Visitor Restriction Policies Research Articles

Visitor Restrictions During the COVID-19 Pandemic and Increased Falls With Harm at a Canadian Hospital: An Exploratory Study.

Falls with harms (FWH) in hospitalized patients increase costs and lengths of stay. The COVID-19 pandemic has resulted in more FWH. Additionally, the COVID-19 pandemic has resulted in increased patients in isolation with fewer visitors. Their relationship with falls has not been previously studied. This is a retrospective, single-site, 12-month before pandemic-12-month after pandemic, observational study. Multiple logistic regression analysis was used to model FWH outcome and associations with isolation and visitor restrictions. There were 4369 isolation events and 385 FWH among 22,505 admissions during the study period. Unadjusted analysis demonstrated a FWH risk of 1.33% (95% CI 0.99, 1.67) in those who were placed in isolation compared to 1.80% (95% CI 1.60, 2.00) in those without an isolation event (χ2 = 4.73,P = 0.03). The FWH risk during the different visitor restriction periods was significantly higher compared to the prepandemic period (χ2 = 20.81, P < 0.001), ranging from 1.28% (95% CI 1.06, 2.50) in the prepandemic period to 2.03% (95% 1.66, 2.40) with no visitors permitted (phase A) in the pandemic period. After adjusting for potential confounders and selection bias, only phase A visitor restrictions were associated with an increased FWH risk of 0.75% (95% CI 0.32, 1.18) compared to no visitor restrictions. Our results suggest a moderately strong association between hospitalized patient FWH risk and severe visitor restrictions. This association was muted in phases with even minor allowances for visitation. This represents the first report of the adverse effects of visitor restriction policies on patients' FWH risks.

Crossroads of well-being and compliance: a qualitative cohort study of visitor restriction policy during the COVID-19 pandemic, the Netherlands, May 2020-December 2021

BackgroundIn this qualitative study we observed in-depth the impact of the visiting restriction policy (VRP, i.e. number of visitors allowed at home) on well-being and compliance during the COVID-19 pandemic to regulate infection rates.MethodsA cohort of 15 interviewees was followed throughout the COVID-19 pandemic in the Netherlands in 12 interview rounds (May 2020-December 2021). Every round semi-structured telephone interviews were conducted by a team of 8 researchers. In total 176 interviews were conducted.ResultsThis study showed that four categories can be identified when observing the impact of the VRP on well-being and compliance. For Resilient-Followers reasons for compliance were risk perception, following government rules, and for some having a small social circle. Because they accepted the situation, well-being was hardly affected. Resilient-Rulebreakers made their own risk assessment of people they met. Their well-being was hardly affected, because they experienced social rest and interpreted the measure in their own way. Suffering-Followers complied, because of risk perception, following government rules, and working in healthcare. However, the VRP had substantial impact on well-being, because social structures were disrupted. Suffering-Rulebreakers gave their own interpretation to the VRP, trying to find a balance between compliance and well-being. We observed that the categories were quite stable over time.ConclusionsThe VRP appeared to be a measure with substantial impact on well-being for some, mostly because social structures were disrupted. The measure showed fluctuating compliance, in which feasibility and frequent changes in the VRP played a role. Well-being seemed related to the number of visitors that was allowed; a restriction of four visitors was feasible, while one visitor resulted in a negative breaking-point in resilience, which had an impact on compliance, even among the most compliant. Taken together, this study provides valuable insights into the implications of and compliance to a VRP during different phases of the COVID-19 pandemic, which may contribute to policymaking during future pandemics.

Visitor restrictions in hospitals during infectious disease outbreaks: An ethical approach to policy development and requests for exemptions.

In this paper, we explore the ethics of restricting visitation to hospitals during an infectious disease outbreak. We aim to answer three questions: What are the features of an ethically justified hospital visitor restriction policy? Should policies include scope for case-by-case exemptions? How should decisions about exemptions be made? Based on a critical interpretive review of the existing ethical literature on visitor restrictions, we argue that an ethically justified hospital visitor restriction policy has the following features: proportionality, comprehensiveness, harm mitigation, exemptions for specific patient populations, visitation decisions made separately from a patient's treating clinicians, transparency, and consistency in application. We also argue that an ethical policy ought to include scope for case-by-case exemptions for individual patients. We propose a process for ethical decision-making that provides a shared language and structure to decrease the risks and burdens of decision-making when clinicians or managers are considering requests for exemptions.

