Unrestricted Visitation Research Articles

Postnatal quietness - the dilemma of visiting hours. A qualitative interview study with maternity care staff

BackgroundAs part of the Person and Family Centred Care, involvement of relatives is a key concept. This means that an unrestricted visiting policy in hospitals wards is widely accepted and implemented. In maternity care, benefits and drawbacks of unrestricted visiting is still discussed, while it is acknowledged that a quiet environment is important for both new parents and newborns to enhance breastfeeding. The COVID-19 lockdown provided an opportunity to study how the restrictions for visitors influenced the work of maternity care staff in Denmark. ObjectiveThis study aimed to explore the experience of maternity care staff on how visitation restrictions for visitors influenced the care of new families in a maternity ward. MethodsIndividual interviews (n = 10) were performed between 20 November 2020 and 25 February 2021. A qualitative descriptive study was performed using thematic analysis. ResultsOne overarching theme was identified: “Framing time to the experience of becoming a parent”. Further, five sub-themes were identified and illuminated in the analysis: “Increasing confidentiality and presence”, “Changing availability and space for guidance”, “Welcoming peacefulness”, “Being gatekeepers”, and “Structuring time is caring”. ConclusionRestrictions for visitors influenced the care of new families because it encourages the space and place of becoming a parent. The hospital environment was shaped in a calm way, which increased the staffs’ bedside time. The experience of an increased confidentiality with new parents led to in-depth conversations, making it easier to identify new parents’ needs, focus on the initiation of breastfeeding, and individual guidance.

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

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.

Continuous Family Access to the Intensive Care Unit: A Mixed Method Exploratory Study.

IntroductionIntensive care unit (ICU) visitation has traditionally been restrictive, primarily due to septic considerations and staff apprehension towards unrestricted visitation policy. However, ICU admission is stressful for patients and their families and the presence of family relatives at ICU patients’ bedside may help alleviate the same. The present study compares the viewpoints of healthcare workers (HCW) and patients’ family members regarding these two types of visitation policies.Materials and methodsThe initial assessment involved a qualitative investigation, based on an inductive grounded theory approach. Participant interviews were audiotaped, transcribed, manually coded, themes analyzed, and aggregate dimensions unfolded. Subsequently, a structured proforma filled by stakeholders and responses were coded as categorical variables (quantitative investigation). Their association with a continuous presence of family members was seen using univariate analysis (Chi-square test) and p <0.05 was considered significant. Satisfaction levels were rated on a Likert scale.ResultsEighty-six stakeholders [group A: HCWs (15 doctors, 29 nurses), group B: patients (n = 18), and their relatives (n = 24)] were interviewed. While group A preferred restricted visitation policy (RVP), group B preferred unrestricted visitation policy (UVP). Quantitative data confirmed that HCWs (92.8% nurses and 85.7% doctors) were more satisfied with RVP and group B (92.3% relatives and 87.5% patients) with UVP. Group A (75.9% nurses and 93.3% doctors) therefore preferred RVP and group B (75% families and 66.6% patients) preferred UVP.ConclusionThe patients and their families were more satisfied with UVP contrary to HCWs who were skeptical towards UVP and preferred RVP.How to cite this articleMahajan RK, Gupta S, Singh G, Mahajan R, Gautam PL. Continuous Family Access to the Intensive Care Unit: A Mixed Method Exploratory Study. Indian J Crit Care Med 2021;25(5):540–550.

COVID-19: No Visitors.

COVID-19: No Visitors.

Family Presence and Visitation Practices in Latin American PICUs: An International Survey.

Over the last two decades, there has been a worldwide cultural shift toward family-centered intensive care. In this article, we conducted a survey of 47 pediatric intensive care units (PICUs) across 11 Latin American countries to assess visitation practices and bedside family presence (with a 97.9% response rate). All PICUs had at least some form of parental visitation. The prevalence of unrestricted (24 hours/day) parental visitation was 63%. Sibling visitation was permitted in 23% of PICUs, while 35% allowed family presence during procedures, and 46% during resuscitation. Only 1 PICU allowed pet visitation. Family visitation and bedside presence are still restrictive in Latin American PICUs, with wide practice variation among the various intensive care units.

Is Open Visitation Really "Open" in Adult Intensive Care Units in the United States?

