Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic

Munshi, Laveena; Odutayo, Ayodele; Evans, Gerald A.; Keresteci, Maggie; Drury, Julie; Kain, Dylan; Johnstone, Jennie; Stall, Nathan M.; Barrett, Kali; Slutsky, Arthur S.; Maltsev, Antonina; Perkhun, Anna; Jüni, Peter; Razak, Fahad

doi:10.47326/ocsat.2021.02.31.1.0

Cited by 8 publications

(12 citation statements)

References 34 publications

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“…One study examining the impact of restrictive visitation policies in Canadian ICUs found communication quality between clinicians and patients was severely diminished by disrupting the flow of information, making grief more challenging, and possibly contributing to moral distress of physicians (20). Importantly, another study found that family members, when using appropriate Personal Protective Equipment, are not significant contributors to hospital spread of COVID-19 infection and prioritizing entry of essential family and caregivers over more general hospital visitors is essential to improve patient care (21). Given the detrimental effect on clinicians and families alike, less restrictive visitor policies would likely ease some of the barriers to communication and therapeutic relationship development across ICU patients and their families.…”

Section: Discussionmentioning

confidence: 99%

“You’re Socially Distant and Trying Not to Be Emotionally Distant.” Physicians’ Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study

Nugent

Golden

Chapa

et al. 2023

Critical Care Explorations

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To: 1) characterize how COVID-19-related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication. DESIGN:We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic. SETTING:We purposively selected hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19. SUBJECTS:We recruited a national sample of ICU physicians from Veteran Affairs (VA) Health Care Systems and their associated academic affiliate hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Twenty-four intensivists from seven VA hospitals and six academic-affiliate hospitals participated. Intensivists noted the disproportionate impact of the pandemic on among people holding minoritized racial and ethnic identities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust and compromised physicians' ability to develop therapeutic relationships. We also identified several perceived influences on patient-clinician communication and the establishment of therapeutic relationships. Barriers included physicians' fear of becoming infected with COVID-19 and use of personal protective equipment, which created obstacles to effective physical and verbal interactions. Facilitators included the presence of on-site interpreters, use of web-based technology to interact with family members outside the ICU, and designation of a care team member or specialist service to provide routine updates to families. CONCLUSIONS:The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among people holding minoritized racial and ethnic identities and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances.

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Section: Discussionmentioning

confidence: 99%

“You’re Socially Distant and Trying Not to Be Emotionally Distant.” Physicians’ Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study

Nugent

Golden

Chapa

et al. 2023

Critical Care Explorations

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“…Restricting hospital visits during the COVID-19 pandemic's rst wave had the following aims: (1) preventing the transmission of SARS-CoV-2 from the community into acute hospitals (infecting healthcare staff and patients), (2) preventing transmission in the other direction (infecting visitors), and (3) maintaining adequate supplies of personal protective equipment (40). At the pandemic's onset, potential visitor-related COVID-19 outbreaks were considered a substantial risk and, thus, all types of visits were restricted, despite a lack of scienti c evidence linking visitors to SARS-CoV-2 transmission (41,42).…”

Section: Visiting Restrictions During the Covid-19 Pandemicmentioning

confidence: 99%

Relatives' experiences of visiting restrictions during the COVID-19 pandemic’s first wave: a PREMs study

Tacchini-Jacquier

Monnay

Bonvin

et al. 2022

Preprint

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Background: During the COVID-19 pandemic, most countries introduced temporary visiting restrictions on the relatives of acute care hospital patients, whether or not they were infected with SARS-CoV-2. This affected relatives’ psychological and emotional states and how closely they could be involved in their loved one’s hospitalization. Study Aims: Investigate relatives’ experiences of visiting restrictions during the COVID-19 pandemic’s first wave and of the support offered by Valais Hospital’s healthcare staff. Method: Relatives and patients who had been discharged between February 28 and May 13, 2020, were asked to complete a patient-reported experience measures (PREMs) questionnaire, whether or not they had been infected by SARS-CoV-2. Relatives were asked about how visiting restrictions had affected them, their perceptions of the severity of the COVID-19 pandemic, the quality of communication concerning their loved ones’ health status during their hospitalization, and the information received from healthcare staff. Descriptive and inferential statistics were computed. Results: Of 866 PREMs questionnaires returned, 818 were analyzable, and 543 relatives had experienced visiting restrictions to their loved ones: 92 relatives (87%) of COVID-19 patients and 451 relatives (66%) of non-infected patients, with heterogenous effects on their psychological and affective status. Overall, whether or not relatives were subjected to visiting restrictions, they perceived themselves to be well treated, well informed, and that communication with hospital healthcare staff was satisfactory. However, relatives subjected to visiting restrictions reported significantly lower scores on the quality of communication than other relatives. The relatives of patients in gynecology/obstetrics and internal medicine wards were significantly more affected by visiting restrictions than were the relatives of patients in other wards. Numerous relatives subjected to visiting restrictions reported regular communication with their loved ones or with healthcare staff, at least once a day (n = 179), either via videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® or via mobile phone text messages. Discussion Visiting restrictions affected relatives differently depending on the wards their loved ones were hospitalized in. Healthcare institutions should investigate the utility of visiting restrictions on patients, how they affect relatives, and how to improve personalized patient–relative communications.

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“…Clinicians recognize the importance of patient relationships with, and caregiving by, family in hospitals, nursing homes, and long-term care (LTC) settings. 2,3 Although institutional visitor policies had become more flexible in response to patient and family needs over time, 4,5 the COVID-19 pandemic reversed this progress, often closing doors to family/ caregivers.…”

Section: Introductionmentioning

confidence: 99%

Ethical Guidance on Family Caregiving, Support, and Visitation in Hospitals and Residential Health Care Facilities, Including During Public Health Emergencies: an American College of Physicians Position Paper

2023

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Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms.

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Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic

Cited by 8 publications

References 34 publications

“You’re Socially Distant and Trying Not to Be Emotionally Distant.” Physicians’ Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study

“You’re Socially Distant and Trying Not to Be Emotionally Distant.” Physicians’ Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study

Relatives' experiences of visiting restrictions during the COVID-19 pandemic’s first wave: a PREMs study

Ethical Guidance on Family Caregiving, Support, and Visitation in Hospitals and Residential Health Care Facilities, Including During Public Health Emergencies: an American College of Physicians Position Paper

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