Families in Critical Care
N
eeds of
Patients’
Family Members in an
Intensive Care Unit With
Continuous Visitation
By Mini Jacob, RN, MSN, Cynthia Horton, RN, BS, CRRN, Sharon Rance-Ashley,
RN, BSN, Tera Field, RN, MSN, Robbie Patterson, RN, MSN, Claudette Johnson, RN,
MSN, Holly Saunders, RN, BSN, Tracy Shelton, RN, BSN, Jessica Miller, RN, BSN,
and Carmen Frobos, BS
E BR
Evidence-Based Review on pp 126-127
©2016 American Association of Critical-Care Nurses
doi: http://dx.doi.org/10.4037/ajcc2016258
118
Background Although many critical care experts and
national organizations support open visitation in intensive care units (ICUs), most ICU visiting policies do not
allow unrestricted presence of patients’ family members.
Objective To describe how well the needs of family
members were met in an adult neuroscience ICU with
a continuous visitation policy and an adjoining private
suite for patients’ family members.
Methods An exploratory, descriptive study design was
used to identify the effects of continuous family visitation
in the neuroscience ICU on patients’ family members
and their needs and experiences during their time in
the unit. A convenience sample of consenting family
members completed a survey of family need items 72
hours after the patient was admitted to the unit.
Results The most important needs identified by the 45
family members surveyed were items relating to information about the patient, visiting the patient, being given
hope, talking with a doctor each day, and being assured
that the best care is being given to the patient. Least
important items were related to physical comforts for
the family members. The vast majority of family members rated their needs as being met for all of the items
in the survey and reported a high level of satisfaction
with care.
Conclusion In a neuroscience ICU with an open visitation
policy and a private suite for patients’ family members,
family members rated their needs as being met at a high
level, unlike in prior studies in units with limitations on
family visitation. The rank order of the importance of
each need in the survey was similar to rankings in prior
studies in a variety of critical care units. (American
Journal of Critical Care. 2016;25:118-125)
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F
amily members of critically ill patients experience significant psychological and
physiological stress during their loved one’s stay in an intensive care unit (ICU).1,2
In descriptive research studies3-7 in the 1970s and 1980s, family members of ICU
adult patients consistently identified similar high-priority needs during the time of
the critical illness. Some of the highest ranked needs included the need for information about their loved one, to be geographically close to their loved one, and to know that
their loved one is receiving the best care possible.
In more recent descriptive studies8-14 of family
needs in a variety of different critical care situations,
ranking of needs was similar to the rankings in
the earlier studies. In some of these studies,3,8,9,10,14
researchers also sought to determine how well
family members’ needs were met during the patient’s
stay in the ICU. Several of the most important needs
identified by patients’ family members were not
found to be met at a high level, including needs
for information and presence.
On the basis of the identified needs of patients’
family members for information about their loved
ones and the need for proximity to the loved ones
during their ICU stay, critical care experts and professional organizations have advocated for visitation
policies in critical care units that minimize restrictions on family member visitation.2,3,15-20 Despite
these recommendations, surveys of critical care unit
administrators indicate that most critical care units
continue to have moderately restrictive policies for
family visitation.21-23 Although it is not clear why
such a disparity exists between the recommended
visitation policy and actual practice, one likely reason is the negative attitude that many critical care
nurses have toward “open” or less restrictive visitation policies.22,24-26
Since 2007, the policy for family visitation in
the neuroscience intensive care unit at Emory University Hospital (Atlanta, Georgia) has allowed continuous visitation by patients’ family members. The
continuous visitation policy not only allows family
members to be at their loved one’s bedside 24 hours
a day, but also allows family members to sleep in a
family suite adjacent to the patient’s room. Patients’
rooms can accommodate 4 family members at the
About the Authors
Cynthia Horton, Sharon Rance-Ashley, Tera Field, Robbie
Patterson, Claudette Johnson, Holly Saunders, Tracy Shelton, and Jessica Miller are staff nurses, Carmen Frobos is
a family coordinator, and Mini Jacob is the nurse educator
in the neuroscience intensive care unit, Emory University
Hospital, Atlanta, Georgia.
