Opening visiting hours in intensive care units: helpful or harmful to patients

¶ … Opening visiting hours in the Intensive Care Unit Harmful or Helpful to the Patient

As the healthcare system starts making that move in the direction of a client-driven model, opening visiting hours are becoming a topic of discussion and interest. Studies that go all the way back to the 1970s has produced argument and conjecture over the perfect visiting practices in the adult intensive care unit. This literature explores the effects of having a policy that is for opening visiting hours and how it has an effect on the patients.

According to various studies, ever since the 1970s, there has been visiting practices in intensive care units (ICU) that goes all the way back to a time where it was not talked about much. Over the last 10 years, there has not been enough research or data that could measure this issue of opening visiting hours being harmful or helpful to the patients. Some experts have been able to puzzle together some evidences that it can be harmful and at the same time there is other research that proves that it can also be helpful as well. In putting together the literature review, most of the examination basically has come from the United States, United Kingdom and with few articles being created in South Africa, France, Germany or even Australia (Clifford, 2006).

According to the research, there are mixed emotions by hospital staff and workers on rather not these opening hours are beneficial or if they are really a big problem that can do more harm in the future instead of good. However, since the issue is growing, it is wise to get an overview of studies to see what directions other experts have been able to discover. The literature review will explore both sides of the issue. (Bunker, 2006).

The Concern of the Visitation Hours

It is important to dive deeper and gets a better understanding on what "visiting" is supposed to mean. Visiting is a general term that has a variety of suggestions in the hospital setting. For the most part of this paper the term will be used a lot. "Restricted" basically means that only so many people are allowed to visit at either a certain part of the day or at a particular time with permission which is normally set by hospital rules. "Open" means people that are family are able to visit anytime throughout the 24-hour day, and this can go on for as long as they desire (Bunker, 2006). Both of these "open" and "closed have cause quite an uproar in the good and bad light. Researchers would say having too much restriction can bring the spirits down on the patient, therefore causing there moods and even in some cases their health to start changing. Nurses have complained that too much interaction with patients because of the "open" policy has caused it to get in the way of their work. What they are saying is that it is impossible for them to do an accurate job with the patients if family members are coming in and out of the room 24/7. Nurse complains that they find it hard to concentrate and also blame that on the declining health of the patient. However, in this essay the word "flexible" will be utilized in order to explain the variety of visiting practices which will go up under the excesses of "open" and "restricted" policy (Biley, 2007).

Is current visiting policy an issue?

Most of the information comes from nurses and patients they that have or are already in a hospital. The research goes into the ICU that occurs in both places such as the private and public hospitals. The same issues that occur in private ICU are the same that go on in the public. Nurses have complained in both settings but much less in the public. It is not much of an issue in the public because a lot of restriction can apply depending on the hospital. The patients seem to be less joyful in the private because the policy is much different. Research shows that these patients in private have less joy because time is cut down on the visitation. Research shows that many of the private hospitals believe that too much family visitation can cause some stress on the patients. Therefore, a lot of these hospitals do not have the 24/7 policy because for health reason. However, for some individuals, who are nurses in and working in some of the private hospital ICU, have been noticing a lot of restrictive practices especially when the family comes to visit them (Bunker, 2006). These comprise of family associates being made to stand and wait for excessive periods of time. Some were even sent out, while other family members were deprived of the chance to help with personal hygiene care (Dracup, 2006). Equally, there have been other times when the attendance of family, for example, a family member crying irrepressibly at the side of the bed, can make the patient mad disturb care, or a huge amount of visitors to the patient, has lessened alongside ideal patient care (Bunker, 2006). Nurses are the ones that have the power to enforce or to be compassionate in regards to visiting limits. The apparent chance of visiting events confuses the family and could make their anxiety worse.