Evidence indicates that open visitation in adult intensive care units is a best practice for patient- and family-centered care, and nurses substantially influence such visitation patterns. However, it is unclear whether intensive care units in Magnet and Pathway to Excellence (MPE) facilities nationwide implement this in practice. To describe current national visitation practices in adult intensive care units and determine whether they have changed since the last national study, which used data from 2008 to 2009. From February through April 2018, websites of MPE hospitals were reviewed in order to identify their adult intensive care unit visitation policy. If this information was unavailable online, the hospital was telephoned to obtain the policy. From May through August 2018, follow-up telephone calls were made to hospitals that reported open visitation, during which intensive care unit nurses at the hospitals were asked to verify that the policy did not restrict visiting hours or the number, type, or age of visitors. Among the 536 MPE hospitals contacted, 51% (n = 274) indicated that they allowed open visitation. Further examination, however, revealed that 64% (n = 175) restricted the number (68.2%), age (59.5%), or type (4.4%) of visitors, or visiting hours (19.8%). Only 18.5% of MPE hospitals (n = 99) allowed unrestricted visitation. This study suggests a lack of progress toward implementing open visitation in adult intensive care units nationwide. Research on MPE hospitals that have adopted truly open visitation policies is needed to identify successful methods for implementing and sustaining open visitation.

Implementation of Open Visitation in an Adult Intensive Care Unit: An Evidence-Based Practice Quality Improvement Project.

Implementation of Open Visitation in an Adult Intensive Care Unit: An Evidence-Based Practice Quality Improvement Project.

ICU医护人员对非限制性探视制度的认知调查

ICU医护人员对非限制性探视制度的认知调查

Parental Presence at the Bedside of Critically Ill Children in a Unit With Unrestricted Visitation.

To determine the percentage of time that critically ill children have a parent at the bedside and to identify extrinsic factors that are associated with percent of time with parental presence at the bedside. Prospective cohort study. PICU in a single tertiary care children's hospital. Primary two parents of all children admitted to the PICU on 12 preselected days during a 1-year period from 2014 to 2015. None. A total of 111 observations of 108 unique PICU admissions and families were performed. Children had at least one parent present a mean of 58.2% (SD, 34.6%) of the time. Mothers spent more time at the bedside (56.3% [SD, 31.0%]) than fathers (37.3% [SD, 29.5%]) (p = 0.0001). Percent of time with parental presence at the bedside was positively correlated with age (rs = 0.23; p = 0.02) and negatively associated with Pediatric Risk of Mortality III score (rs = -0.26; p = 0.01). Percent of time with parental presence at the bedside was lower for children who were mechanically ventilated (42.8% [SD, 35.5%]) than not (64.5% [SD, 32.2%]) (p = 0.01) and whose parent(s) were single (45.5% [SD, 27.5%]) or cohabitating/common-law (35.7% [SD, 26.4%]) compared with parents who were married (64.2% [SD, 34.2%]) or separated/divorced (68.3% [SD, 28.8%]) (p = 0.02). Percent of time with parental presence at the bedside was higher for children with chronic illnesses (63.4% [SD, 32.9%] vs 50.1% [SD, 35.8%] without; p = 0.04), when there was a bed in the patient room (61.4% [SD, 34.0%] vs 32.5% [SD, 28.3%] without; p = 0.01), and when parents slept in the patient room (90.3% [SD, 11.2%]) compared with their own home (37.6% [SD, 34.4%]) (p < 0.0001). Percent of time with parental presence at the bedside was not correlated with day of PICU stay, number of siblings, previous PICU admission, isolation status, or nursing ratio. Children had a parent present at the bedside approximately 60% of the time. The parents of younger, sicker children may benefit from supportive interventions during PICU admission. Further research is needed to examine both extrinsic and intrinsic factors affecting parental presence at the bedside.

Preventive human rights monitoring in child and adolescent psychiatry and welfare institutions

Since 1July 2012 the Austrian Ombudsman Board (AOB) together with its six regional expert commissions form the so called "National Prevention Mechanism" implementing the UN Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). The commissions are mandated to conduct regular, unrestricted and unannounced visits to all types of places in which there is or can be adeprivation or restriction of personal liberty, such as prisons, police stations, but also psychiatric hospitals or residential homes/groups for children and juveniles supervised by youth welfare services. 20monitoring visits have been held in departments for Child- and Adolescent Psychiatry between 2012 and 2016. In the field of residential groups for young people 40visiting protocols (out of atotal of 176 between 2015 and 2016) have been chosen for this analysis. The following article overviews the legal sources and key issues of the monitoring process in this field as well as the commissions' findings and recommendations.

How Efficient Is Apis cerana (Hymenoptera: Apidae) in Pollinating Cabbage, Brassica oleracea var. capitata? Pollination Behavior, Pollinator Effectiveness, Pollinator Requirement, and Impact of Pollination.

