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Honarmand K, Mehta S. Consequences of visitor restriction policies in the intensive care unit during the COVID-19 pandemic. Can J Anaesth 2021; 68:1465-1470. [PMID: 34212307 PMCID: PMC8247615 DOI: 10.1007/s12630-021-02048-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kimia Honarmand
- Department of Medicine, Division of Critical Care, Western University, London, ON, Canada.
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Lamiani G, Guerriero V, Vegni E. Opening Intensive Care Units to Family Members: A Contribution From the Attachment Theory. Crit Care Nurse 2021; 40:11-12. [PMID: 32236436 DOI: 10.4037/ccn2020500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Giulia Lamiani
- Department of Health Sciences, University of Milan, Italy. Institute of Orthophonology, Rome, Italy
| | - Viviana Guerriero
- Department of Health Sciences, University of Milan, Italy. Institute of Orthophonology, Rome, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Italy. Institute of Orthophonology, Rome, Italy
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Kandori K, Okada Y, Ishii W, Narumiya H, Maebayashi Y, Iizuka R. Association between visitation restriction during the COVID-19 pandemic and delirium incidence among emergency admission patients: a single-center retrospective observational cohort study in Japan. J Intensive Care 2020; 8:90. [PMID: 38624408 PMCID: PMC7719735 DOI: 10.1186/s40560-020-00511-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 01/04/2023] Open
Abstract
Aim This study aimed to identify the association between total visitation restriction because of the coronavirus 2019 (COVID-19) pandemic and the incidence of delirium for emergency inpatients. Methods This was a single-center, retrospective, observational cohort study conducted at a tertiary critical care center in urban Kyoto, Japan. Adult emergency patients hospitalized between January 1, 2019, and June 30, 2020, were recruited. In response to the COVID-19 pandemic, the authors' hospital began restricted visitation on March 28, 2020. This study defined before visitation restriction as January 1, 2019, through March 31, 2020, and after visitation restriction as April 1, 2020, through June 30, 2020. We did not restrict emergency services, and there were no changes in the hospital's routine, except for visitation restrictions. The primary outcome was the incidence of delirium. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for delirium incidence was calculated to compare the before and after visitation restriction periods, and the logistic model was used to adjust for seven variables: age, sex, ward type on admission, primary diagnosis, ventilator management, general anesthesia surgery, and dementia. Results Study participants were 6264 patients, median age 74 years (56-83), and 3303 men (52.7%). The total delirium incidence in entire research period was 2.5% (158 of 6264 patients), comprising 1.8% (95/5251) before visitation restriction and 6.2% (63/1013) after visitation restriction. The AOR for delirium incidence was 3.79 (95% CI, 2.70-5.31) after visitation restriction versus before visitation restriction. Subgroup analysis showed no apparent interaction for delirium incidence. Conclusion Visitation restriction was associated with an increased incidence of delirium in emergency inpatients.
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Affiliation(s)
- Kenji Kandori
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| | - Yohei Okada
- Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Wataru Ishii
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| | - Hiromichi Narumiya
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
| | - Yoshiro Maebayashi
- Department of Psychiatry, Japanese Red Cross Society, Kyoto Daini Hospital, Kyoto, Japan
| | - Ryoji Iizuka
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Society, Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto, 602-8026 Japan
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Flexible Versus Restrictive Visiting Policies in ICUs: A Systematic Review and Meta-Analysis. Crit Care Med 2019; 46:1175-1180. [PMID: 29642108 DOI: 10.1097/ccm.0000000000003155] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To synthesize data on outcomes related to patients, family members, and ICU professionals by comparing flexible versus restrictive visiting policies in ICUs. DATA SOURCES Medline, Scopus, and Web of Science. STUDY SELECTION Observational and randomized studies comparing flexible versus restrictive visiting policies in the ICU and evaluating at least one patient-, family member-, or ICU staff-related outcome. DATA EXTRACTION Duplicate independent review and data abstraction. DATA SYNTHESIS Of 16 studies identified for inclusion, seven were meta-analyzed. Most studies were rated as having a moderate risk of bias. Among patients, flexible visiting policies were associated with reduced frequency of delirium (odds ratio, 0.39; 95% CI, 0.22-0.69; I = 0%) and lower severity of anxiety symptoms (mean difference, -2.20; 95% CI, -3.80 to -0.61; I = 71%). Flexible visiting policies were not associated with increased risk of ICU mortality (odds ratio, 0.71; 95% CI, 0.38-1.36; I = 86%), ICU-acquired infections (odds ratio, 0.98; 95% CI, 0.68-1.42; I = 11%), or longer ICU stay (mean difference, -0.26 d; 95% CI, -0.57 to 0.05; I = 54%). Among family members, flexible visiting policies were associated with greater satisfaction. Among ICU professionals, flexible visiting policies were associated with higher burnout levels. CONCLUSIONS Flexible ICU visiting hours have the potential to reduce delirium and anxiety symptoms among patients and to improve family members' satisfaction. However, they may be associated with an increased risk of burnout among ICU professionals. These conclusions are based on few studies, with small samples and moderate risk of bias.
