Perceptions of an open visitation policy by intensive care unit workers

Abstract

BackgroundAn intensive care unit (ICU) admission is a stressful event for the patient and the patient’s family. Several studies demonstrated symptoms of anxiety, depression, and posttraumatic stress disorder in family members of patients admitted to ICU. Some studies recognize that the open visitation policy (OVP) is related to a reduction in symptoms of anxiety and depression for the patient and an improvement in family satisfaction. However, some issues have been presented as barriers for the adoption of that strategy. This study was designed to evaluate perceptions of physicians, nurses, and respiratory therapists (RTs) of an OVP and to quantify visiting times in a Brazilian private intensive care unit (ICU).MethodsThis observational and descriptive study was performed in the medical-surgical (22 beds) and neurologic ICU (8 beds) of Sírio-Libanês Hospital (HSL), São Paulo, Brazil. All physicians, nurses, and RTs from ICU were invited to participate in the study. A questionnaire was applied to all ICU workers who accepted to participate in the study. The questionnaire consisted of 22 questions about the visiting policy. During five consecutive days, we evaluated the time that the visitors stayed in the patient room, as well as the type of visitor.ResultsA total of 106 ICU workers participated in this study (42 physicians, 39 nurses, and 25 RTs). Only three of the questions exposed a negative perception of the visiting policy: 53.3% of the participants do not think that the OVP consistently increases family satisfaction with patient’s care; 59.4% of ICU workers think that the OVP impairs the organization of the patient’s care; 72.7% of participants believe that their work suffers more interruptions because of the OVP. The median visiting time per day was 11.5 hours.ConclusionsAccording to physicians, nurses, and respiratory therapists, the greatest impact of OVP is the benefit to the patients rather than to the family or to the staff. Furthermore, they feel that they need communication training to better interact with family members who are present in the ICU 24 hours per day.

Anxiety, depression, and satisfaction in close relatives of patients in an open visiting policy intensive care unit in Brazil

“…There are many studies suggesting interventions to better communication by specifics strategies to decrease stress in family members and to improve family satisfaction [7][8][9][10][11]17]. In addition, others efforts intended to make the family comfortable in the ICU, such as the architectural design and visiting hour policies have been carried out [13][14][15][16].…”

“…Since 1979, when Molter published the Critical Care Family Needs Inventory [6], many studies have focused on attendance to those needs in an attempt to reduce these symptoms and to increase family satisfaction [7][8][9][10][11][12]. One of these efforts is a change from restrict visiting ICU to an open visiting policy (OVP), which allows access to family at all hours (24 hours) and can meet at least 1 of the major family needs: to stay often with the patient [13][14][15][16].…”

Percepção De Familiares Sobre Visitas a Pacientes E Regras Em Unidade De Terapia Intensiva

“…Estudos demonstram que a atuação do psicólogo pode contribuir com a equipe nessas questões (13,(18)(19) , por ser um profissional capacitado para lidar com as questões psicológicas envolvidas no processo de adoecimento e hospitalização, tanto em relação aos pacientes quanto com seus familiares. Sentimentos de tranquilidade e esperança relacionados à comunicação com a equipe e à possibilidade de estar próximo ao paciente e acompanhar seu processo de tratamento também foram mencionados, o que corrobora a literatura (5) e indica a necessidade de a equipe estar preparada para receber e comunicar-se de forma adequada com os familiares (16,20) . Foi possível observar que as características familiares podem interferir na forma como seus membros vivenciam a situação atual.…”

“…Um estudo realizado com 106 profissionais que trabalham em UTI demonstrou que a maioria deles considera que a presença do familiar prejudica a organização do atendimento ao paciente, interrompendo suas atividades com maior frequência. Além disso, neste mesmo estudo embora 50% dos participantes não considere que a visita aberta não diminui realmente a ansiedade e o estresse da família, a maioria deles (67,9%) considera que a flexibilidade em relação a visitação é importante se houver uma necessidade para isso (16) . Outros autores também destacaram o prejuízo ao trabalho da equipe e incluíram o risco de infecção e como justificativas para a restrição das visitas em UTI (9)(10) .…”

“…Apesar dos benefícios percebidos, para que as políticas abertas de visitação possam ser efetivadas na prática, é necessário investimento institucional em infraestrutura para acolher os familiares (8) . Estratégias de qualificação e capacitação do profissional para lidar com os familiares, em especial na comunicação, também podem contribuir nesse processo (16) . A segunda categoria engloba os "Sentimentos despertados" pela visita nos participantes.…”