Open Visitation Research Articles

Visita aberta em uti adulto: utopia ou realidade?

Objetivo: refletir acerca da implementação de políticas de visitação aberta em Unidade de Terapia Intensiva (UTI) adulto. Método: estudo teórico-reflexivo a partir da revisão da literatura, dividido em três categorias: a caracterização da visita aberta no Brasil e mundo; a percepção do paciente, da equipe e dos familiares; a influência da visitação aberta sobre os desfechos clínicos. Resultados: a implementação da visita aberta é uma realidade, já instituída em alguns serviços no Brasil e no mundo, que necessita de apoio por parte dos profissionais envolvidos no processo de cuidado. A inserção dos familiares nas UTIs pode minimizar os desconfortos vivenciados pelas famílias e pacientes durante a internação, desde que associada ao acolhimento e comunicação efetivos da equipe assistencial. Considerações finais: os pacientes internados em UTI passam por situações de estresse e ansiedade. Assim, a inclusão da família deve ser considerada no seu plano terapêutico por meio da visitação aberta.

Family Satisfaction in Critical Care Units: Does an Open Visiting Hours Policy Have an Impact?

This is a cross-sectional prospective observational study conducted between November 1, 2009, and January 31, 2010, in 2 critical care units with 2 different visiting policy systems, unit A (open visiting hours) and B (restricted visiting hours), comparing family satisfaction in both units using the CCFSS questionnaire. Responses were grouped in 5 satisfaction constructs, namely, the support construct, which assesses the degree of satisfaction with the support of the intensive care staff as perceived by relatives; the assurance construct, which assesses the degree of satisfaction regarding honest answers being given and the responder's confidence that the patient is receiving the best care possible; the proximity construct, which assesses the degree of satisfaction with the physical and emotional access to the patient; the information construct, which assesses the degree of satisfaction with the adequacy of information given to relatives; and the comfort construct, which assesses satisfaction with physical comfort and amenities. During the study period, 115 questionnaires were distributed in each of the 2 sites. The response rates in units A and B were 92% (106) and 100% (115), respectively. The mean stay time in the intensive care unit was 3.7 days. There were more trauma cases in unit A and more cardiac patients in unit B. There was no significant difference between the 2 units in any of the 5 satisfaction constructs, the support, assurance, proximity, information, and comfort constructs, although there was a nonsignificant trend favoring the unit with the more liberal visit policy regarding amenities (unit A). We concluded that family satisfaction to care provided in intensive care as measured by the CCFSS questionnaire was not influenced by frequency of visitation among Saudi families. Factors other than open visiting hours may be important to evaluate.

Open visitation and nurse job satisfaction: An integrative review.

To explore the effect of open visitation on critical care nurse job satisfaction. Open visitation has many benefits for ICU patients and families. However, ICU open visitation also affects nurses' work environment. Because nurse satisfaction is crucial to overall patient satisfaction, nurses' perceptions, experiences and opinions about open visitation should be considered. A literature search was performed through CINAHL Complete, MEDLINE Complete, PubMed, ScienceDirect, Academic Search Premier and PsychINFO. Key terms, inclusion criteria and exclusion criteria were applied. Duplicates and articles focusing on family presence during end of life care were excluded. Articles were evaluated for data quality, resulting in 14 articles. Family presence can negatively affect nurses' workflow and environment. Nurses report a loss of control, interruptions in care and increased workloads with open visitation. Therefore, nurses prefer restricted visitation. The literature evidence encourages visitation policies that support nurses in managing the additional work and stress of meeting patient and family needs. Implementation of evidence-based strategies to support nursing staff in stressful ICU environments can improve job satisfaction. The conclusions of this integrative review can be utilized by hospitals considering or implementing ICU open visitation.

Quality Improvement Initiative for Family-Centered Care in the Neonatal Intensive Care Unit of a Tertiary Hospital in South Africa.

The introduction of family-centered care in the neonatal intensive care unit was identified as a high priority to facilitate bonding and attachment with potential positive outcomes for the parents and infants. The aim of the study was, therefore, to develop and implement a quality improvement initiative to foster family-centered care in a tertiary neonatal intensive care unit from birth onward. A pretest posttest intervention design was used using mixed methods over 3 phases to determine the perceived level of family-centered care according to healthcare professionals and parents using self-administered questionnaires; to develop and implement a quality improvement initiative to enhance family-centered care in a neonatal intensive care unit using a nominal group technique, followed by the quality improvement process; and to evaluate the outcomes of the initiative by repeating the self-administered questionnaires to parents and staff. Various activities were introduced as part of the initiative such as early breastfeeding, early introduction of parents to their infant, open visitation policy, and involvement in caring activities. The perceived level of care according to staff and parents increased. It is expected to enhance bonding and attachment between the infants and their parents, with consequential long-term positive outcomes.

