Opening Visiting Hours in the Intensive Care

¶ … 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.

Patient preferences

A lot of different studies display that patients want flexible visiting practices and there is a lot of proof to make the suggestion that this is beneficial for them for the reason that it has an effect their health (Fontaine, 2004). Simpson (2007) related patients' preferences for certain visitations among ICU patients and CCU patients and. She discovered individual aspects have predisposed how patients witnessed perfect visiting rules involving age, illness related characteristics, personality and types of units. There were different views going on among CCU patients and ICU patients. The CCU patients favor afternoon and evening visitations even though the patients in ICU have no preference when it comes down to open policy. CCU patients are the ones that did want open visitations that were longer than ICU patients.

Livesay (2004) did a survey that involved 20 ill patients in a 25 bed joint medical CCU and ICU in a 400-bed Veterans Affairs Hospital concerning their fulfillment with the present visiting policy. Questionnaires were used to assess the opening visitation in critical care. In addition, that survey was used to see how this policy had an effect on the patients. The patients had to complete the items on how visitors affected the health of the patients. In this study, A Likert-type scale of 1 to 5 was utilized in order to get a rank of all of those that had an optimistic view when it came down to the visiting policy. Research shows that from analysis of this survey, changes were applied and secondary study results displayed "open visiting hours are showing that they have been having an optimistic results on the patient" (p. 9) and "trying to get a setting that has more visitation policies are beneficial because they could possibly reduce the length of the patient's hospital stay" (Biley, 2007).

Gonzalez (2004) also did examine some patients' preferences for family visitation in an ICU and a compound care medical unit. Sixty-five patients contributed in an organized interview that evaluated patients' preferences for visitations, stressors and welfares of visiting, and patients' professed fulfillment with hospital strategies for visitations. Other experts clearly show in this essay that patients in both units valued visitation as a non-demanding experience for the reason that visitors offered comfort, ease and reassuring. Patients in the ICU appreciated the detail that visitors could help them in understanding the material delivered by healthcare providers and that visitors could offer info to aid nurses in appreciating a patient's coping style and personality. Patients in the ICU that participated in opening visiting hours had felt more of a satisfaction with visiting practices than the patients in the difficult care medical unit, even though each of the groups did sort of favor visitations of 55 to 60 minutes, four to five times a day (Caine, 2005)

Differences among the complex care medical unit and ICU could be predisposed by age, illness-connected character, forms of unit characteristics, and gender. The patients in Intensive care unit Gonzalez (2004) study had showed that there was a difference to what men and women patients mentioned when it came down to having open visitation in the ICU. Both of them agreed that the longer the hours the better they felt. Women appeared to want the visitations more than men because their reactions were different. The study showed that have a restriction on the visiting hours affected the women patients more than it did the males (Biley, 2007). This study disclosed that patients both male and female evidently appreciated the worth in having visitors and is very content with a visiting recommendation that is flexible enough to accomadate the patient's desires and the wishes of the visitors. The scholars made the point that 'patients that are part of the CCMU and ICU believed that having open hours really did make a difference in the patient recovery process (p. 196).

This research showed that patients do prefer to have opened visiting hours nevertheless also specified they would like some limitations also with the visits. The one that did not really benefit from the open visitations were usual those that were much older and did not have any families to come visit them. Also studies showed that nurse and patients that had a good connection had more open visiting hours because a lot of the nurses would bend the rules for the patient because they may have been fond of them. Giuliano, 2004). The studies showed that patients that did not have a close relation with the nurses and staff had more restrictive open visitations. The studies showed that if patients did desire to have personalized restrictions, in most cases it is because they did not have many people that would come and visit them or in some cases the patient was too ill to want any kind of visitation s so the nurses were responsible for putting on some of the restrictions. However, the literature does not really provide a clear perspective on the right way to address these concerns.

These studies were a way of offering the insight into the minds of patients and staff in regards to the open visitation and rather or not it has any effect on the patients. The study showed that the patients were able to give their input in some hospitals in suggesting some recommendations of how they can either enforce restrictions on the open visitation or lift the restrictions and provide more hours that are flexible and beneficial for them. Patients evidently are able to observe the value in having visitors and are very content with a visiting advice that is flexible enough to meet their wants and the needs of members in the family. Even though patients are very much interested in having open visitations that are stretchy, this does not really speak for the other patients may or may not have the same health that is in the ICU (Caine, 2005). It also lightens the sole needs and diversity that is between patient populations.