Optimizing Family Presence through Medical Education.

AbstractMany family members are wary of asking whether they can be present in the intensive care unit (ICU) while patients are receiving care. However, the opportunity to be present can be profoundly beneficial, especially to family members as they approach the grieving process. In the long run, this may decrease emotional complications such as post-traumatic stress disorder (PTSD) and complex grief. Family presence may also be profoundly important to patients, who may find comfort in the presence of their loved ones. Optimizing the needs of distressed families remains a controversial topic because it may distract physicians from providing needed medical care. Both parties may benefit maximally, however, through proactive training and early education during medical school, as this article will outline. Family members who may want to visit but are unable to be present in person may also benefit through virtual telehealth visits. Finally, we acknowledge specific cases that may pose ethically difficult dilemmas for ICU providers. Solutions that may be optimal in these situations will be suggested.

The presence of family during resuscitation in critical care settings: Nurses perspectives.

INTRODUCTION: Family presence during resuscitation (FPDR) is now an accepted practice in many western countries as research proven its positive impact on patient, family and also health care providers. In Malaysia, it is not known whether nurses in critical care settings agrees on family members' presence during the resuscitation process. This study aims to determine the perspectives of nurses toward family presence during resuscitation in critical care settings at Hospital Universiti Sains Malaysia. This study specifically looked at the risk and benefits perceived by nurses related to family presence during resuscitation, the self-confidence perceived by nurses related to family presence during resuscitation, and the correlation between nurses' perception of risk and benefits with self-confidence related to family presence during resuscitation. MATERIALS AND METHODS: A cross-sectional study was conducted using a self-administered questionnaire entitled the Family Presence Risk-Benefit Scale and Family Presence Self-Confidence Scale. Purposive sampling method was used to include 130 nurses working in eight Intensive Care Units at Hospital Universiti Sains Malaysia. Descriptive statistics and Pearson's Correlation test were used to analyse the variables of FPDR. RESULTS: Findings revealed that nurses in the critical care setting perceived low risk-benefit and low self-confident with regards to family presence during resuscitation. Pearson correlation analysis showed no correlation between perceptions of risk-benefits and self-confidence among critical care nurses (r = -0.016). CONCLUSION: Relatively, nurses perceived that family presence during resuscitation would place high risk and low benefit to the family members. Thus there is a need for education, training, and guideline to enrich the concept of FPDR and its implementation.

Effect of protocol-based family visitation on physiological indicators in ICU patients: a randomized controlled trial.

BACKGROUND: Intensive care unit (ICU) patients often experience significant physiological stress. This study evaluated the effect of a defined family visitation protocol on physiological responses in the ICU. METHODS: A randomized, block-randomized clinical trial was conducted on 78 ICU patients at Imam Reza Hospital between February 8, 2017, and August 8, 2017. The intervention group received protocol-based visits, and the control group continued with standard visitation. Block randomization was utilized for group assignments. The primary outcome was the measurement of physiological signs using designated monitoring devices. Data were analyzed using SPSS version 22, employing independent t-tests, Mann-Whitney U test, repeated measures analysis, and Friedman's test. RESULTS: The results showed no significant differences in systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and arterial blood oxygen levels between the two groups. However, heart rate in the intervention group was significantly lower in three stages before, during, and after the meaningful visiting (P = 0.008). CONCLUSION: Protocol-based scheduled family visits in the ICU may reduce physiological stress, as evidenced by a decrease in patients' heart rate. Implementing tailored visitation protocols sensitive to patient preferences and clinical contexts is advisable, suggesting the integration of family visits into standard care practices for enhanced patient outcomes. TRIAL REGISTRATION: IRCT20161229031654N2; 25/01/2018; Iranian Registry of Clinical Trials ( https://en.irct.ir ).

Violence against nurses by patients and visitors in the emergency department: An integrative review.

AIM: This integrative review explored violence against emergency nurses by patients/visitors, examining its nature, contributing factors and consequences. DESIGN: Integrative review. DATA SOURCES: Articles were obtained from PubMed, CINAHL, EMBASE, Web of Science and PsycInfo databases, up until December 2021. REVIEW METHODS: 26 articles were reviewed, evaluating study quality with the Crowe Critical Appraisal Tool and synthesizing conclusions through theme development and coding. RESULTS: This review delves into the issue of violence perpetrated against emergency nurses by patients and visitors. It elucidates three overarching themes: the nature of violence, the contributing factors and the consequences of such acts. CONCLUSION: The findings inform healthcare policy for the development of prevention approaches while identifying research gaps and emphasizing the need for alternative study designs and methodologies. IMPACT: This review has implications for nursing practice, policymaking and research, emphasizing the need for stakeholder engagement and tailored interventions for at-risk emergency nurses. NO PATIENT OR PUBLIC CONTRIBUTION: This project was an integrative review of the literature therefore no patient or public contribution was necessary. WHAT ALREADY IS KNOWN: Violence by patients and visitors in healthcare settings, especially in emergency departments, has garnered considerable attention. WHAT THIS PAPER ADDS: This review specifically examines violence-targeting emergency department nurses from patients and visitors, assessing its characteristics, contributing factors and consequences. IMPLICATIONS FOR PRACTICE/POLICY: The findings will guide stakeholder engagement in developing interventions to support vulnerable emergency nurses.

The impact of visiting restrictions in intensive care units for families during the COVID-19 pandemic: An integrative review.

AIM: To synthesize current evidence about the impact visiting restrictions in adult intensive care units have on family members during the COVID-19 pandemic. DESIGN: Integrative literature review. METHODS: A total of 104 articles were retrieved. Screening yielded a total of 23 articles which were appraised for quality. Reflexive thematic analysis was applied to synthesize findings and extract themes. DATA SOURCES: CINAHL Plus, Ovid MEDLINE, PubMed and ProQuest databases were searched for articles between January 2020 and November 2022. RESULTS: The findings were grouped into two main themes with six subthemes. Theme 1: not being present at the bedside, and Theme 2: altered communication added to family members' distress. Findings indicate that visiting restrictions imposed during the COVID-19 pandemic had negative consequences for family members. CONCLUSION: The patient and their family are inherently connected, prioritizing family presence with the return of flexible, open visitation policies in ICU must be a priority to mitigate further harm and adverse outcomes for all. REPORTING METHOD: The review complies with the PRISMA guidelines for reporting systematic reviews. IMPLICATIONS FOR PROFESSION: Nursing leaders must be included in the development of future pandemic policies that advocate family-centred care. NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was included in this review.

Recommendations on specific precautions for companions/ visitors of patients hospitalized: characteristics and barriers to implementation / Recomendações sobre precauções específicas para acompanhantes/visitantes de pacientes hospitalizados: características e barreiras para implementação / Recomendaciones sobre precauciones específicas para acompanhantes/visitantes de pacientes hospitalizados: características y barreras para su implementación

Justification and Objectives: despite the importance of companions/visitors for hospitalized patients under specific precautions, it is noted that risks of exposure and dissemination of microorganisms in health services by this population are still incipient in the literature. Thus, the objective was to characterize the current recommendations on specific precautions for companions and visitors of hospitalized patients and to analyze the barriers to their implementation from infection preventionists' perspective. Methods: a descriptive and exploratory study with a quantitative approach, with 89 infection preventionists, between March and June 2020. Data collected by electronic questionnaire, "snowball" sampling and analyzed according to frequency of responses. Results: hand hygiene was the most recommended recommendation (>95.0%). As for non-conformities, staying in the room without attire (78.6%), going to other rooms (53.9%) and keeping doors open as aerosol precaution (51.7%) stood out. Regarding the strategies adopted to guide companions/visitors, there was a predominance of individual verbal guidance (92.4%). The main barrier cited was the lack of institutional policy (56.2%). Conclusion: there was no uniformity in the recommendations, and non-conformities and barriers were listed. The importance of specific prevention guidelines for this public and effective educational strategies for its implementation are highlighted.(AU)

