Nursing

 

Nursing

1. Develop a written proposal by doing the following:
2. Identify a problem or issue related to practice, policy, population, or education that aligns with the organizational priorities you seek to solve.

I hope to address the limitations of visiting hours for patients in the Intensive Care Unit.

1. Explain the problem or issue, including why it applies to the area of practice you chose and the healthcare environment.

Admission to the Intensive Care Unit is a critical situation for both the patients and their relatives. There exists a feeling of being in an unfamiliar environment, fear and overwhelming helplessness, and an additional lack of awareness resulting in the crisis among the patients and their relatives. Therefore, it is highly important to pay attention to the specific needs and requirements of these patients, and the responsiveness of the medical personnel is one of the important elements in fostering quality care. Visiting the patients comes as a positive way to help both the patients and their families cope with the stress and offer numerous benefits to the patients’ recovery. Therefore, it places significance and best interests of the patients to adopt the best visitation policy.

As an ICU registered nurse at our local hospital, the current visiting policy’s restriction is wanting. The policy offers limited visitation hours that limit the patient’s families and friends to participate in providing quality care for the patient. Often, the ICU provides a setup where we face life-threatening decisions, and urgency in decision making is key. Often, the ICU medical personnel makes critical decisions for the patients in the place of their family members. Sometimes, this practice happens since the designated family members cannot be reached. From my experience as a Registered Nurse (RN) working in the ICU, family presence at the bedside reassures the patients, offers them comfort, reduces their levels of perceived stress and anxiety, and offers good planning of quality that increases patient’s care. When relatives are restricted visitation, they do not get to take part in their relative’s well-being. They may lack the information on their patients’ clinical status as the medical staff are also limited to offer information during this time.

Additionally, the major problem of restricted visitation is a large number of visitors within a limited time. The visiting time is currently limited to 8-9 am/pm, and there are no family members allowed to stay overnight. However, visiting is allowed in extreme circumstances such as withdrawal of care or looming death. During patients’ surveys, most feedbacks have been negative based on the limited visiting hours, and the patients and their families feel as if the hospital is not accommodating.

2. Discuss your investigation of the problem or issue.

I have previously interviewed with some of my patient’s families during my involvement with them. Five out of six families identified that they felt that the hospital’s visitation policy was too restrictive. Additionally, they also brought up complaints that they felt left out in their patients’ critical decision-making process. According to some recent research, the increase in relaxed visitation policies can increase quality care, resulting in improved patient outcomes. According to Jacob 2016, patients in an ICU setup with more open visitation care have responded afterward that it created a conducive environment to their recovery instead of restrictive visitations where they feel isolated. Besides relatives in a unit that used open visitation, they felt their needs were well catered for instead of restrictive policies. I have also interacted with my fellow nurses and other medical personnel’s in the unit, who have also established that they had legitimate concerns with the visitation policy. The concerns included, high prevalence of stress among the patients and privacy concerns as family members were present during shift change after prolonging their stays.

I have had the opportunity to interact with other hospitals with an ICU similar to ours but with more open visitation policies. Families were also accepted to remain at the bedside of their relatives at particular exceptions, leading to increased care to the patients. The families also felt like they were incorporated in the patient’s care and were generally more satisfied.

1. Include evidence to substantiate the problem or issue.

The evidence of this issue is stated in the patient’s experience. The patients have reported their stay being stress due to the limitation of familiar people that they know and the feeling of isolation and being alone during one of the most critical moments in their life. Families have also reported that the policy is less accommodative during the surveys conducted after patients’ discharge, particularly rating this service the lowest.

3. Analyze the state of the situation using current data.

According to the American Journal of Critical Care, there is a growing body of evidence supporting open and patient-centered visitation guidelines. Their researchers have identified that even minimal limitation of restricted visitation policies in Intensive Care units leads to improved family satisfaction and positive perception among the nurses. There have also been numerous studies that have shown that open visitations also led to patients’ satisfaction without representing a safety risk. Contrary, the studies have suggested that patients do well medical when their families are free to visit them and accompany them in intensive care units.

1. a) Analyze areas that might be contributing to the problem or issue.

The major contributing factor to this problem is the nurses themselves. Most of the nurses in our unit have worked in the hospital for over twenty years. These colleagues come with old habits and have been stubborn to reset the old policies. This policy was also last updated in the last ten years, and there have been no changes afterward. Most importantly, the restrictive policy was a norm for most policies in the past. Still, when the medical professionals realized that open visitation in healthcare helps aid in the patients’ quality care, most of the hospitals have adapted to introduce open visitations in their medical facilities; however, this has not been the case for our hospital. Some nurses fear that open visitation policies will impede their ability to provide care and maintain better infection control. There is also concern that this policy will result from uncontrolled chaos and disturbance and reduce the continuity and consistency of healthcare provisions from the medical staff. However, even though I have witnessed relatives not following orders during visitations hours, I have also seen confused, agitated, and frightened patients respond well after interaction with their relatives or having a bedside interaction.