A Concept Analysis of Family Presence During COVID-19.

In 2020, the COVID-19 pandemic required health care organizations throughout the United States to implement strict visitor restriction policies to mitigate the spread of the virus. These policy changes had a direct impact on family presence (FP) in hospital settings. The aim of this study was to conduct a concept analysis of FP during the COVID-19 pandemic. Walker and Avant's 8-step method was used. Four defining attributes of FP during COVID-19 were derived based on a review of the literature: being there or with, seeing is believing, during challenging times, and subjective advocates. The COVID-19 pandemic was the main antecedent of the concept. The consequences and empirical referents were discussed. Model, borderline, and contrary cases were developed. This concept analysis provided an understanding of the concept of FP during COVID-19, which is imperative to optimizing patient care outcomes, as literature identified a support person or system as an extension of the care team that facilitates successful care management. Whether by advocating for their patients to have a support person present during team rounds, or by stepping in as the patient's main support system in the absence of family, nurses must find a way to do what is best for their patients even during the unprecedented times of a global pandemic.

Intimate partner violence screening during COVID-19.

Emergency Department (ED) screening for intimate partner violence (IPV) is typically nursing-initiated, often with visitors present. Since the onset of the COVID-19 pandemic, we have seen both an increase in societal stress, a known exacerbator of IPV, and the implementation of visitor restriction policies. This combination presents the need for enhanced IPV screening and the opportunity to perform screening in a controlled, patient-only environment. Our goal was to evaluate the frequency of nurse-initiated screening for IPV prior to and during the early months of the COVID-19 pandemic as well as the frequency of positive screens for IPV. We conducted a retrospective cross-sectional study evaluating all adults (age >18 years) presenting to a tertiary care center ED. Patients were identified as presenting prior to the COVID-19 pandemic (June 1, 2019 to August 31, 2019) and after the COVID-19 visitor restriction policies (June 1, 2020 to August 31, 2020). Descriptive statistics were performed using chi-square and t-tests compared the demographic variables. Chi-square was used for a bivariate analysis of our primary outcomes (IPV screening performed and screening positive for IPV). Further analysis was done using a binary logistic regression model adjusting for the demographic characteristics. Both the odds of nursing-initiated IPV screening and the odds of verbally screening positive for IPV significantly increased (OR 1.509, 95% CI 1.432-1.600) and (OR 1.375, 95% CI 1.126-1.681) respectively following the implementation of COVID-19 visitor restriction policies. These findings suggest that nurse-initiated IPV screening should continue to be performed with the patient privately, even after COVID-19 related ED visitor restrictions are removed. These findings also support the hypothesis that the stress related to COVID-19 is contributing to a rise in IPV.

Patient perspectives on colorectal cancer care delivery during the COVID-19 pandemic: A qualitative interview study.

