Area Of Concern Research Proposal Example

ICU nurses knowledge and practices on open ICU visitation policies

ICU Nurses Knowledge and Practices on Open ICU Visitation Policies

The area of concern is nurses’ knowledge and practices on open/ flexible ICU visitation policies. This is an area of concern because studies have established that most hospitals within the US still have restrictive visitation policies (Liu, Read, Scruth, & Cheng, 2013). This is in spite of the existence of an abundance of evidence-based findings that suggest that open visitation policies have physiologic and psychological benefits to patients and their relatives (Davidson et al., 2007).

Study Design

The study will use a cross-sectional survey design. The study is quantitative in nature but will utilize a descriptive design. The cross-sectional survey will entail collection of data at one time. Questionnaires will be distributed amongst nurses working in the ICU of MMM hospital.

Research Problem

A preponderance of literature suggests that flexible ICU visitation policies have physiologic and psychological benefits for ICU patients and their families (Fumagalli et al., 2006). For patients, they help reduce anxiety, depression, and confusion, improve physiologic parameters like intracranial pressure and heart rate, enhance patient satisfaction, and reduce length of ICU stay. For relatives, they help to reduce symptoms of anxiety and depression, improve satisfaction, foster better understanding of patients (Williams, 2005), and provide more chances for family/patient teaching (Marco et al., 2006). Open ICU visitation policies have been met with a lot of skepticism in spite of the existing evidence (Liu, Read, Scruth, & Cheng, 2013). The reasons cited for the skepticism include open visitation policies interfere with day-to-day workflows, essential treatments and care, patient resting times, and increase patient distress. These reasons are based on anecdotal evidences and have not been proved in any clinically sound studies (Noordermeer, Rijpstra, Newhall, Pelle, & van der Meer, 2013). A recent study revealed that most US hospitals still have restrictive ICU visitation policies (Liu, Read, Scruth, & Cheng, 2013). Therefore, there is a gap between knowledge and practice.

Purpose of the Study

The purpose of the proposed study is to assess the knowledge and practices of ICU nurses on open ICU visitation policies. Findings from descriptive, intervention, and review studies suggest that ICU patients and their significance others prefer open visitation policies as compared to restrictive visitation policies (Fumagalli et al., 2006). The findings from such studies further suggest that flexible visitation policies have physiologic and psychological benefits to patients and their family members (Davidson et al., 2007). For patients, open visitation policies; help to reduce confusion, anxiety, and agitation, cardiovascular complications, and length of ICU stay. Flexible visitation policies also help to enhance a patient’s feeling of security and patient satisfaction. Lastly, they help to improve the quality and safety of care rendered to patients. For relatives, open visitation policies, increase family satisfaction, reduce family member anxiety, promote better communication, increase opportunities for family patient teaching, and contribute to more enhanced understanding of patients (Fumagalli et al., 2006). In spite of the above evidence, nurses have been reported to be skeptical of open visitation policies. They have been found to cite a number of concerns such as open visitation policies interfere with daily workflow, interrupt essential treatments and care, and increase a patient’s physiologic stress and risk for infection and septic complications, and reduce patient rest opportunities. These anecdotal theories are of the view that open visitation policies lead to poor patient outcomes. Notably though, there is no sound clinical evidence that supports these theories (Davidson et al., 2007). In spite of this knowledge though, recent studies have established that most hospitals in the United States still practice restricted visitation policies (Liu, Read, Scruth, & Cheng, 2013). Further, other studies report that nurses are often unaware of evidence-based practices due to poor research skills and lack of time to look for such evidence. The purpose of the proposed study, therefore, is to assess the knowledge and practices of ICU nurses on open visitation policies. Evaluation of the knowledge and practices of ICU nurses on open visitation policies is essential as it will help to identify barriers to the adoption of this evidence-based practice.

