Open Visitation Research Articles

Healthcare Provider's Preferences on Open Versus Restricted Visiting Hours in Surgical Intensive Care Unit.

The increasing consideration of open visiting hours in intensive care units (ICUs) has presented implementation challenges. Recognizing the invaluable insights of healthcare providers, this study aimed to assess their perspectives on the potential impact of altering ICU visiting policies on patient care. In a single-institution, cross-sectional study, a five-point Likert survey was administered to healthcare providers working in a surgical ICU to assess their perceptions of open and restricted visiting hours. Descriptive statistics were used to analyze the responses. Ninety-three healthcare providers participated, including nurses (53%), resident physicians (23%), and other healthcare professionals. The majority (81%) did not believe that open ICU visiting hours would enhance patient-centered care. Providers expressed concerns that open visitation could lead to increased provider stress (89%), physical barriers to patient access (80%), disruption in workflow (90%), and provider burnout (76%). Conversely, they perceived that restricted visitation would preserve patient privacy (87%), promote better healing for patients (64%), reduce provider stress (81%), and improve workflow (95%). Nurses were more likely than resident physicians to perceive that open ICU hours would alleviate familial stress (p=0.022). Additionally, both nurses and other healthcare providers recognized the potential for open ICU hours to improve communication between patient families and healthcare teams (p<0.05). Notably, there were no significant differences among providers in perceptions of the impact of open versus restricted visitation on provider stress, workflow, or other factors (p>0.05). This survey reveals a negative perception of open ICU visiting hours among healthcare providers in a surgical ICU, with concerns that such a change could increase stress for both patients and providers. These findings underscore the potential challenges and negative impacts of implementing open visiting hours in this setting, emphasizing the need for careful consideration and further research to inform policy decisions and visitation practices.

The impact of visiting restrictions in intensive care units for families during the COVID-19 pandemic: An integrative review.

To synthesize current evidence about the impact visiting restrictions in adult intensive care units have on family members during the COVID-19 pandemic. Integrative literature review. A total of 104 articles were retrieved. Screening yielded a total of 23 articles which were appraised for quality. Reflexive thematic analysis was applied to synthesize findings and extract themes. CINAHL Plus, Ovid MEDLINE, PubMed and ProQuest databases were searched for articles between January 2020 and November 2022. The findings were grouped into two main themes with six subthemes. Theme 1: not being present at the bedside, and Theme 2: altered communication added to family members' distress. Findings indicate that visiting restrictions imposed during the COVID-19 pandemic had negative consequences for family members. The patient and their family are inherently connected, prioritizing family presence with the return of flexible, open visitation policies in ICU must be a priority to mitigate further harm and adverse outcomes for all. The review complies with the PRISMA guidelines for reporting systematic reviews. Nursing leaders must be included in the development of future pandemic policies that advocate family-centred care. No patient or public contribution was included in this review.

Family Engagement in the Adult Cardiac Intensive Care Unit: A Survey of Family Engagement Practices in the Cardiac Critical Care Trials Network.

Cardiovascular and critical care professional societies recommend incorporating family engagement practices into routine clinical care. However, little is known about current family engagement practices in contemporary cardiac intensive care units (CICUs). We implemented a validated 12-item family engagement practice survey among site investigators participating in the Critical Care Cardiology Trials Network, a collaborative network of CICUs in North America. The survey includes 9 items assessing specific engagement practices, 1 item about other family-centered care practices, and 2 open-ended questions on strategies and barriers concerning family engagement practice. We developed an engagement practice score by assigning 1 point for each family engagement practice partially or fully adopted at each site (max score 9). We assessed for relationships between the engagement practice score and CICU demographics. All sites (N=39; 100%) completed the survey. The most common family engagement practices were open visitation (95%), information and support to families (85%), structured care conferences (n=82%), and family participation in rounds (77%). The median engagement practice score was 5 (interquartile range, 4). There were no differences in engagement practice scores by geographic region or CICU type. The most commonly used strategies to promote family engagement were family presence during rounds (41%), communication (28%), and family meetings (28%). The most common barriers to family engagement were COVID-related visitation policies (38%) and resource limitations (13%). Family engagement practices are routinely performed in many CICUs; however, considerable variability exists. There is a need for strategies to address the variability of family engagement practices in CICUs.

