| Learning Objective #1: Discuss issues related to the presence of visitors and nursing practice in one critical care unit | |||
| Learning Objective #2: Explore approaches found effective by nurses working with visitors in one critical care unit |
Objective - To explore the nature of nursing practice with visitors in the critical care setting from the perspective of individuals identified as expert at working with families.
Design, Methods - A qualitative investigation utilizing participant observation, formal and informal interviews, and review of selected documents was conducted.
Sample, Setting - The study occurred in the intensive care unit of a community hospital in New England. Eight staff nurses identified by administrators as experts in managing families participated.
Research Questions - How do expert nurses incorporate visitors into their daily practice? What range of strategies do expert nurses actually use, with whom and with what perceived degree of effectiveness? How did these nurses gain their knowledge about working with visitors?
Findings, Conclusions - Patients were the nurses' top priority. None planned for visitors. All were aware of the usual visiting patterns for their shift and defined family widely. Families were viewed as extensions of the patient but sometimes became client or partner. Of the posted visitation rules, the call before coming and two visitor limit were most consistently enforced.
Nurses attempted to balance the family's need for access and their own need to safely manage unstable patients. Open communication was essential. Visiting rules were consistently suspended for dying patients with "do not resuscitate" status. The nurses learned to manage visitors predominately through trial, error and life experience.
Implications - The primacy of the patient rather than the family emerged and nurse’s work was a central focus. Future research might extend to sites with higher acuity and less seasoned staff. Potentially useful strategies for routine and problematic visitor encounters were identified and the role of family caregiver during times of physiologic crisis was suggested. Programs to assist nurses in working with families might be developed.
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