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Abstract |
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• Objectives To describe patients’ preferences for family visiting in an intensive care unit and a complex care medical unit.
• Methods Sixty-two patients participated in a structured interview that assessed patients’ preferences for visiting, stressors and benefits of visiting, and patients’ perceived satisfaction with hospital guidelines for visiting.
• Results Patients in both units rated visiting as a nonstressful experience because visitors offered moderate levels of reassurance, comfort, and calming. Patients in the intensive care unit worried more about their families than did patients in the complex care medical unit but valued the fact that visitors could interpret information for the patients while providing information to assist the nurse in understanding the patients. Patients in the intensive care unit were more satisfied with visiting practices than were patients in the complex care medical unit, although both groups preferred visits of 35 to 55 minutes, 3 to 4 times a day, and with usually no more than 3 visitors.
• Conclusions These data provide the input of patients in the ongoing discussion of visiting practices in both intensive care units and complex care medical units. Patients were very satisfied with a visiting guideline that is flexible enough to meet their needs and those of their family members.
As knowledge of environments that support family-centered care has evolved, changes have been made in visiting practices for pediatrics and obstetrics. Conversely, adult care units, both general care and intensive care units, have been slow to change their family visiting practices.3–5 Nurses often think they must control visits by patients’ families and others to protect what the nurses perceive to be the best interests of the patients, although nurses can identify the beneficial effects of visiting both for patients and patients’ families.6–9 Current nursing literature clearly indicates that family visiting practices in acute care settings still vary widely and that debates continue in many areas of care.
| Nurses can identify the benefits of visiting, both for patients and for patients’ families.
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Because of the paucity of literature, research is needed to determine patients’ preferences with respect to visits by their families. Nurses require these data in order to influence individual patients’ care, nurses’ attitudes, and institutions’ visiting policies.10 Thus, the purpose of our study was to describe patients’ preferences for family visiting in an intensive care unit (ICU) and a complex care medical unit (CCMU), specifically the stressors, benefits, preferences, and outcomes of such visiting.
| Guidelines for visiting patients in acute care settings vary widely.
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Methods |
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Sample
The study took place in an ICU and a CCMU at Massachusetts General Hospital, a large academic medical center in Boston. The ICU had a contractual visiting policy that allowed an individualized approach for families’ visits; the CCMU followed the hospital’s standard, which allowed family visits between 1 PM and 8 PM. Patients were approached while they were inpatients in 1 of the 2 units. Patients were asked to participate if they were more than 18 years old, alert, oriented with no known active psychiatric illness, and able to speak English. ICU patients had to be in stable hemodynamic condition and not intubated (a situation that may not reflect typical ICU patients).
A total of 62 subjects, 31 ICU patients, and 31 CCMU patients agreed to participate in this study. The subjects included 36 men and 25 women, with a mean age of 61 years. (One ICU patient did not complete the demographic section because of fatigue.) All the ICU patients were in private rooms; 28 (90%) of CCMU patients were in semiprivate rooms. Table 1
gives demographic and hospital environment data (n=61).
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For this study, the questionnaire was altered to address not only subjects in an ICU but also subjects in a CCMU. The revised instrument is called Patient’s Perceptions of Visiting in the Hospital. Each stressor, benefit, and outcome of visiting was measured on a 5-point Likert scale, with higher scores indicating more stressors, more benefits, more adverse outcomes, and higher satisfaction with visiting. Demographic data were modified to include reason for hospital admission and current and preferred hospital accommodations. The Cronbach 
for the benefit subscale for this sample was .89.
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Results |
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).
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). A total of 23 (37%) of the 62 patients in the study thought that offering unlimited visiting hours was the best guideline for visits, whereas 35% wished to have visitors only once a day. Only 8% thought that having visitors in the morning was appropriate, and 50% preferred visitors in the afternoon. Patients thought it appropriate for both nurse and patients to ask visitors to leave; 32% thought that all visiting should end at 8 pm, and 22% wanted visitors restricted if a patient was experiencing signs or symptoms.
| One third of patients thought that having unlimited visiting hours was best; another third wanted visitors only once per day.
