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Limited versus Open Visitation in critical care unit

Proposal overview

Family members need their proximity to be close to the patients. This has been an issue of debate, characterized by myriad of controversies, involving nurses, families and patients. As Lockwood notes, a section of the nursing fraternity strongly hold that restricted visitation is the way to go (Lockwood, B. 2010).The position assumed by this group of practitioners fails to be in harmony with what Vickie believes as the right thing to do. 

To Vickie, flexible or open visitation is good for the family and the patient, but at the discretion of the nursing practitioner. She contends that “while sometimes visitation may be inconvenient for the nurses”, the goal of nursing is always to give “the best possible care” for their patients (Vickie, A., 2005).She further notes that there is nothing wrong doing what is in the best interest of the patient (Vickie, A., 2005), even though some of her nursing colleagues had totally different views concerning this flexible visitation. 

Partly in support of (Vickie, A., 2005), is Henneman and Dewa who posit that open visitation is significant in helping improve the condition of the patient and satisfy the needs of both the patient and the family at the same time (Henneman EA, McKenzie JB, & Dewa CS, 1992, 85-93)

The common knowledge held by many nurses supporting restrictive visitation, as Armellino, Griffin,and Fitzpatrick confirms, is that the limited visitations in critical care units is needed to provide safety and protection of the patient from what the nurses perceive as acting in the best interest of the patient(Armellino, DW. Griffin, M. T., & Fitzpatrick, J J., 2010).

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These are indications that research studies that have so far been conducted by different professionals have not yet helped solve the many controversies existing between restrictive and open visitation policies. The policies have incessantly faced many challenges from either sides, the family versus nurses, nurses against themselves, and patients at the mercies of the two decision makers (Smith, et al,2009).

In their research work published in a journal titled, “Journal of Nursing Care Quality”, Patricia Roland, Janet Russell among others, highlights that the need to look into the effects caused by restrictive visiting as opposed to open visiting had been facilitated by the dissatisfaction state of the family members against the restrictive visiting policy. “When family members became dissatisfied with a restrictive visiting policy in a combined coronary and medical intensive care unit, this situation was seen as an opportunity to better meet patient and family needs” (Roland PB, Russell, JR, Richard KC, & Sullivan, SC., 2001).According to the “Journal of Nursing Care Quality”, some literature reviews also showed that “open visitation policies enhanced patient and family satisfaction” (Roland PB, Russell, JR, Richard KC, & Sullivan, SC., 2001). 

In line with all these issues raised, this paper, therefore, endeavors to investigate and re-assess the impacts that are likely to be brought about by limited versus open visitation in the critical care units. To what extent will restricted visitation policies hamper or improve the conditions of the patients? How about open visitation policies; do they have greater impacts as compared to the limited visits? These are a few of the questions that this paper will be seeking to address elaborately. 


Armellino, DW. Griffin, M. T., & Fitzpatrick, J J. Journal of Nursing ManagementHealth 

Reference Center Academic via Gale2010. 796 (8). 

Henneman EA, McKenzie JB, Dewa CS. An evaluation of interventions for meeting the 

Information needs of families of critically ill patients. Am J Crit Care. Boston. 

Massachusetts General Hospital.1992. 85–93. 

Lockwood, B. Workplace culture and critical thinking. Dissertations & Theses. United 

States. University of Illinois: Chicago. 2010. Publication No. AAT 3381327

Roland PB, Russell, JR, Richard KC, & Sullivan, SC .Journal of Nursing Care Quality. 

Managing Clinical Outcomes. January 2001. 15(2): 18-26 

Smith, et al .The Impact of Hospital Visiting Hour Policies on Pediatric and Adult 

Patients and their Visitors .Systematic Reviews. Evidence-Based 

Resources: Joanna Briggs Institute.2009. 38-79

Vickie A. Critical Care Visitation. Dimensions of Critical Care Nursing –Featured Journal 

2005.Vol 24.48-49


Reaction Paper to Japan Earthquake 

Organizational development reaction paper to Japan earthquake

Japan was hit by the largest earthquake ever recorded on this country that is used to earthquakes on March 2011. The earthquake left hundreds of people killed, missing, injured and a lot of destruction to property. The reaction by the humanitarian, relief and rescue organizations were timely though the incorporation Organizational Development (OD) principles in their rescue operations could have improved the quality of the rescue efforts. Organizational development refer to the use theories, values, strategies and technologies all aimed at facilitating change in the process to enhance the performance of an operation (Rothwell and Sullivan 2005.