Sleep in the Intensive Care Unit in a Model of Family-Centered Care

The desire for families to be physically present to support their loved ones in the intensive care unit, and guidelines in favor of this open visitation approach, require that clinicians consider both patient and family sleep. This article reviews the causes of poor sleep for patients and their family members in the intensive care unit as well as the expected changes in cognition and emotion that can result from sleep deprivation. Measures are proposed to improve the intensive care unit environment to promote family sleep. A framework to educate family members and engage them in preservation of their and their loved one's circadian rhythm is also presented. Although further research is needed, the proposed framework has the potential to improve outcomes for patients and their families in the intensive care unit.

Improving Nurse Satisfaction With Open Visitation in an Adult Intensive Care Unit.

The focus on patient- and family-centered care (PFCC) has become increasingly prevalent throughout health care. In the intensive care unit (ICU), family involvement becomes critical, as patients are often unable to fully engage in their care. After expanding family visitation to 24 hours, nurses in a surgical ICU perceived that they did not have the ability to tailor the visitation to meet the patient's condition and there was an opportunity to improve nurse satisfaction related to PFCC. The objective of this performance improvement project was to increase nurse satisfaction related to PFCC and create consistency across clinicians for visitation practices. The Unit Practice Council developed staff guidelines for family visitation that included scripting prompts the nurse could use when communicating with families. The adoption of staff guidelines for family visitation was helpful in creating a culture change toward PFCC. Nurses' overall mean stress level with PFCC decreased, and their perception of having difficulty in reducing patients' or families' anxieties also decreased. The development of guidelines for family visitation can be easily implemented across other critical care environments. Scripting prompts along with the visitation guidelines can serve as a useful strategy to build nurses' skills in communicating with families.

A Paradigm Shift for Patient/Family-Centered Care in Intensive Care Units: Bring in the Family.

A Paradigm Shift for Patient/Family-Centered Care in Intensive Care Units: Bring in the Family.

Association Between Clinical Nurse Specialist's Presence and Open Visitation in US Intensive Care Units.

Current evidence shows that an open visitation policy can benefit patients and families during intensive care unit (ICU) stays. Therefore, an unrestricted visitation policy in the ICU has been proposed as part of patient-centered care. The purpose of this secondary analysis is to explore the likelihood of an ICU with a clinical nurse specialist (CNS) having an open visitation policy when compared with an ICU without a CNS. This is a secondary analysis of a survey conducted between 2008 and 2009, describing the ICU visitation practices in more than 600 hospitals across the United States. χ Analysis was performed comparing the presence of CNS in the ICU with visitation policies, with P < 0.05 considered statistically significant. There were data from 347 hospitals used in the analysis, with 47 hospitals (13.5%) having open visitation policies. There were 108 hospitals (31%) that had a CNS present in the ICU; 14 of the hospitals (13%) had open visitation policies. No significant correlation was found between a CNS being present in the ICU and open visitation policy (odds ratio, 0.93; P = .83), regardless of hospital geographic regions. Although CNS presence was not associated with open visitation in this study, given the strong evidence to support the benefits to patients and the CNS role as a change agent in the hospital system, liberalization of visitation in the ICU is an area that could benefit from CNS advocacy.

Chartering Change: Exploring the Complexity of Implementing a Charter to Support Open Visitation Among Cardiac Surgery Intensive Care Unit (CSICU) Nurses

Chartering Change: Exploring the Complexity of Implementing a Charter to Support Open Visitation Among Cardiac Surgery Intensive Care Unit (CSICU) Nurses

Surveying Issues That Arise in Women's Prisons: A Content Critique ofOrange Is the New Black

AbstractThe character Piper Chapman is presented in the Netflix original series,Orange Is the New Black(OITNB). Piper's story opens the door to the female correctional facility. With the mass incarceration of non‐violent, drug offending females comes the need for gender‐specific assessment, programming, and reentry efforts. It is the goal of this essay to briefly review several issues observed inOITNB(gender, victimization, sexuality, mental health/addiction, and race) and to raise awareness on additional issues related to women and crime. The essay will also provide a discussion on female relationships to include both outside loved ones as well as newfound friends within the facility and the accompanied policy implications. Research supports the idea that contact with prosocial loved ones reduces distress and recidivism. Policy implications suggest a need for more open visitation, assistance with welfare agencies, collaboration for reentry, and overall gender‐specific programming needs for female offenders.