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Huynh TG, Owens RL, Davidson JE. Impact of Built Design on Nighttime Family Presence in the Intensive Care Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 13:106-113. [DOI: 10.1177/1937586719836287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: Determine whether dedicated family space changes family presence at night in the intensive care unit (ICU). Purpose: To measure family presence at night before and after moving to an ICU with in-room family space. Background: The safeguarding phenomenon families experience may lead to the desire to sit vigil at the bedside. Lack of dedicated family sleep space may exacerbate sleep deprivation for those who wish to be present at night. Sleep deprivation decreases cognition and capacity for decision-making. Traditionally, ICU rooms have not included dedicated family areas or sleep surfaces. National recommendations include designing new hospital ICU rooms with dedicated family space. It is not known if the built design changes family presence at night. Method: Family presence was measured for 30 nights pre- and postmove to a newly built ICU with dedicated family space. The policy for open flexible family presence remained the same before and after the move. Results: There was a statistically significant increase in proportion of occupied patient rooms with visitors following the move to the new ICU designed with family space (31% difference, x2= 5.675, 95% CI [5.74, 51.29], p = .0172). Conclusions: Families utilize the space when available. Further research is needed to quantify quality and quantity of family sleep and impact on decision-making and interactions with the care team. Sleep deprivation may decrease for families who would have remained in the unit without available family space and sleep surface.
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Affiliation(s)
| | - Robert L. Owens
- Medical Oncology Intensive Care Unit, Jacobs Medical Center, UC San Diego Health, La Jolla, CA, USA
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Owens RL, Huynh TG, Netzer G. Sleep in the Intensive Care Unit in a Model of Family-Centered Care. AACN Adv Crit Care 2018; 28:171-178. [PMID: 28592477 DOI: 10.4037/aacnacc2017393] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The desire for families to be physically present to support their loved ones in the intensive care unit, and guidelines in favor of this open visitation approach, require that clinicians consider both patient and family sleep. This article reviews the causes of poor sleep for patients and their family members in the intensive care unit as well as the expected changes in cognition and emotion that can result from sleep deprivation. Measures are proposed to improve the intensive care unit environment to promote family sleep. A framework to educate family members and engage them in preservation of their and their loved one's circadian rhythm is also presented. Although further research is needed, the proposed framework has the potential to improve outcomes for patients and their families in the intensive care unit.
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Affiliation(s)
- Robert L Owens
- Robert L. Owens is Assistant Professor of Medicine, University of California San Diego, Division of Pulmonary, Critical Care, and Sleep Medicine, La Jolla, CA 92037 . Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Giora Netzer is Associate Professor of Medicine and Epidemiology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Truong-Giang Huynh
- Robert L. Owens is Assistant Professor of Medicine, University of California San Diego, Division of Pulmonary, Critical Care, and Sleep Medicine, La Jolla, CA 92037 . Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Giora Netzer is Associate Professor of Medicine and Epidemiology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Giora Netzer
- Robert L. Owens is Assistant Professor of Medicine, University of California San Diego, Division of Pulmonary, Critical Care, and Sleep Medicine, La Jolla, CA 92037 . Truong-Giang Huynh is ICU Assistant Nurse Manager, Jacobs Medical Center, University of California, San Diego Health, La Jolla, California. Giora Netzer is Associate Professor of Medicine and Epidemiology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Family Satisfaction in Critical Care Units: Does an Open Visiting Hours Policy Have an Impact? J Patient Saf 2018; 13:169-174. [PMID: 25136852 DOI: 10.1097/pts.0000000000000140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For critically ill patients, the interaction between health care providers and family members is essential in daily decision making. Improving this relationship has a positive impact on satisfaction with the overall care provided to patients and reduces family member symptoms of depression, anxiety, and posttraumatic stress disorder. In this study, we analyzed the impact of visitation policy (open versus restricted) on family satisfaction using the previously well-validated Critical Care Family Satisfaction Survey (CCFSS) questionnaire. METHODS This is a cross-sectional prospective observational study conducted between November 1, 2009, and January 31, 2010, in 2 critical care units with 2 different visiting policy systems, unit A (open visiting hours) and B (restricted visiting hours), comparing family satisfaction in both units using the CCFSS questionnaire. Responses were grouped in 5 satisfaction constructs, namely, the support construct, which assesses the degree of satisfaction with the support of the intensive care staff as perceived by relatives; the assurance construct, which assesses the degree of satisfaction regarding honest answers being given and the responder's confidence that the patient is receiving the best care possible; the proximity construct, which assesses the degree of satisfaction with the physical and emotional access to the patient; the information construct, which assesses the degree of satisfaction with the adequacy of information given to relatives; and the comfort construct, which assesses satisfaction with physical comfort and amenities. RESULTS During the study period, 115 questionnaires were distributed in each of the 2 sites. The response rates in units A and B were 92% (106) and 100% (115), respectively. The mean stay time in the intensive care unit was 3.7 days. There were more trauma cases in unit A and more cardiac patients in unit B. There was no significant difference between the 2 units in any of the 5 satisfaction constructs, the support, assurance, proximity, information, and comfort constructs, although there was a nonsignificant trend favoring the unit with the more liberal visit policy regarding amenities (unit A). CONCLUSIONS We concluded that family satisfaction to care provided in intensive care as measured by the CCFSS questionnaire was not influenced by frequency of visitation among Saudi families. Factors other than open visiting hours may be important to evaluate.
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Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 45:1751-1761. [PMID: 28749855 DOI: 10.1097/ccm.0000000000002624] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine whether patient- and family-centered care interventions in the ICU improve outcomes. DATA SOURCES We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016. STUDY SELECTION We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs. DATA EXTRACTION We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes. DATA SYNTHESIS There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis. CONCLUSIONS Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.