Justificativa e Objetivos: apesar da importância dos acompanhantes/visitantes para pacientes hospitalizados em precauções específicas, nota-se que os riscos de exposição e disseminação de microrganismos nos serviços de saúde por essa população ainda são incipientes na literatura. Dessa forma, objetivou-se caracterizar as recomendações vigentes sobre precauções específicas para acompanhantes e visitantes de pacientes hospitalizados e analisar as barreiras para a sua implementação sob a ótica de prevencionistas de infecção. Métodos: estudo descritivo e exploratório, de abordagem quantitativa, com 89 prevencionistas de infecção, entre março e junho de 2020. Dados coletados por questionário eletrônico, com amostragem tipo "bola de neve" e analisados segundo frequência das respostas. Resultados: a higienização das mãos foi a recomendação mais indicada (>95,0%). Quanto às não conformidades, destacou-se permanecer no quarto sem paramentação (78,6%), frequentar outros quartos (53,9%) e manter portas abertas em precaução para aerossóis (51,7%). Referente às estratégias adotadas para a orientar os acompanhantes/visitantes, houve predomínio da orientação verbal individual (92,4%). A principal barreira citada foi a falta de política institucional (56,2%). Conclusão: não houve uniformidade nas recomendações, e não conformidades e barreiras foram elencadas. Destaca-se a importância de diretrizes de prevenção específicas para esse público e estratégias educativas efetivas para sua implementação.(AU)

Justificación y Objetivos: a pesar de la importancia de los acompañantes/visitantes para pacientes hospitalizados bajo precauciones específicas, se advierte que los riesgos de exposición y diseminación de microorganismos en los servicios de salud por parte de esta población son aún incipientes en la literatura. Así, el objetivo fue caracterizar las recomendaciones vigentes sobre precauciones específicas para acompañantes y visitantes de pacientes hospitalizados y analizar las barreras para su implementación desde la perspectiva de los preventivos de infecciones. Métodos: estudio descriptivo y exploratorio con enfoque cuantitativo, con 89 prevencionistas de infecciones, entre marzo y junio de 2020. Datos recolectados por cuestionario electrónico, muestreo "bola de nieve" y analizados según frecuencia de respuestas. Resultados: la higiene de manos fue la recomendación más recomendada (>95,0%). En cuanto a las no conformidades, se destacó permanecer en la habitación sin atuendo (78,6%), ir a otras habitaciones (53,9%) y mantener las puertas abiertas como precaución contra los aerosoles (51,7%). En cuanto a las estrategias adoptadas para orientar a los acompañantes/visitantes, hubo predominio de la orientación verbal individual (92,4%). La principal barrera citada fue la falta de política institucional (56,2%). Conclusión: no hubo uniformidad en las recomendaciones, y se enumeraron las no conformidades y las barreras. Se destaca la importancia de pautas de prevención específicas para este público y estrategias educativas efectivas para su implementación.(AU)

After COVID-19 vaccinations: what does living and working in nursing homes look like?

BACKGROUND: Nursing homes were disproportionally affected by the COVID-19 pandemic. Vaccination was considered critical for the normalization of daily live of nursing home residents. The present study investigates the impact of the prolonged COVID-19 pandemic and the effect of vaccinations on the daily lives of residents and staff in Dutch nursing homes. SETTING AND PARTICIPANTS: The sample consisted of 78 nursing homes that participated in the Dutch national pilot on nursing home visits after the COVID-19 pandemic. One contact person per nursing home was approached for participation in this mixed-methods cross-sectional study. METHODS: Data was collected twice through questionnaires in April and December 2021. Quantitative questions focused on recent COVID-19 outbreaks, progress of vaccination, effects of vaccination on daily living in the nursing home and burden experienced by staff. Open-ended questions addressed the prolonged effect of the pandemic on residents, family members and staff. RESULTS: The overall vaccination rate of residents across nursing homes appeared to be high among both residents and staff. However, daily living in the nursing home had not returned to normal concerning personal interactions, visits, the use of facilities and work pressure. Nursing homes continued to report a negative impact of the pandemic on residents, family members and staff. CONCLUSIONS: Restrictions to the daily lives of residents in nursing homes were stricter than restrictions imposed on society as a whole. Returning to a normal daily living and working was found to be complex for nursing homes. With the emergence of new variants of the virus, policies strongly focusing on risk aversion were predominantly present in nursing homes.

