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

Abstract

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.

“I don’t know how we would have coped without it.” Understanding the Importance of a Virtual Hospital Visiting Program During the COVID-19 Pandemic

“…The results of our study align well with the mental health impact reported in published studies of patient and family experience of visiting restrictions in adult (4,5,26) and pediatric intensive care unit settings (27)(28)(29). Rose et al (5) reported a large multicenter cohort representing adult family members experiencing at least one ICU virtual visit in 37 UK hospitals in the second COVID-19 wave and found high levels of psychological distress with over 60% reporting severe distress prior to their first virtual visit with their loved one.…”

“…During this time, several organizations looked to launch various versions of virtual visiting opportunities for families of admitted patients. The majority of the published literature on such programs to date has been focused on programs implemented in adult and pediatric intensive care units, where virtual visiting has been very successful in connecting patients, families, and health care providers in a timely way (4)(5)(6)(7)(8)(9). To our knowledge there is very little, if any, published on virtual family visiting programs in general medical wards or other areas in the hospital.…”

Up to the Challenge: Adapting Pediatric Intensive Care During a Global Pandemic

“…Achieving FCC for adult patients required innovation and dedicated resources to facilitate interventions such as virtual visits, family orientation and to mark the story of the patient’s illness journey. Virtual visits were seen as beneficial for communication and orientation activities and also provided an opportunity for family members to make sense of their own emotions and coping ( 7 ). Typically, facilitating FCC would fall to bedside nursing staff.…”

Family Engagement in the Adult Cardiac Intensive Care Unit: A Survey of Family Engagement Practices in the Cardiac Critical Care Trials Network

“…Virtual ICU visitation was shown to be beneficial for patients (reduced psychological distress), families (improved sense-making, happiness, gratitude), and the health care team (improved morale). [22][23][24] The use of virtual communication strategies with the health care team during the pandemic was also shown to be a positive experience for family members and health care providers alike. 25 Increasing virtual visitation and other virtual family engagement strategies, such as virtual participation in ICU rounds, can also be useful for family members who live far away from the hospital or who have work or social reasons that they cannot attend in-person, as well as for infection control reasons.…”