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Ivany A, LeBlanc C, Grisdale M, Maxwell B, Langley JM. Reducing infection transmission in the playroom: Balancing patient safety and family-centered care. Am J Infect Control 2016; 44:61-5. [PMID: 26341403 DOI: 10.1016/j.ajic.2015.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Family-centered care requires that institutions develop strategies to allow sibling visitors to hospitalized children while reducing risks of infectious disease transmission. Most guidelines recommend that siblings not be permitted to visit playrooms. This approach was not seen as consistent with family-centered care in our setting; therefore, in a pilot project we developed an approach for screening siblings with cooperation of families, child life specialists, the care team, and the infection prevention and control service. METHODS A literature review using CINAHL and PubMed databases (Medical Subject Heading terms: visitors to patients, child, infection, nosocomial, and siblings) from 2004-2014 did not uncover formal established methods for reducing playroom infectious disease exposures. Benchmarking with other Canadian centers revealed a diversity of approaches. Child life, the ward staff, and infection prevention and control at this center collaborated to develop a sibling screening strategy. RESULTS The collaborative approach led to a process based on a screening form that is introduced to the family during admission. The process requires the cooperation of the admitting nurse, parents, and child life staff. In the first 2 years of the project, approximately 10% of screened siblings had a potentially communicable illness. CONCLUSION A collaborative multidisciplinary approach based on family center care principles led to a process whereby siblings of hospitalized children can be allowed to visit playrooms, while reducing risk of infectious disease transmission.
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Affiliation(s)
- Allana Ivany
- Infection Prevention and Control Services, Dalhousie University, Halifax, NS, Canada
| | - Chantal LeBlanc
- Child Life Services, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | | | - Bridget Maxwell
- Infection Prevention and Control Services, Dalhousie University, Halifax, NS, Canada
| | - Joanne M Langley
- Infection Prevention and Control Services, Dalhousie University, Halifax, NS, Canada; Child Life Services, IWK Health Centre, Dalhousie University, Halifax, NS, Canada; Departments of Pediatrics and Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
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Khaleghparast S, Joolaee S, Ghanbari B, Maleki M, Peyrovi H, Bahrani N. A Review of Visiting Policies in Intensive Care Units. Glob J Health Sci 2015; 8:267-76. [PMID: 26755480 PMCID: PMC4954899 DOI: 10.5539/gjhs.v8n6p267] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022] Open
Abstract
Admission to intensive care units is potentially stressful and usually goes together with disruption in physiological and emotional function of the patient. The role of the families in improving ill patients' conditions is important. So this study investigates the strategies, potential challenges and also the different dimensions of visiting hours' policies with a narrative review. The search was carried out in scientific information databases using keywords "visiting policy", "visiting hours" and "intensive care unit" with no time limitation on accessing the published studies in English or Farsi. Of a total of 42 articles, 22 conformed to our study objectives from 1997 to 2013. The trajectory of current research shows that visiting in intensive care units has, since their inception in the 1960s, always considered the nurses' perspectives, patients' preferences and physiological responses, and the outlook for families. However, little research has been carried out and most of that originates from the United States, Europe and since 2010, a few from Iran. It seems that the need to use the research findings and emerging theories and practices is necessary to discover and challenge the beliefs and views of nurses about family-oriented care and visiting in intensive care units.
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Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties. Crit Care Med 2015; 43:1731-44. [PMID: 25821917 DOI: 10.1097/ccm.0000000000000980] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties. DATA SOURCES We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013. STUDY SELECTION Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility. DATA EXTRACTION Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies. DATA SYNTHESIS The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce. CONCLUSIONS Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.
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Paul RG, Finney SJ. Family satisfaction with care on the ICU: essential lessons for all doctors. Br J Hosp Med (Lond) 2015; 76:504-9. [DOI: 10.12968/hmed.2015.76.9.504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richard G Paul
- NIHR Clinical Research Fellow in Adult Intensive Care, Royal Brompton Hospital, London SW3 6NP
| | - Simon J Finney
- Consultant in Adult Intensive Care in the Adult Intensive Care Unit, Royal Brompton Hospital, London SW3 6NP
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Prichard C, Newcomb P. Benefit to Family Members of Delivering Hand Massage With Essential Oils to Critically Ill Patients. Am J Crit Care 2015; 24:446-9. [PMID: 26330438 DOI: 10.4037/ajcc2015767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Charlsea Prichard
- Charlsea Prichard is manager of the trauma intensive care unit at Texas Health Harris Methodist Hospital, Fort Worth, Texas. Patricia Newcomb is a nurse scientist at Texas Health Resources, Fort Worth, Texas
| | - Patricia Newcomb
- Charlsea Prichard is manager of the trauma intensive care unit at Texas Health Harris Methodist Hospital, Fort Worth, Texas. Patricia Newcomb is a nurse scientist at Texas Health Resources, Fort Worth, Texas
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Di Bernardo V, Grignoli N, Marazia C, Andreotti J, Perren A, Malacrida R. Sharing intimacy in "open" intensive care units. J Crit Care 2015; 30:866-70. [PMID: 26160723 DOI: 10.1016/j.jcrc.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/03/2015] [Accepted: 05/16/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Opening intensive care units (ICUs) is particularly relevant because of a new Swiss law granting the relatives of patients without decision-making capability a central role in medical decisions. The main objectives of the study were to assess how the presence of relatives is viewed by patients, health care providers, and relatives themselves and to evaluate the perception of the level of intrusiveness into the personal sphere during admission. MATERIAL AND METHODS In a longitudinal and prospective design, qualitative questionnaires were submitted concomitantly to patients, relatives, and health care providers consecutively over a 6-month period. The study was conducted in the 4 ICUs of the public hospitals of Canton Ticino (Switzerland). RESULTS The questionnaires collected from patients, relatives, and health care providers were 176, 173, and 134, respectively. The analysis of the answers of 120 patient-relative pairs showed consistent results (P < .0001), whereas those of health care providers were significantly different (P < .0001), regarding both the usefulness of opening ICUs to patient relatives and what was stressful during admission. CONCLUSIONS Relatives in these "open" ICUs share a great deal of intimacy with the patients. Their presence and the deriving benefits were seen as very positive by patients and relatives themselves. Skepticism, instead, prevailed among health care providers.