Corresponding author: Mini Jacob, RN, MSN, Neuro ICU,
Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA
(e-mail: mini.johney.jacob@emoryhealthcare.org).
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Jacob3_16pgs.indd 119
bedside during the day and 2 during the night. Family
suites are equipped with 2 chairs that can convert to
beds, telephone, cable television, wireless Internet
access, a table, chairs, a closet, and a sink. A family
coordinator for the unit is also available to provide
information and logistical support to patients’ family
members. Family members are provided with an
identification card for unit access during the night.
Family members may stay with the patient and
observe any procedures that occur in the patient’s
room, including placement of invasive devices. During
emergency situations, a unit
staff nurse and hospital chaplain stay with the family members to provide support and
minute-to-minute updates on
the patient’s condition. Family
members are also invited to join
the bedside shift report and the
nursing and medical team rounds; they are also
updated on the patient’s status and encouraged to
create goals for the day. In the case of dying patients,
all family members are allowed to be with the patient
at the same time, including underage children.
This level of open visitation is rare. Although
approximately 50% of hospitals report “open visitation,” patients’ family members are not encouraged to stay continuously with adult patients if
they desire.22 Several studies have involved surveys
of nurses about visitation in ICUs with “open”
visitation policies,25,27-30 but no studies have involved
surveys of patients’ family members about their
needs and how well those needs have been met in
ICUs with visitation policies that allow unrestricted
or continuous visitation. Although staff in our neuroscience ICU and national experts2,3,15-20 believe that
a continuous visitation policy should ensure that family members’ needs for information about and presence with their loved one are completely met, to
date, no data have validated that belief or assumption.
The purpose of this study was to determine the
needs of patients’ family members, and how well
those needs were met, in an adult neuroscience ICU
with a policy of continuous visitation for patients’
family members.
Most critical care
units still have
moderately restrictive
visiting policies.
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Materials and Methods
This study was conducted in a 27-bed neuroscience ICU at Emory University Hospital, a 571-bed
academic medical center in Atlanta, Georgia. Study
approval was obtained from the institution’s investigational review board before data collection.
Study Design
An exploratory, descriptive study design was
used to identify the needs and experiences of family
members of patients in a neuroscience ICU with
continuous family visitation. Dependent variables
were the needs and the experiences of patients’
family members.
Sample Selection
A convenience sample of family members was
studied for 2 months. Inclusion criteria were that the
individual was mentally competent and was a family
member, significant other, and/or close friend of a
patient who had been present in the neuroscience
ICU for at least 48 hours during the preceding 3 days.
Family Member Needs Survey
The survey completed by family members was
composed from 3 different sources: the Critical Care
Needs Inventory (CCNI),2,3 the Family Satisfaction
in the ICU (FS-ICU) survey,31-35 and investigator-
developed statements specific to the neuroscience
ICU at the facility. Total time to complete the paper
and pencil survey was less than 15 minutes. Participants were offered assistance in completing the survey, if needed.
1. The original CCNI tool was a 45-item listing
of family members’ needs.2,3 The importance of each
individual need is rated on a 4-level Likert scale
(4 = very important, 3 = important, 2 = not important, 1 = not important at all), as is the family member’s experience with
how well that need was
met during the ICU stay
(1 = met, 2 = partly met,
3 = not met, no
score = do not remember). Space was also
provided for additional
comments or suggestions by the family member
about each need item. The CCNI is a valid and reliable survey tool.30 For this study, the final item
relating to the waiting room was deleted because
the neuroscience ICU does not have a traditional
waiting room.
2. Twenty-four survey items were added to the
CCNI by study investigators to assess family members’
needs related to aspects of care or unit structure
The neuroscience unit
was designed for patients
and their families to feel
comfortable and welcome.
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unique to the neuroscience ICU and/or the continuous visitation policy (eg, access to CaringBridge,
access to wireless Internet, presence of a convertible
bed in the family studio). Ratings for each item were
constructed in the same manner as for the CCNI.
3. FS-ICU survey. The original FS-ICU survey
was a 34-item listing of various aspects or components of patient care in the ICU,31,32 later revised
to a 24-item survey.33-35 Family members rate how
well they perceived care delivery for each aspect
or component on a 5-level Likert scale (1 = excellent, 2 = very good, 3 = good, 4 = fair, 5 = poor).
The FS-ICU is a valid and reliable survey tool.31,33
Twelve items from the 24-item FS-ICU survey were
deleted for this study because of redundancy with
items on the CCNI.
Neuroscience ICU’s Physical Environment and
Visitation Policy
The neuroscience ICU was designed for patients
and their families to feel comfortable and welcome
in the ICU and with a goal to better meet the needs
of patients’ family members to be present with their
loved one. A family waiting room outside the patient
care area consists of a large waiting room, an eating
area, including a refrigerator to store family members’ food, a microwave, an ice machine, a children’s
corner with toys and entertainment, a quiet room,
and several computers for family use. A family
coordinator is also present in this area to greet and
orient family members to the unit and the policies
and procedures and resources available to support
families during their loved one’s stay (eg, CaringBridge, dining resources, social workers, chaplains,
and financial aid services). The large waiting room
has sofas, chairs, a large television, wireless Internet
service (also available throughout the unit), and
laundry and shower facilities for family use.
The patient care area of the neuroscience ICU
has 20 private rooms with 2 central nurses’ stations.
Each patient’s room has an entry area for hospital
staff to use medical computers with the patient
easily visible. Connected to the patient’s room is
the family studio, with a door to ensure privacy
(see Figure). The studio has 2 reclining chairs that
can be converted into beds, a table and 2 chairs, a
lamp, a telephone, a large closet, a sink, a television, and wireless Internet access.
Family members are encouraged to physically
stay in the patient’s room or the family studio 24
hours a day. Up to 4 visitors, 12 years or older, may
visit from 9 am to 9 pm, and 2 family members over
the age of 18 years may stay overnight. Exceptions
to the number and age of visitors are made for
end-of-life situations and individual circumstances.
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Study Procedure
Between 48 and 72 hours after a patient was
admitted to the neuroscience ICU, informed consent
was obtained from 1 eligible family member by a
study investigator not involved in the direct care of
the patient. The consenting family member was given
the Family Member Needs survey to complete in the
family studio during a quiet time. After completing
the survey, family members placed the survey into
a preaddressed, sealed envelope and gave it to the
study investigator. Survey responses were not shared
with unit personnel unless requested to do so by the
family member. The study investigator was available
for the family member while the family member
was completing the survey to answer any questions
and to assist with survey completion if requested.
Data Analysis
Descriptive statistics were used to summarize
responses to the surveys. A rank order listing of
family member needs was based on the mean Likert
score for each item on the survey, with percentages
calculated for how well each family need was met.
Results
A total of 55 family members of patients were
invited to participate in the study, with 4 declining
participation. Of the 51 consenting family members, 45 completed the survey during the 2-month
period of the study. The family members were from
21 to 86 years old (mean [SD], 50.3 [13.8] years).
Most of the participants were women (86%), spouses
of the patient (40%), and either lived with the patient
(62%) or saw the patient frequently (55%) before
admission to the neuroscience ICU (Table 1). In
the 2 days before completing the survey, 71% of the
family members had spent almost all the time in
the neuroscience ICU with the patient.
Mean scores for the ratings of individual needs
and how well those needs were met are summarized
in Table 2 (available online only—www.ajcconline
.org). Family member need items were arranged in
rank order in the table, with the original item order
in the survey tool indicated by the number in
parentheses that precedes each item.
Mean (SD) scores for the 43 needs items on the
CCNI survey (Table 2, online only) ranged from 4.0
(0.0), which was the highest score possible, indicating that the item was very important, to 2.8 (1.1).
The most important needs identified by a family
member on the CCNI survey were items relating to
information about the patient, visiting the patient,
being given hope, talking with a doctor each day,
and being assured that the best care is being provided for the patient. Least important items on the
list of 43 items related to physical comforts for the
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Figure View of a patient’s room and family studio from the
nurses’ alcove.
family members. Mean scores for how well needs
were met during the hospitalization ranged from
1.0 (0.2), where a score of 1 meant that the need
was met and a score of 3 meant that the need was
not met at all, to 2.2 (1.4).