 OD is a process that starts with identification of the need for a change or a problem that needs a solution for improvement of operations. The problem in this case of Japan earthquake is the need to bring relief in terms of rescuing the affected people, creating awareness on the after-effects of the disaster and providing recuperating necessities to the affected people. This problem should be clearly understood and all efforts of finding solutions should be directed towards it. The assessment of the magnitude of the destruction caused by the earthquake is the next step that should follow to determine the level of intervention that the teams involved in the relief-creating process should adopt. More than one intervention strategies may be adopted and used in different areas because the earthquake struck different areas of Japan.

 Planning for interventions strategies adopted is very crucial for disasters like earthquakes because quick evaluations are required to determine the satisfactory progress made and if there is need for adoption of alternative intervention methods. In this particular Japan disaster, the OD process is cyclical because it should only end when everybody affected by the disaster is accounted for. Implementing the interventional strategies and evaluation of such strategies is the most important steps in the OD process. These two steps help in determining the success of the rescue operation as well as proposing points of improvement or alternative strategies for the same and future disasters.


Rothwell, W. J. and Sullivan, R. (2005). Practicing Organization Development: A Guide for Consultants. San Francisco: John Wiley and Sons.


Innovative Opportunities for Nurses


Nursing is a healthcare profession that is very critical in the field of medicine. Nurses work in a wide array of environments and specialties. These include emergency departments, outpatient and intensive care units. Nurses dedicate their lives to making patients recover fast and also in a well rounded environment. Since the year 2002, Infinity Nurse Practitioners has been employing nurses whose specialty is in medical management of residents of skilled nursing facilities (Infinity NP, 2010).

According to Infinity nurse practitioners, early intervention in the well being of patients is the foundation for effective deliberation of their vision (2010). These efforts enhance the lives of beneficiaries of these services. This ensures that adequate quality care is accorded to the beneficiaries. In collaboration with other physicians who offer primary care, NPS accords timely reactions for to a wide assortment of needs. This includes routine checks for patients with chronic conditions and also victims of random accidents and injuries.

The number of patients who need constant or urgent medical attention in America is growing relative to the country’s population. The government finds strain on health facilities to offer these services to needy individuals. This puts strain on the government in offering these medical services to society. At times, the situations may be so hard to a point medical institutions find it necessary to cut down on costs. This may be done through lying off part of the staff and also incorporating other cut back methods.

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As American citizens and leaders continue to face the problem how to satisfy the needs of needy citizens with chronic diseases and disabilities (Stone, 2000), nurses continue to find it hard to find sustainable jobs. The media has even shown the burden that individuals, family units and society continues to face as a result of the current state of the quality of care accorded owing to the tough financial times being experienced. Policymakers’ efforts to implement strategies that improve the conditions in the health industry have been minimal in securing the interest of nurses. 

Optional Services

In an effort to ensure their interest of nurses, nurses have come up with initiatives to ensure their livelihood. Registered nurses have many options to specialize in different areas of treatment (Bureau of Labor Statistics, 2010). According to the bureau, nurses providing preventive care and Telehealth services (which are offered through electronic equipment such as videoconferencing, internet or even the telephone (Scofield, 2008).

The Bureau of Statistics maintains that some emergency nurses who may be qualified to provide services as transport nurses could provide medical attention to patients who could be transported by air to the nearest medical institution for medical care. This is an effort that creates more jobs to nurses as hospitals and other medical institutions may not be able to accommodate them due to lack of adequate funds.  Organizations that offer these services my employ nurses to offer the services as a way of creating jobs. Nurses that provide holistic services take part in services such as acupuncture, aroma therapy, massages and biofeedback (Bureau of Statistics, 2010). The bureau adds that nurses are dedicated to treat patients with spiritual, mental and physical health.

Nurses on House call

The bureau of Statistics suggests that home healthcare nurses would grant home nursing care to patients. This care is usually in the form of follow up care that is done after the patients are discharged from health institutions. Patients that require follow up care are usually discharged from rehabilitation, nursing facilities and long term care units. Palliative care and hospice nurses provide care to patients at home or in their respective hospice settings. They focus on improving or maintaining the quality of life for the terminally ill individuals.