33 Background: The COVID-19 pandemic generated unprecedented interruptions and impacts on healthcare services across the US, including cancer care delivery. Patient perspectives on navigating colorectal cancer (CRC) care throughout the pandemic have not been well documented. This study explored patient experiences and perspectives around CRC care delivery throughout the pandemic by examining the impacts of COVID-19 on planned treatment, healthcare access, and quality of care. Methods: Patients diagnosed with CRC prior to January 2020 and who received treatment for CRC during 2019 participated in this qualitative study. Semi-structured interviews explored treatment experiences before and during the pandemic and were conducted between December 2021 and March 2022. Thematic analysis was used to identify key themes. Results: Twenty-four patients with CRC (mean age 45.4 years [SD=9.7]; 75% female; 62.5% current stage IV) completed an interview. Participants reported diminished mental health as the most salient impact of the pandemic related to their CRC care. Participants expressed how difficult, isolating, and lonely they felt navigating cancer treatment, particularly as a result of visitor restriction policies that did not allow their support person (e.g., spouse) to be present during visits or stays. Increased anxiety, fear, and worry over how the pandemic may affect their planned cancer care, including fear of contracting the virus themselves, were major concerns. Other impacts experienced included barriers to physically accessing care facilities (e.g., reduced appointment availability, staffing shortages), delays to patients’ planned treatment (e.g., canceled surgery), and increased access to and use of telehealth, which was perceived as being more convenient and safer than in-person visits. Participant perspectives on the quality of care they received throughout the pandemic were based on frequency and personalization of patient-provider communication, ability to access their usual care and support services (e.g., care navigators, support groups), and provider attention to their mental health. To improve the quality of cancer care in a pandemic setting, participants recommended personalized and frequent communications from the oncology care team, holistic care that includes mental health support, and streamlined insurance preauthorization processes. Conclusions: While the long-term impacts of COVID-19 on CRC care delivery have yet to be fully understood, this study highlights the key challenges patients experienced while receiving CRC care during the pandemic. Recognizing the strain of the pandemic on patients’ mental health and well-being will help to ensure patient-provider communication and support services consider the short and long-term effects of the pandemic for cancer patients as well as help contribute to improved treatment-related outcomes.

#Morethanavisitor: Experiences of COVID-19 visitor restrictions in Canadian long-term care facilities.

ObjectiveThe purpose of this study was to understand the experiences of families, residents, and staff around visitor restriction policies in long‐term care during the COVID‐19 pandemic in Canada.BackgroundBeginning in March 2020, public health orders across Canada restricted visitors to long‐term care facilities to curb the spread of the infection. This included family caregivers who provide significant support to residents to meet their physical, psychological, social, and safety needs.MethodWe collected data from publicly available news and social media. News articles, blogs, and tweets from Canada were collected from March 2020 to April 2021. In total, 40 news articles, eight blogs, and 23 tweets were analyzed using generic qualitative description.ResultsReports from family members indicate that some residents may have died from malnutrition, dehydration, and isolation, rather than from COVID‐19, because of the sudden and prolonged absence of family caregivers. There are long‐term impacts on family suffering and long‐term care worker burnout. Policy and structural issues were identified.ConclusionExperiences in long‐term care reflected not only impacts of pandemic‐related visitor restrictions, but also long‐standing funding and workforce issues.ImplicationsInvolvement of family, and specifically family caregivers, is crucial in policy decisions, even in unusual circumstances, such as the pandemic.

COVID-19 hospital and emergency department visitor policies in the United States: Impact on persons with cognitive or physical impairment or receiving end-of-life care.

ObjectiveTo characterize the national distribution of COVID‐19 hospital and emergency department visitor restriction policies across the United States, focusing on patients with cognitive or physical impairment or receiving end‐of‐life care.MethodsCross‐sectional study of visitor policies and exceptions, using a nationally representative random sample of EDs and hospitals during the first wave of the COVID‐19 pandemic, by trained study investigators using standardized instrument.ResultsOf the 352 hospitals studied, 326 (93%) had a COVID‐19 hospital‐wide visitor restriction policy and 164 (47%) also had an ED‐specific policy. Hospital‐wide policies were more prevalent at academic than non‐academic (96% vs 90%; P < 0.05) and at urban than rural sites (95% vs 84%; P < 0.001); however, the prevalence of ED‐specific policies did not significantly differ across these site characteristics. Geographic region was not associated with the prevalence of any visitor policies. Among all study sites, only 58% of hospitals reported exceptions for patients receiving end‐of‐life care, 39% for persons with cognitive impairment, and 33% for persons with physical impairment, and only 12% provided policies in non‐English languages. Sites with ED‐specific policies reported even fewer exceptions for patients with cognitive impairment (29%), with physical impairments (24%), or receiving end‐of‐life care (26%).ConclusionAlthough the benefits of visitor policies towards curbing COVID‐19 transmission had not been firmly established, such policies were widespread among US hospitals. Exceptions that permitted family or other caregivers for patients with cognitive or physical impairments or receiving end‐of‐life care were predominantly lacking, as were policies in non‐English languages.