Evolution of Visiting the Intensive Care Unit.

This article gives a historical perspective of visitation in the intensive care unit (ICU) since the establishment of critical care units. Initially, visitors were not allowed because it was thought to be harmful to the patient. Despite the evidence, ICUs with open visitation have consistently been in the minority and the COVID-19 pandemic halted progress in this area. Virtual visitation was introduced during the pandemic to maintain family presence, but limited evidence suggests that this is not equivalent to in-person visitation. Going forward ICUs and health systems must consider family presence policies that allow for visitation under any circumstance.

[Children visiting intensive care units and emergency departments : Kids are welcome!] / Besuche von minderjährigen Angehörigen in der Intensiv- und Notfallmedizin : Kinder als Besucher willkommen!

In this white paper, key recommendations for visitation by children in intensive care units (ICU; both pediatric and adult), intermediate care units and emergency departments (ED) are presented. In ICUs and EDs in German-speaking countries, the visiting policies for children and adolescents are regulated very heterogeneously: sometimes they are allowed to visit patients without restrictions in age and time duration, sometimes this is only possible from the age of teenager on, and only for a short duration. A request from children to visit often triggers different, sometimes restrictive reactions among the staff. Management is encouraged to reflect on this attitude together with their employees and to develop a culture of family-centered care. Despite limited evidence, there are more advantages for than against a visit, also in hygienic, psychosocial, ethical, religious, and cultural aspects. No general recommendation can be made for or against visits. The decisions for a visit are complex and require careful consideration.

Chapitre 5. COVID et privation du droit de visites en établissement sanitaire et médico-social : Maintenir la relation et penser l'usage des outils numériques.

The right to visit our next of kin and friends has been challenged since the beginning of COVID epidemic. In Health and social care services, the visits’ limitation has and continues to have consequences on the persons under care, their relatives and the care workers. This article aims to review the investigations of the Normandy Ethical Support Unit who has set up at the beginning of the COVID crisis, in response to the referrals from the fields in connection with the visits’ restrictions. This crisis served as a reminder of the importance of physical contact in maintaining social interactions. It also drew collective attention to the implementation of digital tools to counterbalance geographical distance, lack of time, and more broadly the evolution of society. The deployment of the digital tool raises many ethical questions and must be considered without neglecting physical contact.

Developing a Decision Pathway for Family Presence During Resuscitation.

BACKGROUND: The standard of care for family presence during resuscitation (FPDR) is evolving, and leading organizations collectively recommend establishing institutional policy for its practice. Although FPDR is supported at this single institution, the process was not standardized. METHODS: An interprofessional group authored a decision pathway to standardize the care of families during inpatient code blue events at one institution. The pathway was reviewed and applied in code blue simulation events to highlight the role of the family facilitator and the importance of interprofessional teamwork skills. RESULTS: The decision pathway is a patient-centered algorithm that promotes safety and family autonomy. Pathway recommendations are shaped by current literature, expert consensus, and existing institutional regulations. An on-call chaplain responds to all code blue events as the family facilitator and conducts assessments and decision making per the pathway. Clinical considerations include patient prioritization, family safety, sterility, and team consensus. One year after implementation, staff felt that it positively affected patient and family care. The frequency of inpatient FPDR did not increase after implementation. CONCLUSION: As a result of the decision pathway implementation, FPDR is consistently a safe and coordinated option for patients' family members.

The effect of video visitation on intensive care unit patients and family members outcomes during the COVID-19 pandemic: A randomised controlled trial.

