Intensive Care Unit

Visiting Hours in the Intensive Care Unit



Visiting Hours in the Intensive Care Unit

Introduction

In many acute care hospitals, unit visitation restrictions have been relaxed, but heavy restriction on visitors, and visitation hours continue to be the norm for most ICUs. This paper aims to analyze the logical argument against and for the visiting hours in Intensive Care Unit (ICU). A survey conducted by the American Association of Critical Care Nurses indicated that only 14% of ICUs had open visiting all hours of the day, and 44% were open on a scheduled basis. More recently, researchers found that of 171 hospital ICUs polled in their survey, only 32% did not limit the time of day or length of time for visitation. However, of those 32%, the majority (91%) set a minimum age of 12 for visitors and 78% restricted visitors to a maximum of two at a time (Irwin & Rippe, 2003).

Background

ICU staff members typically cite three major concerns associated with liberalizing visiting hours; visitors interfering with care for the patient, exhaustion of family and friends, and undue physiological stress for the patient associated with unrestricted visiting hours. Although there may be some validity to visitors interfering with patient care, undue concern over interfering with care fosters an environment in the ICU that becomes convenient for the staff, as opposed to patients receiving care. Many ICU nurses who support liberal visitation in ICUs have found ways to alter the timing of care routines to accommodate family and friends at the bedside (Campbell, 2004).

Favor

Current evidence does not validate the concerns that liberal visiting hours have a negative impact on family members. Rather, visitor presence provides an avenue of improved communication between patients and staff as well as increased opportunities for patient and family education in addition, increased (Campbell, 2004). Finally, the belief that visitor hours restriction is set in place so as to reduce physical stress for the patient, implies that visitor presence evokes stress. The presence of friends and families reassures and calms the patient, provides some familiarity in an unfamiliar environment, and helps the patient to sense. The literature also suggests that there are no adverse physiological changes associated when family and friends are visiting on unrestricted hours. Kleman et al. (1993) showed no cardiovascular changes to heart rate, blood pressure, ST-segment elevation or depression, oxygen saturations, and premature ventricular contractions (PVCs) before, during, or after family visits. Fumagalli et al. (2006) showed a statistically significant decrease in the rates of pulmonary edema and shock with an unrestricted visiting policy versus a restricted visitor policy (Apostolakos & Papadakos, 2001). It was hypothesized that this was to the result of closer surveillance of the critical care patient by family and friends who were at the patient's bedside more frequently than the critical care staff. Based on the most conclusive evidence available, the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM) recommend open, flexible visitation for families of ICU ...