Open Visitation in the ICU

Open Visitation in the ICU

Privileges to visit the Intensive Care Unit (ICU) have been a controversial topic since a long time. It is a simple issue between rules and emotions. When a loved one is fighting between life and death, all family and friends wish to visit that person. They want to be there to show support and love for the one who is suffering. There are many different arguments that arise with this issue. Different people like the patients, the nurses, their family the doctor and the hospital care staff have varying perspectives. Even with so many different perspectives, this topic has not attained much attention. Therefore, the main problem over here is whether open visiting hours in the intensive care unit (ICU) are beneficial or harmful to the patient? The mainstream of this study is basically derived from New Zealand, United Kingdom, and America. (Clifford, 2006) During the time when a person is admitted into the ICU, the emotions of the family are very extreme. The entire system of the house is messed up and along with the patient suffering; the family is also suffering as well. Guilliano (2004) has stated that the family is an integrated system. Thus it is clearly stated that the family would want to meet the one who is admitted in the ICU.

The problem arises due to the stress that occurs due to increased amount of patients. A big number of visitors have shown to reduce and even negatively affect ideal patient care. (Bunker, 2006) Apart from the array of germs and infections that visitors bring, their presence can hamper the healing process as well. Patients who are in the CCU or ICU would have a weak immune system thus they are more susceptible to infections that any family or friend could bring along. Also, the patient himself is already stressed out and in pain and seeing their loved ones suffer because of them can be a psychological trauma. Due to this debate, it needs to be figured out whether open visitation is beneficial or harmful for the patient.

The research approach and design being planned is basically a quantitative method through the means of a survey. Surveys are deemed the appropriate way for many researches because they easily represent the opinions of a certain population. This quantitative approach will quite rightly gather the opinions from both the nurses and the family. Therefore, it becomes easier to reach a conclusion as to whether open visitation is beneficial to the patient or not.

This four-week research project will basically focus on the nurses in the ICU and the families of the ICU patients. This approach is a good choice since it will cover both the nurses and the families of the patients. As discussed before, the major issues arise between the differences of what the nurses want and what the families want. Gathering information from both the nurses and the family members will thus cover both the viewpoints in this research. The ICU nurses are busy and quite overwhelmed with all their duties at hand. Similarly, the families who have a loved one suffering may not be in a right emotional state at the time. Thus, observing their behavior or interviewing them extensively is one possible approach. Also, questioning them with the proper questions and surveying them seems a rather appropriate approach in this research project.

The purpose of this proposal is to emphasize on how this problem is very crucial and common in the critical care settings today. To go into simpler divisions of the problem, visitation privileges have basically been divided into either open or visiting. The restrictive settings basically allow the hospitals to only allow a certain number of people to visit at one time or another. However, the Open visiting allows the family to come and check on the distressed patients whenever they want regardless of the time (Bunker, 2006). Seeing how there are only two general categories under which visiting falls, many times hospital staff allow bending of the rules for the restricting visiting practices. A major reason this occurs is due to sympathy that the nursing staff feels towards the family or friends of the patient who is in the ICU.

As it is known people in the ICU are going to be exposed to various germs. Thus, the lack of agreement between different hospitals has lead do confusion. The different visiting practices and disagreement is present in most places because the nurses seem to alter the rules with every family. For instance, even if there is the rule of strict visitation, nurses might change the rules for a certain family. Thus, a major purpose of this research is to declare and explore whether open visitation is beneficial or harmful. With a statement or research conclusion available, the rules might be made uniform in more hospitals. Therefore, when the opinions of both sides are clearly known, this can eventually lead to a more uniform protocol in all ICU and CCU settings.

Currently, in most of the hospitals, the visiting timings are 11: am to 12 noon, 2 pm till 4 pm, 7 to 8 pm and no limitations on how many visitors come to visit the patient. (Biley, 2007) it is seen that when the patient is in the ICU, he is under a lot of stress. This means the patient is worried not only about himself, but what his family is going through and any financial crisis because of the illness. This could give the patient an increased level of fear and anxiety. Thus Biley (2007) believes that if the patient could have any interference that decreases any of these anxiety or pressures, then it will, therefore, help the patient in the long run.