Open visitation in the NICU: nurses’ perspectives on barriers and facilitators†

Abstract Objective This study aimed to investigate the nurses’ perspectives on open family visitation and its barriers and facilitators in neonatal intensive care units (NICUs). Methods This is a descriptive, cross-sectional study. A total of 113 nurses employed in 3 main NICUs of Tabriz participated in the study through the census sampling method. Nurses’ perspectives on open visitation and its facilitators and barriers were assessed and analyzed using the Beliefs and Attitudes toward Visitation in NICU Questionnaire (BAVNIQ) and descriptive and analytical statistics, respectively. Results Approximately 74% of the nurses who participating in the study had a moderate perspective on open visitation. From the nurses’ viewpoint, “Parents’ low awareness of sensitivity and hygienic principles of the NICU” was the first (90.3%) barrier, and the 2 factors, namely, “physical structure of the ward/lack of sufficient space” and “far distance between family’s residence and the hospital/having another child,” were the second (86.8%) barrier with an equal percentage. Among the facilitating factors, “Supporting employed parents during the neonate’s hospitalization” and “providing facilities for family accommodation in the hospital” were the first (82.3%) and the second (79.6%) facilitators, respectively, for open visitation. Conclusions The majority of NICU nurses had a moderate perspective on the family open visitation. This reluctance seems to be originated mainly from the factors inhibiting open visitation, making its implementation challenging for nurses. The perspective of the frontline staff in caring for vulnerable infants on facilitators and barriers to open visitation may help policymakers, managers, and relevant officials in decision-making and implementing new visiting policies in the NICUs.

Needs of Family Members of Intensive Care Patients.

This article reports the results of a research project designed to identify the needs of family members and others who are coping with hospitalization of loved one in the intensive care unit, thus alleviating stress. The health care provider's viewpoints were also considered. Study participants were 9 family members of intensive care unit patients and 24 health care providers working in intensive care units. Data were collected and analyzed from 24 individual interviews (average of 35 minutes per interview) and 1 focus group interview (1 hour). The findings revealed 2 basic needs: (1) reducing concerns and (2) being supported. The first need could be addressed by open visitation, access to information, assurance of quality of care, and empowerment via education and involvement. The second need could be met by emotional support, access to facilities, and postdischarge support. Health care providers and decision makers can use these results to respond to these needs and increase people's satisfaction of intensive care unit services.

Benefits of a Safe Pandemic Visitation Policy

Open visitation has been severely curtailed during the COVID-19 pandemic to prevent spread of the virus. Before the pandemic, visitors enjoyed almost unrestricted access to their hospitalized loved ones. These visitors were often a source of support to the health care team, helping us get to know the patient better and helping us communicate effectively with the patient, which improved overall patient safety. These benefits to both patients and the health care team are what Marmo and Milner want us to remember. Marmo and Milner point out the negative impact of restrictive visitation practices on the health care team, as team members became surrogates for families unable to visit. They found that continued restrictions contributed to symptoms of posttraumatic stress disorder, burnout, intent to leave their jobs, and increased violence directed at health care workers. Based on these findings, many believe it is time to develop safe, sensible pandemic visitation policies.We have learned a lot in the past 2 years about what it takes to facilitate safe visitor presence at the patient’s bedside during a pandemic. In addition, several patient-centered care groups have worked hard to provide detailed guidelines for implementing safe family/visitor presence in hospitals during challenging times like these. Developing a safe and sensible pandemic visitation policy is essential, and doing so will benefit the patient, family/visitor, and the health care team.

Clinical Pearls.

