Preferences in surgical waiting area amenities - Statistical Data Included

AORN Journal,  June, 2002  by Julie M. Carmichael,  Patricia Agre

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In the summer of 2000, staff members at a large comprehensive cancer center initiated plans to design new OR suites, including a waiting area for family members (ie, relatives, significant others, friends). This waiting area would replace the waiting room located in a public access lobby on the hospital's main floor. The lobby featured a wall of large bay windows that provided natural light and a view of the outside, along with rows of sofa chairs positioned near amenities, such as rest rooms, pay telephones, the gift shop, the cafeteria, and the information desk. To ensure that the proposal for a new waiting area would meet user needs, staff members in the patient and family education department conducted a formal needs assessment. The results provide valuable insights about which amenities family members believe would contribute to a more comfortable and supportive experience.

GOAL AND OBJECTIVES

The goal of this needs assessment was to develop a proposal for a new waiting area that would ensure family members' comfort and satisfaction during their wait. The objectives were to understand the importance family members and principal caregivers place on

* being informed of their loved one's progress through surgery,

* frequency of patient updates,

* amenities in the waiting area, and

* visiting the patient in the post-anesthesia care unit (PACU).

MATERIALS AND METHODS

The needs assessment comprised five components. These included a literature review, telephone interviews with perioperative staff members at other facilities, a survey of perioperative staff members at the cancer center, interviews with patients' family members and friends, and written surveys administered to patients' family members and friends.

Literature review. The literature review was conducted using the key word waiting rooms. Staff members performing the assessment searched Medline for the years 1980 to 2000 and then expanded the search to include the key words design, policies, and visitation. Fifty-eight references met these criteria, but on review, only 20 were pertinent to the needs assessment. Six of the articles addressed surgical waiting areas, 11 focused on visitation in the critical care unit (CCU), two involved music therapy in the intensive care unit (ICU), and one dealt with caring for patients and their family members in the ICU. No articles specifically addressed amenities family members need in surgical waiting areas.

Family members find waiting for loved ones undergoing surgery to be stressful. (1) Providing various amenities and services could help create a more supportive and relaxing atmosphere. One researcher found that assigning volunteers to assist family members and regular staff-family member interaction increased perceived support. (2) Another researcher compared the impact of an educational videotape, nurse-family member interaction, and both on perceived support. (3) Family members who received these interventions perceived increased support compared to those in the control group who did not receive any interventions.

Another amenity that has been shown to increase comfort is music. Visitors who listened to music reported lower stress levels and a greater sense of relaxation compared to those in the control group. (4) Patients in the ICU who listened to personally selected music experienced reduced heart rate, systolic blood pressure, pain, and anxiety. (5) Another amenity thought to reduce anxiety during the waiting period is the use of pagers. (6) Researchers found that providing family members with pagers allowed them the freedom to walk around without missing any pertinent information and increased the amount of time they spent outside the waiting area; however, this amenity had little effect on family members' anxiety levels.

The literature revealed that opinions on visitation policies for the PACU varied. Most nurses believe that family member visitation is important to patient recovery. (7) Even in the face of restrictive policies, nurses have been documented to be lenient, favoring visitation and often deviating from hospital policy. (8) Some believe that visits provide psychological benefit to patients but have negative consequences on family members (eg, exhaustion) and staff members (eg, disruption). (9) One group of researchers reported that family members believe frequent visitation in the CCU is very important to patient recovery. (10) Reasons that family members want to be close to their hospitalized relatives can be categorized as protective involvement in patient care, feelings of uncertainty, making life and death decisions and living with loss, evolving relationships, life transitions as a result of the patient's illness, and caring for themselves and remaining hopeful. (11) One researcher indicated that visitation policies should be tailored to patients' preferences and illness-related characteristics. (12) Contracted visitation (ie, visitation agreed upon by the nurse and family members) was found to increase satisfaction for patients, family members, and staff members by permitting more control over each individual's schedule and less disruption to patient care. (13) One group of researchers found that teaching hospitals had the most liberal visitation policies and allowed the longest duration of visits. (14)