Advantages of Innovative Nursing Activities

By offering these services in these settings, innovative ways of offering jobs to nurses are implemented. More nurses find job opportunities and at the same time more efforts will be accorded quality care that ensures their lives are improved or their quality maintained. Such opportunities are innovative as they tackle both the sustainability of the availability of jobs to nurses and at the same time ensure quality of life of patients. Some nurses may choose to go into private practice to offer these services in a freelance mode so as to source for clients who are willing to pay for the services that the nurses offer. This will create more jobs to nurses that may be experiencing problems of job sustainability.


The innovation of these opportunities will be an added input to the increase of employment in the current and future periods. Such nurses working in these innovative plans are much better as they can be able to determine their area of work, time schedules and also amount of income a nurse earns.


Infinity Nurse Practitioners  (2010). The opportunity to make a difference and the freedom to be yourself. Employment Opportunities .

  Scofield, J. (2008). Innovative Nursing Placement Program Expands Throughout Country. Foundation for California Community Colleges .

Stone, R. I. (2000). Long-Term Care for the Elderly with Disabilities: Current Policy, Emerging Trends,and Implications for the Twenty-First Century. Milbank Memorial Fund .


Week 4 Discussion

Affordable Care Act

The Affordable Care Act (ACA) and Patient Protection is based on the significance to reduce healthcare care spending. In today’s healthcare system, the rapid rise in healthcare spending has become a threat to the future of the United States (Sanders et al. 2016). As an advanced practice nurse, I have the potential to lower the healthcare cost by assuming provider roles within the healthcare workforce to provide care services equal or better quality at lower costs than other care providers.

         Also, as an advanced practice nurse, I will strive to reduce medical errors by being in the frontline of medical care in the hospital and supply caretakers and clinicians with diagnostic information that is critical in preventing medical errors. I would advocate for implementation of healthcare informatics which will help to reduce medical errors and improve patient outcome. Healthcare informatics does not only give providers timely and accurate access to patient information, but it also reduces and prevents medical errors (Van Cott, 2018).

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         Misuse and overuse of services are problems that affect both cost and quality of care. It is estimated that about 30% of all healthcare spending in the U.S lead to no benefit to the patient and some even results in harm (Nassery et al. 2015). For instance, unexplained use of angioplasty, open heart surgery, and use intensity of healthcare care system cost approximately 600 billion dollars per year avoidable costs. Misuse of drugs and treatment is also estimated to cost 53 dollars, and overuse of antibiotics for respiratory conditions cost about 1.2 billion dollars (Nassery et al. 2015). These are just a few examples that plague all purchasers of healthcare including state employee benefit purchasers and Medicaid agencies. As an advanced practice nurse, I would make efforts to reduce misuse and overuse services by identifying opportunities to minimize misuse and overused services. For instance, I would encourage my organization to prioritize among a list of misused and overused services. I would also support the organization to consider criteria for prioritizing such as frequency and cost of the problem and relative risk to patient safety. This approach will help to create awareness of services which are likely to be overused or misused.  



  1. Nassery, N., Segal, J. B., Chang, E., and Bridges, J. F. (2015). Systematic overuse of healthcare services: a conceptual model. Applied health economics and health policy, 13(1), 1-6.
  2. Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., ... and Salomon, J. A. (2016). Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. Jama, 316(10), 1093-1103.
  3. Van Cott, H. (2018). Human errors: Their causes and reduction. In Human error in medicine (pp. 53-65). CRC Press.

Impact of Pandemic on Opioid Dependent Patients in the United States

The Opioid Epidemic During the COVID-19 Pandemic

With the current global pandemic of the coronavirus, it is evident that other deadly illness continue to receive little or no attention within the healthcare system.   In the United States, the arrival of the Covid 19 coronavirus pandemic continue to provide an anticipated haven for the already dangerous opioid epidemic. There have also been a lot of covid-19 related protective shelter in place orders which continue to push individuals to fight for the sobriety into the level of isolation and continue to reduce the access to opportunity and treatment for the distraction from addiction (National Institution of Drug Abuse, 2020).  In this regard, the addiction community continue to raise a lot of alarm in the current regarding the current epidemiological climate for opportunity and climate alone as a major risk factor in regard to substance the relapse of substance abuse which continues to make the pandemic appear as a national relapse trigger.  The issue of social distancing thus continues to seal a surge when it comes to the people of opioid abuse, thus leading to the mortality and morbidity that is larger than anyone seen before.

