Using Evidence to Overcome Obstacles to Family Presence

Abstract

Family presence is advocated by many professional organizations and recommended in practice guidelines. However, firmly held beliefs often prevent full implementation of family presence on rounds and with visiting. This article will review the evidence surrounding common concerns that family presence will increase infection, have adverse effects on the physiologic status of the patient, defer from teaching opportunities, or otherwise interfere with rounds. The notion that families need to be encouraged to go home to rest is also explored. A case study describing 1 unit's efforts to improve family presence is described. Strategies to overcome obstacles inhibiting family presence will be provided.

Hospital visiting policies – impacts on patients, families and staff: A review of the literature to inform decision making

“…According to these authors, one of the only legitimate concerns pertains to the risk that family members experience increased anxiety when participating in patient rounds, but the authors note that this risk exists especially if the rounds are not organized in such a way as to take into account the presence of families at the patient's bedside. [13] …”

“…Among the seven papers included in our study, we found that only three were of good quality; [8,12,16] the others were of low-to-medium quality. [11,[13][14][15] Main limitations of the later were the poor research methodology descriptions, as well as poor descriptions and poor critical assessment of the primary studies they included. A brief description of the reviews we included in our synthesis and a summary of their results are presented in Table 2.…”

“…In addition to concerns regarding the risk of infection, Davidson et al [13] assessed whether other concerns, often referred to in justifying restrictive visiting policies, were based on evidence. The authors concluded that the possibility that family presence may be detrimental to the psychological state of the patient, may slow down patient rounding or decrease the quality of patient education were unsubstantiated.…”

“…[1,4,17,18] Among the seven reviews included, five were exclusively focussed on intensive care units (ICUs), [11,12,[14][15][16] while the other two were not confined to a specific type of unit. [8,13] While most of the reviews had the overarching goal of assessing and synthesizing evidence on the perceived impacts on patients, visitors and staff of open or flexible visiting policies, they varied in types of studies they included, indicators and methodologies they used to assess impacts. The quality of their methodologies.…”

“…Of this number, 18 documents were excluded. Eleven documents were included, seven literature reviews [8,[11][12][13][14][15][16] and four practice guidelines. [1,4,17,18] Among the seven reviews included, five were exclusively focussed on intensive care units (ICUs), [11,12,[14][15][16] while the other two were not confined to a specific type of unit.…”