Hi everyone. My name is Valerie and I live in Michigan. I graduated with my ADN in 2010, and have worked mostly critical care since then. I currently work in a 33-bed combined CVICU/SICU/Trauma ICU in a teaching hospital. This class is one of 3 classes that I need to complete before finishing my BSN! I am in the “home stretch”, and am excited to learn more about research and start clinical later this semester with a preceptor in my leadership class. Since my future goal is to become a CRNA, I think this class will be helpful. Since most CRNA programs are changing over to a DNP, more emphasis will be placed on research in those programs.
Research plays an important role in my bedside practice, and helps improve patient care. I sit on our ICU unit-based practice council. Part of our job as a group is to determine what is “best practice” using evidence-based research. By doing this, we have implemented several new treatment protocols alongside the physician staff, including a new policy regarding earlier tube-feeding of ventilated patients to cut down on pressure ulcer problems. We are currently investigating whether we should implement a 24/7 visiting hour policy for the ICU patients. Currently we have a locked unit with established visiting times. While the literature suggests that it is better for the patient to have a family member present 24/7, we have run into problems with violent, aggressive family members who cause security issues that could potentially put the staff and other patients in harms way.
I am looking forward to working with everyone this semester.
Welcome, Valerie! Love the picture; my daughter rides a horse named Mako and we love all things horses in our house!
24/7 visitation is definitely supported in the literature, but often becomes troublesome for the reasons you mentioned. In our unit, we also found it difficult to have extended time to provide needed patient cares like the in-depth assessment of the critical patient, bathing, mobility, etc. In addition, the patients with increased ICP precautions needed decreased stimulation.
My question is, does it have to be 24/7 or limited? Why is there not another creative option? Maybe your unit could come up with a new strategy where patient/staff safety isn’t compromised and patients have the support systems available when needed on an unlimited basis. Use the literature to help create your answer!
Hello Professor Gabel,
I have read about the AACN’s Synergy Model being in favor of a support person for the patient at all times (something I came across while studying for the CCRN). I am going to look into the literature to see if I can find further studies. Right now the unit has visiting hours from 11am-8pm, with two visitors at a time. Obviously we make exceptions for withdrawal of care or other situations such as trauma patients that get admitted in the middle of the night. Outside of visiting hours, letting families in is at the discretion of the nurse. We are very reasonable people, but as you pointed out, many sedated and ventilated patients need decreased stimulation, and the patient cares and assessments provided in the ICU can be lengthy and frequent!
I am planning on suggesting a concept of giving one family member unlimited access, and possibly providing a wrist band for that person. We will just have to figure out how they can get in and out of the locked unit outside of normal visiting hours. I am hoping to find the literature to support this instead of a “free-for-all” type of visitation policy.
This is a great start! You could potentially use this as your research poster in this course, and then your capstone project in 449 and 450.
I love that you are part of a team that looks for ways to improve care using evidence-based research. Working in a fairly small facility myself I often feel like I’m out on my own looking for ways to improve. It also provides you with a wonderful opportunity to do additional research.
I admire your ambition to continue on for your CRNA. That is both exciting and challenging. I look forward to learning from you and your experiences as they are far different from my own.
Thank you Tammy! I am both excited and a little bit terrified about continuing down the path to CRNA school. Our ICU governance committee is relatively new. We never had one in the past, but our new manager came with lots of ideas and thus the committee was formed. Prior to this, we were doing a lot of things because “this is the way we have always done them.” It’s nice to have a committee that focuses on improvement. I look forward to working with you in class!