Research has shown that unrestricted visitation is beneficial and contributes to high-quality family-centered care. However, with the onset of the COVID-19 pandemic most hospitals banned visitors. In the ensuing time, despite repeated evidence of the negative effects of restricted visitation on patients, caregivers, and families, many hospitals continue to enforce a restrictive policy.Marmo and colleagues examined current visitation policies of Magnet and Pathway to Excellence facilities that had unrestricted visitation policies in their adult intensive care units before the pandemic. They found that All participating nurse leaders thought that the decision to restrict during the pandemic was made by external systems with no input from nursing.None of the hospitals went back to an open visitation policy, and most study participants thought that open visitation polices would not return.Nurse leaders described restricted visitation causing harm to patients, families, and nurses.Although technology capabilities such as virtual visiting allowed family participation, these methods added further responsibility and strain to the nursing staff. The authors recommend that hospitals use the best evidence available and shared decision-making with all key stakeholders to develop safe visitation policies and practices.See Article, pp 31-41Infants with critical congenital heart disease (CCHD) often require complex medical care at home following surgery. The caregivers of these infants must learn a great deal of medical skills through extensive training, often in a short period. Many caregivers experience stress and feel unprepared for postdischarge parental care.Shackleford and colleagues describe nurses’ perceptions of a 24-hour rooming-in program for caregivers of infants with CCHD. They identified 3 themes: This study was the first to examine rooming-in with caregivers of patients with CCHD. Although areas of improvement were recognized, findings suggest that a rooming-in program for CCHD infant care can effectively support the quality of discharge education.See Article, pp 54-61Psychological distress of family caregivers of critically ill patients can result in post–intensive care syndrome– family after hospitalization. This distress also occurs during hospitalization and may include anxiety, lack of sleep, and decrease in sound decision-making. However, little research has explored the factors that affect caregiver stress during the hospitalization.Blok and colleagues interviewed adult family caregivers (most were adult children and patient spouses) in person in the intensive care unit to explore their sources of psychological distress. They found Overall, findings show that factors influencing family distress are wide-ranging and vary by level of caregiver anxiety. The authors suggest early identification and assessment of family factors to develop strategies for reducing distress.See Article, pp 21-30Delirium during hospitalization in the intensive care unit (ICU) contributes to adverse consequences such as prolonged hospital stay, increased hospitalization cost, and increased mortality risk. As several risk factors contribute to onset of delirium, prediction models have been developed. However, some models are more thoroughly validated than others, and the effect of mechanical ventilation on one of the models’ prognostic accuracy needs further study.Van Nieuw Amerongen and colleagues compared 3 prediction models—the PRE-DELIRIC, E-PRE-DELIRIC, and Lanzhou models—in adult ICU patients receiving and not receiving mechanical ventilation. They found Although there are limitations with any model, the findings support the use of a prognostic tool during the first 24 hours of ICU stay to support decision-making in delirium care.See Article, pp 43-50

The beliefs and attitudes of intensive care unit nurses and patient families regarding an open visitation policy in China.

To investigate the beliefs and attitudes of intensive care unit (ICU) nurses and patients' family members towards an open visitation policy in the ICU in China and to explore the reasons that promote or hinder open visitation to improve visitation policy. Open visitation policies are widely recommended in many countries. However, there are gaps between evidence and practice. Most ICUs in China still use a restrictive policy for family visits, which raises controversy. There are limited visiting times, and family visitors are not allowed to enter the ICU. A multicentre survey was conducted in seven hospitals in China. The Beliefs and Attitudes towards Visitation in the Intensive Care Unit Questionnaire (BAVIQ) was administered to ICU nurses and patient families from 11 the ICUs of seven hospitals. A total of 275 questionnaires were completed and returned by ICU nurses and 139 by patients' family members. Among nurses, the belief scale score was 2.87 ± 0.33 (range 2-4), and the attitude scale score was 5.53 ± 1.12 (range 2.33-7). The belief scale was divided into three subscales: nurses, patients, and patients' families. The subscale score for patients' families was the highest, and the nurses' subscale score was the lowest. Most (84.0%) of the nurses were satisfied with the current ICU visitation policy. The belief and attitude scores were 3.13 ± 0.39 (range 1.96-4) and 6.18 ± 1.20 (range 1.67-7), respectively, for family members. The scores of the three subscales, that is, patients, patients' families and nurses, were 3.13 ± 0.40, 3.26 ± 0.43, and 3.04 ± 0.49, respectively. Nurses' beliefs and attitudes towards implementing an open visitation policy in China are at a less positive level than those of patient family members. The beliefs and attitudes of nurses towards open visitation policy in China need to be improved. The question of how to mobilize nurses' enthusiasm for an open visitation policy poses a challenge for ICU management.