Theoretical Framework

Roger’s (2003) diffusion of innovations theory will be used as the theoretical framework for the study. Originally designed for diffusion of innovations in technology, the theory has been applied to other disciplines like nursing and political science. The theory focuses on the process of adoption of innovations and has four main elements: innovation, communication channels, social system, and time. Rogers (2003 as cited in Keele, 2010) describes the adoption of innovations as an uncertainty reducing process in which individuals seek and process information about the merits and demerits of an innovation. Rogers (2003) also proposed characteristics of innovations that help to lower uncertainty. These attributes include compatibility, relative advantage, trialability, complexity, and observability. According to Rogers, individual, organizational, or group perceptions of these attributes influence the rate at which innovations are adopted. Rogers (2003 as cited in Keele, 2010) additionally describes the innovation-decision process as a five-step process. The five steps follow one other in a time-ordered fashion and include knowledge, persuasion, decision, implementation, and confirmation. Roger’s (2003 as cited in Keele, 2010) diffusion of innovations theory has been selected as the theoretical framework for the study because it can be used to describe a change in practice. In this case, it can be used to explain the process of adoption of open ICU visitation policies.

Settings of the Study

The study will be conducted at the ICU of MMM hospital. MMM hospital is a 600-bed hospital located in NNN. Its ICU has a capacity of 25 beds and admits all categories of patients requiring critical or intensive care.

Extent of the Literature Review

The Cinahl, PUBMED, and Medline databases will be queried for qualitative and quantitative articles on ICU visitation policies. The search for articles will be limited to the 1990s due to the paradigm shift in thinking about ICU visitation policies that occurred during this period. The literature review will include adult, pediatric, and neonatal literature available in the English language. The search will incorporate published and unpublished studies, dissertation abstracts, randomized trials, descriptive surveys, and intervention studies from Europe and North America. Other than nursing articles, relevant literature from the disciplines of psychology, medicine, and behavioral sciences will be reviewed. The topics to be covered by the review will include advantages and disadvantages of open visitation policies, nurses attitudes and practices on family visitation, patient and family needs and preferences with regards to ICU visitations, and levels of evidence of published studies. The main search terms to be used will include ICU visitation policies, open/flexible visitation policies, advantages, disadvantages, concerns, qualitative, quantitative, family visitation, patient needs, and patient satisfaction.

Sample

The target population of the study consists of all nurses working in ICU settings irrespective of whether it is a general or a specialized ICU. In this case, the sample for the study will consist of nurses working in the hospital’s ICU who consent to participate in the study. The sample for the study will be identified through convenience sampling, a strategy in which a researcher selects easily accessible participants for participation in the study. For the study, all ICU nurses who will be on shift at the time the researcher distributes the research questionnaires will be included in the study once they provide informed consent.

Approval to Conduct the Study

Before carrying out a study, a researcher should seek institutional approval from the institutional review board of the particular entity the researcher wishes to conduct a study in. Seeking permission from an institutional review board prior to executing a study is a requirement by the federal government. The institutional review bodies consist of five or more members drawn from the organization and laypersons with no direct associations to an organization. The review bodies review the objectives of a study, its methodologies, and potential benefits and risks to participants. It also looks at issues of privacy and informed consent. Permission to conduct the proposed study will be sought from the institutional review board of the hospital. Notably, although permission to carry out the study will be sought from the hospital’s institutional review board, the ultimate responsibility for ensuring the study is ethical will remain with the researcher.

Ethical Considerations

The ethical concerns in the proposed study include protection of human subjects and integrity of the study. When conducting a study, a researcher should respect the rights, dignity, privacy, and sensitivities of the study population as well as the integrity of the institution where a study is carried out. Protection of respondents in this study will be achieved through informed consent, maintenance of confidentiality of the information provided by respondents, and protection of respondents from harms. Prior to participating in the study, the researcher will explain to the participants the purpose of the study, methods to be used in the conduct of the study, risks involved, and demands placed on them from participating in the study. Direct written consent will then be sought from each participant. Each participant will also be informed that participation in the study is voluntary and they are free to withdraw their participation at any time. Participants will be assured that all information they provide with be treated with utmost confidentiality. Any integrity breaches during the conduct of a study weaken or invalidate the findings of the research. Precautions against integrity breaches will be observed during the execution of the study. These precautions will include honesty in the reporting of data, methods, and results; objectivity in the analysis and interpretation of data; respect for intellectual properties; maintenance of good records during the execution of the study; and sharing of study findings (Shamoo & Resnik, 2009).