It should be seen that a major aspect of nursing is that they have to deal with the family of the patient. The doctor or the surgeon would do their examining and then go away but the nurses have to deal with this and they are all the ultimate deciders. My approach to this problem is that open visitation is beneficial and actually helpful to the patients. This research will go on to see the benefits of open visitation and how it affects the prognosis of the patients in the intensive care units. The major goal is to prove that open visitation is actually a best system for the patient in the ICU. (Bunker, 2006)

The sample that has been chosen for this research is quite diverse and constitutes of persons of different ethnic, educational and economic levels. This is crucial when it comes to the sort of methodology that this research will depend on. Since the basic purpose of the research is to distinguish the opinions of two different sub-sets: the nurses and the family members. It is important for this population to not be included towards a certain stereotype. It is presumed that in a population when all the items are covered and no element of chance is remaining that is when the highest level of accuracy is obtained. (Kothari, 2009) Even though there is no set way of determining the element of bias in a sample, the sampling technique for this research is quite diverse. This will, therefore, render our methods more accurate and will provide a fair conclusion.

The target audiences for this study are the critical care nurses. As of now, the majority of the critical care nurses are not in favor of the open visitation. Many nurses feel that open visitation in the ICU is more of interference. They feel that the flow of care is hindered and that the patients are put at more risk. Apart from that, the rest of the times the individuals are also shortened. As it is mentioned before, that the results or conclusion of this study will go on to educate and inform the nurses whether open visitation is harmful or beneficial to the patients.The participants in this study will be the unit nurses and the families of the ICU/CCU patients. The ages of the participations are from 18 to 80-year-old adults. This creates quite a diverse group for a research and thus it would provide a significant input for the analysis.

The number of participants might vary since this is a four-week project. Furthermore, the group consists of both male and female nurses and family members. These participants can surely differ depending on their assignment or the relationship to the patient. Surely, the individuals will be told of what the study is about and how their data would be used. Leedy and Ormrod (2010) really stress on the need for participantsto be aware of the study before hand. The participant group is of different ethnic groups and different educational and economic groups as well. This sort of participant group is recommended because it covers different races.

Hypothesis statement

My research basically promotes that it is beneficial to have open and unrestrictive family visitation. Thus, the hypothesis here is that if the visitation is made open, the patient, the nurses and the family will benefit in the long run.

Task 2

The basic problem in this research is to figure out whether open visitation will benefit or harm the patients in the ICU. The study being carried out is to determine what the nurses and the family of the ICU patients have to say about this issue. This topic is very controversial because the rules and regulations are not the same in all hospitals. Even if there are strict rules established, many nurses go on to bend the rules on their own liking or convenience. This, therefore, leaves a lot of ambiguity for the medical world including the nurses and the family of the patient. With more insight as to what the two populations think, this matter can be looked into for further exploration.

The research design will basically consist of quantitative approach towards the ICU nurses and the family of the patients. Both the groups will be questioned regarding their opinions and the results will be inferred statistically from there. Since this research is basically looking for the opinion and point-of-view of a certain population, quantitative approach is the best choice.

Quantitative approach is chosen because the opinions of the two masses would differ and that is what we really want to find out. We want to investigate this question while keeping nurses and the family of the patients in mind. This sort of approach can be easily carried out through surveys like interviews, questionnaires and observation of the participants. The role and bias of the researcher is that open visitation in the ICU will be beneficial to the patient. Therefore, the researcher is looking to develop the results of this study into further research. The interesting thing here is that all the nurses and all the family members do not have the same opinion on this matter. Therefore, such a study is being carried out to find out the general opinion.

The sampling techniques that were chosen were such that the any person who is an adult of 18 years to 80 years can take part in the study. The participant either has to be a nurse or an attending family or friend of the patient admitted in the ICU. The participants are of diverse educational, economical and ethnic background. This decreases the bias in the research and thus hopes to make the results more accurate. The target audiences for this research are the critical care nurses. A uniform opinion and an explanation on this matter might help them to reach a consensus on how the ICU patient'svisitation should be managed.

The basic data collection method will be through survey of the nurses and the family of the patients. Surveying can include many different routes such as observing the two groups, interviewing them, or having them fill out a questionnaire. Seeing how this is a 4-week project, it is possible to observe and survey the nurses and the family of the patient.Many patients that are in the CCU are not there for a long period of time. Therefore, the researcher can observe and take notes on the behavioral indications that both the groups give. The former method might not give much information as the presence of the researcher might cause the persons to perform differently. Therefore, interviewees with pre-conceived questions area also a way of data collection. This sort of method would rather rely on how well the interviewer carries out his or her tasks with the participants. Lastly, the method of data collection is questionnaires. These questionnaires are used because in these the respondent and the researcher never really come in contact. The questionnaire has to be prepared very carefully and then given to the nurses and the family of the patient.

This whole research is basically trying to gather the opinions and thoughts of two different populations. As mentioned earlier, the data collections were to be observational studies, interviews and questionnaires. For observing the two groups, the research would first require to have the two groups distinctly outlined. After the group focus has been created, and then the observation checklists would be required. Characteristics that show content or disapproval of visiting practices should be incorporated in the checklists.