Open visitation policy in intensive care units in Jordan: cross-sectional study of nurses' perceptions

IntroductionIntensive care unit patients and families experience significant stress. It creates frustrations, nervousness, irritability, social isolation for patients, anxiety, and depression for families. An open visitation policy with no time or duration limits may assist in reducing these negative experiences. However, most Jordanian and regional hospitals within the Middle-East and Northern Africa (MENA) have not implemented this strategy.PurposeTo evaluate nurse managers' and nurses' perspectives on the effects of an open visitation policy at intensive care units (ICUs) on patients, families, and nurses' care.MethodA cross-sectional, descriptive, and comparative survey design was used.ResultsA total of 234 nurses participated in the study; 59.4% were males, and 40.6% were females. The mean of their age was 28.6 years, with a mean of 4.1 years of experience. Nurses generally had negative perceptions and attitudes toward the open visitation policy and its consequences on the patient, family, and nursing care.ConclusionsICU managers and staff nurses did not favor implementing an open visitation in their units despite its known benefits, international recommendations, and relevance and compatibility with the local religious and cultural context. A serious discussion regarding this hesitation from the side of the healthcare professionals should be started to find a suitable solutions that consider the benefits of the open visitation policy and the challenges that prevent its implementation in the Jordanian and Arabic cultures.

Patient and family engagement in patient care and research in Canadian intensive care units: a national survey.

While patient and family engagement may improve clinical care and research, current practices for engagement in Canadian intensive care units (ICUs) are unknown. We developed and administered a cross-sectional questionnaire to ICU leaders of current engagement practices, facilitators, and barriers to engagement, and whether engagement was a priority, using to an ordinal Likert scale from 1 to 10. The response rate was 53.4% (124/232). Respondents were from 11 provinces and territories, mainly from medical surgical ICUs (76%) and community hospitals (70%). Engagement in patient care included bedside care (84%) and bedside rounds (66%), presence during procedures/crises (65%), and survey completion (77%). Research engagement included ethics committees (36%), protocol review (31%), and knowledge translation (30%). Facilitators of engagement in patient care included family meetings (87%), open visitation policies (81%), and engagement as an institutional priority (74%). Support from departmental (43%) and hospital (33%) leadership was facilitator of research engagement. Time was the main barrier to engagement in any capacity. Engagement was a higher priority in patient care vs research (median [interquartile range], 8 [7-9] vs 3 [1-7]; P < 0.001) and in pediatric vs adult ICUs (10 [9-10] vs 8 [7-9]; P = 0.003). Research engagement was significantly higher in academic vs other ICUs (7 [5-8] vs 2 [1-4]; P < 0.001), and pediatric vs adult ICUs (7 [5-8] vs 3 [1-6]; P = 0.01). Organizational strategies and institutional support were key facilitators of engagement. Engagement in patient care was a higher priority than engagement in research.

From Open to Closed: COVID-19 Restrictions on Previously Unrestricted Visitation Policies in Adult Intensive Care Units.

In March 2020, rising numbers of COVID-19 infections contributed to changes in intensive care unit visitation policies, with some facilities allowing no visitors. To compare visitation policies of Magnet and Pathway to Excellence hospitals with prepandemic open visitation in adult intensive care units. A mixed-methods study was conducted from January through March 2021. Quantitative data on visitation policies were extracted from websites of 96 Magnet and Pathway to Excellence hospitals that had allowed unrestricted visits in adult intensive care units before the pandemic. Qualitative data were collected via semistructured interviews with 9 nurse leaders from these hospitals. More than 1 year after the start of the pandemic, all of the hospitals had instituted restricted visitation policies. The policies varied, with little to no evidence-based justification. Restrictions included 83% of hospitals (n = 80) allowing just 1 visitor per day and 69% of hospitals (n = 50 of 72) allowing no visits at all for patients with COVID-19 in the intensive care unit. Five themes were found when nurse leaders' interviews were analyzed: visitors not welcome, doing harm, external decisions at system level, visiting within limits, and changes in critical care nursing work. Results of the study suggest that despite the vast amount of evidence supporting the benefits of visitation and the harms of restricted visitation and expert recommendations for returning safe visitation to hospitals, Magnet and Pathway to Excellence hospitals continue to enforce restricted visitation policies in intensive care units. Patients, families, and nursing and health care staff must partner to create pandemic-proof visitation policies.

