Perspectives of intensive care nurses on open visits in an ICU

Alonso-Rodríguez, A.; Martínez-Villamea, Silvia; Sánchez-Vallejo, Antonio; Lorenzo, Josefa Gallego; Fernández-Menéndez, M.

doi:10.1016/j.enfie.2020.02.007

Cited by 9 publications

(15 citation statements)

References 31 publications

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“…Irrespective of inperson visiting restrictions, obvious advantages of virtual visiting include enabling access for family members who live in a different city, or indeed country, those with substantial work or caregiving commitments, and those family members with frailty or physical incapacity 7 8. Furthermore, virtual visiting may help alleviate some of the challenges of organising inperson ICU visiting, which can be stressful and exhausting for families, with many reporting feeling obliged to remain at the bedside for prolonged periods of time 9 10…”

Section: Introductionmentioning

confidence: 99%

Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members

et al. 2022

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ObjectiveTo understand the experiences and perceived benefits of virtual visiting from the perspectives of intensive care unit (ICU)-experienced clinicians and non-ICU-experienced family liaison team members.DesignQualitative descriptive study.SettingAdult intensive care setting across 14 hospitals within the UK National Health Service.ParticipantsICU-experienced clinicians and non-ICU-experienced family liaison team members deployed during the first wave of the COVID-19 pandemic.MethodsSemistructured telephone/video interviews were conducted with ICU clinicians. Analytical themes were developed inductively following a standard thematic approach, using ‘family-centred care’ and ‘sensemaking’ as sensitising concepts.ResultsWe completed 36 interviews, with 17 ICU-experienced clinicians and 19 non-ICU-experienced family liaison team members. In the context of inperson visiting restrictions, virtual visiting offered an alternative conduit to (1) restoring the family unit, (2) facilitating family involvement, and (3) enabling sensemaking for the family. Virtual visits with multiple family members concurrently and with those living in distant geographical locations restored a sense of family unit. Family involvement in rehabilitation, communication and orientation activities, as well as presence at the end of life, highlighted how virtual visiting could contribute to family-centred care. Virtual visits were emotionally challenging for many family members, but also cathartic in helping make sense of their own emotions and experience by visualising their relatives in the ICU. Being able to see and interact with loved ones and their immediate care providers afforded important cues to enable family sensemaking of the ICU experience.ConclusionsIn this UK qualitative study of clinicians using virtual ICU visiting, in the absence of inperson visiting, virtual visiting was perceived positively as an alternative that promoted family-centred care through virtual presence. We anticipate the perceived benefits of virtual visiting may extend to non-pandemic conditions through improved equity and timeliness of family access to the ICU by offering an alternative option alongside inperson visiting.

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Section: Introductionmentioning

confidence: 99%

Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members

et al. 2022

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“…The accompaniment of family members in the ICU is one of the main points for improvement (25) but remains an “unfinished business” throughout the world, where a culture of restricted visits to the ICU predominates. The percentages of open-door policies are highly variable, for example, 70% in Sweden and 2% in Italy (25, 32–35). In Spain, in 2015, 90% of ICUs maintained restrictive visit (33), which is currently magnified due to the COVID-19 pandemic (36).…”

Section: Discussionmentioning

confidence: 99%

“…The interpretation of "open doors" does not have a consensus definition in the literature, challenging the adoption of this practice (32). Alonso-Rodriguez et al (34) found that intensive care Spanish nurses are reluctant to make more flexible protocols; 80% believe that the family feels obliged to stay with the patient, and 70% do not believe that it reduces family's anxiety. However, Giannini et al (35) found that, although partial liberalization of visitation policies was associated with some increase in burnout levels among intensive care Italian nurses, they eventually recognized its potential benefits not only for patients and their families but also for the nursing staff.…”

Section: Original Clinical Reportmentioning

confidence: 99%

The Psychological Impact on Relatives of Critically Ill Patients: The Influence of Visiting Hours