For the interviews, pre-set questions need to be made. This would require the researcher to thoroughly study the two opposing viewpoints in detail. Only then would the answers really be able to depict what the opinion of the nurse or the family members are. The same goes for the questionnaires as well. The questionnaires might as well be the most important data collection till out of all three. As mentioned before, these are filled out by the participants when they are not under the influence of the researchers. This allows them to fill it easily and independently thus giving more accurate findings.

The data collected will more or less depict either one of the two opinions. As it was stated earlier, the questions should be regarding the subject that hand. Thus, with the answers to the interview questions or the questionnaire, it will be able to conclude whether the certain nurse or the family member is in favor of open visitation or not. Many times, in interviews especially, the interviewers may go on to ask reasons for the opinions as well. Thus apart from opinions or sides, the research will present the different sides of the story. It will tell what the majority of the population of attendants of patients and nurses think about visiting practices.

Subsequent to the data being collected, it will be analyzed. For analyzing the data, the researcher needs to establish different categories and apply these categories to raw data that they collected. The application of the categories is also done through tables and statistical inferences. Thus with the tables and graphs made, the researchers can quickly analyze whether their results support the hypothesis or not.

Task 3: Research Strategy and Data Analysis

Open visitation in the ICU is a very crucial topic and needs a great deal of research and attention before any definite conclusion is drawn pertaining to the safety of the patients in the ICU (Bourman, 1985). While devising this proposal, the first priority was to make sure that the maximum number of research paper were studied and the results were critically analyzed before carrying out the research for this particular proposal.

The main design of this research proposal was the use of a descriptive correlational method. Participants for this research were chosen randomly from 6 hospitals in New York and the results were the studied. The number of participants for this study was 226. The participants were the staff nurses of the ICUs of the randomly selected hospitals. Anonymous questionnaires were used to collect the data. These questionnaires had 4 parts. Two scales were used to analyze the beliefs and mindsets of the burses. Another scale was used to assess the attitude of the nurses' towards visits of the families of the patients who have been admitted in the ICU. The fourth part of this questionnaire was a demographic data collection sheet that consisted of five open ended questions pertaining to the current ICU visiting policy. A statistical analysis was also performed once the data was collected by making use of the SPSS version 17.0.

A number of trusted and reliable databases were used to retrieve the research articles that were relevant to this topic. Among these databases were OneFile, Info Trac, Medline, CINAHL and ProQuest. The main reason for the collection of this data and thorough research was that it was important for us to study the factors that may facilitate or impede the visiting practices that are prevalent in the ICUs. The search terms that were used using the aforementioned databases were physiological, care, critical, life, family, intensive, needs, visit, restriction and open. The search terms were used both as individual words as well as in combination with one another so as to retrieve the maximum number of research papers on this topic. The combinations were also used with Boolean operators. Most of the information was sought from America and Canada so as to explore the visitation in the ICUs in these regions as the context is likely to be similar for these two places rather than the United Kingdom or any other European country. A total of 36 articles were used to compare the data that was collected by us and the data that was given as part of the literature review in these papers to make an analysis of the results. These articles discussed in details the pros and cons of allowing open visitation in the ICUs pertaining to the frequent visits by family members of the patients and small children from the perspective of nurses.

The literature that was used to make an analysis of the data that was collected as a part of this research proposal and that has already been collected by other researchers. All the articles that were made a part of the research were in English and dated from 1875 and onwards. All of these articles were related to the critical care patients, critical care nurses, family members of the patients who are in the critical care, interaction of the patients in the critical care with the nurses and their families and the preference of the patients for visiting them while they are in the critical care.

The rationale of this analysis was to find out if the results of this research were in consistence with the findings of the other researchers. The analysis was of significance since any conclusion that would be made on the basis of the results obtained using the methodology that has been explained above would have a direct impact on the health of the patients who are admitted in the ICU.

According to the results of this research, the main conclusion was that the nurses do believe that the family of the patients in the ICU should be given relaxation pertaining to visitation (Hammond, 1995). The nurses do understand that when a loved one is admitted in the ICU, it is a very critical time for the family. They believe that the relaxation of visitation might also have a positive impact on the health of the patient as they have the moral support when their family is around. The nurses were also of the view that when they have to interact with the attendants of the patients regarding the health and progress of the patients, they often do not feel confident and qualified enough to explain to the attendants how their relative or friend is doing. However, the nurses were also concerned about the harmful effects that leniency in visitation could cause. The most important negative effect is the introduction of pathogens that the family and other visitors are likely to bring in every time they come in from outside. Moreover, when some of the relatives are over emotional in front of the patient, it gets them thinking that their condition is miserable and they might not ever get out of the hospital.