Cabbage is a cross-pollinated crop because of sporophytic self-incompatibility, and honey bees play an important role in its pollination. Though Asian honey bees, Apis cerana F., are used in pollination of cabbage, the rate of visitation, behavior, pollinator efficacy, and impact on seed-set are to be determined. Apis cerana occupy a share of 19.18% of all the flower visitors of cabbage in natural habitat of North Western Indian Himalayas. Pollination behavior in terms of peak activity, flowers processed per unit time, time spent per flower, and time spent in search of flowers are studied separately for both pollen and nectar foragers. Pollinator effectiveness as measured by seed set in flowers excluded from bee visitation, single bee visit, and unrestricted pollinator visits was 0.11. Studies on the impact of A. cerana bee pollination in cabbage seed production revealed an increase of 17.28% in siliqua per panicle, with 26.11% increase in seed yield. For assessing the requirement of A. cerana to pollinate one hectare of cabbage, flower availability and the speed with which the pollen and nectar foragers process the flowers are taken into consideration. A forager is estimated to pollinate 4,780 flowers a day, but cabbage flower requires 9.09 visits of A. cerana for optimum seed set. Thus, a maximum of 4,999 bee foragers or 8.33 colonies are needed to effectively pollinate 1 ha of cabbage. Though A. cerana is a good pollinator, our findings suggest that it is not an ideal pollinator of cabbage.

Intensive Care Nurses' Attitude on Palliative and End of Life Care.

Background:Intensive Care Unit (ICU) nurses have a vital role in the implementation of end of life (EOL) care. There is limited data on the attitude of ICU nurses toward EOL and palliation.Aim:This study aimed to investigate knowledge, attitude, and beliefs of intensive care nurses in eastern India toward EOL.Materials and Methods:A self-administered questionnaire was distributed to delegates in two regional critical care nurses' training programs.Results:Of 178 questionnaires distributed, 138 completed, with a response rate of 75.5*. About half (48.5*) had more than 1 year ICU experience. A majority (81.9*) agreed that nurses should be involved in and initiate (62.3*) EOL discussions. Terms “EOL care or palliative care in ICU” were new for 19.6*; 21* and 55.8* disagreed with allowing peaceful death in terminal patients and unrestricted family visits, respectively. Work experience was associated with wanting unrestricted family visitation, discontinuing monitoring and investigations at EOL, equating withholding and withdrawal of treatment, and being a part of EOL team discussions (P = 0.005, 0.01, 0.01, and 0.001), respectively. Religiousness was associated with a greater desire to initiate EOL discussions (P = 0.001).Conclusion:Greater emphasis on palliative care in critical care curriculum may improve awareness among critical care nurses.

Set of Quality Indicators of Pediatric Intensive Care in Spain: Delphi Method Selection.

Introduction:This study objective was to identify, select, and define a basic set of quality indicators for pediatric intensive care in Spain.Methods:(1) Review of the literature to identify quality indicators and their defining elements and (2) selection of indicators by consensus of a group of experts using basic Delphi methodology (2 rounds) and forms distributed by email among experts from the Spanish society of pediatric intensive care.Results:We selected quality indicators according to their relevance and feasibility and the experts’ agreement on their incorporation in the final set. We included only those indicators whose assessment was within the highest tertile and greater than or equal to 70% evaluator agreement in the final selection. Starting from an initially proposed set of 136 indicators, 31 experts first selected 43 indicators for inclusion in the second round. Twenty indicators were selected for the final set. This “top 20” set comprised 9 process indicators, 9 of results (especially treatment-associated adverse effects), and 2 indicators of structure. Several of them are classical indicators in intensive care medicine (rates of hospital-acquired infections, pressure ulcers, etc.), whereas others are specifically pediatric (eg, unrestricted parent visitation or training the parents of technology-dependent children).Conclusions:We reached a consensus on a set of 20 essential quality indicators for pediatric intensive care in Spain. A significant subset reflects the peculiarities of pediatric care. We consider this subset as a starting point for future projects of network collaboration between pediatric intensive care units in Spain.

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.