Evaluating Pediatric Families' Understanding of and Reactions to COVID-19 Visitor Restrictions.

The COVID-19 pandemic led to changes in hospital visitor policies and little is known about the impact on patients and their families. This study evaluated families’ understanding of and reactions to COVID-19-related visitor restriction policy at an academic children's hospital. We conducted a cross-sectional study with families of patients admitted to the pediatric ICU and general pediatric wards from September 2020 to November 2020. Parents (n = 73) completed a survey assessing communication, understanding of and satisfaction with visitor policies, strategies of coping with illness, and Hospital Anxiety and Depression Scale (HADS) scores. Descriptive analyses were performed to summarize data. Associations between outcomes and participant characteristics were examined. A majority (88%) of respondents reported hospital visitor restrictions were explained, usually in-person (94%), and understood the policy “very well” (68%), but none correctly identified all reasons for visitation restrictions. Eighty-five percent reported other family/friends would have visited, however minority families were more likely to report they would have had fewer visitors if restrictions were not in place (P = 0.0385). A majority (69%) were satisfied with how the hospital handled visitor polices, and parents of older children were more satisfied (P < .0001). HADS scores were consistent with anxiety or depression in about half of respondents. Forty percent of respondents believed restrictions affected their own and their child's ability to cope during hospitalization. Parents expressed satisfaction with and understanding of visitor policies but did not understand the rationale for visitor restrictions. Visitor restrictions may impact parental and child coping and mental health outcomes.

The coronavirus pandemic: exploring expectant fathers’ experiences

ABSTRACT The Coronavirus pandemic raises significant concerns about pervasive social inequities and disparate gender relations, particularly between mothers/fathers. Indeed, the pandemic engendered a general retreat into traditional parenting roles across myriad, everyday, institutional, spaces, including workplaces, homes, and welfare/healthcare services. These effects have been especially marked for couples expecting a child. Visitor-restriction policies, implemented to curb viral-spread within healthcare settings, effectively ‘barred’ many expectant fathers in the UK (and elsewhere) from attending antenatal appointments, and even the birth of their child; milestone moments widely regarded as significant socio-cultural ‘rites-of-passage’ in fathers’ transition to parenthood. Many pregnant women had to face these moments alone, sparking campaigns including #ButNotMaternity. This paper critically examines how such institutional responses exhibit a complex ‘welfare trade-off’ effectively (re)positioning fathers as spectators, rather than participants, in pregnancy/parenthood and risk embodying a potential U-turn to recent decades’ emphasis on involved, equitable fatherhood. Drawing upon the accounts of expectant mothers/fathers in the UK reported in the popular press since March 2020 and the #ButNotMaternity campaign, it employs thematic social-media analysis to explore the emotional impacts of visitor-restrictions and the gendered, emotional governance of parenting amidst the pandemic through the exclusion of particular (fathers’) bodies within maternity care spaces.

The Health Equity Impact Assessment: A Case Study in COVID-19 Visitor Policy.

The Health Equity Impact Assessment: A Case Study in COVID-19 Visitor Policy.

The Impact of Visiting Restrictions During the COVID-19 Pandemic on Pediatric Patients

Visitor restriction policies have been implemented on many hospital units as a result of the Covid-19 pandemic. These policies are integral to the strategies that hospitals are using to limit exposure risks during the pandemic. However, visitor restriction policies disproportionally affect hospitalized children. The trauma caused by lack of family at the bedside of adult patients during the Covid-19 pandemic has been studied but there is a lack of primary research on the impact of the Covid-19 visiting policy restrictions on pediatric patients. Long term studies are needed to understand the effect of this separation on children and their caregivers.

