A. Develop a written proposal by doing the following:

1. Develop a written proposal by doing the following:
2. Identify a problem or issue related to practice, policy, population, or education that aligns with the organizational priorities you seek to solve.

I am hoping to solve the problem of visitation hours in the ICU, which are very limited.

1. Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare environment.

Currently, I am a nurse at a local hospital in the state, and I have noted that there is a policy in place which limits the number of hours that relatives, and other visitors can spend with the patient while in the ICU. Consequently, this affects the quality of care, in that critical decisions have to be made by the staff in lieu of the family, obviously because the designated family members cannot be reached on time. When this happens, the wishes of the patient may fail to be honored, and this may create a negative perception about the whole ordeal.

In the course of my practice as an ICU nurse, I have noted that the presence of family members at the bedside of the patient helps to provide comfort, reassure the patients, allow planning of the patient care, and as well helps to reduce anxiety on the part of the patient. In the current situation where the family members have very limited contact with the patient they feel as though they are not allowed to participate in caring of their patient, or that they have not been adequately informed. Currently, patients in the ICU ward can only be visited at between 8.30 AM to 10Am, and then between 8.30Pm to 10.30Pm. No other visitation is allowed, unless under some extra ordinary circumstances such as in the case of an imminent death, or withdrawal of care. When patients are surveyed in order to gauge their level of satisfaction, they have always had a negative attitude regarding the limitation in visiting hours.

2. Discuss your investigation of the problem or issue.

Provide evidence to substantiate the problem or issue (e.g., organizational assessment, national source documents, evidence from a stakeholder).

In the course of my work as an ICU nurse, I have had the opportunity to interview a number of patients’ family members. The consensus of at least two out of every three respondents have been that the policy on visitation is unnecessarily strict, and that they felt left out of the decision making policy regarding their patients’ care. According to a study by Chapman (2016), he found that relaxed visitation policy can substantially improve patient outcomes. A study published in the American Journal of Critical care posited that in the event where members of the family are allowed into the patients ward, they felt like the needs of the patients were being catered for (Jacob M. 2016)

3. Analyze the state of the situation using current data.
4. Analyze areas that might be contributing to the problem or issue.

In my unit, there are nurses who have worked for more than two decades. As a result , a culture has been established which has then been accepted as the normal way of doing things. In deed, this policy has not been reviewed for more than 8 years. The feeling among other nurses in the unit is that the a relaxed policy would impede their ability to discharge their mandates, and this in effect means they are okay with the status of the policy as it is. There has been instances where family members who are rude and overbearing unnecessarily disturb the patient, even after numerous directions not to do so. On the other hand, there has been instances as well where an agitated and frightened patient starts to respond when the family members are allowed to the bedside.

4. Propose a solution or innovation for the problem or issue.
5. Justify your proposed solution or innovation based on the results of your investigation and analysis.

After the completion of the interviews with the charge nurses, fellow nurses and even the unit manager, my recommendation would be that there should be a relaxed visitation policy in the Intensive Care Unit. Most of the staff responded in a positive way to this proposal. A policy of open visitation has been shown to increase patient response and family satisfaction since they are allowed to participate in the care of their loved one. (Junior et al, 2018). However, in order to facilitate this desired change, I suggest that all staff should be involved in the policy formulation, so that they will not resist the changes when it is finally enforced.

5. Recommend resources to implement your proposed solution or innovation. Include a cost-benefit analysis of your proposed solution or innovation.

If these changes were to be implemented, there would be no increases in the cost. However, there would be a slight increase in the department, since the staff would need to be retrained further so as to be accommodative to the new change. As well, posters would have to be printed giving the new directions on the open visitation policy for the ICU unit. If the patients and their families are satisfied with the new policy, then the hospital would benefit through increased reimbursement rates. So as to communicate the new changes, the staff would have to be notified via e-mails, print outs of the new policy as well as in service education.

6. Provide a timeline for implementation based on your proposal.

This proposal can be implemented within one month, after which it would be important to re-evaluate the successes of the proposed changes. After this period, there will be a session to modify the policy, if indeed there will be areas that need further refinement.

7. Discuss why each key stakeholder or partner is important for the implementation of the solution or innovation.

Some stakeholders would need to be involved in having a successful implementation of these recommendations. One is the administrator of the department, who would be tasked with ensuring that the hospitals are fully staffed so that the recommended patient to nurse ratio is achieved. In this regard, the professional associations must advice the physicians, nurses, as well as the administrators of various facilities on the need for enhancing these changes. Since the nurses are a major stakeholder, they too must be kept abreast of the new developments, and they must be proactive to ensure the successful change in the policies governing visitation hours for patients in the ICU.

1. Summarize your engagement with the key stakeholders or partners, including the input and feedback you received.

After a series of meetings to explain the necessity of the changes to the major stakeholders, they were supportive of the idea and were convinced that it would drastically improve the image of the unit and the hospital as a whole.

1. Discuss how you intend to work with those key stakeholders or partners in order to achieve success.

Since the unit administrator is a key stakeholder, I envision working with him throughout the proposed implementation period to iron out any hindrances that may occur. Further, since he is overall responsible for the administrative work in the unit, it would be productive to have him fully understand the potential benefits that will accrue from the changes in ICU unit visitation hours, as well as the possible resistance that may be there. Moreover, the nurses are a crucial stakeholder who must be roped in since they are in charge of the patients in the ward, and will have to deal with the families.

8. Discuss how your proposed solution or innovation could be implemented, including how the implementation could be evaluated for success.

To implement this change, the unit will need to hold several meetings with the various stakeholders, to explain the proposed changes, and as well answer any pertinent questions. All departments, including security, nursing and the administrator must be in support of the proposal so that it can be successfully implemented.

To evaluate the success or otherwise of the proposed changes, I propose to hold a weekly meeting to review the implementation, so that any challenges can be addressed before they escalate.

1. Explain how you fulfilled the following roles during your process of investigation and proposal development:

1. Scientist

– As a scientist, I carried out simple research to establish how the system can be made better.

2. detective

– I interacted with the family members of the patients to try and understand how they perceived the procedures, including the environment in the ICU.

3. manager of the healing environment

– As the person in charge of the patients in the unit, I was able to identify the factors that may be hindering the healing progress of my patients and therefore proposed the changes that would enhance and improve the patients stay in the hospital.