The existence of policies, practices and perceptions regarding children as visitors to public hospitals in uMgungundlovu, KwaZulu-Natal Province

Background. Current policies and practices regarding child visitors in hospitals in uMgungundlovu, KwaZulu-Natal Province, South Africa, are unknown. Existing literature focuses on provision for child visitors in specialised units in well-resourced countries. Objective. To identify policies, describe current practices and determine the perceptions of healthcare workers to child visitors. Methods. Interviews were conducted with 7 nursing managers regarding the existence and content of a hospital visitors’ policy, 12 operational managers (OMs) to describe ward practices regarding child visitors, and 12 professional nurses and 11 doctors to determine their attitudes towards children as visitors in all four general state hospitals in uMgungundlovu between October 2013 and July 2015. Results. Five out of seven nursing managers were aware of a visitors’ policy in their hospital. These policies allowed children to visit family or parents in adult wards, but only 2 would allow children to visit a family member and only 1 would allow visits to a friend in the children’s wards. According to the nursing managers, policy was that the visitor must be over 5 years of age to visit in an adult ward while 2 out of 3 nursing managers allowed only children over 12 years of age to visit in children’s wards. Visits must occur during prescribed visiting times and the visitor must be accompanied by an adult. In practice, 7 out of 12 OMs allow child visitors in their wards. Only 2 out of 7 OMs allow unrestricted visitation by children and only to non-infectious patients in children’s wards – this is subject to variable age restrictions in adult wards and an age limit of 12 years in children’s wards. In all wards, visits by children are restricted to prescribed visiting times and conditional on an adult escort. Three out of seven OMs allow 2 visitors only, although most (5 out of 7) allow visits of unlimited duration. Staff who favoured child visitors were more likely to be younger, male and employed as health professionals for <5 years. More doctors than nurses believed that children should be allowed to visit family and/or friends in hospital. Justifications for not allowing children to visit centred on infection risks and the emotional trauma of visiting a sick loved one. The child, patient and health professional were seen to benefit socially from child visitors, although there are positive and negative emotional consequences for the patient and the child. Conclusion. Hospitals do make provisions for visitors, but most exclude young children, particularly those who are most vulnerable to the negative consequences of separation from a parent or family member. While policies do exist to guide child visitation in uMgungundlovu, such policies are restrictive, inconsistent and do not necessarily reflect day-to-day practices.

Visita restrictiva / Visita no restrictiva en una unidad de paciente crítico adulto

Objetivo: buscar evidencia que responda a la pregunta ¿cuál es el impacto en el paciente, familia y personal de salud de visitas no restrictivas versus restrictivas? Método: revisión sistemática. Estrategia de búsqueda: 1993-2016 en Cochrane Library, Joanna Briggs, EBSCO,PubMed, CINHAL, Trip DataBase, con términos Mesh y palabras claves. Criterios de selección de artículos: revisiones sistemáticas,ensayos clínicos randomizados, no randomizados, cohortes, casos controles, estudios descriptivos correlacionales, UCI adultos, español e inglés. Recolección y análisis: selección inicial de 293 artículos, aplicando criterios de selección quedaron 13 artículos para análisis crítico.Calidad metodológica analizada con guías CASPe. Resultados: la visita no restrictiva no incrementa riesgo de infección, la ansiedad delpaciente es menor, la satisfacción de enfermeras es mayor, la presencia familiar ayuda a recuperación del paciente, la familia está más informada, satisfecha y con mejor conocimiento de situación. La frecuencia de complicaciones cardiovasculares es mayor en pacientes con visitas restrictivas. Conclusiones: las visitas no restrictivas en UCI no generan daño al paciente, por el contrario contribuyen a la recuperación de su salud física y emocional.

Satisfaction With Elimination of all Visitation Restrictions in a Mixed-Profile Intensive Care Unit

Open and patient-tailored guidelines have been recommended as the preferred visitation model in critical care settings; however, many critical care units continue to restrict visitation. To determine whether a transition from minimally restrictive to unrestricted visitation hours improves satisfaction of patients' family members and whether such a transition affects nurses' satisfaction and nurses' perceptions of satisfaction among patients' families. Using a prospective, observational design in a 24-bed intensive care unit in a tertiary care hospital, validated instruments were used to survey family members visiting patients and all nurses working in the unit before and after a change in the visitation policy. Visitation hour guidelines were changed from closed during nursing hand-off report (3 hours daily) to open at all times, depending on patients' preference and clinical status. One hundred three family members (50 before and 53 after the change in visitation guidelines) and 128 nurses (61 before and 67 after the policy change) were surveyed. Unrestricted visitation hours significantly improved family members' satisfaction with the convenience of visitation hours and waiting room ambiance, and nurses' perceptions of families' satisfaction also improved. Elimination of even minimal restrictions on visitation hours improved family satisfaction and improved nurses' perceptions of family satisfaction with the visitation policy. Nurses' satisfaction did not change. These findings support open and patient-centered visitation guidelines in critical care settings.

Developmental centered care. Situation in Spanish neonatal units

Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown.To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006.A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire.The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01).The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits.

Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España

IntroductionDevelopmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. ObjetiveTo determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. Material and methodsA descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. ResultsThe survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01). ConclusionsThe implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits.