identify a problem or concern that nursing can change and develop a PICOT question

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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.

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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) AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 Jacob3_16pgs.indd 118  www.ajcconline.org 2/11/16 11:00 AM 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). www.ajcconline.org 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. AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 119 2/11/16 11:00 AM 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. 120 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. AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 Jacob3_16pgs.indd 120  www.ajcconline.org 2/11/16 11:00 AM 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 www.ajcconline.org Jacob3_16pgs.indd 121 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. AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 121 2/11/16 11:00 AM 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 AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 Jacob3_16pgs.indd 122  www.ajcconline.org 2/11/16 11:00 AM 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 www.ajcconline.org Jacob3_16pgs.indd 123 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 AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 123 2/11/16 11:00 AM 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 AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 Jacob3_16pgs.indd 124  www.ajcconline.org 2/11/16 11:00 AM 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 view of the article. 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 presence. In Molter N, ed. AACN Protocols for Practice: 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. 5. Leske J. Needs of relatives of critically ill patients: a follow-up. Heart Lung. 1986;7:49-57. 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. 7. Stillwell S. Importance of visitation needs as perceived by family members of patients in the intensive care unit. Heart Lung. 1984;13:238-242. 8. Maxwell K, Stuenkel D, Saylor C. Needs of family members of critically ill patients: a comparison of nurse and family perceptions. Heart Lung. 2007;36:367-376. 9. Mendonca D, Warren N. Perceived and unmet needs of critical care family members. Crit Care Nurs Q. 1998; 21:58-67. 10. Warren N. Perceived needs of family members in the critical care waiting room. Crit Care Q. 1993;16:56-63. 11. Verhaeghe S, Defloor T, Zuuren F, Duijnstee M, Grypdonck. The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature. J Clin Nurs. 2005;14:501-509. 12. Kleinpell R, Powers M. Needs of family members of intensive care patients. Appl Nurs Res. 1992;5:2-8. 13. Sims J, Miracle V. A look at critical care visitation. Dimens Crit Care Nurs. 2006;25:175-181. 14. Engli M, Kirsivali-Farmer K. Needs of family members of critically ill patients with and without brain injury. J Neuro Nurs. 1993;25(2):78-85. 15. Leske J. Overview of family needs after critical illness: from needs assessment to intervention. AACN Clin Issues Crit Care. 1991;2:220-226. 16. Family presence: visitation in the adult ICU. Crit Care Nurse. 2012;32(4):76-78. 17. AACN Practice Alert. Family presence: visitation in the adult ICU. Aliso Viejo, CA: American Association of Critical-​Care Nurses. http://www.aacn.org/wd/practice/content​/practicealerts /family-visitation-icu-practice-alert.pcms?menu=practice. Issued November 2011. Accessed December 15, 2015. www.ajcconline.org Jacob3_16pgs.indd 125 18. Davidson JE, Powers K, Hedayat KM, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35(2):605-622. 19. Berwick D. Don Berwick’s challenge: eliminate restrictions on visiting hours in the intensive care unit. Institute for Healthcare Improvement. http://www.ihi.org/knowledge​/Pages​ /ImprovementStories/DonBerwicksChallengeEliminateRestrictionsonVisitingHoursintheIntensiveCareUnit.aspx. Issued April 29, 2011. Accessed December 15, 2015. 20. Berwick D, Kotagal M. Restricted visiting hours in ICUs. JAMA. 2004;292:2721. 21. Smith L, Medeves J, Harrison MB, Tranmer J, Waytuck B. The impact of hospital visiting hour policies on pediatric and adult patients and their visitors. J Adv Nurs. 2009;​ 65(11):​2293-2298. 22. Kirchoff K, Dahl M. American Association of Critical-Care Nurses’ national survey of facilities and units providing critical care. Am J Crit Care. 2006;15:13-27. 23. Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM. Visiting hour policies in New England intensive care units: strategies for improvement. Crit Care Med. 2007; 35(2):497-501. 24. Puz C, Tracy M. Getting to best practice on visiting time—yes, but. AACN News. 2002;19(5):7. 25. Livesay S, Gilliam A, Mokracek M, Sebastian S, Hickey J. Nurses’ perceptions of open visiting hours in neuroscience intensive care unit. J Nurs Care Qual. 2005;20:182-189. 26. Whitten S, Pittiglio L. Critical care open visiting hours. Crit Care Nurs Q. 2011;34:361-366. 27. Marco L, Bermejillo I, Garayalde N, Sarratte I, Margall M, Asiain M. Intensive care nurses’ beliefs and attitudes towards the effect of open visiting on patients, family and nurses. Nurs Crit Care. 2006;11:33-41. 28. Berti D, Ferdinande P, Moons P. Beliefs and attitudes of intensive care nurses towards visits and open visiting policy. Intensive Care Med. 2007;33:1060-1065. 29. Garrouste-Orgeas M, Phillippart F, Timsit J, et al. Perceptions of a 24 hour visiting policy in the intensive care unit. Crit Care Med. 2008;36:30-35. 30. Leske J. Internal psychometric properties of the Critical Care Needs Inventory. Heart Lung. 1991;20(3):236-244. 31. Heyland DK, Tranmer JE; Kingston General Hospital ICU Research Working Group. Measuring family satisfaction with care in the intensive care unit: the development of a questionnaire and preliminary results. J Crit Care. 2001;16(4):142-149. 32. Heyland DK, Rocker GM, Dodek PM, et al. Family satisfaction with care in the intensive care unit: results of a multiple center study. Crit Care Med. 2002;30:1413-1418. 33. Wall RJ, Engelberg R, Downey L, Heyland DK, Curtis JR. Refinement, scoring and validation of the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey. Crit Care Med. 2007;35(1):271-279. 34. Rothen HU, Stricker KH, Heyland DK. Family satisfaction with critical care: measurements and messages. Curr Opin Crit Care. 2010;16:623-631. 35. Heyland D, Korol J. Family satisfaction survey. Carenet— Canadian Researchers at the End of Life Network. Issued 2013. http://www.thecarenet.ca/57-researchers/our-projects​ /family-satisfaction-survey. Accessed October 23, 2014. 36. Simon SK, Phillips K, Badalamenti S, et al. Current practices regarding visitation policies in critical care units. Am J Crit Care. 1997;6:210-217. 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. AJCC AMERICAN JOURNAL OF CRITICAL CARE, March 2016, Volume 25, No. 2 125 2/11/16 11:00 AM Copyright of American Journal of Critical Care is the property of American Association of Critical-Care Nurses and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. 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 1 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 2 Chamberlain College of Nursing NR439 PICOT Worksheet 4/19/17 jw NR 439 PICOT Worksheet 3
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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)...


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