Communication, Family-centered care, Visitation



  1. Heitman, Linda PhD, RN, ACNS-BC
  2. McClard, Catherine RN, BSN, CCRN


Critical care nurses identified that, although a liberal visitation policy was followed, patients and families occasionally expressed preferences for verbal communication, rather than have the visitor physically present in the unit. Previously tested communication devices interfered with operating equipment resulting in poor reception. The purpose of this project was to find an effective method for patients to verbally communicate with visitors.


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The last thing I can remember about my grandfather was getting to visit him in the critical care unit one time before he passed away. I was only 10 years old, and children were not allowed in the unit. All I can remember now is the machinery that was connected to him. It was very overwhelming for me as a child. I do not remember "seeing" him. I did not see him as the person I knew, but just "something" lying there hooked up to all of those machines.


This is not a memory we wish to create for children who have someone close to them as a patient in critical care. For a child to communicate verbally without their loved one, absent of frightening visual images, is a welcome alternative for families. For patients, those who can speak and those who cannot, the sound of the voice of someone they love could be immeasurably comforting. Critical care nurses can play an integral part in helping to preserve the spirit of the family.



Staff nurses identified that, although a liberal visitation policy was followed, patients and families occasionally expressed preferences for verbal communication with each other, rather than have the visitor physically present in the critical care unit. Previously tested devices for this purpose often interfered with the operation of existing equipment in the unit, compromised privacy, and or were difficult to operate. The purpose of this project was to find a simple, inexpensive, effective method for patients to verbally communicate with family members and friends when an alternative method of communication was requested by them.



An infant monitor was chosen for the project after testing a variety of models. The biomedical department was consulted to ensure that the device met equipment safety standards for the unit. Preliminary trials with the chosen devices showed no interference with equipment currently in use in the unit. Voice transmission was successful from a variety of sites within the unit and in adjoining rooms outside the unit. A project team of critical care nurses was assembled. In-services explaining the purpose and protocol of the project were conducted for the entire staff. For the project, 3 groups of individuals were identified for participation in the project: (1) patients with young children and grandchildren who feared they would be frightened by the physical environment of the unit, (2) family members and friends of patients on isolation when limitation of visitors was requested by the family or staff, and (3) friends designated by the patient or family. An information sheet outlining the project was placed at the registration desk in the critical care waiting room. The information sheets directed family members interested in participating in the project to convey their wishes to the nurse caring for their family member. Staff nurses were encouraged to identify potential patients and families who might be candidates to participate in the project.


Three infant monitors were placed in the unit. Instructions for use of the monitors and the protocol for the project were placed in a case with each monitor. A confidentiality statement and an evaluation sheet were placed in individual envelopes next to the monitors. When a patient and family member were identified for participation in the project, the staff nurse caring for the patient reviewed the process for voice transmission with them. A confidentiality statement was signed by the patient and the family member. When the project participant was a child, the confidentiality statement was signed by the child's parent or guardian. A time for the voice transmission was scheduled. The visitor was taken to a designated area just outside the unit to maintain privacy. Children were accompanied by an adult. The critical care nurse assigned to the patient assisted the patient and the visitor.



At the conclusion of each transmission, the staff nurse assisted with the completion of the evaluation and outcomes form. The form included evaluation of the project by the patient, when feasible, a family member, or friend and the staff nurse. In addition, a comments section allowed for narrative responses. Data were collected over a 4-month period with a total of 17 transmissions completed. Data sets were assessed for demographic and transmission data.



Patients, family, friends, and staff agreed participation in the project provided an effective alternative for visitation. The monitors proved simple to use with minimal interference. Evaluations completed by parents and grandparents of young children relayed that they were particularly pleased that their youngest family members were included in the critical care experience. Staff noted that children appeared at ease and enthusiastic throughout the transmission. Family and friends of patients in isolation, and visitors who were not feeling well themselves cited their appreciation for an opportunity to speak to the patient without physically entering the unit. Interestingly, large, extended families stated they felt they were not as intrusive in their request to communicate with patients when they could speak to the patient without trying to negotiate a time to visit with numerous other relatives and friends.


The monitors were of significant benefit for teenage patients in the unit. While parents permitted the patient's closest friends to visit the patient, other friends were permitted to visit with the patient through conversations using the infant monitors. Nurses felt that utilization of the infant monitors helped to honor their patient's wishes to communicate with friends and family, promoted patient and family safety, and helped to promote family-centered care. Additional applications of the monitors for use in the critical care unit, and other departments throughout the hospital, were identified by the critical care unit staff nurses. Upon their recommendation, selected applications are being adopted and evaluated in the critical care unit and other patient care areas.



The authors thank the Michael Williams family for their contributions to this endeavor.