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Affiliation(s)
- Valentina Di Bernardo
- Intensive Care Unit, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland; Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland; Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland.
| | - Chantal Marazia
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland; Département d'Histoire des Sciences et de la Vie et de la Santé, University of Strasbourg, Strasbourg, France
| | - Jennifer Andreotti
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, Bern, Switzerland
| | - Andreas Perren
- Intensive Care Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
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Riccioni L, Ajmone-Cat CA, Rogante S, Ranaldi G, Ciarlone A. New roles for health-care workers in the open ICU. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bernal-Ruiz D, Horta-Buitrago S. Cuidado de enfermería para la familia del paciente crítico desde la teoría de la comprensión facilitada. ENFERMERÍA UNIVERSITARIA 2014. [DOI: 10.1016/s1665-7063(14)70928-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
PURPOSE The purpose of the study was to explore the satisfaction of patients' families and nurses with visitation guidelines in the 5 critical care units at a 435-bed acute care hospital in the southeastern part of the United States. PROBLEM STATEMENT The restriction of visitation hours for intensive care unit patients has significant implications for the health and well-being of the patient and their family. Although traditionally both facilities and staff have cited reasons to restrict family visitation, research indicates that these practices may have a detrimental effect on the overall health of the patient. METHODS A descriptive correlational design is utilized in this study. Subjects consisted of family members of patients in 1 of the 5 critical care units and nurses providing care in these units. Family and nurses completed a questionnaire on their perspective of the critical care visiting hours. RESULTS The majority of families visiting patients in the critical care setting followed the posted guidelines and were very satisfied with the guidelines. The hours most convenient for families to visit at the bedside were from 4 to 8 PM. The majority of nurses wanted to keep visiting hours during day-shift hours; family members were divided on having all hours available for visitation. Nurses had varied perspectives on whether visitation should be allowed as a restraint alternative, when family is out of town, patient emotional needs, eminent death, at time of discharge instructions, and to speak with a physician. CLINICAL IMPLICATIONS Family member visitation in the intensive care unit setting should be flexible and open. This may include tailoring a plan on admission with the family to allow open access to the patient during times when they are most available; thus, each family has a plan that suits its unique dynamics.
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Athanasiou A, Papathanassoglou ED, Patiraki E, McCarthy MS, Giannakopoulou M. Family visitation in greek intensive care units: nurses' perspective. Am J Crit Care 2014; 23:326-33. [PMID: 24986174 DOI: 10.4037/ajcc2014986] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Archonto Athanasiou
- Archonto Athanasiou is a staff nurse in the intensive care unit, 401 Military Hospital, Athens, Greece. Elizabeth D.E. Papathanassoglou is an associate professor, Department of Nursing, Cyprus University of Technology, Nicosia, Cyprus. Elisabeth Patiraki is a professor and Margarita Giannakopoulou is an assistant professor, Faculty of Nursing, University of Athens, Athens, Greece. Mary S. McCarthy is a nurse scientist, Madigan Army Medical Center, Tacoma, Washington
| | - Elizabeth D.E. Papathanassoglou
- Archonto Athanasiou is a staff nurse in the intensive care unit, 401 Military Hospital, Athens, Greece. Elizabeth D.E. Papathanassoglou is an associate professor, Department of Nursing, Cyprus University of Technology, Nicosia, Cyprus. Elisabeth Patiraki is a professor and Margarita Giannakopoulou is an assistant professor, Faculty of Nursing, University of Athens, Athens, Greece. Mary S. McCarthy is a nurse scientist, Madigan Army Medical Center, Tacoma, Washington
| | - Elisabeth Patiraki
- Archonto Athanasiou is a staff nurse in the intensive care unit, 401 Military Hospital, Athens, Greece. Elizabeth D.E. Papathanassoglou is an associate professor, Department of Nursing, Cyprus University of Technology, Nicosia, Cyprus. Elisabeth Patiraki is a professor and Margarita Giannakopoulou is an assistant professor, Faculty of Nursing, University of Athens, Athens, Greece. Mary S. McCarthy is a nurse scientist, Madigan Army Medical Center, Tacoma, Washington
| | - Mary S. McCarthy
- Archonto Athanasiou is a staff nurse in the intensive care unit, 401 Military Hospital, Athens, Greece. Elizabeth D.E. Papathanassoglou is an associate professor, Department of Nursing, Cyprus University of Technology, Nicosia, Cyprus. Elisabeth Patiraki is a professor and Margarita Giannakopoulou is an assistant professor, Faculty of Nursing, University of Athens, Athens, Greece. Mary S. McCarthy is a nurse scientist, Madigan Army Medical Center, Tacoma, Washington
| | - Margarita Giannakopoulou
- Archonto Athanasiou is a staff nurse in the intensive care unit, 401 Military Hospital, Athens, Greece. Elizabeth D.E. Papathanassoglou is an associate professor, Department of Nursing, Cyprus University of Technology, Nicosia, Cyprus. Elisabeth Patiraki is a professor and Margarita Giannakopoulou is an assistant professor, Faculty of Nursing, University of Athens, Athens, Greece. Mary S. McCarthy is a nurse scientist, Madigan Army Medical Center, Tacoma, Washington
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Partial liberalization of visiting policies and ICU staff: a before-and-after study. Intensive Care Med 2013; 39:2180-7. [DOI: 10.1007/s00134-013-3087-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
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Errasti-Ibarrondo B, Tricas-Sauras S. [Benefits of flexible visitation in the intensive care units for the family of critical patients]. ENFERMERIA INTENSIVA 2012; 23:179-88. [PMID: 23040835 DOI: 10.1016/j.enfi.2012.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 04/25/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022]
Abstract
AIM To identify, analyze and summarize the main effects that may be related to flexible visitation policies for the relatives of critically ill adults. METHOD A review of the literature was conducted in the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library and CUIDEN. Thematic content analysis was used to evaluate selected articles. RESULTS Fifteen articles were included in this review. Four main themes emerged from the thematic content analysis. Themes included the main effects of flexible visitation policies for the family of the critical patients such as: improvement of satisfaction, reduction of anxiety and stress, satisfaction regarding their own family needs, and the role of the family in the patient's care. CONCLUSION According to the existing evidence, flexible visitation policies appear to be both beneficial and decisive. It seems to be necessary to favor the participation of the family in the care of the intensive patient as well as the acquisition of a more prominent role the visitation context and in their relationship with the patient.