Mean (SD) scores for the 24 needs items specific
to the visiting situation in the neuroscience ICU and
developed by the study investigators (Table 2, online
only) ranged from 3.9 (0.3), where a score of 4 meant
very important, to 2.8 (1.2). The most important
needs identified by family members from these items
related to information about
the patient, being close to or
present with the patient, and
being able to sleep when staying overnight. Least important
items related to physical comforts for the family members
and being included on physician rounds. Mean (SD) scores
on how well needs were met
on the investigator-developed
items ranged from 1.0 (0.2), where a score of 1
meant that the need was met, to 2.0 (1.0), where a
score of 2 meant that the need was partially met.
Mean (SD) scores for the 12 satisfaction items
on the survey (Table 3) ranged from 1.2 (0.5), where
a score of 1.0 meant excellent, to 1.8 (1.1). Highest
satisfaction scores were for the care provided by
nurses and doctors and for courtesy and respect
given to the patient and family. The lowest satisfaction score was for frequency of physician communication with the patient’s family.
Fifteen of the 45 family members provided
specific suggestions for care improvements, and
18 provided other comments on the survey tool
Family members
noted that getting
information about
the patient, visiting,
and being given hope
were most important.
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Table 1
Characteristics of family members of patients
in the neuroscience intensive care unit (N = 45)
No. (%) of
family members
Characteristic
Sex
Male
Female
6 (14)
37 (86)
Relationship to patient
Parent
Spouse
Significant other
Child
Friend
Other
9 (18)
18 (40)
3 (6)
10 (22)
0 (0)
1 (2)
Lived with patient before admission
Yes
No
28 (62)
17 (38)
How often did you see patient before hospitalization?
> Once a week
Once a week
Once a month
Once every 6 months
Once every year
Not even every year
25 (55)
11 (24)
6 (13)
1 (2)
0 (0)
2 (4)
Ethnicity
White
Hispanic
African American
Asian
Other
20 (44)
3 (7)
20 (44)
1 (2)
0 (0)
Educational level completed
Grade school
High school
Community college
College
Graduate school
2 (4)
11 (24)
14 (31)
8 (18)
10 (22)
Time spent with patient last 2 days
Almost all the time
At least 24 hours
At least 12 hours
At least 6 hours
< 6 hours
32 (71)
10 (22)
1 (2)
1 (2)
1 (2)
(summarized in Table 4). Specific compliments
about the care provided by the unit staff far exceeded
the number of negative comments about either the
staff care or the physical environment of the neuroscience ICU.
Discussion
The most important needs identified by family
members on the CCNI survey were items relating to
information about the patient, visiting the patient,
being given hope, talking with a doctor each day,
and being assured that the best care is being provided for the patient. Least important items were
related to physical comforts for themselves. According to responses to how well individual needs were
122
met on the CCNI, the vast majority of family members rated their needs as being met for all of the
items in the survey. According to the survey results,
family members’ satisfaction with care was very high.
Compared with prior studies3-10,12,14 of the needs
of adult family members of ICU patients, family
members’ most and least important needs have
not changed. Prior studies included family members whose loved ones were cared for in a variety
of different types of adult ICUs, including medical,
surgical, neuroscience, mixed medical-surgical,
and coronary care units. The consistency in how
family members ranked their needs, particularly
the most and least important needs, despite the
type of ICU and diagnosis, supports the universal
nature of what is important to patients’ family
members during a critical illness.