Consequences of visitor restriction policies in the intensive care unit during the COVID-19 pandemic

Consequences of visitor restriction policies in the intensive care unit during the COVID-19 pandemic

An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic

PurposeIn response to the rapid spread of SARS-CoV-2, hospitals in Canada enacted temporary visitor restrictions to limit the spread of COVID-19 and preserve personal protective equipment supplies. This study describes the extent, variation, and fluctuation of Canadian adult intensive care unit (ICU) visitation policies before and during the first wave of the COVID-19 pandemic.MethodsWe conducted an environmental scan of Canadian hospital visitation policies throughout the first wave of the pandemic. We conducted a two-phased study analyzing both quantitative and qualitative data.ResultsWe collected 257 documents with reference to visitation policies (preCOVID, 101 [39%]; midCOVID, 71 [28%]; and lateCOVID, 85 [33%]). Of these 257 documents, 38 (15%) were ICU-specific and 70 (27%) referenced the ICU. Most policies during the midCOVID/lateCOVID pandemic period allowed no visitors with specific exceptions (e.g., end-of-life). Framework analysis revealed five overarching themes: 1) reasons for restricted visitation policies; 2) visitation policies and expectations; 3) exceptions to visitation policy; 4) patient and family-centred care; and 5) communication and transparency.ConclusionsDuring the first wave of the COVID-19 pandemic, most Canadian hospitals had public-facing visitor restriction policies with specific exception categories, most commonly for patients at end-of-life, patients requiring assistance, or COVID-19 positive patients (varying from not allowed to case-by-case). Further studies are needed to understand the consistency with which visitation policies were operationalized and how they may have impacted patient- and family-centred care.

Health Policy and Health Services Delivery in the Era of COVID-19.

Health Policy and Health Services Delivery in the Era of COVID-19.

The Initial Impact of the Coronavirus Disease 2019 Pandemic on ICU Family Engagement: Lessons Learned From a Collaborative of 27 ICUs.

To describe the impact of coronavirus disease 2019 on family engagement among ICUs participating in a multicenter collaborative promoting implementation of family-centered care projects and to report sites' experiences with the collaborative itself prior to its cancelation due to the pandemic in March 2020. Cross-sectional survey. Twenty-seven academic and community ICUs in the United States and South Korea. Site leaders. Prior to March 2020, all sites had participated in 6 months of webinars, monthly calls, and listserv communication to facilitate projects and to collect preimplementation family satisfaction and clinician perception data. Planned projects included ICU orientation initiatives (12, 44.4%), structured family care conferences (6, 22.2%), and ICU diaries (5, 18.5%). After cancelation of the collaborative, 22 site leaders (81.5%) were surveyed by phone from June 2020 to July 2020. Twenty (90.1%) reported having stopped their site project; projects that continued were 1) a standardized palliative extubation protocol and 2) daily written clinical summaries for families. Sites described significant variability in visitor restriction policies and uncertainty regarding future policy changes. Four sites (18.2%) reported that their hospital did not provide personal protective equipment to visitors. Regarding video conferencing with families, 11 sites (52.4%) reported clinicians' using their own personal devices. Two-hundred twelve family surveys and 346 clinician surveys collected prior to cancelation highlighted a broad need for family support. When leaders were asked on a scale from 0 to 10 how helpful collaborative activities had been prior to cancelation, mean response was 8.0 (sd 2.5). While the collaborative model can help promote ICU family engagement initiatives, coronavirus disease 2019 has impeded implementation of these initiatives even among motivated units. ICUs need adequate personal protective equipment for visitors and video conferencing capabilities on hospital devices while strict visitor restrictions continue to evolve.

Hospital Policies During COVID-19: An Analysis of Visitor Restrictions.

