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Prospectus: Physicians’, Registered Nurses’, and Patients’ Perspectives of Open Visitation in the Critical Care Unit:

Prospectus: Physicians’, Registered Nurses’, and Patients’ Perspectives of Open Visitation in the Critical Care Unit Shannon Marsh, RN, BSN, CCRN MSNC 5311 Dr. Eileen Curl Lamar University

Purpose of the Study:

Purpose of the Study To examine the physicians’, nurses’, and patients’ perspectives of open visitation guidelines in the intensive care unit (ICU) To discover if any of these groups have differences in opinion on the benefits of open visitation To discover if any of these groups show stronger support or resistance to open visitation To allow the members of each group to view the opinions of other members of the healthcare team

Significance of the Study:

Significance of the Study Many ICU’s are changing to open visitation guidelines The Centers for Medicare & Medicaid Services (CMS) now support open visitation policies (Department of Health and Human Services, Centers for Medicare and Medicaid Services, 2011 ) Studies show many benefits of open visitation in the ICU Better psychological recovery & improved satisfaction of patients’ family member Some healthcare workers are still opposed to the idea of open visitation guidelines (Riley , White, Graham, & Alexandrov 2014 ) There is little research on the perspective of patients in the ICU

Significance Continued…:

Significance Continued… This study may… Provide insight to patients’ perspectives on open visitation guidelines Demonstrate what groups need more education on the benefits of open visitation policies Assist in writing hospital policy and educating staff regarding ICU visitation guidelines

Problem Statement:

Problem Statement Many research findings suggest that an open visitation policy in the critical care unit is beneficial to both patients and families, but other research studies demonstrate that some healthcare workers are opposed to open visitation guidelines. There is not enough research on patients’ perspectives of open visitation. More research on the opinions of physicians, nurses, and patients on open visitation guidelines is needed.

Theoretical Framework:

Theoretical Framework Imogene King’s Theory of Goal Attainment: Nursing is process of interaction between the nurse and the client where each perceives the other and the situation as they plan and set goals (“Goal Attainment,” 2016 ). The goal of nursing is the optimal health of individuals and groups and states that humans are constantly interacting with their environment (“Imogene King’s Theory of Goal Attainment,” 2012 ). Perception is a key concept of TGA and is the basis for data collection. If there is a conflict between the nurse’s and client’s perception of care, stress will occur, and optimal client health will not be achieved ( Alligood , 2010).

Literature Review:

Literature Review Chapman et al. (2016 ) Satisfaction of patients’ family members increased after open visitation; nurses’ satisfaction was mixed Athanasiou et al. (2014 ) Nurses felt that open visitation hampered nursing care, but did notice some benefits to the patient Livesay et al . (2005) Nurses felt that open visitation policies had both negative and positive effects on the patients Riley , White, Graham, & Alexandrov (2014) Patients’ family members were in favor of open visitation, physicians were opposed, and nurses were mixed

Definitions of Variables:

Definitions of Variables Theoretical The AACN defines “open visitation” as the, “unrestricted presence and participation of a support person” (AACN Practice Alert, 2016, p. e15 ). Operational The perspectives of physicians, nurses, and patients will be defined operationally by using a survey tool including multiple questions on a Likert scale that pertain to different aspects of open visitation in the critical care unit . This is a newly developed tool.

Research Questions and Research Design:

Research Questions and Research Design Research Questions 1. What are the perspectives of patients, physicians, and nurses on open visitation in the critical care unit ? 2. How do physicians, registered nurses, and patients differ in their perspectives of open visitation in the critical care unit? Research Design Descriptive correlational study and will be considered level IV research

Assumptions & Limitations of the Study; Sample and Sampling Method:

Assumptions & Limitations of the Study; Sample and Sampling Method Assumptions: There are differences in opinion on open visitation policies ( Livesay et al., 2005). Participants will answer the survey questions honestly. Limitations Convenience sampling from one hospital Sample Convenience sample of at least 10 physicians, 10 nurses, 10 patients Quota sampling to obtain 50% day shift/night shift nurses Method Will email the survey to all physicians and ICU nurses Will deliver the survey to all ICU patients by hand

Instruments:

Instruments The “Perspectives of Open Visitation Survey ” 15 question survey with answers on a Likert scale All participants in each category will get the same questions The questions will be derived from topics and themes discovered in the literature review A panel of four nurses with expertise in research will be asked to review the survey before it is administered

Data Analysis:

Data Analysis Research Question Level of Measurement for Each Variable Statistical Method Proposed 1. What are the perspectives of physicians, nurses, and patients on open visitation in the critical care unit? Variable 1: Type of participant (physician, registered nurse, patient) Level of measurement: Nominal Variable 2: Perspective of open visitation Level of measurement: Ordinal (questions measured on a Likert scale) Descriptive Statistics 2. How do physicians, registered nurses, and patients differ in their perspectives of open visitation in the critical care unit? Variable 1: Type of participant (physician, registered nurse, patient) Level of measurement: Nominal Variable 2: Perspective of open visitation Level of measurement: Ordinal (questions measured on a Likert scale) Chi-square ( X 2 ) test ( Polit & Beck, 2012)

References:

References AACN Practice Alert (2016). Family visitation in the adult intensive care unit. Critical Care Nurse (36) 1, p. e15-e19. Alligood , M. R. (2010). Nursing theory: Utilization & Application (4 th ed.). Maryland Heights, MO: Mosby . Athanasiou , A., Papathanassoglou , E. D. E., Patiraki , E., McCarthy, M. S., & Giannakopoulou , M. (2014). Family visitation in greek intensive care units: Nurses’ perspective. American Journal of Critical Care (23) 4, p. 326-333. Chapman, D. K., Collingridge , D. S., Mitchell, L. A., Wright, E. S., Hopkins, R. O., Butler, J. M., & Brown, S. M. (2016). Satisfaction with elimination of all visitation restrictions in a mixed-profile intensive care unit. American Journal of Critical Care (25) 1, p. 46-50. Department of Health and Human Services, Centers for Medicare & Medicaid Services (2011). CMS Manuel System. Retrieved from https:// www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R75SOMA.pdf “ Goal Attainment,” (2016). Nursing Theory . Retrieved from http:// www.nursing-theory.org/theories-and-models/king-theory-of-goal-attainment.php “Imogene King’s Theory of Goal Attainment,” (2012 ). Nursing theories: A companion to nursing theories and models . Retrieved from http:// currentnursing.com/nursing_theory/goal_attainment_theory.html Livesay , S., Gilliam, A., Mokracek , M., Sebastian, S., & Hickey, J. (2005). Nurses’ perceptions of open visiting hours in neuroscience intensive care unit. Journal of Nursing Care Quality (20) 2, p. 182-188 . Polit , D.F., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice, (9 th ed.). Philadelphia: Lippincott Williams & Wilkins. Riley, B. H., White, J., Graham, S., & Alexandrov , A. (2014). Traditional/restrictive vs patient-centered intensive care unit visitation: Perceptions of patients’ family members, physicians, and nurses. American Journal of Critical Care (23) 4, p. 316-324.