A Proposed Framework for Navigating Visitation: Maintaining Patient Safety and Compassionate Care

BackgroundVisitation is a key component to patient-centered care, infection prevention and healthcare operations during the COVID-19 pandemic. Although visitation guidance exists, there is no adaptable published framework among acute care facilities. Objectives include defining key variables and data sources to develop risk matrices, explaining how visitation matrices inform developing a tiering system allowing for fluctuating visitation, and providing an adaptable, dynamic framework to serve as a blueprint whereby infection prevention, patient safety and adherence to guidelines are the focal points.MethodsAn organizational level, multidisciplinary taskforce was developed to address and implement rapidly evolving public health recommendations for visitation. A comprehensive framework was created including matrices, communication pathways and a score-based tiered approach that allowed for flexibility and swift adaptability. This innovative framework weighed patient, visitor and staff safety while aligning with organizational values of compassionate patient-centered care.ResultsTwo matrices served as risk assessments whereby a risk score was determined. Inpatient matrix variables consisted of disease severity circulating, probability of COVID-19 admissions and census stratified by critical care and medical surgical beds. Emergency Department (ED) matrix criteria were modified to include positive case probability, average daily census, and admission from ED. Within each variable group, the quantitative data were categorized into sub-risk groups and assigned a score from low to high. Tiered guidance resulted from the matrices’ score and included five levels ranging from open visitation to completely closed. Patient care area level guidelines were specified.ConclusionsComprehensive tiered guidance is the summation of balancing consistently applied, impartial methodology and the subjective component: continuing to align with providing compassionate care. The taskforce role surpassed policy revisions by creating a nimble mechanism to execute visitation guideline changes while ensuring clear communication. Proposed matrices and tiering system must be documented in the literature for healthcare facilities to adapt and use in future pandemics.

Paediatric Critical Care or Emergency Care: What Information Must A Good Strategy Contain?

This write up on critical care and emergency care of children: What must a good strategy contain? surrounds issues of what a critical care package should be even in resource poor settings. Paediatric critical care consists of identification of children at risk of dying or having adverse outcomes, and in need of intensive monitoring and provision of appropriate interventions. Emergency care is defined by the World Health Organization (WHO) as care for the acutely ill and injured delivered by frontline providers who manage medical, surgical, and obstetric emergencies, relying on early recognition and resuscitation. In developing countries, majority of mortalities occur due to infectious diseases which are treatable and have potential for full recovery if appropriate definitive care as well as intensive care is given to those who come critically ill. In Cameroon, maternal, child and adolescent related diseases account for 18.3% of the burden of disease and 14.4% of deaths. Some of these deaths could be prevented if there are adequate paeditric critical care facilities to handle the critically ill children. However, paediatric critical care services are largely unavailable in most developing countries 23. The objectives of this seminar are to describe the nursing strategies used in the critical and emergency care of children, outline parent’s expectations of the critical care/emergency care of their children by nurses and lastly to describe healthcare managers’ responsibilities in critical care/emergency care of children. It has been observed that nursing strategies include monitoring, assessment, vital sign monitoring, ventilatory management, medication administration, intravenous insertion and infusion, central line care, catheters care, maintenance of a running record of the patient’s status, performance of cardiopulmonary resuscitation and other lifesaving techniques. Parent’s expectations include guidance, reassurance and timely and comprehensive information on the progress and prognosis of critically ill children; open visitation policy and involvement in their child’s care 8, while healthcare managers’ responsibilities were found to be ensuring adequate skill and knowledge among emergency services providers, and availability of pediatric critical care medications, equipment, and supplies. The results can be used to implement good critical care strategies and hence better care outcomes.

Comparison between the perceptions of family members and health professionals regarding a flexible visitation model in an adult intensive care unit: a cross-sectional study

OBJECTIVE: To compare the perceptions of patients’ relatives with the perceptions of health professionals regarding a flexible visitation model in intensive care units. METHODS: Cross-sectional study. This study was carried out with patients’ relatives and members of the care team of a clinical-surgical intensive care unit with a flexible visitation model (12 hours/day) from September to December 2018. The evaluation of the flexible visitation policy was carried out through an open visitation instrument composed of 22 questions divided into three domains (evaluation of family stress, provision of information, and interference in the work of the team). RESULTS: Ninety-five accompanying relatives and 95 members of the care team were analyzed. The perceptions of relatives regarding the decrease in anxiety and stress with flexible visitation was higher than the perceptions of the team (91.6% versus 58.9%, p < 0.001), and the family also had a more positive perception regarding the provision of information (86.3% versus 64.2%, p < 0.001). The care team believed that the presence of the relative made it difficult to provide care to the patient and caused work interruptions (46.3% versus 6.3%, p < 0.001). CONCLUSION: Family members and staff-intensive care unit teams have different perceptions about flexible visits in the intensive care unit. However, a positive view regarding the perception of decreased anxiety and stress among the family members and greater information and contributions to patient recovery predominates.