In response to the COVID-19 pandemic, hospitals have developed visitor restriction policies in order to mitigate spread of infection. We reviewed hospital visitor restriction policies for consistency and to develop recommendations to highlight fair and transparent restrictions, exceptions, and appeals in policy development and implementation. Collection and analysis of public-facing visitor restriction policies during the first 3 months of the pandemic. General acute care hospitals representing 23 states across all 4 major regions of the United States. A cohort of the 70 largest hospitals by total bed capacity. Characteristics of visitor restriction policies including general visitor restriction statement, changes/updates to policies over time, exceptions to policies, and restrictions specific to COVID-19-positive patients. Sixty-five of the 70 hospitals reviewed had public-facing visitor restriction policies. Forty-nine of these 65 policies had general "no-visitor" statements, whereas 16 allowed at least 1 visitor to accompany all patients. Sixty-three of 65 hospitals included exceptions to their visitor restriction policies. Setting-specific exceptions included pediatrics, obstetrics/gynecology, emergency department, behavioral health, inpatient rehabilitation, surgery, and outpatient clinics. Exceptions that applied across settings included patients at end of life and patients with disabilities. Visitor restriction policies varied significantly among hospitals in this review. These variances create challenges in that their fair application may be problematic and ethical issues related to allocation may arise. Five recommendations are offered for hospitals revising or creating such policies, including that offering transparent, accessible, public-facing policies can minimize ethical dilemmas. In addition, hospitals would benefit from communicating with each other in the development of visitor policies to ensure uniformity and support patients and family members as they navigate hospital visitation.

Patient Experience on a Hospital Oncology Service Before and After Implementation of a No-Visitor Policy During COVID-19.

Hospital visitor restriction policies prompted by Coronavirus Disease 2019 (COVID-19) may lead to a less comfortable or informed inpatient experience for oncology patients admitted for non-COVID-19 conditions. We surveyed oncology inpatients before (n = 47) and after (n = 65) implementation of a no-visitor policy using a validated questionnaire to measure patient experience. Results revealed no significant difference in the percentage of patients reporting “no problems” (P < .05) in all questions. Patient experience was not adversely impacted by visitor restrictions enacted in response to COVID-19 on an oncology service, as measured by a questionnaire capturing common concerns among inpatients.

249: ICU Visitor Restriction Policies and Approaches to Family Engagement During the COVID-19 Pandemic

INTRODUCTION: Communication with family members of ICU patients has changed dramatically during the COVID-19 pandemic To investigate these changes, we interviewed site project leaders among ICUs that had participated in the Family Engagement Collaborative (FEC), a shared learning experience begun by SCCM in September 2019 that promoted ICU family engagement projects among participating sites before being cancelled in March 2020 due to COVID-19 METHODS: We developed a structured set of survey questions regarding the impact of COVID-19 on ICU family visitation and engagement and assessed content validity via an iterative process amongst FEC leadership From June 9 to July 17, we contacted the site leader of all 27 ICUs that had participated in the FEC and administered the survey by phone We also asked site leaders to provide a copy of their current visitor restriction policy RESULTS: 22/27 (81 5%) site leaders participated When asked about the peak of the pandemic in their respective ICUs, 2 sites (9 1%) reported having had a strict no-visitor policy without any exceptions The remaining sites all reported a variety of exceptions, with a majority allowing visitation for patients at the end-of-life Regarding current policies, all sites now have some visitor restriction exceptions in place, but with significant variability;at least half (12, 54 5%) of sites now permit at least 1 visitor for non-COVID patients during defined visitor hours Four sites (21 1%) reported that their hospital did not provide PPE to visitors 16 sites (84 2%) were unclear of their hospital's timeline for further relaxing visitor restrictions All but 1 site (95 5%) reported now using video conferencing with families;however, 10 sites (47 6%) reported clinicians' using their own personal devices for conferencing Among hospitals providing devices for staff, approximately 1 device had been provided on average for every 13 ICU beds CONCLUSIONS: While ICU visitor policies have somewhat relaxed since the peak of the pandemic, there is considerable uncertainty about how policies might change moving forward ICUs need additional resources to provide PPE for visitors and to ensure adequate video conferencing capabilities on hospital devices

Visitor Restriction Policy on Pediatric Wards During Novel Coronavirus (COVID-19) Outbreak: A Survey Study Across North America.

Visitor restriction policies in pediatric wards during the novel coronavirus (COVID-19) outbreak are variable. Among 36 hospitals that responded to our survey, 97% allowed at least one visitor, with 67% restricting to one caregiver. 69% required the visitor to wear personal protective equipment and only 19% allowed non-household visitors.