ICU Nurses Beliefs and Values Towards an Innovative ICU Risk Assessment Application



Foley, Jane, “ICU Nurses Beliefs and Values Towards an Innovative ICU Risk Assessment Application,” Scholar@Simmons, accessed January 16, 2021,


ICU Nurses Beliefs and Values Towards an Innovative ICU Risk Assessment Application


Foley, Jane




The aim of this study was to explore the Intensive Care Unit (ICU) Resource Nurses’ beliefs and values regarding an innovative on-line risk assessment tool, ICU Intensity Index (I3), at Beth Israel Deaconess Medical Center (BIDMC). The I3 is an IT application that predicts the risk of a patient harm occurring in the ICU. With the support from the Gordon and Betty Moore Foundation the I3 application was developed in collaboration with ICU leaders at BIDMC and system engineers. A retrospective analysis of environmental factors, such as patient admission, transfers, and discharges within the ICU; staff factors, including level of nursing experience, and patient factors such as the Sequential Organ Failure Assessment Score (SOFA) and nursing intensity as measures of patient acuity, were used to understand the impact they collectively have on actual patient harms. Assessing the intensity of the ICU environment, and how it relates to the likelihood of patient harm as a way to describe risk state of the unit, is a fundamentally different approach that has potential to improve patient safety. The successful adoption and implementation of the I3 application has the potential to change how ICU nurses and physicians assess intensity and subsequent risk in the ICU. Additionally, this application has the potential to change how ICU workflow and resources are deployed. (Stevens, 2017) The ICU Resource Nurses are key stakeholders in the ICU environment and their beliefs and values towards an innovative risk assessment tool will inform the development of the implementation and dissemination plan for the I3.

Method: Two semi structured focus group interviews were conducted with the ICU Resources Nurses. Twelve of the seventeen ICU resource nurses participated. Using open ended questions, the focus groups were designed to answer the research question “what are the ICU resource nurses’ beliefs and attitudes towards using an electronic tool to assess overall risk in the ICU environment”. The participants were given the opportunity to reflect and respond on how the functionality of the I3 application would influence their decisions in the allocation of nursing resources; the impact the tool would have on nursing workflow; and how could the tool inform strategies to mitigate the risk of patient harm. A Qualitative Analysis of the focus group transcripts was conducted.

Results: The main thematic finding was the nurses’ descriptions of skepticism. This was reflected by expressed lack of trust in the accuracy of the tool’s ability to in capture the full range of factors that represented risk to a patient, as well as in statements of concern that the tool would result in loss of control/autonomy in staffing decisions currently made by the Resource Nurses. Additionally, there were concerns expressed related to the changing landscape of critical care and general initiative overload. Qualitative data may not be widely generalizable, but this study suggested a lack of readiness by frontline ICU Resource Nurses at BIDMC to adopt the use of an innovative risk assessment tool; and a preference to rely on their clinical experience and nursing intuition for decision making. Findings from this study may be of importance in the future planning and design of innovation and quality improvement initiatives in an ICU at an academic medical center.

Keywords: innovative technology, nurses’ intuition, ICU environment, implementing change


Simmons College (Boston, Mass.)


1 PDF (74 Pages)




Doctoral Dissertations