Let Them In: Family Presence during Intensive Care Unit Procedures.

Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient's room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented.

Needs of Patients' Family Members in an Intensive Care Unit With Continuous Visitation.

Although many critical care experts and national organizations support open visitation in intensive care units (ICUs), most ICU visiting policies do not allow unrestricted presence of patients' family members. To describe how well the needs of family members were met in an adult neuroscience ICU with a continuous visitation policy and an adjoining private suite for patients' family members. An exploratory, descriptive study design was used to identify the effects of continuous family visitation in the neuroscience ICU on patients' family members and their needs and experiences during their time in the unit. A convenience sample of consenting family members completed a survey of family need items 72 hours after the patient was admitted to the unit. The most important needs identified by the 45 family members surveyed were items relating to information about the patient, visiting the patient, being given hope, talking with a doctor each day, and being assured that the best care is being given to the patient. Least important items were related to physical comforts for the family members. The vast majority of family members rated their needs as being met for all of the items in the survey and reported a high level of satisfaction with care. In a neuroscience ICU with an open visitation policy and a private suite for patients' family members, family members rated their needs as being met at a high level, unlike in prior studies in units with limitations on family visitation. The rank order of the importance of each need in the survey was similar to rankings in prior studies in a variety of critical care units.

Who Should Be at the Bedside 24/7: Doctors, Families, Nurses?

Critical illness does not keep to regular, daytime business hours; we must provide high-quality care and support for intensive care unit (ICU) patients 24 hours per day, 7 days per week. Whether this mandates the presence of similar numbers and types of personnel throughout all hours of the day, however, has been the subject of much debate and substantial research. In this article, we review the available literature on the consequences of having three groups of care providers at a patient's bedside overnight: physicians, visitors, and nurses. Though few of the studies on this topic are randomized and prospective, several themes have emerged from the existing data. First, there is dramatic variation in practice between and within countries. Second, the weight of evidence does not indicate that patient outcomes are improved by having an intensivist present overnight in ICUs that are staffed by intensivists during the daytime hours. Third, although visitation is highly restricted in many ICUs-out of concerns for disruption of care and a negative physiological or psychological impact on patients-the available data suggest that patients and their families generally benefit from open visitation policies. And finally, although there is little debate that nurses are (and should be) available in the ICU 24/7, existing data do not provide much of a consensus about the details. Uncertainties include whether outcomes are better when each nurse is assigned only one patient (or, more generally, the optimal patient:nurse ratio), who these nurses should be (e.g., registered nurses vs. other personnel), and what their roles should entail (e.g., managing ventilators). As such, we cannot yet identify the optimal overnight nurse staffing strategy. What is clear is that the critical care community needs more and better data to further define these aspects of the relationship between ICU structure and ICU outcomes.

The Visitation Conditions, Parents’ Anxiety and Nurses’ Attitudes of Open Visitation in Attitudes of Open Visitation in

The Visitation Conditions, Parents’ Anxiety and Nurses’ Attitudes of Open Visitation in Attitudes of Open Visitation in

Anxiety, depression, and satisfaction in close relatives of patients in an open visiting policy intensive care unit in Brazil

PurposeThe purpose of the study is to evaluate the satisfaction and symptoms of anxiety and depression in family members in an open visiting intensive care unit (ICU). Material and methodsA prospective study conducted in a 22-bed mixed ICU in a tertiary hospital in Sao Paulo, Brazil. Family members were enrolled 2 days after admission, and they completed a modified version of Critical Care Family Needs Inventory and the Hospital Anxiety and Depression Scale (HADS). ResultsA total of 471 families were interviewed between March 2011 and 2013. Prevalence of anxiety and depression were of 34% and 17%, respectively. We found a high satisfaction score, median of 13 (12-14), and 5% of families were dissatisfied. The daily visiting time was 12 (8-22) hours, and until 10 hours per day, there was a positive association between visiting hours and satisfaction (P = .004). Dissatisfied families reported higher rates of anxiety and depression (P < .001). Visiting hours presented negative interaction between HADS and Critical Care Family Needs Inventory. Patients' severity had a trend toward dissatisfaction (P = .08) and affected emotional disorders (P < .001). ConclusionsFamily members in an open visit ICU reported low rates of symptoms of anxiety and depression and high satisfaction. Visiting hours were associated with the satisfaction score and were a protective factor for family members with higher HADS score.

Magnet journey: a quality improvement project—implementation of family visitation in the PACU.

