An exploration of the nature of nursing practice related to the presence of visitors in the critical care setting
The need for and importance of visiting hours for relatives of critically ill patients has been well documented and passionately debated in the nursing literature for many years. Nurses tend to be the primary gatekeepers in the ICU yet little empirical knowledge exists related to the phenomenon of visiting from the perspective of the bedside nurse. ^ A three-phase qualitative research investigation was undertaken with eight critical care nurses identified by managers as being experts at working with families. Data were gathered using participant observation, interviews and document review. Three research questions guided this investigation: (1) How do expert nurses incorporate visitors into their daily practice? (2) What range of strategies do expert nurses actually use, with whom and with what perceived degree of effectiveness? and (3) How did these nurses gain their knowledge about working with visitors? ^ Findings indicated that patients were the nurse's top priority. Families were viewed as extensions of the patient although some became client or partner. Of the posted rules for visitation, the call before coming and two visitors at a time limit were most consistently enforced. All participants defined family widely. ^ These nurses followed a similar pattern when meeting family members. Nurses attempted to balance the needs of the family for access and their own need to safely manage unstable patients. Open communication was essential to preventing and resolving conflicts. When a patient was dying and had a “do not resuscitate” status, visiting rules were consistently suspended. The nurses learned to manage visitors predominately through trial, error and life experience. ^ From a theoretical perspective, the primacy of the patient rather than the family emerged and nurse's work was a central focus. Future research might extend this study to sites with higher acuity and less seasoned staff. Implications for educators include program development to assist nurses in working with families. From a practice perspective, the study identified potentially useful strategies for routine and problematic visitor encounters, highlighted difficulties associated with managing an unstable patient and an anxious family and suggested the role of family caregiver during times of physiologic crisis. ^
Health Sciences, Nursing
Mary E. McGinn Farrell,
"An exploration of the nature of nursing practice related to the presence of visitors in the critical care setting"
Dissertations and Master's Theses (Campus Access).