According to Biley (2007) right now in some places, the visiting rule for some hospitals is observed by experts to be restrictive for no reasons. They believe putting the unnecessary restriction for visiting hours, will have an effect on the patients. However, having visitation in the surgical wards is permitted just during time periods of11.00 am to 12.00 noon, 2:00 PM to 4:00 PM, and 7:00 PM to 8:00 PM with no limitations on the amount who could come and visit (Biley, 2007). Some patients still argue that this is not enough time for them. Some hospitals do offer the booklet for the family members that gives them material on the ICU setting, however this does not do them any good because it does not tell them any type of strategies for the visiting hours. (Biley, 2007). In reality, common practice for having visitations in the ICU is supposed to be "open" in that there are no orders to be able to put some restriction on visiting at any time or even how long. This in many hospitals, according to research does bring up a lot of various concerns as day-to-day choices are left to the discretion of the professional nurses that are having to work in this area. Open visiting according to research in some countries is encouraged by doctors and nurses. Studies do show that it does have some effect on the patients (Biley, 2007).

Cultural differences also have to be looked at when visiting policies are done. Although it was challenging for the Maori in New Zealand which lead to cultural safety turning out to be an essential portion of nursing exercise, its values are appropriate to whatever the culture could be. The knowledge is even more significant now with cumulative cultural diversity in patient and populations in New Zealand. Ramsden (Giuliano, 2004) makes the suggestion that cultural safety does happen when individuals are feeling safe to utilize a health service that is delivered by individuals from a different culture that is not their own, devoid of jeopardizing their own culture. She has the belief that has something to do with nurses that have an interaction with and paying attention to their patients, devoid of making judgments when it comes down to their social and cultural backgrounds. It is about patients that are feeling safe regardless of where they come from.

Are visiting practices an Issue?

Visitation that is Restrictive

In history, the set-up of the environment in critical care has been influencing rules that connect to visiting in these places. Hamner (1990) documents that in 1970 the Public Health Service in the United States circulated references that family that is doing the visiting be not be as open to instant family members for times that were short and that a waiting room be made available (Caine, 2005). In 1965, suggestions were being made to take away the restrictions in order to accomadate the patient (Fontaine, 2004). This was sort of normal of a lot of the critical care areas during this era. Usually, visiting practices most of the time were usually presented to allow hospitals to regulate and manage with relatives of the patients', than to advantage patients in expressions of rest and quietness (Milne, 1998). Despite these practices which are being presented in the 1960s, new research makes the point that restrictive visiting practices are still going on in many critical care regions today (Livesay, 2004).

A lot of different writers are showing that restrictive visiting is connected to beliefs that are traditional in place of evidence-based research. Hopping et al. (1992) did a survey with 40 coronary care units (CCU), and likened issues connected to the control and setting of visiting strategies in CCUs. They were able to discover that there are a lot of liberal visitations instructions in teaching hospitals in place of community hospitals, and the basis for restrictive visiting rules comprised increased rest or sleep for the patients, nurses needing more control, uninterrupted adjustment of shift report and reduced crowding in the unit (Bunker, 2006).

A lot of studies make the suggestion that official and unit needs are driving visiting strategies more than patients' emotional or medical essentials. Gonzalez (2004) did a survey that had something to do with visiting practices in 70 ICUs in the United Kingdom, and discovered no consensus regarding ultimate visitation policies. This again highpoints that the mainstream of ICUs experienced some type of visiting that is restrictive. Typical instances of restrictive practices comprised visiting just among assured times, children being restricted, limitations of whom and the amount of individuals could visit, and the time of visit. This certain study has been reproduced by Plowright (2007) to find out whether two years after the presentation of the results of Caine (2005) visiting inside the ICU location continued to be restricted (Livesay, 2004). Even though more promising results were discovered concerning some features of visiting practices, just nine of the 51 ICUs that participated in the study that requested to have open visiting really had this. The children not being able to visit had an effect on the patients. It caused them to be more stressful thus having more issues.

Nurses played a role in everything being so restrictive. Research shows that some of them believed the restriction were meant to benefit the patient. The report by Gonzalez, (2004) surveyed 205 critical care nurses in six urban hospitals in the U.S.A. concerning their insights about open vs. restricted visiting hours. All of these results showed that most of these nurses did not want to make that many restrictions for the patients because they saw changes in patient health when there were no restrictions. Variables that are having an effect on visiting practices were the patient's necessity to have some rest, the nurses' assignment, and the optimistic effects of having visitation with the patients, specifying that common practice was frequently more open than the hospital policy.

