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WGU C493 Leadership and Professional Image PORTFOLIO Task 1.
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WGU C493 Leadership and Professional Image PORTFOLIO Task 1.
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WGU C493 Leadership and Professional Image PORTFOLIO Task 1.A. Develop a written proposal by doing the following:
1. Identify a problem or issue related to practice, policy, population, or education
that aligns with the organizational priorities you seek to solve.
The problem I hope to solve is limited visiting hours in the Intensive Care Unit.
a. Explain the problem or issue, including why it is applicable to the area of
practice you chose and the healthcare environment.
I am an ICU registered nurse at a local hospital in Tucson, AZ. On my unit there is
currently a policy of limited visiting hours. This limits the patient’s family’s and other visitors
the ability to participate in care. Often in the ICU setting, we are faced with making life
prolonging decisions. Too many times ICU staff end up making the patient’s decision in the lieu
of the family. This happens sometimes because we cannot reach designated family members.
Medical providers are put in the position to make life prolonging decisions instead of family
members can result in patient’s wishes not being honored. From my personal experience as an
ICU RN family at bedside may reassure patients, provides comfort, reduces anxiety and provides
good planning of patient care. When families are not permitted to visit, they feel as though they
are not participating in care, or well informed. At present, visiting is limited to 8-10am/pm, no
family members are to stay overnight in the patient’s room, and visiting is allowed during
extenuating circumstances, such as withdraw of care, or imminent death. On patient satisfaction
surveys, responses have been negative regarding the limited visiting hours. Patients and families
have stated they feel the unit is not accommodating.
2. Discuss your investigation of the problem or issue.
a. Include evidence to substantiate the problem or issue.
I have interviewed several of my patient’s families during my involvement with their
care. Two out of the three families I have interviewed stated they felt as though the visitation
policy was too restrictive. They went on to say they felt as though they were not involved in
decision making. Some recent studies have found that relaxed visitation polices can improve
patient outcomes (Chapman, D. K. 2016). In a study cited in the American Journal of Critical
Care, states that family members of patients in a unit with open visitation felt their needs were
met to a high standard vs previous studies of units with restrictive visitation (Jacob, M. 2016).
Our hospital has a sister hospital located across town. The sister hospital has a similar
ICU with an open visitation policy. I have had the opportunity to work on that unit. One or two-
family members or visitors can remain at bedside with few exceptions. Families of patients feel
they are participating in patient care and generally are more satisfied.
I reviewed our unit visitation policy to determine what parts of the policy may need to be
modified. The American Association of Critical-Care Nurses believes that family at bedside is
greatly beneficial to patient outcomes. I spoke with several ICU nurses in my unit. They had
legitimate concerns with an open visitation policy. Several concerns brought up include; families
hindering patient care, additional stress caused to patients, privacy concerns due to family
members being present during shift change.
, 3. Analyze the state of the situation using current data.
a. Analyze areas that might be contributing to the problem or issue.
Nurses. Some nurses have worked in my unit for over 20 + years. With
veteran nurses come old habits. It is widely known that nurses are stubborn
creatures. We develop habits and are set in our ways. This restrictive policy was
last updated over 10 years ago. Some nurses on my unit feel as though
unrestrictive family visits impede their ability to provide critical care. I have
witnessed this first hand. Overbearing family members overstimulating an
intubated patient, or a family member placing three blankets on a febrile patient
after numerous directions not too. I have seen it all. On the opposite end of the
spectrum, I have seen a confused, agitated, and frightened patient respond well to
having family at bedside providing frequent redirection.
4. Propose a solution or innovation for the problem or issue.
a. Justify your proposed solution or innovation based on the results of your
investigation and analysis.
After completing interviews with my fellow nurses, charge nurses, and unit
manager my recommendation is to allow open visitation for the ICU. All staff
responded positively to my proposal. Open visitation policy has shown to increase
patient, nurse, and family satisfaction by improving participation in care (Kozub,
E, 2017). To facilitate this change, I suggest involving staff in the desired policy
change. If staff are involved in the policy change, they may be less resistant to
change.
5. Recommend resources to implement your proposed solution or innovation.
a. Include a cost-benefit analysis of your proposed solution or innovation.
There is no direct increase in cost associated with open visiting hours. Extra costs
that may be incurred by the unit could be in the form of extra training for staff or
printed posters explaining the open visiting policy. Increased patient/family
satisfaction could produce higher reimbursement rates for the hospital. Unit policy
will require modification to change the limited visitation policy to an open visitation
policy. Staff will need to be notified of the change in the form of emails, in-service
education, and print outs of new policy. The unit manager, charge nurses, and staff
nurses will have the expectations of the new policy explained.
6. Include a time-line for implementation based on your proposal.
Project planning will begin January 2018. Surveys and interviews will be
conducted and wrapped up no later than February 28th. Results of interviews and
surveys will be analyzed and reviewed no later than April 15th. The proposed policy
will be presented to facility administration in the form of a draft by May 1st. If
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