Multi-Organ Dysfunction: Individuals with multiple organ system failures, such as acute kidney injury, liver dysfunction, or respiratory failure, may require specialized care in the SICU.
  12. Critically Ill Burn Patients: Burn patients with severe burns often require intensive care, including wound management, fluid resuscitation, and nutritional support.



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