Open visitation in intensive care units: benefits versus patient harm

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 4

The main issue that we are trying to address with this research proposal is whether or not the time of visiting the patients in the critical care should be increased and whether or not the family of the patients should be allowed to meet their loved ones while they are in the ICU any time that they want. The main aim and objective of this research proposal was to find out from the perspective of a nurse what are the positive and negative effects of making relaxations in the visiting policy of the ICUs in many different hospitals of the world and specifically in New Zealand, America and the United Kingdom. The significance of this research with respect to nurses is that these are the people who are dealing with the patients as well as the family of the patients who want to visit them inside the ICU. The mindset and belief of the nurses about this topic is of importance when it comes to the policy making regarding the visitation of patients in the ICU. As a part of this research proposal, may surveys were carried out to make an analysis of the whole scenario. The standard times for visiting the patients in the critical care of the randomly chosen hospitals were noted along with number of hours that these people were allowed in the critical care areas. The families of the patients were also made a part of the research proposal; however, the main focus of this research proposal was the nurses since these are the people who have to tackle the whole situation.

One of the most important factors that need to be assessed here are the harmful effects that might result from the relaxation visiting hours in the critical care areas. A quantitative approach was used and surveys were conducted separately from the families of the patients as well as the nurses since it was expected that both the groups would have differing opinions on the topic. The purpose of this research proposal was to get together the opinions and beliefs of the two groups of people who are important to the patients in the critical care and then devise a policy that would satisfy both the groups.

Another important part of this research proposal to analyze the data that was collected and to assess the results of the data and then infer from these results whether or not the nurses support the relaxation in the visiting hours of the ICUs. Different medical databases were used to analyze these results by comparing them to the papers that have already been published in different medical journals. The purpose of this analysis was to make sure that before any conclusions are made, a thorough research on this topic is conducted. The statistical analysis of the data that was collected was also made using different software. There were some specific criteria according to which the literature review of the articles that were published in articles was used. The main focus was yet again kept on three groups of people. The patients who are in the critical care, the loved ones of these patients who are in emotional trauma and the nurses who are taking care of these patients. It was made sure that the opinions of the family of the patients and nurses are valued for the betterment and better health of the patients (Caine, 1985).

As in any other research proposal, this research proposal was also hindered by a number of limitations. Firstly the number of hospitals that were randomly chosen was only 6. Since this number is very small, the results of this research proposal could not depict a generalized opinion of the nurses and the family members of the patients. Moreover, the surveys were conducted while the family members were there in the hospital and waiting to see their loved ones. Under such circumstances, they would obviously want that the number of hours for which they can visit their family members in the ICU should be increased. It would be better to interview these people when they are not going through any kind of emotional distress.

In the end I would like to mention that the data collected during the compilation of this research proposal is consistent with my hypothesis that if the policy of visiting the patients in the ICU is changed, the families of the patients, the patients themselves as well as the nurses are likely to benefit from this in the long run (Henneman, 1989).