Policy Memorandum
To: Angela Adjetey, Nursing Director of Oncology Service Line. New york Presbyterian Hospital Weill/Cornell
From: Chinsia Francis-Hill
Re: Visitation Policy for Medical Oncology Unit
Date: 9/15/15
EXECUTIVE SUMMARY
The medical oncology/hematology unit is designed to meet the medical and emotional needs of oncology patients. It is concerned with diagnosis, chemotherapy administration, hospice and palliative care (New York Presbyterian Hospital, 2014). Being admitted on a medical oncology/hematology unit can be very challenging and depressing for patients, nurses, ancillary support staff and family members (American Cancer Society, 2014). At this current hospital, open visitation hours are well supported to meet psychological and emotional needs of all patients. According to Center of Medicare and Medicaid centers (CMS), every hospital should inform patients of their visitation rights (CMS, 2015). One of the main advantages of open visiting hours is that family members can be with the patient all the time in case of physical and emotional hardships (Pervan, Cohen, & Jaftha, 1995). The same advantage has been a limitation for patients and staff members. Hence, visitation hours can be tailored, due to infection control, treatments, social issues and end of life care (New York Presbyterian Hospital, 2015). But in recent times, there have been challenges that have become a burden for patients, staff members and visitors on the medical oncology unit. This is contributed by open visitation policy. Such challenges include fatigue due to the lack of sleep, interference with patient care and lack of privacy (Johnson et al., 2013). Therefore, visitation policy should be tailored according to unit base.
PROBLEM
Fatigue is one of the major side effects of receiving chemotherapy treatment and radiation (National Comprehensive Cancer Network, 2015). Not having adequate sleep and rest affects healing and may negatively affect patient quality of life (National Comprehensive Cancer Network, 2015). A recent study shows that 70% of ICU patients have sleep disturbance, which is the most traumatic aspects of their ICU stay. According to Matthews, sleep disturbance causes fatigue, which is mostly caused by the family members communicating and huddling in the hallway (Matthew, 2011). This issue affects Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) and eventually affects revenue.
Open Visitation hours are also problematic for patient care. Family members can exhibit potential interference in the medical care and their behavior may cause problems to staff members (Johnson et al., 2013). A recent survey was conducted which illustrates the negative impact of 24-hour visiting policy. The results show that “53.3% of the participants do not think that the open visiting policy consistently increases family satisfaction with patient’s care; 59.4% of ICU workers think that the open visiting policy impairs the organization of the patient’s care; 72.7% of participants believe that their work suffers more interruptions because of the open visiting policy” (Ramos et al, 2013). Families can cause delay or may prevent the completion of medication procedure and may verbally abuse staff members. Families may demand excessive staff time, which ultimately affects other patient’s care and may even cause disputes between families (Johnson, et al., 2013). Caregivers may reflect confusion because of the intense anxiety and overwhelming nature of their experience. Some families at the hospital have unrealistic expectations of nurses and ancillary support staff and sometimes may become violent (Berger et al., 2010).
Continuous and prolonged visiting hours affects patient privacy. Patients may also feel uncomfortable when visitors are around. As a result, patient may feel that their dignity is being loss (Hunter et al., 2010). On the oncology unit, visitors oftentimes consist of five or more family members. They sometimes share restroom and may try to seek medical information of the neighboring patient. Another issue associated with lack of privacy is that patient may not express their needs and may withhold critical information if they think someone could hear what they have to say. Hence, ultimately affect patient care (Hunter et al, 2010). At this current hospital, most rooms are semi-private and family members may camp out in patient’s room as well as sharing restroom. This behavior is unacceptable and has caused inappropriate behaviors on the oncology unit. It often leads to disturbance to other patients and sometimes cause disputes between family members on our current oncology unit.
POLICY OPTIONS
Complications due to open visitation hours for families ultimately have resulted in a need of new visiting policy for families of patients that are admitted on the medical oncology unit.
Visitors should not sleep in semi-private room
First of all, patient should only be allowed to sleep over only if there is a need for a night stay: The requesting patient’s family member or proxy must be referred to the Nurse Manager /Nurse administrator on call only if its urgent situations such as end of life, newly diagnose or first line of chemotherapy. All visitors must be instructed to stay in the patient’s lounge. However, due to space limitations cots or foldout chairs should not be allowed in the visitors lounge as well.
Informed Knowledge: Clarification of visiting hours
Open visitations and sleeping over should be clarified and inform to patients and visitors at admission. Visiting hours for families should be flexible however, families should always follow directions in an appropriate manner. Family members should understand the difference between open visitations and sleeping over. The advantage of this clarification is to give patients sufficient time to take a rest, reduce noise level, meeting patient expectations and satisfaction (McAdam, 2013). A study was conducted on a visitation practice in a healthcare setting. The result shows that family members are more likely to be cooperative when information is given to them at admission (McAdam, 2013)
Two visitors rule
Thirdly, only two visitors are allowed to visit a patient in a semi-private room at the same time. At admission, it should be a policy for each patient to receive a booklet of visitation guidelines. This booklet will educate patients and family members of visitation rights and the rules associated with the hospital policy. It will also prepare family members to decide on what time will be appropriate to visit their love ones. Consistency is key. The same information should be communicated to visitors with no exception.
