Open Visits Research Articles

OPEN REGIME OF INTENSIVE CARE UNITS PATIENT VISITS: EXPERTS OPINION

Resume. The issue of open visits to intensive care units is currently a topical, acute and ambiguous issue. In Ukraine, it is actively discussed in the media, social networks, the medical community. Appropriate working groups of the Ministry of Health are being set up to optimize the regulatory framework on this issue.The article reviews the literature on the problems of open visits of adult patients undergoing treatment in the intensive care unit. Opinions on this issue are quite contradictory. On the one hand, there is a position that the stay of relatives in the ICU 24/7 improves the results of treatment, creating a more comfortable psychological atmosphere for the patient. On the other hand, and this approach prevails, a number of studies indicate an increase in the number of bacterial complications in patients with unlimited visits, complication of working conditions of medical staff, which leads to a deterioration in treatment outcomes in general.Public organization «Association of Anesthesiologists of Ukraine» conducted an online survey among anesthesiologists - members of the association for find out the opinion of Ukrainian experts about open visits to ICU’s patients. Most of the anesthesiologists surveyed are inclined to a limited visitation regime.

Perspectives of intensive care nurses on open visits in an ICU

ObjectiveTo determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy. MethodA cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions. Results101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family. ConclusionsMost of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family.

Perspectivas de los profesionales de enfermería de cuidados intensivos sobre las visitas abiertas en una UCI

ObjectiveTo determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy. MethodA cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions. Results101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family. ConclusionsMost of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family.

ICU Nurses’ Perception of Visits to Patients

Introduction. Visits to patients are part of a positive and effective strategy of helping patients and their families to better adapt to the stress caused by a patient’s admission to an intensive care unit (ICU). Aim. To determine the ICU nurses’ perception of visits to patients. Methods. The study was conducted at the University Hospital Centre Zagreb (UHC). The cross-sectional study included nurses who work in ICUs. An anonymous, self-designed questionnaire was used and filled in by 44 respondents. The questionnaire consisted of 17 closed-ended questions pertaining to demographic data, questions related to information on visits and questions about the concept of open visits. Results. Out of the total number of 44 respondents, 25 respondents stated that their ICU has booklets about the manner of visits and visiting hours, and that they hand them out to families, while 19 respondents stated that they do not have such booklets. 61% of the respondents feel they have sufficient training to communicate with the patient’s family. 41% of the respondents said that the visits had a positive effect on the patient’s condition and only 2% stated that the visits had no positive effect. 57 % of the respondents think that visits sometimes have a positive effect on the patient’s condition. Of the total number of respondents, 84% feel that visiting hours should be limited. Respondents feel that visits sometimes impede them in their work (66%), while 59% of the respondents feel that visits help spread infections. Out of the total number of respondents, only 32% of them stated that they were familiar with the open ICU concept. Conclusion. More than half of the respondents stated that they have a written visiting policy on ICU wards, and that they are trained to communicate with the family members of patients. Most respondents feel that visits contribute to the spread of infections and that they would limit children’s visits to the ICU. The respondents’ poor knowledge of the open ICU concept creates one of the barriers to introducing it in their wards.

Integrated continuous care: implementation in Mato Grosso do Sul, Brazil

The demographic transition that occurred in Brazil brought changes in its health indicators. Integrated Continuous Care (ICC) was organized as a health care model aimed at increasing the independence and well-being of people with acute or recent functional dependence. This study aimed to describe the development and implementation of the Integrated Continuous Care in the state of Mato Grosso do Sul, Brazil. This care model utilized the principles of the National Humanization Policy, such as the extended and shared clinic, embracement, educational practices and meetings with caregivers, families, and patients, open visits, participation and autonomy of the patient and family in the construction of the Singular Therapeutic Project, and shared discharge from hospital. Assistance and support to patients who were already released from ICC must be increased in the primary health care setting to ensure continuity of recovery, better readaptation, and successful family and social reintegration. As a positive result, we set up an outpatient clinic for ICC patients who needed continuous clinical follow-up after rehabilitation. This allows patient re-evaluation, reduces re-admission rates, and maintains the domiciliary care management educational process. As an innovative approach to improving health care outcomes, ICC allows the patients to leave the hospital environment and go home on some weekends. The ICC project has enabled many advances, especially in patient-centered care and shared decision-making. The support of the São Julião Hospital administration has been vital to the success of ICC Unit treatments.

