Partial liberalization of visiting policies and ICU staff: a before-and-after study

Abstract

Partial liberalization of ICU visiting policies was associated over the course of a year with a small but significant increase in staff members' burnout levels. Nonetheless, doctors and nurses viewed the policy positively, maintaining this opinion after 1 year. Negative views were strongly correlated with burnout.

Reappraisal of visiting policies and procedures of patient’s family information in 188 French ICUs: a report of the Outcomerea Research Group

“…Ten years later, and after the publication of international guidelines and position statements made by scientific societies, institutions, and committees, which supported the need for families’ presence based on patient’s preferences and promoted the implementation of an “open ICU model” [16], numerous French ICUs have taken into account the message, and 23.9 % of them open their units on a 24-h-a-day basis. We are facing an evolution of practices in Europe with increased accessibility for families, like in Italy where ICUs have been closed for many years [17, 18] before extending visiting hours [19] and in France [12, 14, 20]. This evolution has probably multiple drivers: expert’s conferences in scientific meetings, positive communication of caregivers in ICUs which have extended these practices [12, 19, 20] and knowledge by the intensivists of the absence of scientific proofs justifying closing ICUs to families.…”

“…We are facing an evolution of practices in Europe with increased accessibility for families, like in Italy where ICUs have been closed for many years [17, 18] before extending visiting hours [19] and in France [12, 14, 20]. This evolution has probably multiple drivers: expert’s conferences in scientific meetings, positive communication of caregivers in ICUs which have extended these practices [12, 19, 20] and knowledge by the intensivists of the absence of scientific proofs justifying closing ICUs to families. Broad visiting duration was associated with a protective effect on dissatisfaction and on anxiety and depression symptoms [21].…”

What is “severe burnout” and can its prevalence be assessed?

“…As a consequence, the prevalence of burnout has varied dramatically from one study to another (e.g., [4,5]). Inevitably, as long as what is meant by ''burned out'' remains elusive, estimating the importance of the burnout phenomenon will remain challenging.…”

Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

“…Dr. Jones provides a conceptual model for the trajectories of care after critical illness that could be used to guide rehabilitation efforts in the future. Last, Giannini et al [58] assessed the impact of partial liberalization of ICU visiting policies associated with staff burnout. If doctors and nurses overall viewed the policy positively, having negative views on open visitation policies strongly correlated with burnout.…”

“…Finally, a study of visiting policies in a pediatric ICU provides insights into care at the opposite end of the age spectrum. Giannini conducted a before-after study in eight Italian ICUs who were changing their family visiting policies to increase family visiting hours to at least 8 h per day [58]. They surveyed ICU nurses and physicians before, 6 months after, and 12 months after the liberalization of visiting hours and assessed attitudes toward the new policy as well as clinician burnout.…”