Discuss about the Policy Brief.
Visitors are not allowed traditionally in PACU because of high patient acuity and turnover, residual effect of anesthetic agent on postoperative patients. Despite the evidence, that supports family visitations in the PACU as one of the family-centered care approaches; parental presence remains a controversial issue for nurses working in the post anesthesia setting (Nadeau et al., 2016). Family visitation or parental presence in the Post Anesthetic Care Unit may have two different influences to the patient recovery that may be positive or negative. Regarding this fact visitation in PACU began to appear in literature in 1984 as some article claim that visitation might upset patient and challenge nurses to perform their duty. Opposing the fact, nurses responded to published article-advocating parent’s visitation because of close proximity to ORs, complication and first paced recovery process. In spite of these facts, parental PACU visitation is allowed in many countries and in many hospitals to initiate family centered care approach where patients are highly vulnerable and dependent on others activity (Houle, Belew & Miller, 2015). Many researches has shown that post operative patients in post anesthetic stage feel comfortable by the presence of their loved ones which is increasing the significance of the parental PACU visitation.
Timely identification and supervision of several issues that arise in postoperative period saves live, time and money. Post Anesthetic Care Unit is one of the most important segments for patient recovery after surgery. This unit is dedicated to deal with the health and mental condition of the patient after surgery so that they recover as early as possible (DeMarco & Tufts, 2014). While attending their duty most of the Post Anesthetic Care Unit faces several issues that hamper the process as well as the patient recovery. In such situation disturbance for the patient and for the support staff may lead postoperative complications. To monitor such situation need of certain policies are very important to restrict the unauthorized entry and disturbance. At the same time visitation of the family members particularly for parents will improve the mental condition of the patient if family members are able to create a positive environment for the patient recovery (Carter et al., 2012). Several researches suggest that health recovery is highly associated with the mental state of the patient because it will enhance the self-confidence that will help the recovery process.
The incidence of anxiety among the children is high. Almost 40% to 60% children exhibit psychological or physiological complications due to high anxiety in pre operative period due to the fear of unknown persons and unknown activities around them (Lalani, Ali & Kanji, 2013). To reduce the incidence of such events many health care organization has feel the need of parental visitation and taken the initiative to implement specific policies to solve the problem. The ultimate goal of the health care staff and organization is to initiate proper treatment of their patients therefore it has become necessary to allow family visitors in post anesthetic situation (Jennings, 2002).
According to Stevenson (2014), conducting a survey with PACU staff, it was evident that 57.1% nurse in this segment feels that it is their duty to provide emotional support to the family members of the patient. When nurses doing such activity then they also feel comfortable by releasing the tension of family members. Almost 47% nurse in the survey supported the parental visitation in spite of the disturbance during their duty. It is true that nurses feel discomfort during the family visit in PACU, but after the visitation patients become relax and the job of a PACU nurse becomes easier.
Charlton (2015) has supported the parental visitation in postoperative situation, which is beneficial for the patient recovery. While doing such research other facts are also evident that are not supporting the postoperative visitation. The first concern is the hygiene issue and it affects the recovery of the patients. Most of the visitors enter into the Post Anesthetic Care Unit without disinfecting their body that may increase the infection of the patient. Apart from that, many parents are not so mentally strong and they become senseless looking at the condition of their child. This type of situation is very difficult to handle for the PACU staff. Patient also become mentally week that hinder the recovery process (Lee, Li & Yates, 2015). Allowing parental visitation in PACU make it granted for parents and they request for sudden visit to the patient which irritate the hospital staff.
The history of visitation policies can be traced back in 1880. The almshouses were constructed for the ill patients and less number of visitors appeared, because of the social stigma involved. In 1998, there were restricted visitation policies in the hospitals. This was derived from the development of the Intensive Care Unit in 1960. There were restrictions in the visitation policies. The restrictions were based on parameters like duration, frequency, number of allowed visitors and age of the visitors.
Initiating parental visitation in PACU is an essential element to promote family-centered care approach in the surgical complex setting. It required leadership support, resources, forming a multidisciplinary team that involves all preoperative nurses in day surgery, operating room, post anesthesia care unit, anesthesiologists, family-centered care coordinators and liaison services (Kamerling and Cunning, 2008).
Identifying the role of all team members to collaborate at a high level and setting up a quality improvement program to measure the progress of implementation. Along with that patient and family satisfaction during discharge is also essential to achieve a satisfactory outcome.