OBJECTIVE: To investigate the effect of video visitation on intensive care patients' and family members' outcomes during the COVID-19 pandemic. DESIGN: This is a randomised controlled trial. SETTING: An adult intensive care unit in a tertiary hospital in Beijing, China. METHODS: A total of 121 adults, who were >18 years of age, conscious, able to communicate verbally, and admitted to the intensive care unit for over 24 hours were randomised into the intervention (video visitation) (n = 65) and control (n = 56) Groups. A total of 98 family members participated. Patient primary outcomes included anxiety and depression, measured using the Hospital Anxiety and Depression Scale. Secondary outcomes included patient delirium and family anxiety assessed using the Confusion Assessment Method scale and Self-Rating Anxiety Scale, respectively; and patient and family satisfaction, measured using a questionnaire routinely used in the hospital. RESULTS: There were no statistically significant differences between the groups in patients' anxiety (t = 1.328, p = 0.187) and depression scores (t = 1.569, p = 0.119); and no statistically significant differences in delirium incidence between the groups (7.7 % vs 7.1 %, p > 0.05). There were no significant differences in changes in family members' anxiety scores (t = 0.496, p = 0.621). A statistically significant difference in satisfaction was found between the two group patients (86.1 % vs 57.2 % of patients were satisfied with using video visitation, p < 0.05), and the result of family members' satisfaction was also statistically significant (88 % vs 62.5 % of family members were satisfied with using video visitation, p < 0.05). CONCLUSION: Video visitation did not seem to influence anxiety, but the use of video visitation can improve the patient and their family members' satisfaction. Future research is needed to determine the feasibility of embedding video visitation into routine practice, and the optimal frequency and length of video visitation in relation to patients' and family members' outcomes. IMPLICATIONS FOR CLINICAL PRACTICE: Video visitation improved patient and family members' satisfaction. Therefore, clinicians should consider using video visitation when face to face visit is restricted. Video visVitation did not reduce patient anxiety significantly in this study maybe because the average length of intensive care stay was too short. Future research is needed on its effect on long term intensive care patients.

Virtual Visitation in a Neonatal Intensive Care Unit: Insights From 5 Years Using a PDSA Model to Improve Family-Centered Care.

This 5-year study evaluated a virtual visitation implementation initiative in a neonatal intensive care unit. Our objectives were to (1) use the Plan-Do-Study-Act methodological framework to implement a virtual visitation program, (2) investigate whether implementation of virtual visitation could be done with no patient harm and minimal workflow disruption, (3) foster a top-down participatory structure for decision making, and (4) evaluate parent use and satisfaction. The study involved a qualitative and quantitative description of cycles and results. Routine collection of outcome data allowed problems that arose as a result of changing practices to be quickly and efficiently addressed. The study results suggested that the virtual visitation implementation initiative in a neonatal intensive care unit using Plan-Do-Study-Act cycles helped create an environment of trust and provided benefits. A steady increase in the use of virtual visitation by parents and their extended families indicated utilization. During the COVID-19 pandemic, virtual visitation helped families feel connected with each other and their neonate, despite being in separate locations.

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

AIMS: To 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. BACKGROUND: Open 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 DESIGN: A multicentre survey was conducted in seven hospitals in China. The 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. RESULTS: Among 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. CONCLUSION: Nurses' 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 PRACTICE: The 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.

Impact of an inclusive COVID-19 visitation policy on patient satisfaction and visitor safety.

BACKGROUND: The COVID-19 pandemic presented unique and unprecedented challenges due to limited knowledge regarding the virus's transmissibility. With guidance from the Center for Disease Control (CDC), healthcare systems instituted widespread visitor restrictions. Hospitalization is a stressful time for patients. Visitor support can help minimize this during and after discharge. METHODS: A telephone interview was conducted among hospitalized COVID-19 positive patients discharged between March 1st and August 31st, 2021 to explore the patients and visitors' experiences and the impact of the visitor policy during their hospitalization. RESULTS: A total of 238 patients were interviewed. For patients with visitors, 98% felt that the presence of visitors improved their overall wellbeing and satisfaction. Additionally, 86% reported that visitors were involved in helping with their care upon discharge. For patients with no visitors, 59% felt that having a visitor would have improved their hospital stay. Nearly 50% reported that the absence of visitors made it difficult for family members to remain updated and informed of their hospital care. CONCLUSION: This study demonstrates that visitation for COVID-19 patients can be done safely and that there is a positive impact on patient wellbeing with increased visitor access. As we move towards COVID-19 endemicity, implementing evidence-based visitation policies that maximize patient wellbeing will be essential.