Visitation in Critical Care: Processes and Outcomes of a Performance Improvement Initiative

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: 79%

mentioning

confidence: 99%

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

Chapman¹,

Collingridge

Mitchell

et al. 2015

“…[1][2][3][4][5][6][7][8][9] Families form the fundamental unit of a person's life and function as a team to support the person psychologically, ethically, socially, and spiritually. 8,[10][11][12][13] The burden of pain and disease of one family member will somehow overshadow the well-being of the whole family. 9,14 Negative intense reactions, such as anger, irritability, shock, grief, and loss of control are often prevalent outside the ICUs, creating the need for closeness for family members to stay by the bedside of their beloved.…”

Section: Survey Development and Testingmentioning

confidence: 99%

“…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%

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.

“…5 Some evidence indicates that family members want to perform some patient care such as touching, encouraging, and assisting with daily living routines. 6,7 …”

mentioning

confidence: 99%

Benefit to Family Members of Delivering Hand Massage With Essential Oils to Critically Ill Patients

Prichard

Newcomb

2015

Background In intensive care environments, patients’ families are often encouraged to participate in their loved one’s care; however, many family members feel anxious, depressed, and unsure about how to help patients. Objectives To determine (1) the feasibility of teaching family members a simple intervention combining hand massage with essential oils in a trauma intensive care unit and (2) an effect size for use in designing a more powerful trial. Method A quasi-experimental pilot study of the effect of a family-delivered touch treatment on anxiety and depression of family members of patients. Fifteen family members were assigned to a treatment group, and 15 family members were assigned to a control group. The treatment consisted of the application of hand massage with essential oils for 6 sessions. Each session lasted 5 minutes and was presented twice a day for 3 days. Results The 5-minute intervention was associated with positive change in anxiety and depression scores on the Hospital Anxiety and Depression Scale (HADS) among family members visiting patients. The magnitude of change (improvement) in anxiety scores within the group of treated family members was significantly greater than within family members in the control group. Conclusion Administering a brief hand massage using pleasant-smelling oils to patients in an intensive care unit may reduce anxiety of family members who administer the treatment.