In the PICU, as in all other areas of University of Iowa Children's Hospital, parents and family are important members of the health care team. They bring the child comfort and provide important information to the physicians, nurses, social workers, pharmacists, respiratory therapists, and dietitians caring for their child.

Recently, as part of a research project for the National Association of Children’s Hospitals and Related Institutions (NACHRI), seven PICU nurses conducted a study and pilot program involving parent visitation that resulted in a significant change in the way everyday activity carries on in the PICU.

"It all started with an invitation from NACHRI to come up with an intervention that would make the work environment for nurses a little less difficult," said Tina Davenport, RN "Naturally, we had to choose something we could actually change," she said.

Lori Alliss, RN, assistant nurse manager said, "We had no idea that the seemingly small change we incorporated would have such a significant impact on not only the work atmosphere for our nursing staff, but on the larger scope of family-centered care we provide.

"We do so many difficult things here every day. I never thought this change would bring so much attention; but it has, and it has greatly enhanced the atmosphere for our nurses and the families of patients we care for," she said.

What Allis is referring to is the new Open-Door policy for visitation in the PICU. Previously, parents were prevented from being in the unit at certain times each day. These included: the time when nurses changed shifts and gave reports, during bedside rounds in the area, which began every morning at about

9 a.m. and could last up to three hours, during the time when new patients were being admitted, and during an emergency.

Naturally, this added some stress for patients and families who wanted to be with their children during those times to speak with a physician directly or to check their child’s progress.

The old policy increased stress for nurses as well. In addition to all of their other duties, nurses had to field numerous phone calls from parents and family members.

"I felt quite stressed about this," Allis said. "The old policy often put nurses in the middle of parent-physician communication, and required us to try and guess what time of the day parents could be with their children–a nearly impossible situation given the kind of work we do here."

Nurses also needed to reiterate for parents the details of how their child spent the past 24 hours.

After conducting surveys of families, physicians, and nurses, and after collecting and compiling the data, new guidelines for family visitation were written that effectively invite parents and families to be in the unit whenever they want. Now, parents can observe the medical team’s interaction with their child, listen and ask questions during morning rounds if they choose, and communicate directly with the physician team rather than waiting until later in the day after rounds and procedures are over.

For their work, PICU nurses including Allis and Davenport, Sue Crimins, Kathleen Donovan, Barb Freyenberger, Jeanna Humpton and Tricia Michna were given an Improving Our Workplace Award from the University of Iowa. A reception was held March 9 and the nurses were each given $100 gift certificates from the IOWA Review Committee.

Patients and families were given a reward as well–the reward of greater access to their children and the health care professionals who care for them.

There are certain limits, of course. No more than two visitors are permitted at the bedside at a time. No food is permitted at the bedside, and parents and visitors may still be asked to leave the area during a medical emergency. But these restrictions are understandable and not problematic for families.

The PICU Staff

• Lori Allliss, RN, assistant nurse manager
• R. Erik Edens, MD
• Barb Freyenberger, RN, APN
• Caroline George, MD
• Brenda Gordley, activities therapist
• Michael Kelleher, MD, medical director
• Fred Lamb, MD
• Jeffrey Lobas, MD
• Jessica Moreland, MD
• Doug Morgan, RPh
• Angela Otto, RN, nurse manager
• Jean Ryan, RDLD
• Howard Seigel, senior respiratory therapist
• Sue Witte, MSW

In the know...

• Patients in the PICU include: infants from one month old, newborns with cardiac defects, and children up to 16 years (sometimes older if they are being followed by a pediatric service)
• There are seven private rooms and five beds in the open bay area
• Facility improvements and a move to the Pappajohn Pavilion will take place in about two years
• In the new facility, each room will accommodate a family overnight stay