Nurses’ and physicians’ viewpoints regarding children visiting/not visiting adult ICUs

Abstract

Allowing children to visit adult intensive care units (ICUs) has been an area of controversy. There is a lack of recent research dealing with visits by children and physicians' views and whether differences exist between the views held by nurses and physicians regarding visits by children. The aim of this study was to describe and compare reasons given by nurses and physicians for restricting visits by children to a relative hospitalized in an adult ICU. This was a quantitative, descriptive multicentre study. Nurses and physicians (n = 291) at 72 general adult ICUs participated, each completing a questionnaire. A majority of the nurses and physicians were positive to children visiting patients in ICU, but they also imposed restrictions. The most common reasons were: severity of the patient's injury (50%); the environment was frightening for the child (50%); the infection risk for the child (36%) and the patient (56%). Children <7 years were restricted more than those >7 years. Nurses were more positive than physicians to visits by younger children. Physicians were more positive to visits if the patient was tired and critically ill/injured or was a friend/cousin. More physicians refused visits due to the fact that children are too noisy for the staff. Risks of negative effects on the children's health by visiting patients were also stated. Nurses and physicians still restrict children's visits to adult ICUs for a number of reasons, and nurses' and physicians' views on children visiting differ and so also the views within each professional group. The differences in views show that the dynamics are complicated and this could be attributed to a lack of a common view of care, which prevents family-centred care that includes children from being practised.

Visita de crianças em unidade de terapia intensiva

“…Few institutions have policies for children visits to adult ICU; (5,6,10,11) in some, this analysis depends on individual circumstances and common sense. (11) Two recent studies conducted in Italy found similar results. The first identified that from 104 ICUs, only 22% allowed children below 12 years-old visits.…”

“…(5) The restrictions to children visits to adult ICUs are often based on the fear of exposing the child to hospital infection, (2)(3)(4)(5)(6)(7) However there is no literature evidence of this. In a multicenter quantitative trial (11) aimed to understand the reasons provided by the teams for restricting children visits to adult ICUs, 36% answered that their main reason was fear of infection. However, some of these respondents mentioned that both physicians and nurses use this explanation to disguise a certain emotional unpreparedness to deal with children who have severely ill relatives in the unity.…”

“…However, some of these respondents mentioned that both physicians and nurses use this explanation to disguise a certain emotional unpreparedness to deal with children who have severely ill relatives in the unity. Other authors, (3,7,11) mention that the team is not able to deal with these visits emotional requirements.…”

“…(3,6,7,11) On the other hand, other studies conducted by nurses show that explaining to the child what he/she is about to see and experience would prevent eventual traumas. (3,7,8,11,12) Several studies (2,3,5,11) have shown that a child's visit to a relative in ICU is fundamental, as the child's anxiety, abandonment and fear of death feelings are found reduced after the visit; in addition, having a notion of the disease, the child becomes participant in the hospitalization process. (7,8) Nicholson et al (2,3) studied a sample of 20 children, divided in two groups.…”

“…(7) According to the Children Rights Convention, issued in 1990: "It is recommended that a child is made part of all events around him/her, as well as within the family; a child is entitled to be informed, have his/ her questions answered and have an opinion; thoughts and beliefs should be respected, and the best for the child, done." (11) Protecting a child from unpleasant situations may limit the experience, and delay or spoil his/her emotional development. (8) The child and death Based on infantile psychology and development, the human being, since tender age, faces losses such as: uterus loss, weaning, pacifier removal, brothers/ sisters birth, teeth losses, school changes, toys loss and pet animals' death, parents divorce, etc., among others, inherent to the human being development.…”