The Opioid pandemic continues to also cause the morbidity and pathology beyond the level of bodily health in regard to the individual patient and the collective level.  Just like other forms of epidemics throughout history, the aspects of disability and causation loss and disability can also be viewed in public and the private economies, in addition to the collective societal cache. Also this is perceived in the astronomically inflated managed level of care costs, which also reduces the productivity in the labour market, and the cost of various opportunities in regard to the body of public resources (Parshley, 2020). Also, when looking at the oversimplified view regarding the said situation could also lead for some medical practitioners to refuse the prescriptions for Opioid and coverage which is also an effective response to both the health and the costs of management in regard to the Opioid epidemic.

Various studies have also continued to indicate that patients who suffer from the disorder of opioid dependence in the setting of occupational and spinal disorders that are also less likely to improve the social function and the vocational function which also has longer lengths of disability in 3 ways. Also studies shows that these patients are 2.5 times more likely to have had the pre-treatment surgery, which is 1.7 times more likely to engage in regard to the utilization of healthcare with new providers (Parshley, 2020). They are also 1.5 times more likely to be legally represented. The inefficiencies and the costs are also not viewed in case controlled subjects with same type of spinal pathologies that also do not become opioid dependent.

Also, when looking at the trend of increased disability severity and the length related with the use of opioid, medial charges and private insurance for patients that suffer from abuse of opioid in addition to the dependency which is more than around 550% higher than the average of the annual per-patient charge. The point related to such data also encompasses the costs in regard to related comorbid conditions like pain related diagnosis, substance use and psychiatric behavior.  There is also the issue of increased hospitalization for people with Covid 19 including the increase of people visiting the emergency department. These are also not the costs of opioid prescription, and will not see a reduction of the prescription coverage. Dependent patients will also feel the impact in regard to private insurance which will have to bear with the inflated price tag related to healthcare in regard to the opioid epidemic.  About one third of the patient currently receiving treatment for the use of opioid are covered by the Medicaid (Taylor, 2015). Looking at the impact that the pandemic is making on the physical and institutional costs for opioid epidemic, even with the adequate trials of scale, time and effort to combat it which also calls for the need of a tactical change.

According to the current statistics it is evident that various years of focussing the attack on limiting access to opioid especially for patients that have become independent on the use of opioid which is also not improving the outcome especially for patients in the United States. In the same line, the advent of Covid 19 pandemic continue to offer a lot of painful learning opportunities. Where different insights regarding factors related to issues such as social distancing that continue to worsen the point of epidemic to the opportunities required in combating the problem through a number of treatment approaches to ensure that changes are directed on the antithesis of social distancing (Parshley, 2020).  This means that in the event social distancing is going to bolster the current opioid situation in the country, the opposite behaviors that strengthen the attack on the condition, techniques for stress reduction, emotional resiliency, health education and human connection through group treatment especially where the epidemiology is viewed as being safe. 

In conclusion, the current pandemic as completely altered approaches to opioid dependent patients leading to limited access and optional treatment such as buprenorphine, promotion of sustainable and appropriate physical activity and integrated interdisciplinary modalities.  It is also important to establish a novel treatment approach like one that will invests on the early and robust healthcare alternatives to ensure that patients who are opioid dependent address the factors which makes then vulnerable to opioid dependency.


National Institution of Drug Abuse. (2020, May 27). Opioid overdose crisis | national institute on drug abuse. National Institute on Drug Abuse. Retrieved July 23, 2020, from https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis

Parshley, L. (2020, April 21). The pandemic may fuel the next wave of the opioid crisis. www.nationalgeographic.com. Retrieved July 22, 2020, from https://www.nationalgeographic.com/science/2020/04/coronavirus-pandemic-may-fuel-the-next-wave-of-the-opioid-crisis/

Taylor, D. R. (2015). Managing patients with chronic pain and opioid addiction. In Managing patients with chronic pain and opioid addiction (pp. 39–68). Springer International Publishing. https://doi.org/10.1007/978-3-319-08111-3_4