Data collection

Data for the study will be collected using a self-complete questionnaire. The items to be included in the questionnaire will be indentified through a review of current literature on open ICU visitation policies. Prior to the study, the questionnaire will be piloted amongst nurses in a non-participating hospital. Piloting will be done to assess whether the questions included in the questionnaire are intelligent, unambiguous, acceptable, and inoffensive. Pre-testing will also allow assessment of the time required to complete the questionnaires and the performance of the questionnaires in meeting the objectives of the study (Gerrish & Lacey, 2010). The questionnaire will then be edited depending on the findings of the pilot study. The items to be included in the questionnaire will be measured at two levels of measurement; the nominal and ordinal levels of measurement. The nominal scale of measurement measures items placed in categories on the basis of a given qualitative attribute for instance gender (Waltz, 2005). Items to be measured at this level of measurement will be mainly the demographics of the respondents such as sex and level of education. The ordinal level of measurement entails assignment of numbers to objects in a rank order on the basis of a given characteristic (Waltz, 2005). Nurses’ knowledge and practices on open ICU visitation policies will be measured using this scale. The steps to be followed during the actual data collection will include identification of participants, distribution of questionnaires, and collection of the filled questionnaires. The collected data will then be analyzed using the SPSS software for conducting quantitative analyses.
Persons to be involved in the Study

Resources

Execution of the study requires availability of monetary and non-monetary resources. Money is needed for transport, buying of stationery, printing of questionnaires, data analysis amongst other costs. The non-monetary resources required include time, persons, managerial skills, and materials.
Conclusion
In summary, this proposal has outlined the key areas of the proposed research project. These include the area of concern, type of study, research problem, theoretical framework for the study, extent of the literature review, characteristics of the sample to be used, data collection procedures, ethical concerns, settings of the study, persons to be involved in the study, and resources required to conduct the study. The area of concern is nurses’ knowledge and practices on ICU visitation policies. This is an area of concern because there is a gap between knowledge and practice. The study will utilize a cross-sectional survey design. The sample for the study will consist of nurses working in the ICU of MMM hospital. Rogers (2003) diffusion of innovations theory will be the theoretical framework that will be used for the study. It was selected because it provides a framework for understanding how innovations are adopted by individuals, groups, and organizations. Permission to conduct the study will be sought from the institutional review board of the hospital. The ethical concerns present in the proposed study include the issue of protection of human participants and maintenance of integrity. It is hoped that the findings of the study will illuminate the reasons for the gap in current knowledge and practices with regards to flexible ICU visitation policies.
References
American Association of Critical-Care Nurses (2015). Family presence: Visitation in the adult ICU: Scope and Impact of the problem. Retrieved from http://www.aacn.org/wd/practice/content/practicealerts/family-visitation-icu-practice- alert.pcms?menu=practice
Davidson, J. E., Powers, K., Hedayat, K. M., Tieszen, M., Kon, A. A., Shepard, E., Spuhler, V., Todres, I. D., Levy, M., Barr, J., Ghandi, R., Hirsch, G., & Armstrong, D. (2007). Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2006. Crit Care Med., 35(2), 605-622.
Gerrish, K. & Lacey, A. (2010). The research process in nursing. Iowa: John Wiley & Sons Inc.
Fumagalli, S., Boncinelli, L., Nostro, A. L., Valoti, P., Baldereschi, G., Bari, M. D., Ungar, A., Baldasseroni, G., Geppetti, P., Masotti, G., Pini, R., & Marchionni, N. (2006). Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot randomized trial. Circulation, 113, 946-952.
Keele, R. (2010). Nursing research and evidence-based practice: Ten steps to succeed. New York: Jones and Barlett Learning.
Liu, V., Read, J. L., Scruth, E., & Cheng, E. (2013). Visitation policies and practices in US ICUs. Critical Care, 17, 71.
Marco, L., Bermejillo, I., Garayalde, N., Sarrate, I., Margall, M. A., & Asiain, M.C. (2006). Intensive care nurses’ beliefs and attitudes towards the effect of open visiting on patients, family and nurses. Nurs Crit Care, 11, 33-41.
Noordermeer, K., Rijpstra,T. A., Newhall, D., Pelle, A. J. M., & van der Meer, N. J. M. (2013). Visiting policies in the adult intensive care units in the Netherlands: Survey among ICU directors. ISRN Critical Care.
Shamoo, A. & Resnik, D. (2009). Responsible Conduct of Research (2nd ed.). New York: Oxford University Press.
Waltz, C. F. (2005). Measurement in nursing and health research. New York, NY: Springer Publishing Company, Inc.
Williams, C. M. (2005). The identification of family members’ contribution to patients’ care in
the intensive care unit: A naturalistic inquiry. Nurs Crit Care, 10, 6 –1.