Iglesias

Martı́n

Alcañiz

et al. 2022

Critical Care Explorations

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OBJECTIVES: To identify the psychologic impact of admission to the ICU on the relatives of critically ill patients, the influence of coping, and the factors involved. DESIGN: We performed a cohort study with repeated measures evaluation using descriptive and comparative bivariate and multivariate analyses. SETTINGS: An adult ICU of a third-level complexity hospital. PATIENTS: The family members of patients (maximum of three per patient) staying longer than 3 days. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Psychologic impact was assessed using two subgroups of psychologic distress: anxiety (by the State-Trait Anxiety Inventory) and depression (by the Beck Depression Inventory). Satisfaction and coping were assessed by the Critical Care Family Needs Inventory and the Brief Coping Orientations to Problems Experienced Inventory, respectively. We included 104 family members; psychologic distress was high at admission (72% had anxiety, 45% had depression, and 42% had both) but decreased at discharge (34% had anxiety, 23% had depression, and 21% had both). The risk factors related to psychologic impact were severity (anxiety: Acute Physiology and Chronic Health Evaluation score ≥ 18 points: relative risk [RR], 2; 95% CI, 1–4; p = 0.03), invasive mechanical ventilation (anxiety: RR, 1.9; 95% CI, 1–3.6; p = 0.04), recent psychotropic medication use by relatives (depression: RR, 1.6; 95% CI, 1–2.9; p = 0.05), a restrictive visiting policy (anxiety: RR, 5.7; 95% CI, 2–10.4; p = 0.002), no emotion-focused coping strategy (anxiety: strategy < 11 points, RR, 6.1; 95% CI, 1.2–52; p = 0.01), and functional impairment (depression: Barthel index ≤ 60 points, RR, 7.4; 95% CI, 1.7–26.3; p = 0.01). CONCLUSIONS: The psychologic impact from admission to the ICU on family members is high. Visiting hours is the main modifiable factor to reduce the impact.

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“…However, an open visitation policy poses a great challenge to medical staff, especially to nurses. A Spanish study 12 interviewing 101 nurses showed that most professionals had a negative opinion about open visit policies. Restrictive ICU visitation policies are deeply rooted in the theoretical risk of an increase in physiological stress for patients, interference with the provision of care, and physical and mental exhaustion of family and friends 13 .…”

Section: Introductionmentioning

confidence: 99%

The beliefs and attitudes of intensive care unit nurses and patient families regarding an open visitation policy in China

Cai

Mei

et al. 2022

Nursing in Critical Care

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AimsTo investigate the beliefs and attitudes of intensive care unit (ICU) nurses and patients' family members towards an open visitation policy in the ICU in China and to explore the reasons that promote or hinder open visitation to improve visitation policy.BackgroundOpen visitation policies are widely recommended in many countries. However, there are gaps between evidence and practice. Most ICUs in China still use a restrictive policy for family visits, which raises controversy. There are limited visiting times, and family visitors are not allowed to enter the ICU.Study DesignA multicentre survey was conducted in seven hospitals in China.MethodsThe Beliefs and Attitudes towards Visitation in the Intensive Care Unit Questionnaire (BAVIQ) was administered to ICU nurses and patient families from 11 the ICUs of seven hospitals. A total of 275 questionnaires were completed and returned by ICU nurses and 139 by patients' family members.ResultsAmong nurses, the belief scale score was 2.87 ± 0.33 (range 2–4), and the attitude scale score was 5.53 ± 1.12 (range 2.33–7). The belief scale was divided into three subscales: nurses, patients, and patients' families. The subscale score for patients' families was the highest, and the nurses' subscale score was the lowest. Most (84.0%) of the nurses were satisfied with the current ICU visitation policy. The belief and attitude scores were 3.13 ± 0.39 (range 1.96–4) and 6.18 ± 1.20 (range 1.67–7), respectively, for family members. The scores of the three subscales, that is, patients, patients' families and nurses, were 3.13 ± 0.40, 3.26 ± 0.43, and 3.04 ± 0.49, respectively.ConclusionNurses' beliefs and attitudes towards implementing an open visitation policy in China are at a less positive level than those of patient family members.Relevance to Clinical PracticeThe beliefs and attitudes of nurses towards open visitation policy in China need to be improved. The question of how to mobilize nurses' enthusiasm for an open visitation policy poses a challenge for ICU management.

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Perspectives of intensive care nurses on open visits in an ICU

Cited by 9 publications

References 31 publications

Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members

Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members

The Psychological Impact on Relatives of Critically Ill Patients: The Influence of Visiting Hours

The beliefs and attitudes of intensive care unit nurses and patient families regarding an open visitation policy in China

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