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Abstract

Introduction: In order to develop a more family centered approach to the delivery of ICU care we explored the issue of children visitation of loved ones in the ICU. At the present time ICUs across the United States have varying policies related to children visitation. Some have strict restrictions on those under the age of 16, while others have open visitation regardless of age. These local regulations are often a reflection of the personal views of leadership of the individual unit rather than a well thought out policy and there exists considerable intra- unit variation even among the individual care givers in a particular institution. Even less data exists on the viewpoints of members of the ICU team on the topic of children's visitation in the ICU and little is known about the preferences of the minors themselves. We developed a survey tool to identify and compare the differing attitudes related to children visitation in the ICU by health care providers. Methods: Blinded surveys were distributed to physicians and nurses in 2 community hospital ICUs. Data was collected and compared by gender, occupation and age ( > or < 40). Categories of age permitted in the ICU were broken down as follows ; < 2 years, >2<10 years, >10<13, >13<16, 16 or older, or any age. Critically ill was defined as the inability to communicate either due to the presence of a ventilator or severity of illness. Questions included were: 1) Age at which children should be allowed to visit critically ill family members in the ICU? 2) Do you believe seeing a loved one in this state would have a negative psychological impact on a child? 3) If you do not believe children under the age of 16 should be allowed in the ICU please give a specific reason 4) Age at which children should be allowed to be present during the withdrawal of care? Results: 117 surveys were returned with 77% completed by females, 78% by nurses, and 61% by practitioners less than 40 years of age. Only 15% of all respondents felt that children under the age of 10 should be permitted to visit critically ill family members in the ICU. Males were more likely than female (21 vs. 13%) to permit children less than 10 years of age to visit as were physicians compared to nurses (17% vs. 12%). Only 11 % of all respondents felt that children under 10 years of age should be allowed to be present during withdrawal of with minimal variation across the groups queried 16% of respondents felt that any children under the age of 16 should not be permitted to visit loved ones in the ICU with females being more likely than males to restrict visitation ( 19% vs 11%) to this level. Related to withdrawal of care, 37% of respondents felt that any children under the age of 16 should not be permitted to be present with a preponderance of females ( 41% vs 21%) and nurses (41% vs 22% ) supporting this limitation. Similar responses were seen regarding the psychological impact of children visiting in the ICU with a preponderance of females ( 83% vs 50%), nurses (74% vs 55%) and those <40 ( 72% vs. 53%) feeling that visitation would have a negative impact on children. For those who felt that children under 16 years of age should not be permitted to visit the main reasons given were equally divided between stress and infection risk. Conclusions: The majority of practitioners, regardless of age, profession or gender feel that children less than 10 years of age should not be permitted to visit critically ill family members in the ICU with even fewer feeling it appropriate for children to be present during the withdrawal process. There seems to be a prevalence towards those of female gender and the nursing profession to be more restrictive in their attitudes related to children visitation in the ICU. Further education and study on the role and impact of children visitation in the delivery of family centered care in the ICU needs to be undertaken