Of the 43 CCNI need statements in our survey,
family members had all of their needs met at a very
high level. In prior studies, although some needs
were met at a high level, some needs identified as
very important in the survey were met less than 50%
of the time. In Molter’s original research, family
members identified needs related to talking with a
doctor at least once a day, having knowledge of
chaplain services, needing to have a place to be
alone in the hospital, and needing to have someone
help with financial services. They did not have those
needs met at a high level despite the needs being
ranked highly.3 Maxwell et al8 reported that more
than half of the highest ranked need items were not
on the list of top ranked needs that were met. Items
in that survey that were not well met related to information, comfort, and proximity. Mendonca and Warren9 reported that 4 out of 10 of the highest ranked
needs were not in the top ranked needs that were
met. Needs that were not highly met were related
to needs for information. In Warren’s study,10 items
related to proximity to the patient had lower scores
for being met than other survey items. Prior studies,
though, presented limited objective data on how
well needs were met, summarizing the data in general statements about the highest needs met.3,8‑10,14
In addition, all of these studies but one were conducted before the year 2000, at a time when visitation policies in critical care were very limited (ie,
2 or 3 brief periods for visitation each day).36
Responses by family members about how well
needs were met in our study were almost always
“met,” with few being “partially met” or “not met at
all.” A number of explanations for family members’
needs being met at a high rate in this study could
be advanced, including organizational factors, unit
culture and communication, and other patient or
family satisfaction foci. The high rate of needs being
perceived as “met” could also be due to the liberal
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a
Very good (2)
Good (3)
Fair (4)
1. (75) How well the ICU nurses have cared for your family member.
36
4
2
1
2. (77) How well the doctors have cared for your family member.
34
8
2
1.2 (0.5)
3. (69) The courtesy, respect, and compassion your family member has been
given by the ICU staff.
36
6
3
1.3 (0.6)
4. (74) The teamwork of the ICU staff that takes care of your family member.
36
6
3
5. (70) The courtesy, respect, and compassion you have been given by the ICU staff.
34
8
2
1
1.3 (0.7)
6. (71) How well the ICU staff has assessed and treated your family member’s pain.
36
6
2
1
1.3 (0.7)
7. (72) How well the ICU staff has assessed and treated your family member’s
breathlessness.
27
7
2
1
8
1.4 (0.7)
8. (73) How well the ICU staff has assessed and treated your family member’s
agitation (restlessness).
29
7
4
1
4
1.4 (0.8)
9. (79) How well you were included in decision making about your family
member’s care.
29
7
5
1
6
1.5 (0.8)
10. (76) How often the nurses communicated to you about your family
member’s condition.
32
7
5
1
3
1.5 (0.9)
11. (80) How well you were supported during the decision-making process.
30
6
4
2
12. (78) How often the doctors have communicated to you about your family
member’s condition.
26
8
8
1
Poor (5)
Questions from Family Satisfaction with ICU33-35
Excellent (1)
Not applicable
Table 3
Responses by 45 family members of patients in the neuroscience intensive care unit (ICU) to survey questions on their satisfaction with carea
Score,
mean (SD)
1.2 (0.7)
1.3 (0.6)
1.5 (0.7)
2
1.8 (1.1)
Survey items were from the Family Satisfaction in the ICU33-35 (12 items). Items are arranged in descending order of most important needs and satisfaction
with care, with original survey item number in parentheses before each item.
visiting policy in the unit, because most family members surveyed had been with the patient most of
the time during the 2 days before the survey. Theoretically, a family member’s prolonged physical
presence would most likely have improved communication of information about the patient from care
providers and made them more aware of care that
had been done, both important needs that had not
been well met in prior studies.
The response by family members to the survey
item developed by the investigators about family
members’ being included on physician rounds was
remarkable. The scores on that item were lower
than the scores on many of the other items, and
in particular contrasted with scores on the survey
item that dealt with needing to talk to a physician
once a day. The seeming incongruence of a strong
need to talk to a physician each day but only a
moderate need to be included on physician rounds
may indicate that rounds are not the best way for
family members to have contact with a physician
each day. Future research is needed to clarify the
value to family members of including them on
patient care rounds and/or if their preference is for
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more individualized and direct communication
with the physician.
Clinical Implications
Having an unrestricted visitation policy in an
ICU did not change the family members’ ranking
of the most and least important needs, but their
needs were met more often than had been observed
in prior studies of patients’ family members. Satisfaction levels with care were also very high. Having
a more liberal visiting policy could improve satisfaction levels of family members during the ICU stay.
Study Limitations
This study surveyed only family members or
significant others who had spent a large amount of
time with the patient while in the neuroscience
ICU. We did not survey family members who had
spent limited amounts of time in the neuroscience
ICU, and their needs and views could be different.
Another limitation of the study is that the neuroscience ICU was a newly renovated unit, structured to
accommodate the open visitation policy of the unit.
