NR 351 Week 3 Discussion – Integration of Evidence-Based Practice into Professional Nursing Practice
While working in the Cardiovascular Recovery Unit (CVRU), I see problematic nursing care issues on a daily basis. The CVRU I work in has about 12 nurses. All of which show up to work each and every day to give their best to the patients we serve. Even though each nurse works so very hard to do their absolute best while caring for our extremely sick patients, there will always be areas in which we can improve our (nursing) standards of care. Nursing care issues have and will always be areas of healthcare that providers need to focus and improve on to better serve our patient population.
The nursing care issue I chose to focus on for this week’s discussion question is relevant across the board in all areas of the Critical Care Units. I believe that one of the biggest nursing care issues we face within the Critical Care Units is patient-centred visitation. At times we are so focused on caring for the critical patient we forget about their family dynamics and support system, their family. This nursing issue focuses directly on the patient and their family’s needs. Being in the CCU is a very hard time for anyone, and it is made worse when we try to keep families out.
“The Nurse of the Future will provide holistic care that recognizes an individual’s preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care” (Massachusetts Department of Higher Education, 2010, p.9).
All names in my example below were changed to protect the patients and their families.
NR 351 Week 3 Discussion – Integration of Evidence-Based Practice into Professional Nursing Practice
For example, I am taking care of a 66 old patient immediately post cardiovascular bypass surgery named Fred. Fred had a difficult and longer-than-usual surgery. Upon arrival at the CVRU, we tried to get him stabilized, and he was bleeding and in need of many blood products. The surgeon has talked with the family in the consultation room and explained we would come to get them as soon as we get him settled. Labs were drawn and sent, stat blood products are transfusing, fluids were given, vasopressors were started in the Cardiovascular Operating Room (CVOR), and an insulin drip was started after getting a glucose level that was in the parameters to start it. The family is calling to see if they can come in. The charge nurse is talking with them while 2-3 nurses are trying to stabilize Fred so his family can come in to see him. Finally, after 60 minutes, the family is asked.
To come in to see Fred and for the nurse caring for him to update them on his condition. Immediately the wife states,” I am staying all night”. I explain, “It will be better for you and Fred if you go home and get some much-needed rest and come back in the morning when he could possibly be breathing on his own and awake to let you know how he is doing”. At first, she baulks at the idea, but after further encouragement and reassurance, she decides to go home after giving her direct phone number and telling her to call anytime to check up on him throughout the night.
This family, like so many others, after a family member has a CABG, valve replacement, or whatever they need cardiovascular-wise, will feel they were not heard when they wanted to stay with their loved one, but our CVRU is very small, and there is no room with all the equipment needed in the room to care for their loved one and them too. We do our best by answering all questions and phone calls when they call throughout the night to keep them informed on how their loved one is doing. We tell them if we need them, they will be the first ones we call after the surgeon. The next morning, Fred was extubated and breathing on his own with 4 litres of oxygen per nasal cannula. It was about 0600, and Fred’s wife called in and gave the good news with a large dose of support. She was told when he moved out to the 6th floor. She will be able to stay with him there. She stated,” Thank you all for everything you have done.”
I used the following as my search criteria on CINAHL:
Open visitation in the ICU (13 results)
Families in the ICU (8 results)
Patient and family’s open visitation in the ICU (39 results)
Patients (45,673 results)
A patient needs open visitation (54 results)
*In my advanced search, I chose only articles that were “Peer Reviewed” and primarily authored by a nurse. This gave me the ability to trust that the research and knowledge stated are, in fact, accurate.
NR 351 Week 3 Discussion – Integration of Evidence-Based Practice into Professional Nursing Practice
The one article that came up in all of my searches was Traditional/Restrictive vs patient-centred intensive care unit visitation: perceptions of family members, physicians, and Nurses, written by Riley, White, Graham, & Alexandrov (2014). I chose this article for several reasons. For one, the main topic of my paper was in the title; it was also written by several nurses within the last five years – making the research utilized in the paper more pertinent to our current nursing practice. As stated in the conclusion of the article, “Patient-centered care is an expectation among patients, patients’ families, and health quality advocates. These exploratory methods increased understanding of the powerful perceptions of family members, physicians, and nurses involved with patient care and provided direction to plan interventions to implement patient-centred, family-supportive ICU services” (American Journal of Critical Care. 2014; 23:316-324)
References:
Massachusetts Department of Higher Education. (2010). Creativity and connections: Building the framework for the future of nursing education and practice. Retrieved from http:// www.mass.edu/currentinit/documents/NursingCoreCompetencies.pdf
Riley, B.H., White, J., Graham, S., & Alexandrov, A. (2014). TRADITIONAL/RESTRICTIVE VS PATIENT-CENTERED INTENSIVE CARE UNIT VISITATION; PERCEPTIONS OF PATIENTS’ FAMILY MEMBERS, PHYSICIANS, AND NURSES. American Journal of Critical Care, 23(4), 316-324 9p., doi; 10.1037/ajcc2014980
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Question 
As a professional nurse, you realize that your nursing care area often sees patients with the same particularly challenging nursing care issue (NOT medical care issue). Include all of the following in your answer to this discussion:
Identify the nursing care issue or problem and justify why it is a nursing care issue in need of implementation of evidence. Remember, this should not be a medical
Explain how you would search the nursing literature for evidence on this topic (including search terms you would use) and how you would critically appraise the evidence found in your search. NOTE: You do not need to perform the search and provide an article for this discussion, but you may do so if you like.