Comparison between the perceptions of family members and health professionals regarding a flexible visitation model in an adult intensive care unit: a cross-sectional study.

To compare the perceptions of patients' relatives with the perceptions of health professionals regarding a flexible visitation model in intensive care units. Cross-sectional study. This study was carried out with patients' relatives and members of the care team of a clinical-surgical intensive care unit with a flexible visitation model (12 hours/day) from September to December 2018. The evaluation of the flexible visitation policy was carried out through an open visitation instrument composed of 22 questions divided into three domains (evaluation of family stress, provision of information, and interference in the work of the team). Ninety-five accompanying relatives and 95 members of the care team were analyzed. The perceptions of relatives regarding the decrease in anxiety and stress with flexible visitation was higher than the perceptions of the team (91.6% versus 58.9%, p < 0.001), and the family also had a more positive perception regarding the provision of information (86.3% versus 64.2%, p < 0.001). The care team believed that the presence of the relative made it difficult to provide care to the patient and caused work interruptions (46.3% versus 6.3%, p < 0.001). Family members and staff-intensive care unit teams have different perceptions about flexible visits in the intensive care unit. However, a positive view regarding the perception of decreased anxiety and stress among the family members and greater information and contributions to patient recovery predominates.

Humanizing the intensive care unit experience in a comprehensive cancer center: A patient- and family-centered improvement study.

Improving family-centered outcomes is a priority in oncologic critical care. As part of the Intensive Care Unit (ICU) Patient-Centered Outcomes Research Collaborative, we implemented patient- and family-centered initiatives in a comprehensive cancer center. A multidisciplinary team was created to implement the initiatives. We instituted an open visitation policy (OVP) that revamped the use of the two-way communication boards and enhanced the waiting room experience by hosting ICU family-centered events. To assess the initiatives' effects, we carried out pre-intervention (PRE) and post-intervention (POST) family/caregiver and ICU practitioner surveys. A total of 159 (PRE = 79, POST = 80) family members and 147 (PRE = 95, POST = 52) ICU practitioners participated. Regarding the decision-making process, family members felt more included (40.5% vs. 68.8%, p < 0.001) and more supported (29.1% vs. 48.8%, p = 0.011) after the implementation of the initiatives. The caregivers also felt more control over the decision-making process in the POST survey (34.2% vs. 56.3%, p = 0.005). Although 33% of the ICU staff considered OVP was beneficial for the ICU, 41% disagreed and 26% were neutral. Only half of them responded that OVP was beneficial for patients and 63% agreed that OVP was beneficial for families. Half of the practitioners agreed that OVP resulted in additional work for staff. Our project effectively promoted patient- and family-centered care. The families expressed satisfaction with the communication of information and the decision-making process. However, the ICU staff felt that the initiatives increased their work load. Further research is needed to understand whether making this project universal or introducing additional novel practices would significantly benefit patients admitted to the ICU and their family.

Beliefs and attitudes of nurses towards open visiting policy in neonatal intensive care units: A descriptive cross-sectional study in northwest of Iran

IntroductionOpen visiting policy (OVP) allows the family to access the infant 24 hours a day. Nurses' beliefs can help to better plan on visiting policies. This study investigated the attitudes of nurses in Neonatal Intensive Care Units (NICUs) towards open visiting. MethodsThis descriptive cross-sectional study was conducted in NICUs of the three main hospitals in Iran. All nurses with six months of work experience participated to the study. The “Beliefs and Attitudes toward Visitation in NICU Questionnaire” (BAVNIQ) was used. The data were analyzed using SPSS software version 19. FindingsThe cumulative percentage of agreement and disagreement of 113 participated nurses’ towards the OVP was 46% and 66.91%, respectively. The highest scores about open visiting was in the moderate and weak rank. ConclusionThe study showed that NICU nurses had a moderate to poor attitude towards OVP. Improving nurses attitudes before changing visiting policies seems indispensable.