Quiet Time
Quiet Time hours must be respected. If a patient and overnight visitor wish to converse during quiet time, they must go to the patient lounge. All cell phones should be turn off or be place on silent when visiting a patient in a semi-private room. All calls should be answered in the patient lounge and not in patient’s room or hallway.
Security Rounding
Security rounding should be implemented to identify disruptive behaviors. Visitors should check with security before entering the unit. Clarification of disruptive and unsafe behaviors should be communicated to visitors during this time.
Late visitation
The patient and the registered nurse taking care of the patient should do approval for late visitation. Patient and visitors should communicate in the patient lounge and not in patient’s room if family members want to visit patient at a late time.
As we move forward, there is a need to improve and individualized visiting policy for oncology patients. These suggestions will assist in achieving these goals and improve patient satisfaction. I thank you in advance for your time, ideas and support. I am looking forward to assist in a solution.
References
American Cancer Society. (2014). Emotional Impact of Cancer Diagnosis. Retrieved from http://www.cancer.org/treatment/treatmentsandsideeffects/emotionalsideeffects/copingwithcancerineverydaylife/a-message-of-hope-emotional-impact-of-cancer
Berger, A. M., Shuster, J. L., & Roenn, J. H. (2010). Principles and Practice of Palliative Care and
Supportive Oncology. United States: Wolters Kluwer Health.
Centers of Medicare and Medicaid Services. (2015). Hospital. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/Hospitals.html
Hunter, J., Goddard, C., Rothwell, M., Ketharaju, S., & Cooper, H. (2010). A survey of intensive care unit visiting policies in the United Kingdom. Journal Association of Anaesthetists of Great Britain and Ireland, 65(11).
Johnson, F. E., Maehara, Y., Browman, G. P., Margenthaler, J. A., Audisio, R. A., Thompson, J. F.,
et al. (2013). Patient Surveillance After Cancer Treatment. United States: Springer Science.
Matthews, E. (2011). Sleep Disturbances and Fatigue in Critically Ill Patients. AACN, 22(3), 204-224.
McAdam, J. (2013). Critcal Care. Open visitation policies and practices in US ICUs: Can we ever get there?, 17(4), 171.
National Comprehensive Cancer Network. (2015). Fatigue. Retrieved from http://www.nccn.org/patients/resources/life_with_cancer/managing_symptoms/fatigue.aspx
New York Presbyterian Hospital. (2014). Cancer. Retrieved from http://nyp.org/services/oncology/index.html
New york Presbyterian Hospital. (2015). Visiting Poilcy.
Pervan, V., Cohen, L. H., & Jaftha, T. (1995). Oncology for Health-Care Professionals. Capetown:
Ramos, F., Fumis, R., Azevedo, L., & Schettino, G. (2013). Ann Intensive Care. Perceptions of Open Visitation Policy by Intensive Care Unit Workers, 3(34).
The writer does a good job of illustrating to seriousness of a 24 hour visitation policy and the effect that will have on the patient. I agree that patients require a tremendous amount of rest, but with that policy, most patient will not be able to receive the required amount of rest they are suppose to get. The writer presents lots of statistical evidence such as how much the patient visitation police effect not only the patient, but also the staff members as well. The staff should be able to focus on their work and devote their attention to the patient. When there is a lot of commotion around, it is hard for the staff members to work in a good environment.
This is such and important topic. With any new policy there are always new problems that develop. I think you illistrated the situation very well along with some solutions. The nurse should not be responsible for policing the hospital and asking family members to leave. Your solutions are reasonable and your memo was well written.
Very Good
This problem’s severity was definitely conveyed well enough that I believe it would get put at the top of the policy changer’s pile, especially since the stance being taken would not be considered very popular by the majority of people, especially those outside of the medical field. Cancer is inherently an emotional topic so it might be helpful to approach the limitation of family visits with more delicate and bureaucratic language. This could also balance out the use of facts and technical terminology. Just adding in a few choice words and phrases that would really appeal to the reader’s humanity for YOUR side of the argument could help alienate less readers. If they happen to be someone that is currently being told they cannot visit their sick family member in the oncology unit, they probably would not be inclined to align their opinion with yours largely due to the emotions being evoked; and you have done a great job of stating the factual benefits of this policy change, it just might be easier for a reader to put their feelings aside and fully comprehend the positive aspects of this change if the idea is being presented in such a technical way.