4. Propose a solution or innovation for the problem or issue.
5. Justify your proposed solution or innovation based on the results of your investigation and analysis

After I completed interviews with my colleagues, incorporating the charge nurses and the unit manager and head of the Intensive Care Operations, most responded positively to my proposal. I propose that in an ideal world, patients should receive optimal care, and nurses of use evidence based practice must ensure maximization of care provided to patients that will produce positive outcomes. Therefore, I propose incorporating open visitation in our facility that will realize the improvement of acre among patients and improve family and patient satisfaction and foster the development of positive nurses’ perceptions. The open policy visitation has proved to increase to facilitate increment in patients’ care among a wide range of literature. To facilitate effective change of the policy without major drawbacks, I also suggest that the staff be involved in making and implementing the desired policy change, which will ensure less resistance to the change.

5. Recommend resources to implement your proposed solution or innovation.
   1. Include a cost-benefit analysis of your proposed solution or innovation.

There are minimal costs that are associated with the implementation of the open visitation policy.  Among the major factors critical in implementing this policy include modification of the hospital facilities and establishment of a private structure for each of the independent units, training of medical staff and personnel, and increasing the number of consultation staff. Privacy is one of the most critical virtues in a hospital setup, and healthcare operatives should always seek to enforce patient’s privacy. When ensuring that patients have a conducive time with their families is necessary to ensure that ate structures support this policy. For instance, it would be inappropriate for a visitor to spend the night in the same bed with the patient or in an uncomfortable environment, requiring modification of the unit structures.

Additionally, given that the family will need a conclusive clinical report about their patient’s well-being, and sometimes waste the time of the medical personnel with repetitive questions, it will be crucial to ensure a consultant’s presence to provide information of the patient’s conditions where necessary. The increase in the number of consultants and staff members will increase the families’ level of satisfaction and eliminate unnecessary traffic.

Necessary training on the staff will be required to improve their perception of the open visitation policy and equip them with the relevant knowledge and skills needed to foster a conducive environment for the policy’s proper implementation and sustainability. Staff will need to be notified of these changes through emails, in-service education, and printouts of the new policy. At the same time, the unit managers and the in-charge nurses will have the duty to explain this new policy’s expectations. There will also be a need to develop visiting cards that offer instruction and guidelines to the patients on their conduct during the visitations and making them aware of the policy. Printed posters can also be used to vacillate explanation and awareness of the open visitation policy.

6. Include a timeline for implementation based on your proposal.

The implementation of this proposal will take a time frame of nine months. The project planning of this policy will begin in February 2021. Surveys and interviews will be conducted to analyze the need and urgency of incorporating an open visitation policy among the hospital’s medical staff, clients, and patients. This interviewing will be wrapped up at the end of the month. Results and findings of these interviews will be conducted within a timeframe of two months and reviewed not later than April 30^th. This proposal will then be presented to the facility administration and stakeholders on May 1^st. There will be a two-week period that will involve modifying the proposal based on the recommendations and reviews aired during the proposal presentation. After approval of this proposal, there will be a stipulated time frame of two months to modify the units’ structures. In August, there will be a gazetted notice for the application of consultants and nursing staff. The interviewing will take place in mid-august and the process of employing more workers completed at the end of the month. During September, there will be a training of both the new workers and current staff and awareness of implantation of the policy into the facility to patients and other clients which will take one month. This process will run concurrently with printing out the cards and posters for awareness of the policy. October 1^st will be the official date for the launching of the open visitation policy into the hospital.

7. Identify key stakeholders and/or appropriate partners that are important for implementing your solution or innovation.
   1. Discuss why each key stakeholder and /or appropriate partner is important for implementing the solution or innovation.

The nurses and the medical personnel in charge of the operations in the intensive care unit are the most important stakeholders. They should be considered during the implementation of this policy for obvious general reasons. Nurses engage in the frontline in providing basic care for patients. Therefore, lack of incorporation of their ideas during this implementation may result from resistance from this workforce leading to a negative environment for patients’ healthcare provision. For obvious reasons, it is imperative to include the staff nurses in the implementation of the policy. These nurses are at the front line of the policy change and will deal with it daily. They must be well versed with the policy for it to work and, most importantly, to effectively enforce it.

