Visiting hours policies in New England intensive care units: strategies for improvement.
OBJECTIVE
Dying patients often feel isolated and alone, and restricted visiting hours in the intensive care unit (ICU) has been shown to increase anxiety and dissatisfaction in both critically ill patients and their families. Unrestricted visiting has been identified as a top-ten need by families of patients in the ICU. Because emotional distress experienced by patients and families may persist well beyond the ICU stay, an open visiting policy, by meeting the needs of patients and families, may improve the quality of end-of-life care in the ICU. This two-part study included a survey to determine the visiting hours policies of New England-area hospital ICUs, and nursing focus groups to describe challenges and barriers that nursing staff working in an open ICU have experienced and to provide solutions that will facilitate implementation of an open visiting hours policy.


METHODS
Two-part study: survey and focus groups.


METHODS
ICUs in New England and one medical ICU in a tertiary care hospital.


METHODS
Registered nurses employed in medical ICUs.


METHODS
Adult ICUs in the six New England states were located using a library listing of all regional hospitals. A telephone questionnaire interview was used to ascertain visiting hours policies in each ICU. Six focus-group sessions were conducted with nursing staff who work in an urban, northeastern ICU with 8 yrs of experience with an unrestricted visiting hours policy.


RESULTS
A total of 171 hospitals completed the questionnaire (96%). From all ICUs surveyed, 62 (32%) had unrestricted, open visiting hours. Out of these, 57 (92%) were medical ICUs or mixed medical/surgical ICUs. Nursing staff identified three major areas of concern with an open visiting hours policy: space, conflict, and burden. Strategies for resolution that are either employed or advocated by nursing staff are described.


CONCLUSIONS
The majority of ICUs in New England have restricted visiting hours. Only one third of ICUs have open visiting policies. Nursing concerns with an unrestricted ICU were identified and solutions were offered that may provide guidance for other ICUs considering adopting an open visiting hours policy.
Lee
Melissa D
MD
Brown Medical School and Rhode Island Hospital, Providence, RI, USA.
Friedenberg
Allison S
AS
Mukpo
David H
DH
Conray
Kayla
K
Palmisciano
Amy
A
Levy
Mitchell M
MM
D017144:Focus Groups; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D009511:New England; D009729:Nursing / Q000592:standards*; D011795:Surveys and Questionnaires; D014789:Visitors to Patients / Q000706:statistics & numerical data*