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Conclusions |
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Although patients in both units expressed satisfaction with flexible visiting hours, patients did indicate times during which visitors should be restricted. These restricted times included times when patients are unsure of the daily routine, when patients are not feeling well, and when family or visitor dynamics are not optimal. Patients from both the ICU and the CCMU expressed concern with having visitors in the early morning and later in the evening when the patients were attempting to rest, and patients expressed a desire to have limited visiting when they were scheduled to have a procedure or when they had the opportunity to speak with their physicians.
| Patients in both units expressed satisfaction with flexible visiting hours.
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In general, visitors are a welcome diversion from the daily hospital routine. One patient from the CCMU explained, "When you are feeling good, it’s nice to have someone come and shoot the breeze with you. It is a long day here when you are alone." The topic of visitors provides an opportunity for patients and nurses to communicate openly and to collaboratively devise a plan for visiting to best meet the needs of the patients, visitors, and healthcare providers.
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ACKNOWLEDGMENT |
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To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.
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When critically appraising this issue’s AJCC journal club article, Visiting Preferences of Patients in the Intensive Care Unit and in a Complex Care Medical Unit, consider the questions and discussion points listed below.
Study Synopsis: Research has explored family member’s and caregivers’ perceptions of visiting practices, yet patients’ perceptions of visiting policies in the intensive care unit (ICU) have not been explored. This study examined the visiting preferences of patients hospitalized in an ICU and in a complex care medical unit. A total of 62 patients participated in a structured interview that assessed their visiting preferences, perceived stressors and benefits of visiting, and satisfaction with hospital visiting policies. Patients preferred flexible visiting with visits of 35 to 50 minutes in length, 3 to 4 times a day, with no more than 3 visitors at a time. The patients rated visiting as a nonstressful experience and cited that visiting offered comfort and reassurance. The results of this study highlight the importance of involving patients in decisions regarding visiting practices in the ICU.
Information From the Authors: Diane Carroll, RN, PhD, co-author of this journal club article, provided additional information about the study. Carroll explained that the research team chose to study the topic in order to assess patients’ perceptions of visiting hours, something that has not been adequately explored. Carroll shared, "The choice for this study was based on a review of the literature that revealed a gap in knowledge regarding patients’ preferences for visiting. We know what families need and want, but there was a paucity of knowledge about patients." Carroll added, "The research suggests that ICU patients perceived a benefit from visitors and that visitors were helpful, but patients wanted flexibility and control over when, how long, and how many visitors they had during the course of hospitalization."
Carroll explained that while the study results were important in identifying patients’ preferences for visiting, additional research is needed. She added, "Based on this limited data set, we could offer no recommendations specifically to define visiting guidelines. The data points to the need for individualization of each patient’s preferences."
Implications for Practice: According to the study results, patients are most satisfied with a visiting policy that is flexible. Of interest is that only 33% preferred unlimited visiting hours, relating that restrictions on visiting hours were beneficial for rest, during procedures, and for time to dialogue with their physicians. Carroll shared, "The major implication for practice is the need to maintain flexible visiting hours to meet patients’ needs and preferences. This data provides nurses with knowledge to better understand patients’ perspectives and the value they place on contact with their families.
Journal Club feature commentary is provided by Ruth Kleinpell.
This article has been cited by other articles:
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  K. G. Mellott, P. B. Sharp, and L. M. Anderson Biobehavioral Measures in a Critical-Care Healing Environment J Holist Nurs, June 1, 2008; 26(2): 128 - 135. [Abstract] [PDF]
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 S. Fumagalli, L. Boncinelli, A. Lo Nostro, P. Valoti, G. Baldereschi, M. Di Bari, A. Ungar, S. Baldasseroni, P. Geppetti, G. Masotti, et al. Reduced Cardiocirculatory Complications With Unrestrictive Visiting Policy in an Intensive Care Unit: Results From a Pilot, Randomized Trial Circulation, February 21, 2006; 113(7): 946 - 952. [Abstract] [Full Text] [PDF]
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