Results may be different in situations where the
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Table 4
Examples of comments written by family members on the survey tool completed
by 25 family members of patients in the neuroscience intensive care unit (ICU)
Specific accolades for neuroscience ICU staff (30 individual comments)
Keep up the good work!
Great hospital and personnel—don’t change!
The staff is beyond excellent!
Staff is excellent on listening!
You are the best of the best.
All nurses have been very informative.
I can’t express how pleased I am with care here . . . I pray nothing changes!!!
Love the studio and chance of interaction with other families in the waiting room.
The family-centered care model works well for my family and is much appreciated.
Everyone has been great to us. They answer all questions and provided information needed. We are so very pleased with the hospital
and accommodations.
Everything has been wonderful now and for the last 7 years.
Truly impressed thus far of the care my sister has been given by the staff and the amenities available during my stay like shower room,
cafeteria, phones, electrical sockets, etc. . . .
We are impressed with the facility and services, as well as the nurses, doctors, and other staff.
The care and efficiency with which we have been treated has impressed us significantly, and [we] hope that this is a model for all future
visits. It has been so easy to ask questions which . . . were easily answered, and we were made to feel very comfortable.
Complaints related to care by the neuroscience ICU staff (7 individual comments)
Communication poor when family member transferred from another site.
Poor communication between care providers.
A lot of attention paid to neuro assessment but basic nursing care not being done.
People need to explain who they are.
The day-shift staff needs to exhibit more compassion. The night shift is excellent!
Out of town visitors who drove 2 hours were allowed only short visit—allow exceptions to extra visits after 9 pm.
Complaints about physical environment at the hospital (10 individual comments)
Food not good/inadequate.
Bathroom is too far from ICU—should have been allowed to use the toilet in the patient’s room or closer to unit.
Bathrooms are not clean.
Need a chair inside the room.
More seating for family inside the patient’s room.
So many staff sometimes—confusing.
A heater to keep the family room warmer.
Specific suggestions to improve care (7 individual comments)
Need a better parking arrangement for long-term stay.
The only small suggestion is to allow visits from children under 12 years old when accompanied by an adult. Children and music lift the
spirits and head.
More communication by nurses and techs as they come in to provide care without informing patient or family about what was to take place.
physical environment of the ICU is not as conducive to or supportive of family members’ presence.
And finally, another limitation is that this study
was focused only on family members’ needs and
did not address satisfaction of nursing or medical
staff with open visitation.
Conclusions
Results of this survey indicate that patients’ family members rated their needs as being met at a high
level in a neuroscience ICU with an open visitation
policy. Compared with prior studies with limitations
on family visitation, needs were met at a high level
for more surveyed items. The higher level of needs
being met in our study may be due to the
124
unrestricted nature of the visitation policy as well as
the supportive physical environment for family presence in the ICU during prolonged periods.
Although needs were met at a very high level, the
rank order of the importance of each need in the
survey was very similar to the rankings in prior
studies in a variety of nonneuroscience ICUs.
ACKNOWLEDGMENTS
Special thanks to Marianne Chulay, RN, PhD, FAAN, for
assistance with study design and manuscript preparation; to Susan E. Shapiro, RN, PhD, FAAN, for research
review and administrative support; to Pam Cosper, RN,
MSN, NEA-BC, Cindi Reynolds, RN, Lisa Reif, RN, MSN, APRNCCNS, CCRN, and all the nursing staff in the neuroscience
intensive care unit for encouragement and support
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of staff involvement in research; and posthumously
to Becky Provine, RN, MSN, NEA-BC, for encouraging and
supporting bedside nurses to conduct nursing research.
FINANCIAL DISCLOSURES
None reported.
SEE ALSO
For more about family visitation, visit the Critical Care
Nurse Web site, www.ccnonline.org, and read the article
by Bishop, “Family Presence in the Adult Burn Intensive
Care Unit During Dressing Change” (February 2013).
eLetters
Now that you’ve read the article, create or contribute to an
online discussion on this topic. Visit www.ajcconline.org
and click “Submit a response” in either the full-text or PDF
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REFERENCES
1. Tracy M. Planning care for critically ill patients and families.
In: Chulay M, Burns S, eds. AACN Essentials of Critical Care
Nursing. 2nd ed. New York, NY: McGraw Hill Publishing;
2010:17-33.
