Hemodynamic monitoring: a comparison of research and practice

Abstract

Measurement of hemodynamic parameters is a common practice and is well researched, but little information is available on the translation of the research into actual practice. To determine (1) the current practice of hemodynamic measurement in relation to positioning of patients and (2) the barriers to use of research related to hemodynamic monitoring. A stratified, random, national sample of 1000 members of the American Association of Critical-Care Nurses was surveyed by mail about hemodynamic monitoring procedures related to the positioning of patients and beds, technique used to determine the position of the bed, number of measurements of cardiac output, use of iced versus room-temperature injectate, use of printed or digital information, nurses' input into written procedures, and barriers to research utilization. In actual practice, 24.1% of the respondents always keep the bed flat when measuring pulmonary artery pressures, 55.0% elevate the head of the bed 30 degrees or less, 80.7% always have patients supine for measurements, and 13.3% place patients in lateral or other positions. Unit policy dictated the flat position in 25.8% of the sample; nurse managers (41.4%), staff nurses (27.5%), and staff committees (31.2%) were involved in writing the procedure. Respondents viewed research related to hemodynamic monitoring procedures as relevant and valuable. The greatest barriers to utilization were lack of staff support for implementation, insufficient time to implement research findings, and feelings among nurses that they lacked authority to implement change. Research findings are generally being implemented at the bedside, although not completely or consistently. Minimizing the barriers to use of research is within the scope of nurses' practice.