Liberalization of visiting policies in the ICU: it is also a matter of good information

Excerpt

Sir: In their recent and interesting survey, Drs. Giannini and colleagues [1] provided the actual picture of the visiting policies in Italian intensive care units (ICUs) and attributed the tendency to strictly limit the presence of family and visitors at the patients bedside, one of their major findings, to cultural (in Italy patients care and needs seem to be considered mainly from a technical point of view) and practical (lack of space in aged hospitals) factors. Basing on a recent experience, we would like to add something to these considerations. Between January and March 2008 we administered a modified version of the beliefs and attitudes toward visitation in ICU questionnaire [2] to the nursing and medical staff employed in the six ICUs of our hospital. The questionnaire was anonymous and was based on 33 statements, 19 assessing beliefs and 14 evaluating attitudes toward visits and open visiting policy. Responders had to indicate their level of agreement for each statement on a five-point rating scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree). The analysis of the items assessing beliefs about visitation in the ICU showed that nurses responded “neither agree nor disagree” in the 29.1% of the cases (range 17–42%) and physicians in the 17% (range 5–25%) probably depicting the lack of a well-established personal point of view about the topics tackled in the survey. In fact, the 53% of the nurses and the 34% of the physicians reported in the questionnaire the need to increase their degree of knowledge in order to elaborate a more aware and informed opinion about family/visitors presence in the ICU and open visiting policy. Therefore, we elaborated an educational plan directed to everyone employed in our hospital’s ICUs and targeted at reporting the consistent body of literature nowadays available showing in an evidence-based fashion that both patients and families may benefit from an open access to the ICU. Opening critical care units is not easy as it calls for rethinking habits and changing mentalities. From this point of view, good information is crucial as skeptical beliefs and attitudes among healthcare professionals toward the “open ICU” will be a substantial barrier when hospitals want to liberalize their visiting policy [2]. In summary, when considering an open policy in the ICU, our experience shows that besides cultural, practical and logistic factors also the degree and quality of caregivers’ information needs to be considered and, if needed, improved. Survey, educational and legislative initiatives (in a recent resolution, our bioethics commission asked the regional Government to formulate specific guidelines prompting hospitals to “open” their ICUs) will help the process of reducing the diffusion of restrictive visiting policies making it possible to consider family members as integral part of patients care [3]. As caregivers, however, we are called to make the first step by keeping our opinion open to current evidence and being available toward patients and families human needs. …