AACN News—May 2007—Practice

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Vol. 24, No. 5, MAY 2007

Task Force Meets to Update Scope and Standards

The AACN Acute and Critical Care Nursing Scope and Standards Task Force, led by Lori Hendrickx, RN, MSN, EdD, CCRN, met March 16 and 17 in Costa Mesa, Calif. to review and update the currently published “AACN Standards for Acute and Critical Care Nursing Practice, 3rd Edition.”

Task force members were selected from AACN’s volunteer database by querying those who had indicated an interest and by requesting an updated biosketch to indicate availability and willingness to serve. Every effort was made in the selection of members to represent regions, facilities of different sizes and multiple types of acute and critical care nursing practice.
Six members were selected from the 39 nurses who expressed interest. They are Sonia Astle, RN, MS, CCRN, CCNS, Mary Ann Degges, RN, MSN, CCNS, John F. Dixon, RN, MSN, CNA-BC, Sonya Hardin, RN, PhD, CCRN, APRN-BC, Melissa Hutchinson, RN, MN, BA, CCRN, CWCN, and Cathy Thompson, RN, PhD, CNS. The Board of Directors of AACN is represented by Marian Altman, RN, MS, CNS, CCRN, ANP; Linda Bell, RN, MSN, and Teresa Wavra, RN, MSN, CNS, provide staff support from the AACN national office.
At the recent meeting, task force members discussed current nursing practice and future directions to be considered in revising the document. The group also determined that information from the AACN Standards for Establishing and Sustaining Healthy Work Environments and the AACN Synergy Model for Patient Care should be included. Participants brought valuable insight from their own practices as well as the vision for defining universal acute and critical care nursing practice.

Although much was accomplished at the meeting, the task force will continue to review completed sections of the document for further revisions before submitting the information to a panel of external reviewers. The group’s goal for this project is to have the revised document published and available by the end of 2007.

The Nursing Scope and Standards Task Force includes (left to right) Melissa Hutchinson, Mary Ann Degges, John F. Dixon, Lori Hendrickx, Sonya Hardin, Cathy Thompson, Marian Altman, Teresa Wavra, Sonia Astle and Linda Bell.

Practice Resource Network: Family Visitation

Q: Does AACN have any suggested practices, resources or best practice statements in terms of flexible, open visiting in adult ICUs?

A: AACN supports open family visitation but realizes that one size does not fit all. Moving to less restrictive and more individualized visiting is recommended. The ideal approach is to consider patient needs and family visiting preferences. “AACN Protocols for Practice: Creating Healing Environments 2nd edition” lists the following options for restricted visiting:
• Flexible visiting—A mutual decision between families and staff regarding who visits and the length and time of those visits.
• Contract—A written agreement with the family, patient and nurse regarding time, frequency and length of visits as well as the number, age and type of visitors.
• Patient-controlled visitation—A device used by the patient to signal when he/she wants (green light) and does not want (red light) visitors.
• Structured—Periodic visitation by two people for a longer period (e.g., 30-60 minutes) than the traditional 5- to-10-minute visit.
• Inclusive—Visiting is open except for specified hours agreed on by staff (eg, at shift change).
• Open visiting—No restrictions placed on frequency, time or length of visits. Number and type of visitors may be restricted.
Nurses sometimes restrict visiting to protect the patient from adverse physiological consequences and or protect their well-being.1 studies have been done that demonstrate this is not the best practice. Families have a beneficial impact on critically ill patient’s response to illness. Studies have shown no significant changes in the patient population group mean in blood pressure, heart rate and premature ventricular contractions and a decrease in intracranial pressure during patient-family interaction. 2,3,4,5,6
Although revising unit visiting policies is a good beginning, it is not enough. A successful transition to more flexible visiting practices depends on the positive beliefs and attitudes of the nursing staff.

1. Molter N. AACN Protocols for Practice: Creating healing environments. 2007 Jones and Bartlett publishers. Boston. Massachusetts.
2. Schulte DA, Burrell LO, Gueldner SH. Pilot study of the relationship between heart rate and ectopy and unrestricted vs. restricted visiting hours in the coronary care unit. Am J Crit Care. 1993;2:134-136.
3. Simpson T, Shaver J. Cardiovascular responses to family visits in coronary care unit patients. Heart Lung. 1990;19:344-351.
4. Treloar DM, Nalli BJ, Guin P, Gary R. The effect of familiar and unfamiliar voice treatments on intracranial pressure in head-injured patients.
J Neurosci Nurs. 1991;23:295-299.
5. Hendrickson SL. Intracranial pressure changes and family presence. J Neurosci Nurs. 1987;19:14-17.
6. Prins MM. The effect of family visits on intracranial pressure. West J Nurs Res. 1989;11:281-297.9

Evidence-Based Practice July 1 Is the Deadline to Apply for AACN Nursing Research Grants

Clinical Inquiry Grant
This grant funds an award of up to $500 to qualified individuals carrying out clinical research projects that directly benefit patients and/or families. Interdisciplinary projects are especially invited. Ten awards are available each year.

End-of-Life/Palliative Care
Small Projects Grant
This grant funds an award of up to $500 to qualified individuals carrying out a project focusing on end-of-life and/or palliative care outcomes in critical care. Examples of topics are bereavement, communication issues, caregiver needs, symptom management, advance directives and life support withdrawal. Two awards are available each year.

Medtronic Physio-Control-AACN
Small Projects Grant
Cosponsored by Medtronic Physio-Control, this grant funds an award for up to $1,500 to a qualified individual carrying out a project focusing on aspects of acute myocardial infarction, resuscitation or sudden cardiac death, such as the use of defibrillation, synchronized cardioversion, noninvasive pacing or interpretive 12-lead electrocardiogram. Examples of eligible projects are patient education programs, staff development programs, competency-based educational programs, CQI projects, outcomes evaluation projects or small clinical research studies. One award is available each year.
To learn more about AACN’s research priorities and grant opportunities, visit the Research area of the AACN Web site or email research@aacn.org.
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