Case Study: Engaging Patient in Shared Decision Making
You are a staff nurse caring for a patient in a critical care unit. The unit policy limits visitors to 10 minutes in the evening hours. You find yourself needing to frequently "bend the rules" because some families and their critically ill loved ones want to spend more time together, and they want more flexibility to visit.
A systematic review of both quantitative and qualitative evidence related to visitation in critical care units came to these conclusions:
- Flexible visiting hours are preferable to patients' families.
- Family members want to be close to the patient, speak to the physician every day, and have access to healthcare professionals with information to give them.
- Nurses understand that flexible visiting hours can be beneficial. Still, they can impede workflow and increase workload. Nurses want to control the policy.
- Hospital administrators should consider the nurses' beliefs and attitudes when they create visiting policies.
Answer the following:
Q1. Given the evidence of visiting hours and the evidence related to the individual and system-level implementation of evidence, what are the key issues related to implementing appropriate visitation policies?
Q2. What might be key individual barriers to evidence implementation?
Q3. What are system-level barriers to evidence implementation?
Q4. What are evidence-based strategies that enhance evidence uptake at both the individual and system levels?
Q5. How might you design an evidence-implementation strategy to overcome barriers and maximize facilitators of evidence uptake?
Q6. How important is it to understand the evidence related to enhancing evidence uptake?
Q7. What evidence needs to be generated to help advance our knowledge toward increasing evidence uptake?
Q8. How do individual barriers and facilitators interact with system-level barriers and facilitators of evidence uptake?
Q9. Do you think an individual can use evidence if the system does not support it in any way? Why, or why not?