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Affiliation(s)
- B Errasti-Ibarrondo
- Departamento de Enfermería de la Persona Adulta, Facultad de Enfermería, Universidad de Navarra, Pamplona, España.
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Falk J, Wongsa S, Dang J, Comer L, LoBiondo-Wood G. Using an Evidence-Based Practice Process to Change Child Visitation Guidelines. Clin J Oncol Nurs 2012; 16:21-3. [DOI: 10.1188/12.cjon.21-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Soumagne N, Levrat Q, Frasca D, Dahyot C, Pinsard M, Debaene B, Mimoz O. Enquête de satisfaction de familles de patients hospitalisés en réanimation. ACTA ACUST UNITED AC 2011; 30:894-8. [DOI: 10.1016/j.annfar.2011.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 05/25/2011] [Indexed: 11/28/2022]
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Connecting hospitalized patients with their families: case series and commentary. Int J Telemed Appl 2011; 2011:804254. [PMID: 22121359 PMCID: PMC3202111 DOI: 10.1155/2011/804254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 08/27/2011] [Indexed: 11/17/2022] Open
Abstract
The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six cases were managed during a five-year period (2006 to 2010). The most common reasons for using Family-Link were related to the logistical challenges of traveling to and from the hospital—principally due to distance, time, family commitments, and/or personal cost. We conclude that videoconferencing provides a solution to some barriers that may limit family presence and participation in care for hospitalized patients, and as a patient-centered innovation is likely to enhance patient and family satisfaction.
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Adams S, Herrera A, Miller L, Soto R. Visitation in the intensive care unit: impact on infection prevention and control. Crit Care Nurs Q 2011; 34:3-10. [PMID: 21160294 DOI: 10.1097/cnq.0b013e31820480ef] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence-based practice has shown that open visitation in the intensive care setting positively impacts patient outcomes. However, many intensive care units continue to strictly limit visitation hours. One concern for nurses is that open visitation will expose their vulnerable patients to an increased risk of infection. This fear is unfounded in professional literature as well as in the experience of a busy intensive care unit in San Antonio, Texas. Keeping our patients safe from hospital-acquired infections requires vigilant attention to infection prevention procedures. Meanwhile, what may actually be bugging our patients is a health care culture that is based on tradition and is blind to the many benefits provided by a more liberal visitation policy rooted in patient-centered care.
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Affiliation(s)
- Sheila Adams
- Baptist Medical Center, San Antonio, Texas, USA.
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Abstract
The purpose of this study was to determine critically ill patients' satisfaction and preference with the restricted visiting hours in the critical-care units in a 435-bed acute-care hospital in North Carolina. The major aims of the study were to (1) identify the time that most patients preferred for visitation and (2) identify how often patients wanted to have visitors. This article discusses the findings of this study, one of which is that patients want more control over visitation.
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Spreen AE, Schuurmans MJ. Visiting policies in the adult intensive care units: A complete survey of Dutch ICUs. Intensive Crit Care Nurs 2011; 27:27-30. [DOI: 10.1016/j.iccn.2010.10.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 09/25/2010] [Accepted: 10/13/2010] [Indexed: 11/27/2022]
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Holly C, Salmond S, Jadotte Y. Families' Experiences of Having an Adult Family Member in a Critical Care Area: A Systematic Review of Quantitative Evidence. ACTA ACUST UNITED AC 2011; 9:1-14. [PMID: 27820189 DOI: 10.11124/01938924-201109641-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Cheryl Holly
- 1.University of Medicine and Dentistry of New Jersey - School of Nursing, New Jersey Center for Evidence-Based Practice: a collaborating centre of the Joanna Briggs Institute, Newark, NJ
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Sauls JL, Warise LF. Interventions for anxiety in the critically ill: a guide for nurses and families. Nurs Clin North Am 2010; 45:555-67, vi. [PMID: 20971336 DOI: 10.1016/j.cnur.2010.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Anxiety is a common feeling for patients and families during the critical care experience. As anxiety for critically ill patients presents increased risks for morbidity and mortality, it is imperative that nurses strive to identify unrelieved anxiety early to prevent adverse events. Alleviating anxiety experienced by families as a result of the critical care experience involves providing assurance, allowing them to remain near the patient, providing accurate and current information, providing for their comfort, and projecting a supportive attitude. As constant care providers, nurses can have the greatest impact on creating an environment that is safe, healing, and humane for critically ill patients and their families.