Over the years, patient- and family-centered care has been a focus of many researchers in the postanesthesia care unit (PACU) setting. Despite evidence pointing to the benefits and positive outcomes of partnering with family in patient care in pediatric and adult PACUs, this practice has not gained popularity in the adult PACUs of many hospitals. The purpose of this project was to test and validate the benefits of including families as partners in care in the PACU. A pre/post exploratory design using survey methodology was used. Survey questionnaires were administered to patients, family, and nursing staff before and after the implementation of a patient visitation program. Patient and family satisfaction increased after implementation of the family visitation program. Nursing satisfaction with and openness to family visitation also increased. Results provide the evidence base to implement an open visitation policy that has been made permanent as a standard of care practiced in all the PACU sites throughout the health system.

Implementing an open unit policy in a neonatal intensive care unit: nurses' and parents' perceptions.

Family presence is linked to reduced stress, better patient safety, and increased family satisfaction. But parental presence can increase nurses' workload and make nurses feel uncomfortable. An open unit (OU) policy and plan for implementation was developed. An anonymous survey was given to nurses about an OU pre- and postimplementation. Responses were used to learn perceived barriers; focus groups were held to understand the concerns and develop solutions. The success of the program was measured by pre/post nursing and parent surveys. Initially, 87% (76/87) of nurses were not in favor of an OU. Most common concerns were as follows: HIPPA 71%, social issues 56%, and increased time for report 45%. Post-OU, only 17% (10/59) were not in favor. Fifty-four percent expressed no major concerns. The most common concerns were as follows: interruptions 25%, limited space 22%, HIPPA 17%. Eighty percent cited benefits for parents. Most common benefits were as follows: increased visiting 49% and improved parent emotional state 43%. Pre-OU, 78% (18/23) of parents felt they were allowed to be with their baby as much as they wanted compared to 92% (36/39) post-OU. Neonatal intensive care unit nurses had reservations toward open visitation, but with education and a focused process for implementation, most nurses favored the change and benefits for families were recognized. Parent satisfaction increased regarding time spent with their infant.

Family visitation in greek intensive care units: nurses' perspective.

Policies of flexible and open visiting in intensive care units benefit both patients and patients' families. In Greek intensive care units, gaps exist between evidence and practice for family visitation, resulting in restricted visiting policies. To explore the beliefs of nurses in Greek intensive care units about the effects of visiting on patients, patients' families, and unit staff and nurses' attitudes toward visiting policies. A descriptive correlational survey was conducted in 6 public hospitals in Athens, Greece, with a sample of 143 critical care nurses. Data were collected via an anonymous questionnaire consisting of 3 validated scales to assess the nurses' beliefs about and attitudes toward visitation. Generally, nurses were resistant to family visiting and open visiting, and most (94.4%) did not want an open policy in their unit. Nurses think that open visiting policies are supportive for patients and patients families, but the overall effects of visiting depend on both the nurse and the patient (91.6%). Nurses reported that open visiting created increased physical and psychological burdens for them (87.5%) and hampered nursing care (75.5%). Years of work experience, staffing level, and number of night shifts worked by nurses per 15 days were factors predictive of nurses' attitudes toward and beliefs about family visitation. Nurses' beliefs about and attitudes toward visitation are important factors in the implementation of more flexible visiting policies in Greek intensive care units. Well-staffed units with experienced nurses and fewer shifts per week may affect nurses' negative attitude toward open visitation.

Open visitation in a neonatal intensive care unit: visitors’ perception

This study aimed to identify the perceptions of parents, caregivers and visitors about the open visitation to newborns hospitalized in the Neonatal Intensive Care Unit. This is a descriptive, quantitative study, involving 50 visitors of newborns hospitalized in the neonatal unit of a school maternity hospital from Natal-RN, from October to December 2012. The data were collected through a questionnaire with closed questions, from which after data analysis, it was observed that most of the fathers, with the exception of family visitors, had free access to the unit, they considered to be well accepted by the staff and the information about the clinical condition of newborns was satisfactory. Most were welcomed and guided by the nurse, and were encouraged to come back for another visit. All of them considered important to visit the mother and the newborn, highlighting the need for bigger integration among professionals and family members.

Improving family-centered care practices in the NICU.

Family presence and participation in care in the NICU is fundamental to the recovery and well-being of the sick neonate and family. However, some NICU visitation policies are not supportive of families. A new visitor-management program was initiated at a local hospital. The program included open visitation for parents and others chosen by parents to be a support during their hospital stay. This quality-improvement project evaluated if there was any improvement in parents' perceptions and experiences of family-centered care after the implementation of the new visitor-management program. The NICU parent survey data revealed a modest positive difference in parent responses after the implementation of the program.