In spite of showing that they have applied more visiting policies that are flexible, individual nurses do and can apply individual restrictions by controlling the number and age of visitors permitted at the bedside, and then making them to leave throughout processes, doctors' rounds and patient handover (Fontaine, 2004). Studies are showing that more nurses are starting to agree with the restrictive policy, therefore restricting the patients time with family. This is reversing the effect of having the optimistic results of visiting on the patients. Nurses' understandings of a perfect visiting policy that they would call comprised restrictions on the amount of visitors (85%), the amount of hours visiting (67%), children visiting (65%), and period of visit (44%) (Fontaine, 2004). Family members' Patients' or needs were categorized as not as significant, even though no basis was given (Giuliano, 2004).

Open visiting

Research shows that the open visitation really benefits the patients. Having a 24-hour day, open visitation with the family has a positive effect on the patients when they are able to see their family all day with the policy (Biley, 2007). Preferably, every one of those that have been affected by the visiting policy, family member, nurse and patient, will need have some say as to the decision-making. Sometimes the nurse or doctor does stand in the way of this policy. Plowright (2007) documents that in 1992 the United Kingdom Central Council for Nursing, Midwifery and Health Visiting Code of Professional Conduct requisite that the registered nurse would need to "act to endorse and protection the interests of the patients," and function in an "co-operative and open method with their families and patients, developing their recognizing and independence and regarding their participation in the preparation and distribution of care" (p. 269).

Notwithstanding indication that the participation of family in a critically ill patient's care is helpful and esteems the privileges of patients and their families to be composed and provide each other throughout an era of crisis and stress, (Fontaine, 2004), nurses still seem to use substantial power and control by limiting companies (Livesay, 2004). These nurses are using their power to actually work against the patient and in some cases has caused some friction among family members, and nurse patient, and drop the chance to bring an optimally beneficial setting for critically ill patients, which may suggest that the practice of nurses' in handling visiting is not inevitably continuously patient focused (Livesay, 2004).

Bunker (2006) makes the argument that patients usually are not abandoning their family ties when they turn out to be ill and that family members are a vital part of the care procedure. He is trying to make the point that nurses can be a hindrance to the patient's health. He makes the point that the nurses need to work with restrictions and not impose them because it actually hurts the patients. Other experts make the point that nurses need to enforce the (Benner, 2008).

Some of the nurses that are working in some critical care units have to put up with placing restrictions on visiting in spite of open visiting rules. More precisely, there reasons that have been provided for restrictions where those patients' circumstances were too perilous or those them required rest, doctors' rounds that have been in development, or merely that nurses found visitors irritating or rude (Dracup, 2006). Dracup also mentions that the bigger time spent with families lessened everything with patient care (Clifford, 2006). Every so often, nurse's bend the rules a little for the patients so that they can be accomadate. (Biley, 2007).

Surveys that have been observing the visiting policies of different ICUs and CCUs display a combination of practices. The restrictions that are on ongoing of visitations, interval of time per visit, amount of visitors, and minimum age requirement were typical (Bunker, 2006). No agreement of a perfect visiting policy was clear in the studies, and visiting customs were different depending on issues for example degree of hospital, kind of hospital, and the phase of education of the nurses (Benner, 2008). This more than likely has a lot to do with some nurses' opinion that visitors are physiologically taxing to patients, and decrease patients' rest necessities (Livesay, 2004).

Nursing literature clearly displays that family visiting practices at times fluctuate extensively and that debate and report continue over rather or not it has a huge effect on the patients (Benner, 2008). This is regardless of the publishing of literature does encourage some sort of change to take place in restrictive visiting rules (Gonzalez, 2004). It is thought-provoking to note that open visiting has been utilized in pediatric populations for some time and in this area it has proven that when the policy has an openness than there is a much better effect on the patients.