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Affiliation(s)
- Jenny L Sauls
- School of Nursing, Middle Tennessee State University, Murfreesboro, TN 37132, USA.
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Roger C, Mari A, Bousquet PJ, Louart G, Casano F, Cuvillon A, Muller L, Zoric L, Saïssi G, Lefrant JY. Élargissement des plages horaires de visites dans une unité de réanimation : l’avis des proches. ACTA ACUST UNITED AC 2010; 29:431-5. [DOI: 10.1016/j.annfar.2010.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 03/11/2010] [Indexed: 10/19/2022]
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Cypress BS. The intensive care unit: experiences of patients, families, and their nurses. Dimens Crit Care Nurs 2010; 29:94-101. [PMID: 20160552 DOI: 10.1097/dcc.0b013e3181c9311a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Past studies have examined how nurses can meet the needs of the critically ill patients and their families and the effects of their relatives' critical illness on the families themselves. However, there is a paucity of research studies in the literature conducted on the triad of nurses, patients, and family members looking at the experience of critical illness and their perspective of each from the other. This qualitative phenomenological study was able to elucidate the experiential descriptions, essential relationships, and meaning of structures of the intensive care unit experiences of the 15 participants during critical illness, and strategies to improve nursing practice, research, and education are presented.
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Whitcomb JJ, Whitcomb JA, Roy D, Blackman VS. Evidence-based practice in a military intensive care unit family visitation. Nurs Res 2010; 59:S32-9. [PMID: 20010276 DOI: 10.1097/nnr.0b013e3181c3c028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The dissatisfaction of family members with a restrictive visiting policy in a combined intensive care and step-down unit provides an opportunity for staff to develop better ways to meet the needs of patients and their families. A review of the evidence-based practice (EBP) literature as the measure of significance indicated that less restrictive visitation policies enhance patient and family satisfaction and offer many physiologic and psychological benefits to the patient. OBJECTIVE The purpose of this study was to determine whether a less restrictive visitation policy could be implemented in the adult critical care department of a naval medical center. METHODS Staff was educated on the use of EBP, specifically the Iowa-based model, and a less restrictive visitation policy was developed and implemented. RESULTS Evaluation of the postintervention survey findings revealed higher patient and family satisfaction. CONCLUSIONS The findings from this EBP project suggest that a more open visitation policy is feasible in adult critical care units, with an increase in overall satisfaction of patients and their families with regard to their stay in the intensive care unit.
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Affiliation(s)
- John J Whitcomb
- Nursing Corps, U.S. Navy, Nursing Research Consultation Service, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.
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Abstract
OBJECTIVES To identify the needs of the family of admitted patients in the Critical Care Unit (CCU), and their level of satisfaction with the attention that they received. DESIGN Cross-sectional, observational study. SETTING Critical Care Unit, Virgen Macarena University Hospital, Seville. SUBJECTS OF THE STUDY: Two-hundred and sixty-eight families were selected through a random sampling system. INSTRUMENTS A survey was developed using bibliography as reference. RESULTS According to information, it was observed that receiving information after visiting hours and its access was difficult in regards to unforeseen changes in the patient's course. On the other hand, there were high levels of satisfactions with the attention received and with the nursing cares. Nevertheless, several deficiencies were observed in the identification of all the professionals, the visiting hours, the physical conditions of the waiting room, and privacy within patient's care environment. CONCLUSIONS One of the principal needs of the relatives was to spend more time with the patients. Regarding to the information, access after visiting hours, and on that regarding unforeseen changes in the patient's evolution should be reviewed. Regarding satisfaction, in general, families were highly satisfied with the attention received, especially with the nurse's care. Nevertheless, these professionals should encourage the participation of the families in the patient's care. Moreover, all the areas of improvement observed should be dealt with urgently, mainly the visiting hours.
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Walls M. Staff Attitudes and Beliefs Regarding Family Visitation After Implementation of a Formal Visitation Policy in the PACU. J Perianesth Nurs 2009; 24:229-32. [DOI: 10.1016/j.jopan.2009.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 01/20/2009] [Accepted: 03/20/2009] [Indexed: 10/20/2022]
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Gardner G, Collins C, Osborne S, Henderson A, Eastwood M. Creating a therapeutic environment: a non-randomised controlled trial of a quiet time intervention for patients in acute care. Int J Nurs Stud 2009; 46:778-86. [PMID: 19167711 DOI: 10.1016/j.ijnurstu.2008.12.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 10/22/2008] [Accepted: 12/18/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. OBJECTIVES The study aim was to evaluate a scheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients' rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients', visitors' and health professionals' satisfaction, and organisational functioning. DESIGN The study was a multi-centred non-randomised parallel group trial. SETTINGS The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. PARTICIPANTS All patients admitted to the two wards in the 5-month period of the study were invited to participate, with a final sample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. METHODS Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and wellbeing were collected using previously validated instruments: a Castle Model((c)) 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. RESULTS Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a 'perceived' difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. CONCLUSIONS The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.
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Affiliation(s)
- Glenn Gardner
- Centre for Clinical Nursing, Royal Brisbane & Women's Hospital & Queensland University of Technology, Brisbane, Australia.