2. Leske J, Pasquale M. Family needs, interventions, and
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Creating a Healing Environment. 2nd ed. Sudbury, MA:
Jones & Bartlett; 2007:30-64.
3. Molter N. Needs of relatives of critically ill patients: a
descriptive study. Heart Lung. 1979;8:332-339.
4. Daily L. The perceived immediate needs of families with relatives in the intensive care setting. Heart Lung. 1984;23:515-518.
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6. Lynn-McHale D, Bellinger A. Needs satisfaction levels of
family members of critical care patients and accuracy of
nurses’ perception. Heart Lung. 1988;17:447-453.
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J Clin Nurs. 2005;14:501-509.
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16. Family presence: visitation in the adult ICU. Crit Care Nurse.
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/family-visitation-icu-practice-alert.pcms?menu=practice.
Issued November 2011. Accessed December 15, 2015.
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To purchase electronic or print reprints, contact American
Association of Critical-Care Nurses, 101 Columbia, Aliso
Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050
(ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org.
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Chamberlain College of Nursing
NR 439 PICOT Worksheet
PICOT Worksheet – Week 3
PART 1: PICOT QUESTION
Name:
Date:
Your Instructor’s Name:
Purpose: To identify a problem or concern that nursing can change and develop a PICOT question to
guide the change project.
Directions: Use the form below to complete the Week 3 Assignment PICOT Evidence Worksheet. This
includes filling in the table with information about your research question and your PICOT elements and
the second part is filling in the Evidence Worksheet.
Step 1: Select the key PICO terms for searching the evidence. Clearly define your PICOT question. List
each element P (problem, population, or problem), I (intervention), C (Comparison with other
treatment/current practice), and O (Desired outcome), T (Time Frame). Is the potential solution
something for which you (as nurse or student) can find a solution through evidence research? Look in
your book for guidelines to developing your PICOT question and also read the required articles.
Step 2: Identify the problem. What have you noticed in your work or school environment that isn’t
achieving the desired patient or learning outcomes? What needs to change in nursing, what can you
change with the support of evidence in the literature? Describe the problem or practice issue that you
want to research. What is your practice area; clinical, education, or administration? (This is NOT where
you will list your PICOT question)
Step 3: How was the practice issues identified? How did you come to know this was a problem in your
clinical practice? Review the listed concerns and check all that apply.
Step 4: What evidence must be gathered? What sources of reliable information will be helpful for your
particular question?
Step 5: What terms will you use in order to make sure that your search is wide enough to obtain
required information but narrow enough to keep it focused? How will you narrow your search if
needed?
NR439 PICOT Worksheet 4/19/17 jw
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Chamberlain College of Nursing
NR 439 PICOT Worksheet
PICOT Question
What is the PICOT question?
Define each element of the question below:
P- (Patient, population, or problem):
I- (Intervention):
C- (Comparison with other treatment/current practice):
O- (Desired outcome):
T- (Time Frame):
What is the practice issue/problem? What is the scope of the issue? What is the need for change?
What is the practice area?
___ Clinical
___ Administration
___ Education
___ Other
How was the practice issue identified?
(check all that apply)
___ Difference between hospital and community practice
___ Safety/risk management concerns
___ Clinical practice issue is a concern
___ Unsatisfactory patient outcomes
___ Procedure or process is a time waster
___ Wide variations in practice
___ Clinical practice issue has no scientific base
___ Significant financial concerns
___ Other:
What evidence must be gathered? (check all that apply)
___ Literature search
___ Clinical Expertise
___ Guidelines
___ Financial Analysis
___ Expert Opinion
___ Standards (Regulatory, professional, community)
___ Patient Preferences
___ Other
Search terms/How to narrow the search?
NR439 PICOT Worksheet 4/19/17 jw
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Chamberlain College of Nursing
NR439 PICOT Worksheet 4/19/17 jw
NR 439 PICOT Worksheet
3
Purchase answer to see full
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