Changing the Concept of Families as Visitors
Viewing families as allies for quality and safety and supporting their presence and participation in care and decision-making requires change in hospital and unit policies and education and support for staff.
University of Wisconsin Introduces Patients' Primary Supports
Sue Sanford-Ring, Director, Quality & Patient Safety, UW Hospital and Clinics met up with Institute President Bev Johnson at the National Patient Safety Foundation in Nashville earlier this year and told her that the University of Wisconsin no longer has visiting hours or 'visitors' for those designated as a patient's primary supports.
Some front-line clinical staff and managers had significant concerns about having family members on units 24 hours a day due to the possibility of infection with immuno-compromised patients and increased demands placed on staff at night. However, nursing leadership believed that family presence and participation were essential to patient- and family-centered care, as well as quality and safety, and wanted to implement a Family Participation Policy based upon experience gained in other hospitals.
Here's how the change was accomplished:
Dianne Danis, Director of Nursing Practice Innovation, planned a design day, bringing together clinical nurses from each inpatient unit, designated to serve as unit-based champions, as well as representatives from other role groups and clinical disciplines and a patient. Everyone came together for one day to review a draft policy, make suggested revisions, learn about the evidence related to family participation (such as no increased infection risk), and hear from a patient about the importance of the issue. The unit champions were brought together again to help plan implementation of the new policy and were key in supporting its acceptance. In addition, a steering committee including management and staff (some in favor of the new policy, some opposed) assisted in working out the operational details such as encouraging units to budget for additional portable cots.
All in all, the policy was implemented without a hitch, and, according to Sue, "having "patients' primary supports' here 24 hours a day is now just how we do things around here!"
Pitt County Memorial Hospital Policy & Procedure: Family Presence and Visitor Guidelines
St. Alexius Medical Center - Policy and Procedure
Resources:
Supporting Family Presence: Key Questions to Ask
For those interested in examining staff practices and hospital infrastructure to determine how well family presence and participation is supported, please download the following resource: Are Families Considered Visitors in Our Hospital or Unit?
Increasingly staff and faculty are including patients and families in the process of rounds. Please download the following resource to view guidelines for conducting patient- and family-centered rounds: Applying Patient and Family-Centered Concepts to Bedside Rounds.
Changing the Concept of Families as Visitors: Supporting Family Presence and Participation, a resource from the Institute for Patient- and Family-Centered Care to assist units and institutions in redesigning "visiting" policies to support family member presence and participation. Please visit our Resources Page.
In October 2008, the Institute for Healthcare Improvement (IHI) completed a 90-Day R&D Project to build on extensive work in the area of patient- and family-centered care. The focus of this project was to identify key drivers that have a positive affect on improving the inpatient care experience.
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About "Open" Visiting Hours in intensive Care Units
IHI
Don Berwick, the president of the Institute for Healthcare Improvement challenged hospitals to rethink restrictive visiting policies in intensive care units. Vicki Jensen Spuhler, RN, MS, CCRN, offers this systematic review of over 50 pieces of published literature of open visiting hours in intensive care units. Spuhler manages the Shock Trauma ICU and the Medical Surgical ICU at LDS Hospital in Salt Lake City, Utah. She is currently working with the Society of Critical Care Medicine on establishing guidelines for visitation in intensive care units. To download this paper, please visit the IHI website.
NACHRI
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When parents of NICU patients stay overnight, only 15 percent of hospitals indicate parents stay bedside in the unit. |
Children's Hospitals Today is a resource from the National Association of Children's Hospitals and Related Institutions (NACHRI). In their Winter 2005 Issue they featured an article entitled Family-Centered Care in the NICU by Mitch Harris, Associate Director, Child Health and Financing, NACHRI and George Little, M.D., Professor of Pediatric Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center.
Telephone interviews were conducted with NICU nurse managers at 61 institutions. Questions focused on two aspects of family-centered care: visitation policies for parents and other family members, and parent participation in unit activities.
This article is available online, Click Here.