The in-charge nurses must be fully involved since they are the ones who will deal with any issues that may arise from the policy change. For instance, family members may have challenges coming to terms with the policy within the first few days and may require numerous directions, guidelines, and work. Additionally, the unit manager in the various units has the final say if the policy will work in the designed units or not. The risk management team and the Chief Nursing Officer (CNO) are also critical since they need to determine the legalities and risks that may need to be addressed before implementing the policy. Risk management and the CNO will need to be involved in writing the policy and determining any legalities that need to be addressed before official implementation.

Other major stakeholders involve the financial investors in the facility. During the implementation, there is a need to source funds to modify the structures, training, and other resource requiring activities. It may, therefore, not be easy to get the necessary funds if the investors disagree with this policy. They should thus be incorporated in this policy preparation to ensure the smooth running of the policy implementation.

1. Summarize your engagement with the key stakeholders and/or appropriate partners, including the input and feedback you received.

During the preparation of this proposal, I spoke to the nurses and other medical support in the facility, which supported my idea. The nurses had some valid concerns that helped to make this proposal solid. Most of them agreed that there was a need to adapt to change and implement the open visitation policy since it was beneficial to the patients and their families, leading to the hospital’s overall benefits. They admitted that the restricted policy creates overcrowding in the rooms due to the limited time and increased stress and anxiety among patients. However, they also agreed that the privacy of patients and the risk of infections would have to be addressed if the open visitation policy was implemented. It was important to note that they had the final say in deciding whether the policy should be implemented since they are the main stakeholders.

I also spoke to the patient’s families, who liked this proposal and maintained that they would back up and adhere to the guidelines and regulations. When speaking to the families, since they all appreciated the proposal, the major concern was how they should conform to the new rules so that the policy would be well enforced.

Lastly, I also spoke to the financial investors during a meeting between the staff and the other stakeholders. Most of them backed the proposal and maintained that so long as the proposal maximized the optimal care of the patients, it was a suitable proposal. Additionally, since they also factor in the features of expenses and the profitability of the hospital. I explained that implementing this proposal would increase the satisfaction among patients that will result in more patients, and building a good reputation for the facility.

1. Discuss how you intend to work with those key stakeholders and/or appropriate partners to achieve success.

The nurses and the ICU unit managers are the primary stakeholders in achieving the success of this proposal. Ultimately, the unit manager is the most important stakeholder to realize its success. They have to decide whether this proposal will be effective for their individuals’ units. I will present my research information and data findings that I have collected during a face-to-face meeting with the unit manager. I will discuss both the benefits and possible drawbacks of the proposal since it is evident that the benefits surpass the disadvantages. After her approval, I will then proceed to the other stakeholders. The unit nurses are the ones who will be most affected by the policy change of this proposal. Their input, support, and feedback are therefore critical in realizing success. They must be well versed since they require to be apt and ready to tackle any challenges that may arise after implementation. I will meet the nurses and my proposal’s advantages and address their concerns and any arising issues. I will also consider any feedback given to me by the unit nurses during the policy formulation.

I will also include the risk management team and the CNO since they are crucial in approving the facility’s policy change. It is necessary to recognize the risks of this proposal and if they manageable for it to thrive. The other nursing staff will be mandated to attend meetings during this proposal’s development that will provide plenty of time to air their opinions and concerns. I will also address the financial investors who will come in handy in funding this proposal. During the meetings, the unit manager will be chaired, who will meet with the unit staff, the risk management team, and the financial investors. In this meeting, the research information will be shared, analyzed, and discussed, and then the desired policy change will be presented.

8. Discuss how your proposed solution or innovation could be implemented
   1. Discuss how the implementation could be evaluated for success.

In the evaluation of the success of this proposal’s implementation, questionnaires will be administered to both the patients and their families. For instance, the facility already administers discharge surveys that seek to analyze the quality of service provided to the patients. This questionnaire will be modified to include the satisfaction of the open visitation policy. The experience with this policy will then be assessed through the surveys. Apart from these, patients and families will continuously be rounded on hospitalization to evaluate the policy change’s performance and the areas they feel require improvement. The unit staff members will air their views during the weekly staff meetings.

1. Explain how you fulfilled the following roles during your process of investigation and proposal development:
   1. Scientist

I fulfilled the scientist’s role through involvement in data and research evaluation to get the relevant knowledge for this proposal. I also engaged in conducting interviews and surveys, which involved getting my data. Lastly, I used this data to evaluate the issue and get conclusive findings to solve the problem.

1. Detective

I conducted an investigation on our facility’s investigation problem, identified the need for change, and analyzed other optimum and feasible solutions to this problem.

1. Manager of the healing environment

I managed to develop a policy that will lead to better patient results and quality care in their recovery process. The new open visitation policy will foster a conducive environment that offers better healing for the patients.