Nevertheless, establishing an educational program to prepare patients and families for surgical experience appears to be the foundation for successful implementation. Evidence suggests that providing patients and relatives online support information and conducting a virtual or personal tour of peri-anesthesia and perioperative resulted in better preparation for surgery. Moreover, offering parents with a concise teaching material focuses on the most important points what to expect in PACU while checking in for surgery. Also, assigning a member from liaison service to coordinate between family and operating room personnel as well as to reinforce education, provide support and guide a family through surgical experience.
Special considerations to patient acuity on arrival to PACU and evaluation of postoperative and post anesthesia measures ensuring all safety and comfort measures in place before reuniting parents with their child (Kamerling and Cunnining, 2008).
The PACU visitation policy should not allow any children in the PACU with their parents. PACU setup may harm both the recovery process of the patient as well as the mental stability of the visiting child. The health condition of children is very vulnerable and they might be infected with other infections. Moreover the patient child will also feel embarrass looking at the visiting child (da Silva Ramos et al., 2013).
The parent visitation is important for both the employees as well as patients. It provides reassurance, comfort and feel good factor for the patients. It also reduces the anxiety of the child. The parents are known to have a calming effect on the child and reduce the requirement of physical restraint. The parent visitation is also needed for the assessment of pain and eliminates the need of analgesia.
The nurses have certain safety concerns regarding parent visitation. They fear about lack of space, lack of resources and lack of privacy caused due to the entry of parents. The entry of parents in the post anesthetic unit would mean potential concerns for a child. It can wake up the child prematurely from the effect of anesthesia and there can be increase in the emergency response. There can be negative reactions from the parents like fainting, shouting, which may hamper the work of the nurses. This may affect the ability of the nurses to take care of the patients.
There should be quality initiatives adopted for overcoming the potential barriers. There should be quality improvement process to assess the progress of the tasks. There should be involvement of the stakeholders and there should be a multidisciplinary approach involved. There should be family education programs to prepare the patients as well as parents for surgery. The employee education is also important. There should be proper reinforcement regarding the expectations from PACU during the onset of the surgery.
Conclusion
Although many PACU staff do not support family or parental visitation still there is need of this for the patient benefit. Several surveys have established the fact that when patient sees their family member in postoperative situation then they become mentally strong and become relax. After the visitation when patient feels better, then the job of a nurse also becomes easier. Therefore, a large portion of nursing staff is supporting the visitation of PACU patient. Many health care organizations are therefore implementing several policies that are associated with the parental PACU visitation to enhance the patient recovery. The policies of the parental visitation should be allowed to promote the family centered care process, which will help the recovery process. To promote the family centric care approach it is important to educate the family member as well as the patient so that they can behave properly to maintain the proper decorum of the care unit. The behavior of the family member is also associated with the recovery process that depends on the mental stability that injects positivity within the patients. However majority of the support is for allowing the parental visitation for its greater benefit of the patients.
References
Carter, A. J., Deselms, J., Ruyle, S., Morrissey-Lucas, M., Kollar, S., Cannon, S., & Schick, L. (2012). Postanesthesia care unit visitation decreases family member anxiety. Journal of PeriAnesthesia Nursing, 27(1), 3-9.
Charlton, S. G. M. (2015). Family presence and visitation in critical care: a rapid evidence assessment (Doctoral dissertation, University of British Columbia).
da Silva Ramos, F. J., Fumis, R. R. L., Azevedo, L. C. P., & Schettino, G. (2013). Perceptions of an open visitation policy by intensive care unit workers. Annals of intensive care, 3(1), 1.
DeMarco, R. & Tufts. K. (2014). The mechanics of writing a policy brief. Nursing Outlook 62 (3), 219224.
Houle, K. E., Belew, J., & Miller, B. (2015). Implementation of a Phase I Caregiver Visitation Program for a Specialized Pediatric Population. Journal of PeriAnesthesia Nursing, 30(4), 301-307.
Jennings, C. (2002). The power of the policy brief. Policy, Politics and Nursing Practice 3(3): 261 – 263.
Lalani, S. B., Ali, F., & Kanji, Z. (2013). Prolonged-stay patients in the PACU: a review of the literature. Journal of PeriAnesthesia Nursing, 28(3), 151-155.
Lee, E., Li, N., & Yates, A. (2015). Magnet Journey: A Quality Improvement Project—Implementation of Family Visitation in the PACU. Journal of PeriAnesthesia Nursing, 30(1), 39-49.
Nadeau, S., Larson, S., Bennick, V., Bergan, T., Martin, L., Senst, K., … & Wait, R. (2016). Development of a Formalized Pediatric Visitation Program in the PACU Through Evidence-Based Practice. Journal of PeriAnesthesia Nursing, 31(1), 73-82.
Stevenson, K. (2014). Registered Nurses’ Experiences of Patient Violence on Acute Care Psychiatric Inpatient Units (Doctoral dissertation).
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