Intensive care nurses’ beliefs and attitudes towards the effect of open visiting on patients, family and nurses

Background 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. Objectives 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. Methods 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. Results 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. Conclusions 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.

Section: Discussionsupporting

confidence: 75%

mentioning

confidence: 99%

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

Chapman¹,

Collingridge

Mitchell

et al. 2015

“…Although approximately 50% of hospitals report "open visitation," patients' family members are not encouraged to stay continuously with adult patients if they desire. 22 Several studies have involved surveys of nurses about visitation in ICUs with "open" visitation policies, 25,[27][28][29][30] but no studies have involved surveys of patients' family members about their needs and how well those needs have been met in ICUs with visitation policies that allow unrestricted or continuous visitation. Although staff in our neuroscience ICU and national experts 2,3,[15][16][17][18][19][20] believe that a continuous visitation policy should ensure that family members' needs for information about and presence with their loved one are completely met, to date, no data have validated that belief or assumption.…”

mentioning

confidence: 99%

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

Jacob

Horton

Rance-Ashley

et al. 2016

Background 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. Objective 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. Methods 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. Results 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. Conclusion 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. (American Journal of Critical Care. 2016;25:118-125) In descriptive research studies [3][4][5][6][7] in the 1970s and 1980s, family members of ICU adult patients consistently identified similar high-priority needs during the time of the critical illness. Some of the highest ranked needs included the need for information about their loved one, to be geographically close to their loved one, and to know that their loved one is receiving the best care possible. About the AuthorsCynthia Horton, Sharon Rance-Ashley, Tera Field, Robbie Patterson, Claudette Johnson, Holly Saunders, Tracy Shelton, and Jessica Miller are staff nurses, Carmen Frobos is a family coordinator, and Mini Jacob is the nurse educator in the neuroscience intensive care unit,

“…Research data 12,22,[31][32][33][34][35][36] on nurses' visitation preferences and satisfaction differ among countries and facilities. Current visiting practices also vary internationally, from closed ICUs to free visiting during the day, indicating that this topic is still controversial.…”

mentioning

confidence: 99%

“…Current visiting practices also vary internationally, from closed ICUs to free visiting during the day, indicating that this topic is still controversial. 35,[37][38][39][40][41][42][43][44] Nurses' concerns about liberalizing visiting hours range from the disorganization of care 8,22,31,[34][35][36] and the psychological burden that nurses receive from the stressed families of patients 8,22,[31][32][33][34][35]37 to the adverse effects on patients' physiological condition 19,20,22,31,35,43,[45][46][47][48] and infection control. 48,49 Despite the effort to address the need for more flexible policies, most general ICUs in Athens, Greece, restrict their visiting hours, as indicated on their official websites and information sheets, a situation that leads to conflicts between health professionals and patients' families.…”

mentioning

confidence: 99%

Family Visitation in Greek Intensive Care Units: Nurses’ Perspective

Athanasiou

Papathanassoglou

Patiraki

et al. 2014

Background 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. Objectives 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. Methods 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. Results 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. Conclusions 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.