You are leading a work group charge with revising the ICU

visitation. The majority of staff skeptical.

What are some objections you

might encounter and how you would

address them?

Group Members:•Nur Syafiqah bt Kamaruzaman

•Aniza bt Saim

•Ku Nur Faezah binti ku zainal

•Nur Shahida Johari

•Siti rosidah binti Idris

•Irwina mustika bt Md Mustapha

Revising ICU Visitation??

Hennesy, D. (2005) says that:“The family is an integral part of healing process of the critically ill patient and critical care nursing interventions must also focus on family. Family-centered care is the concept of treating the patient and family as an inseparable entity, recognizing that illness and injury of one family members invariably affects all the other family members.”

When a patient is critically ill, the family members are often in crises, dealing with the lots of emotions associated with the threat of a serious illness and trying to make sense of a foreign and sometimes frightening intensive care unit (ICU) environment.

Objections that might arise towards the visitation changes:

Interruption of nursing care delivery.

Affects the function of unit by creating chaotic events.

Increase risk of infection

Increase stress among healthcare members and family

Interrupt patient’s rest

Berti, D., Ferdinande, P., Moons, P. (2007) said that:

The majority of the ICU nurses believed that open visiting policies interfered with the nursing care process, namely by hampering adequate nursing care planning, by interfering with direct nursing care, by making the nurses spend more time in providing information to the family, and by being of no help to support caregivers.

Interruption of nursing care delivery.

Affects the function of unit by creating chaotic events.

Kirchhoff et al (1993) says that “Open visiting policies were believed by some nurses to contribute to increased chaos and noise in the unit and leave the nurses less time to take care of patients.”

Livesay, S (2005) says that:

The conservative attitudes toward the number of persons visiting a patient may be attributed to environmental and practical aspects, such as limited space in the patient’s room, guaranteeing the privacy of other patients, limiting the noise on the unit, the number of patients per nurse, and other various factors.

Brown, A. (1976) stated that “Family members were an added risk because of the possibility of infecting patients, of interrupting rest and of causing physiological changes such as tachycardia, arrhythmia, hypertension, anxiety, etc.”

Increase risk of infection

Berwick, D. (2004) mentioned that “Open visitation will expose the vulnerable patient to an increase risk of infection.”

Kirchhoff, K. T., (1993) studied that almost half of the nurses they surveyed still believed that harmful physiological harm would occur to their patients when visitors were at the bedside.

Berwick, D., Kotagal, M. (2004) claimed that “Reasons nurses cited for opposition to liberal visitation included the presumed increase psychological stress for the patients, family interference with the provision of care, and physical and mental exhaustion of family and friends.”

Increase stress among healthcare members and family

How to overcome the skeptical staff regarding the visitation issues?

Briefly explain to the staff on the importance and the benefits of family presence.

Encourage and educate staff to participate family members to achieve optimal patient care synergy model.

Briefly explain to the staff on the importance and the benefits of family presence.

Benefits of family presence are:

• Removed doubt about the patient condition • Witness that everything possible was done• Decrease their anxiety and fear about what was

happening to their loved one.• Sense of closure and grieving should death occurAmerican association of Critical- Care Nurses. Family presence:

Visitation in the adult ICU.(2010)

Halm, M. (2005) mentioned in his research that:

“Allowing family members to observe invasive procedures and resuscitation efforts promote increase knowledge of the patient’s condition. In additional observation allow the family to witness that everything was done, reduce fear and anxiety, and promotes adaptation.”

Moseley, M. J., Jones, A.(1991) says that “Flexible visiting allows for family members to plan more convenient visits and provides family members time to take care of themselves and renew their energy.”

When a loved one is critically ill, the family members are often in crisis, dealing with the roller coaster of emotions associated with the threat of a serious illness and trying to make sense of a foreign and sometimes frightening intensive care unit (ICU) environment.

Hickey, M. (1988) says that,

Stillwell. (1984) has mentioned in his article that “Family members permitted to see their loved ones frequently might be an effective coping mechanism at a time when fears over threatening changes in family roles and responsibilities are a major concern.”

Gonzalez, C. et al. (2004) says that “Visitors provide information that helps nurses to better understand the patient’s personality and coping style.”

Encourage staff to participate family members to achieve optimal patient care synergy model.

“Visitation fostered a link between the patient and the outside environment. It also facilitated cognitive processing of concerns related to the patient's health, provided physical assistance or verbal encouragement, and fostered positive relationships between visitors and patients.”

Simpson T. (1992) highlighted that:

Moseley, M., Jones, A. (1991) stated that “Although family members ask questions and seek information, they also provide the patient with emotional support and may actually facilitate communication between patient and staff.”

Tughan L. (1992) found that family members can provide sensory organization and stabilization to the sensory-overloaded, sleep-deprived patient since they provide familiar voices and touch to help patient in recovery process.

Clowry, M. (1992) stated that:

“Less restrictive, open and flexible policies would facilitate the reduction of stress and frustration felt by patients and families and serve to improve relationships and information sharing with the caregivers.”

ConclusionAs the conclusion, nurses should change their lame beliefs on the change of the visitation policies. They should think holistically especially towards things that might beneficial to their patient’s improvement. In additional, changes in nurses perception towards the stated matter in significant as nurses is the primary domain in ensuring patients will deliver the optimum patient care synergy model.

Livesay, S., Gilliam, A., Mokracek, M., Sebastian, S., (2005) successful adoption and implementation of open visiting policies depends on nurses’ beliefs and attitudes about and satisfaction with visitation and visiting policies, it is important to explore nurses’ views on visitation.

Reference List

Brown A. (1976). Effect of family visits on the blood pressure and heart rate of patients in the coronary care unit. Heart Lung; 5: 291–296.

Berwick DM, Kotagal BA (2004) Restricted visiting hours in ICUs. Time to change. 292:736–737

Clowry, M. (1992). Family functioning during a critical illness: A systems theory perspective. Critical Nursing Clinics of North America, 4. 559

Gonzalez, C., (2004) Visiting preferences of patients in the intensive care unit and in a complex care medical unit. Am J Crit Care 13:194–198

Halm, M. Family presence during resuscitation: A critical Review of the literature. American Journal of Critical Care(2005); 14 (6): 494-512

Hennessy D. Outcomes of elderly survivirs of intensive care: a review of literature. Chest. (2005);127(5): 1764-1774

Hickey, M. (1988) Critical Care nurses’ role with families: a descriptive study. Heart Lung 17:670–676

Livesay, S. (2005) Nurses’ perceptions of open visiting hours in neuroscience intensive care unit. J Nurs Care Qual 20:182–189

Simpson, T. Visitors' verbal behavior with coronary care unit patients. West J Nurs Res. 1992;14:482-497.

Stillwell, S. (1994) Importance of visitation needs as perceived by family members of patients in the intensive care unit. Heart Lung 13:238–242

Titler, M.G. (1995). Impact of adult critical care hospitalization: Perceptions of patients, spouses, children,and nurses.Heart & Lung,20 (2), 174–182.

Tughan L. (1992). Visiting in the PICU: a study of the perceptions of patients, parents, and staff members. Critical Care Nursing Quaterly; 15: 57–68.

Kirchhoff, K.T., Hansen CB, Evans P, Fullmer N. (1985). Open visiting in the ICU: a debate. Dimensions of Critical Care Nursing; 4:296–306.

THANK YOU

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FLOOR?