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Smith L, Medves J, Harrison MB, Tranmer J, Waytuck B. The Impact of Hospital Visiting Hour Policies on Pediatric and Adult Patients and their Visitors. ACTA ACUST UNITED AC 2009; 7:38-79. [PMID: 27820226 DOI: 10.11124/01938924-200907020-00001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Policies concerning restricted or open visiting hours are being challenged in health care institutions internationally, with no apparent consensus on the appropriateness of the visiting hour policies for pediatric and adult patients. The rules that govern practice are often based on the institutional precedent and assumptions of staff, and may have little or no evidence to support them. Policy and practice related to visiting hours is of pressing concern in Canada, and in Ontario specifically, following the reaction to the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003 and subsequent changes in visiting policies in most health care settings. A systematic investigation of the impact of hospital visiting hours on visitors (including patients, families, and significant others) would inform decision-makers who are responsible for hospital policies about the best available evidence. OBJECTIVES The objective of this review was to appraise and synthesize the best available evidence on the impact of hospital visiting hours on patients and their visitors. INCLUSION CRITERIA Types of participants This review considered studies that included both pediatric and adult hospital patients and their visitors. Participants were either patients, visitors, or health care providers in the following hospital settings: medical/surgical units, critical care (ICU, CCU, NICU), pediatrics, maternity, or general hospital wards.Articles were excluded if participants came from the following settings: post-operative and post-anaesthesia care units (PACU), dementia wards, long-term care settings or retirement homes, or delivery rooms. PACUs were excluded because there are aspects of the presence of visitors to these units that are very specific, and differ from the general visits to patients who are not in the immediate post-operative stage. Dementia wards, long-term care settings and retirement homes were excluded because these were considered to be their "home", so visiting would be quite different from that on acute care hospital wards. Finally, delivery rooms were excluded because this review does not evaluate the impact of the outcomes of presence during "delivery" (or other "procedures").Types of interventions Studies were considered for inclusion in this review if they evaluated the effect or impact of visiting policies. This included interventions targeted at limiting or expanding patient visiting. We anticipated a paucity of experimental studies regarding this review question, thus included observational studies where the impact of visiting policy on patients and/or visitors was a focus, but testing intervention(s) may not have been the primary aim. We did not consider observational studies that focused only on the presence of visitors during specific procedures, resuscitation, or childbirth. The reason is that this limited aspect of the presence of a significant other was not considered "visiting" per se, and would be best examined in another systematic review.Types of outcome measures For this review, outcome measures related to both patients and visitors as a result of visiting hour policies were considered, including but not limited to: patient and/or visitor satisfaction; attitudes; beliefs; perceptions; mood; or patient physiological outcomes. These also included health care provider beliefs, perceptions, and attitudes about the impact of visiting policies on patients and/or visitors. Studies were excluded if they examined the trend of current visiting hour policies (with no evaluation of their impact), or if they focused on visitor presence only during emergency procedures, resuscitation, or childbirth.Types of studies Randomized controlled trials (RCTs) or quasi-experimental studies were included. However, given the expected scarcity of these designs relevant to our review question, other quantitative research designs were considered, such as non-randomized controlled trials, before-and-after studies, and descriptive/observational studies. SEARCH STRATEGY Using a defined search and retrieval method the following databases from 1995-2007 were accessed: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews, AMED, and ERIC. METHODOLOGICAL QUALITY Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using standardized critical appraisal instruments for evidence of effectiveness, from the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. DATA COLLECTION Information was extracted from each paper independently by two reviewers using the standardized data extraction tool developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. DATA SYNTHESIS Due to type of designs and quality of available studies, it was not possible to pool quantitative research study results in a statistical meta-analysis. Since statistical pooling was not possible, the findings are presented in a descriptive narrative form. RESULTS Fifteen studies met the inclusion criteria for this review. The study designs were varied, and included one pilot randomized trial, two quasi-experimental studies, eight descriptive studies/cross-sectional surveys, and four pre-post intervention questionnaires. Findings were inconsistent across studies. Nurses inconsistently enforced visiting policies. In ICU settings, liberalized visiting hours did not increase septic complications. One study reinforced the need for increased patient control over visiting (individual visit contracts, devices). Flexible (open) visitation policies increased patient and visitor satisfaction, and sibling visitation was beneficial to the patient and family. In maternity settings, a 'combination policy' was useful (open visiting for partner, more restricted visiting for others). CONCLUSION Key recommendations are provided that refer to clinical practice in critical care, maternity, and general ward settings, as well as recommendations for future research. In critical care settings, policy makers/administrators need to be aware of their staff nurses' beliefs and attitudes about visiting policies, educate them about the rationale for these policies and consider program development to assist nurses to work with families. Open visitation, and ways to increase patient control of visiting should be considered. No connection was found between liberal visiting hours and increased infection rates. When facilitating sibling visitation in the NICU, a pre-visit education process is recommended. Maternity settings may wish to consider a 'combination' policy, where the women's partners and/or significant other would have open visiting (all day), with restricted visiting for others. In other general hospital ward settings, open visiting with a 'quiet hour' is suggested.