Physiological effects

Usually, some nurses may have been afraid of the fact that opens visiting as possibly harmful to patients that are critically ill. Studies show that having too much open visitation can have a negative effect on the patients. There were patients that were basically close to death and maybe having visitations from family members and friends that never had their best interest cause blood pressure to go up. There are cases with the open visitation that patients have died because of un healthy visitation. In these studies, there were not any restrictions in the policy of open visitation. However, some of the other studies after interviewing some of the nurses showed that having open visiting improved intracranial burden, heart rate, blood pressure, and the incidence of premature ventricular and atrial beats (Livesay, 2004). It is thought-provoking to remember that no research backs the credence that visits and family participation can have a negative physiologic result on any of the patients. On the other hand, other opinions reveal that open visiting promotes stress reduction and a sense of calm, thus encouraging patient rest (Dracup, 2006).

In difference, studies done by other scholars may have some contradiction of an earlier study by Allen (2006). Allen's expressive study of 60 CCU patients that connected the outcome of blood pressure, family visits, rhythm, and heart rate. Allen pointed out that family visitations of 15 minutes or even visitations that where every hour appeared to have created an increase in heart rate and systolic blood pressure on patients that were in the CCU. The visitations times that were chosen in the model CCU was the 10 minutes right before the hour of 11 a.m. And 8 p.m. In the study that Allen's performed, nonetheless, it seems that the visiting agenda, instead of the actual visitation, could have been the supreme foundation of patients' stress (Clifford, 2006). Fascinatingly, this study made the mention that symptoms happened either throughout the start of the contact or throughout the first ten minutes. Initial fears connecting to the adverse biological results of visiting patients in critical care parts have not been validated in future literature; nevertheless, these alarms are still quoted as explanations for restraining family visitors (Giuliano, 2004)

Conclusion

Examination of current literature linking to visiting in the ICU displays that visiting practices still fluctuate expansively, and difference and estimation continue over the visiting practices that are ideal in the adult ICU. It would probably be safe to mention that patients in some places to expect to have opened visiting hours and then again a lot would want to have some restrictions on the visiting. It is clear from the research that a lot of the older patients they would favor to have some restrictions for visitation. With that being said, this appears to increase the distresses of how nurses recognize this, and how they would apply a visiting routine to collaborate individual patients. Nurses appear to understand how important it is to families to have those open visitations. Nurses are concerns in regards to family input into care and are conscious of family and patient needs. Even though the nurses at time will have to put some restriction on visitation because they have to preserve the hospital policies. After completing the literature review, there is really no conclusive indication to back the certainty by some nurses that there is a harmful physical outcome of family visiting. The results of these studies have been able to prove the limited wants and assortment among patient inhabitants, and difference among nurses regarding insights, education, experience, or ability to assimilate information that would go into practice. I believe that there is a need to put together more research on this issue within the health care system and the country. The idea of family-centred and complete care in New Zealand desires to be developed and defined within the adult serious care setting. It is clear that more study into the specific needs of the diverse cultural groups is likewise vital. Research significances for future studies of visiting hours would involve additional study to explain visiting preferences founded on gender, evaluation of patients' sleep cultural characteristics clinical sub-populations, and kinds of unit, anxiety, and sleep cycles, pain intensity and amount of misperception in parallel to visiting activities. Visiting activities in relation to patient outcomes for instance complications, length of stay, and the number of days on that they had been on the ventilator also require investigation. Identification of methods to obtain the importance of family visits founded on family and patient satisfaction and physical variations would also be helpful. A relative investigation of the family's and nurses' perceptions and the things that they had experienced with public visitation shows that this is a study that also needs to be researched. More literature studies that involves the acute care setting using a qualitative research type of approach would more than likely help in creating much better understanding and insight to discern any difference among them.

References:

Benner, P.T. (2008). Expertise in nursing practice:. New York City: Springer Publishing Company.

Biley, F.M. (2007). Issues in intensive care visiting. Intensive and Critical Care Nursing, 75-81.