Oleuropein reduces anxiety-like responses by activating of serotonergic and neuropeptide Y (NPY)-ergic systems in a rat model of post-traumatic stress disorder

ABSTRACTPost-traumatic stress disorder (PTSD) is a stress-related mental disorder caused by traumatic experiences. This psychopathological response to traumatic stressors induces anxiety in rats. Oleuropein (OLE), a major compound in olive leaves, reportedly possesses several pharmacological properties, including anti-cancer, anti-diabetic, and anti-atherosclerotic and neuropsychiatric activities. However, the anxiolytic-like effects of OLE and its mechanism of action in PTSD are unclear. The present study used several behavioral tests to examine the effects of OLE on symptoms of anxiety in rats after a single prolonged stress (SPS) exposure by inhibiting the hypothalamic-pituitary-adrenal axis. Male Sprague Dawley rats received OLE (10, 50 and 70 mg/kg, i.p., once daily) for 14 days after SPS exposure. Daily OLE (70 mg/kg) administration significantly increased the number and duration of open arm visits in the elevated plus maze (EPM) test, reduced the anxiety index and grooming behavior in the EPM test, and increased the time spent and number of central zone crossings in the open field test. OLE also blocked the SPS-induced decrease in hippocampal serotonin and neuropeptide Y expression in hippocampus. These findings suggest that OLE has anxiolytic-like effects on behavioral and biochemical symptoms similar to those observed in patients with PTSD.

Effects of Ginsomin<sup>®</sup> on Selected Behaviours in Mice

Objective: To study the effects of ginsomin® on behaviours of healthy mice using the open-field, Y-maze, eight-arm radial maze and the elevated-plus maze. Method: Groups of mice were administered vehicle (distilled water), scopolamine (2 mg/kg), diazepam (2 mg/kg), or one of two doses of ginsomin (0.5 and 1.0 mg/kg) for 21 days. Behavioural assessments were carried out after the first and final dose of treatment. Result: Repeated administration of ginsomin was associated with a decrease in weight gain, in comparison to vehicle. In the elevated plus maze (EPM), administration of ginsomin resulted in an increase in time spent in the open arms and number of open arm visits in comparison to vehicle, but not diazepam control. A dose-related increase in open-field horizontal locomotion and rearing behaviours; and improvements in Y-maze and radial arm maze spatial working-memory performances were also observed. However, self-grooming behaviours were significantly reduced after repeated administration. Conclusion: Ginsomin administration in healthy mice is associated with significant behavioural changes; hence, our findings support its perception as a ginseng-containing mixture with profound central nervous system effects.

Improving compliance with influenza vaccination for hospital healthcare workers from high-risk areas: A 6-year analysis

BACKGROUND: Influenza causes significant morbidity and mortality among patients, mostly those with immunosuppression, at extremes of age, and with significant comorbidities. Healthcare workers (HCWs) play a significant role in preventing morbidity and mortality of their hospitalized patients by being properly immunized against infectious diseases. However, compliance with influenza control programs has been limited overall in the United States, with only 36% of the workers with direct patient care annually immunized. New challenges were placed to increase immunization among HCWs in 2004-2005 due to the influenza vaccine shortage. OBJECTIVES: 1) Increase accessibility to influenza vaccination program for HCWs in high-risk areas at an academic hospital through several activities. 2) Demonstrate through results of aggregated data from 6 years that there was a significant improvement in compliance with the influenza vaccination in those high-risk patient areas. PROJECT: In the past 6 years, we increased the access to influenza vaccination throughout the hospital by 1) open visits to employee health service with nursing staff for vaccination throughout the "flu" season, 2) mobile clinics throughout the hospital's high-risk areas at the various working shifts, 3) intensive educational campaigns, and 4) 12-hour blitzes open to HCWs through a prioritized system. Data on influenza vaccine administered to high-risk HCWs was collected and analyzed by chi square comparing 1999-2000 (baseline) to 2003-2004 and 2004-2005 seasons. LESSONS LEARNED: There was a significant overall improvement in compliance with the influenza vaccination program in high-risk areas (p=0.001) in the year 2003-2004, when compared with baseline year (1999-2000). Two out of five identified high-risk areas had no significant improvement over the past 6 years. Compliance with influenza can be improved with a multifaceted approach emphasizing accessibility. Influenza vaccine shortage may have played a significant role in increasing compliance with the "flu" vaccination among high-risk HCWs. High-risk areas with poor response to the vaccination program will require specific training and different strategic planning.