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Affiliation(s)
- Lisa Smith
- 1 Queen's Joanna Briggs Collaboration, School of Nursing, Queen's University, Kingston, Ontario, Canada - a Collaborating Centre of the Joanna Briggs Institute 2 Library Scientist, Director, Library Planning & Administration, Saskatchewan Provincial Library
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Smith L, Medves J, Harrison MB, Tranmer J, Waytuck B. The Impact of Hospital Visiting Hour Policies on Pediatric and Adult Patients and their Visitors. ACTA ACUST UNITED AC 2009. [DOI: 10.11124/jbisrir-2009-181] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Shirey MR, Fisher ML. Leadership Agenda for Change Toward Healthy Work Environments in Acute and Critical Care. Crit Care Nurse 2008. [DOI: 10.4037/ccn2008.28.5.66] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Maria R. Shirey
- Maria R. Shirey is a principal at Shirey & Associates, Evansville, Indiana, and an adjunct associate professor in the graduate program in leadership and management in the College of Nursing and Health Professions, University of Southern Indiana, Evansville
| | - Mary L. Fisher
- Mary L. Fisher is a professor and associate vice chancellor for academic affairs at Indiana University-Purdue University, Indianapolis, Indiana. When this article was written, she was professor and chair of Environments for Health, Indiana University School of Nursing, Indianapolis
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Use of the internet in staff development and its application in helping critical care nurses to lower family stress. ACTA ACUST UNITED AC 2008; 24:E1-8. [PMID: 18349757 DOI: 10.1097/01.nnd.0000300860.37126.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A systematic review evaluated use of the Internet in nursing staff development and the feasibility of using the Internet to teach critical care nurses how to help families. Use of the Internet to provide staff development had varying success. The keys to success are careful development of the program according to needs and capabilities of the users, strong education pedagogical principles, and constant evaluation for success in order to make alterations as they are needed.
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Visiting policies in Italian intensive care units: a nationwide survey. Intensive Care Med 2008; 34:1256-62. [DOI: 10.1007/s00134-008-1037-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To examine perceptions by intensive care unit (ICU) workers of unrestricted visitation, to measure visiting times, and to determine prevalence of symptoms of anxiety and depression in family members. DESIGN Observational, prospective, single-center cohort. SETTING Medical-surgical ICU in a 460-bed tertiary-care hospital. PATIENTS Two hundred nine consecutive patients hospitalized >3 days were studied over the first 5 ICU days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Characteristics of patients (n = 209), families (n = 149), and ICU workers (n = 43) were collected. ICU workers reported their perceptions of unrestricted visitation, and family members completed the Hospital Anxiety and Depression Scale. Daily severity scores (Simplified Acute Physiology Score II and Logistic Organ Failure) and a workload score (Nine Equivalents of Nursing Manpower) were computed. Maximum median visit length was 120 mins per patient per day and occurred on days 4 and 5. No correlations were found among severity of illness, workload, and visit length. For 115 patients, both nurse and physician questionnaires were available; although several differences were noted, neither nurses nor physicians perceived open visitation as disrupting patient care. The median rating for delay in organizing care was "never" for physicians and "occasionally" for nurses. Nurses perceived more disorganization of care than physicians (p = .008). Compared with nurses, the physicians reported greater family trust (p = .0023), more family stress (p = .047), and greater unease when examining the patient (p = .02). The Hospital Anxiety and Depression Scale indicated symptoms of anxiety in 73 (49%) family members and depression in 44 (29.5%). CONCLUSIONS The 24-hr visitation policy was perceived favorably by families. It induced only moderate discomfort among ICU workers, due to the potential for care interruption, in particular for nurses.
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Visiting hours in the intensive care unit: More evidence that open visitation is beneficial*. Crit Care Med 2008; 36:334-5. [DOI: 10.1097/01.ccm.0000295266.17378.bd] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Horn ER, Kautz D. Promotion of family integrity in the acute care setting: a review of the literature. Dimens Crit Care Nurs 2007; 26:101-7; quiz 108-9. [PMID: 17440292 DOI: 10.1097/01.dcc.0000267803.64734.c1] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The acute illness of 1 family member can then negatively affect all family members and lead to the disruption of family functioning and integrity. During the patient's hospitalization, nurses are in a key position to support family members, maintain family integrity, and ready them for assuming the role of caretaker during the patient's recovery and management of health at home. This article reviews current research findings that provide empirical support for activities that promote family integrity. Strategies for nurses to support family members during the hospitalization of an adult family member and suggestions for future research are provided.
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Berti D, Ferdinande P, Moons P. Beliefs and attitudes of intensive care nurses toward visits and open visiting policy. Intensive Care Med 2007; 33:1060-5. [PMID: 17384930 DOI: 10.1007/s00134-007-0599-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Accepted: 02/26/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the beliefs and attitudes of intensive care unit (ICU) nurses toward visiting, visiting hours, and open visiting policies in critical care settings. DESIGN A descriptive, cross-sectional, multicenter survey. SETTING Seventeen hospitals in Flanders (Dutch-speaking Belgium), including 30 ICUs. Sixteen mixed adult medical/surgical ICUs, three medical ICUs, five surgical ICUs, three coronary care units, two post-cardiac surgery ICUs, and one burn unit. PARTICIPANTS A total of 531 intensive care nurses. MEASUREMENTS AND RESULTS We devised a questionnaire comprising 20 items assessing beliefs and 14 items assessing attitudes. Nurses indicated their level of agreement for each statement on a five-point rating scale. Nurses believed that open visiting hampers planning of adequate nursing care (75.2%), interferes with direct nursing care (73.8%), and causes nurses to spend more time in providing information to the patients' families (82.3%). The presumed effects of visits on the patients and families were contradictory. Most nurses (75.3%) did not want to liberalize the visiting policy of their unit. CONCLUSIONS ICU nurses have rather skeptical beliefs and attitudes toward visiting and open visiting policy. This suggests that the culture at Flemish ICUs is not ready for a drastic liberalization of the visiting policy.
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Affiliation(s)
- Dana Berti
- Katholieke Universiteit Leuven, Centre for Health Services and Nursing Research, Kapucijnenvoer 35/4, 3000, Leuven, Belgium
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