Children visiting family and friends on adult intensive care units: the nurses’ perspective

Abstract

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.

A multicenter survey of visiting policies in French intensive care units

“…They were compelled to call the hospital telephone switchboard first in 6 (6%). Intensive caregivers are at high risk of emotional and physical stress, and the sight of families being exposed to the same stress can lead to a protective response such as restrictive visiting policy [19] and even dehumanization of the critically ill person [20]. From the caregivers' point of view, the rationales for a restrictive policy are the protection of the patient and the protection of caregivers' work and avoidance of a psychological stress induced by the family: visits may be physiologically damaging to the patient, visitors run the risk of infection, and visiting disrupts the unit, draining the staff's time and energy, and distracting them from care [3,16].…”

“…From the caregivers' point of view, the rationales for a restrictive policy are the protection of the patient and the protection of caregivers' work and avoidance of a psychological stress induced by the family: visits may be physiologically damaging to the patient, visitors run the risk of infection, and visiting disrupts the unit, draining the staff's time and energy, and distracting them from care [3,16]. The reasons why children's visits remain restricted in ICUs are always the same: parents, patients, and caregivers want to protect children (and themselves) from additional stress and also to protect both patients and children from the risk of infection [20,21]. Patients, families, and caregivers traditionally agree to limiting children's visits.…”

The perspective of families of the critically ill patient: their needs

“…Marsden [57] believes that restricting the child from visiting is detrimental to the well being of the child, unethical, and importantly, not supported by research. Clarke states that supporting visitation helps the child cope with the stress and intense emotions experienced as a consequence of their sick parents [58,59]. Studies do confirm the child's perspective of the importance to visit their sick family with reduced feelings of guilt and abandonment [60,61].…”

Pain Management as Triadic Interaction: Shifting Alliances in Nurse-Patient-Family-Member Communication

“…Less restrictive visitation policies are based on the idea that the presence of families and support network members has an inherently positive influence on patient outcomes (Berti, Ferdinande, & Moons, 2006;Clarke, 2000;Fumagalli et al, 2006;Whitis, 1994). Their experiences point to important implications for hospital policy, especially when it comes to the ''who'' and ''when'' of patient visitation.…”