Family visitation policies, facilities, and support in Australia and New Zealand intensive care units: A multicentre, registry-linked survey

ObjectiveThe objective of this study was to describe family visitation policies, facilities, and support in Australia and New Zealand (ANZ) intensive care units (ICUs). MethodsA survey was distributed to all Australian and New Zealand ICUs reporting to the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resources Evaluation Critical Care Resources (CCR) Registry in 2018. Data were obtained from the survey and from data reported to the CCR Registry. For this study, open visiting (OV) was defined as allowing visitors for more than 14 h per day. Setting and participantsThis study included all Australian and New Zealand ICUs reporting to CCR in 2018. Main outcome measuresThe main outcome measures were family access to the ICU and visiting hours, characteristics of the ICU waiting area, and information provided to and collected from the relatives. FindingsFifty-six percent (95/170) of ICUs contributing to CCR responded, representing 44% of ANZ ICUs and a range of rural, metropolitan, tertiary, and private ICUs. Visiting hours ranged from 1.5 to 24 h per day, with 68 (72%) respondent ICUs reporting an OV policy, of which 64 (67%) ICUs were open to visitors 24 h a day. A waiting room was part of the ICU for 77 (81%) respondent ICUs, 74 (78%) reported a separate dedicated room for family meetings, and 83 (87%) reported available social worker services. Most ICUs reported facilities for sleeping within or near the hospital. An information booklet was provided by 64 (67%) ICUs. Only six (6%) ICUs required personal protective equipment for all visitors, and 76 (80%) required personal protective equipment for patients with airborne precautions. ConclusionsIn 2018, the majority of ANZ ICUs reported liberal visiting policies, with substantial facilities and family support.

The influence of COVID-19 visitation restrictions on patient experience and safety outcomes: A critical role for subjective advocates

With the emergence of the coronavirus (COVID-19) pandemic in the United States in early 2020, hospitals across the country made the difficult decision to alter visitation policies, by either limiting visitations or restricting visitations altogether by closing access to family, friends and care partners in an effort to reduce further spread of the virus. While there is foundational research on the impact of family and care partner presence on the experience of patients and patient safety outcomes, the actions driven by the pandemic allowed for a real-time comparison of the impact of family or care partner presence or lack thereof. Patient and family engagement has long been a part of patient experience scholarship where the role of family members and care partners as patient advocates and a presence of support has been reinforced. Scholarship and practice have also encouraged movement from restricted visiting hours to having open visitation based on findings that, in addition to better patient outcomes, there is a benefit in nurse job satisfaction and communication when visitations are unrestricted. The purpose of this study is to examine the degree to which hospital visitation restrictions in U.S. hospitals during the COVID-19 pandemic help to explain changes in patient experience and patient safety outcomes. To examine this relationship, patient experience and safety outcomes of a national sample of hospitals (n=32) during the pandemic is compared to previous corresponding performance. The results indicate that hospital performance was negatively impacted on average during the pandemic for hospitals in the sample. However, differences in hospital performance during the pandemic were driven by hospitals that disallowed patient visitations. Hospitals with closed visitations saw most pronounced deficits in their performance with regard to patient ratings of medical staff responsiveness, fall rates and sepsis rates. Performance in hospitals that either remained unrestricted or partially limited their visitations was not appreciably different from pre-pandemic performance, and in some cases performance even improved marginally. The findings of this study indicate that the policy to allow for visitors, or subjective advocates, individuals with a vested interest in the well-being of the patient, is beneficial not only for the patient, but also in sustaining high quality of care. Recommendations are given for how hospitals might achieve improved quality and safety outcomes even in instances when organizations believe visitation needs to be disallowed or restricted. The results of this study suggest those decisions should be made with great care and in only the most extreme circumstances.

Perspectives of intensive care nurses on open visits in an ICU

ObjectiveTo determine the attitude of the nursing professionals of an Intensive Care Unit regarding the effects of open visiting on the daily activities of the patient, their family and professionals, and also to determine their contribution to the current open visiting policy. MethodA cross-sectional descriptive study was performed, with a non-probabilistic discretionary sampling. The sample comprised nursing professionals of the aforementioned Unit. They were given a questionnaire with 26 items and an open question to evaluate their suggestions. Results101 nursing professionals took part in the study, of the 120 working in the Unit under study. Seventy-five point two percent state that the nursing team has to postpone or modify their work due to the presence of the family and 89.9% that their presence produces a physical and psychological burden on the staff. Eighty percent think that the visit exhausts the family and 84.2% that the family feels obliged to remain with the patient. Ninety-four percent think that the effect of the presence of the family depends on the patient and the family. ConclusionsMost of professionals have a negative opinion about the policy of open visits, showing some reluctance when it comes to flexible visiting hours, although they admit that an unrestricted schedule in this type of units implies some benefit for the patient and the family.