Original article
Visiting policies in the adult intensive care units: A complete survey of Dutch ICUs

https://doi.org/10.1016/j.iccn.2010.10.002Get rights and content

Summary

Objectives

Treatment in an intensive care unit (ICU) is not only very stressful for the patient but also for the family as well. An open visiting policy, defined as a policy that imposes no restrictions on visiting hours, duration of visits and/or number of visitors, seems to fit very well both patient and family needs. The purpose of this article is to give an overview of the current situation of Dutch ICUs visiting policies.

Design

Nationwide, telephone-based questionnaire survey.

Participants

(Head)nurses of all ICUs.

Results

The results of this study show that none of the ICUs have an open visiting policy, defined as a policy that imposes no restrictions on visiting time, duration of visits and/or number of visitors. The majority of the Dutch ICUs (85.7%) has restricted visiting policies. Responses were obtained from 100% of the ICUs.

Conclusion

Despite several international guidelines, research and literature about unrestricted visiting hours on the ICUs, none of the ICUs in this study operates with such a visiting policy. If we take these results into account then the question rises if ICUs are aware of these patients and family needs on the ICUs.

Introduction

Treatment in an intensive care unit (ICU) is not only very stressful for the patient but also for the family as well. Meeting the needs of the patients’ family is an essential part of the responsibilities of ICU physicians and nurses (Azoulay et al., 2001, Verhaeghe et al., 2005). Although unrestricted visiting hours have been identified as an important need for intensive care patients and their families, strict visiting hours are still common in the adult ICUs (Berti et al., 2007, Garrouste-Orgeas et al., 2007, Livesay et al., 2005, Plowright, 1998). Nurses favour restricted visiting hours because excessive visits are presumed to be detrimental to the patients, for instance the patient not getting enough rest and to the organisation of care. Too many visits would interrupt the nursing care delivery and have a negative effect on the functioning of the unit (Berti et al., 2007, Berwick and Kotagal, 2004).

An open visiting policy, defined as a policy that imposes no restrictions on visiting hours, duration of visits and/or number of visitors, seems to fit better with patient and family needs (Berwick and Kotagal, 2004, Buchardi, 2002, Marco et al., 2006, Verhaeghe et al., 2005). The presence of family is a positive factor for the patient, giving comfort and reducing the stress level (Giannini, 2007, Eriksson and Bergbom, 2007, Roland and Russell, 2001). Clinical practice guidelines about family-centred care also recommend unrestricted visiting policy in adult ICUs (Davidson et al., 2007). Visiting policies in hospitals for paediatrics, including paediatrics ICUs and obstetrics have changed the last two decades. Conversely, adult care units, both general care and intensive care units, have been slow to change their family visiting practises (Gonzalez et al., 2004).

It is yet unknown if Dutch ICUs underline the importance of the presence of family during the ICU period of the patient. The assumption is that Dutch ICUs do not base their visiting policies on the evidence in the literature that family should have access to their loved one in the ICU whenever they need and that there should be no restrictions on time and duration of visits and/or number of visitors. The Dutch ICU guideline that guarantees high quality in patient care does not mention visiting policies, it only describes the organisation and workflow (NVvA, 2006).

The aim of this survey was to study visiting policies in the Dutch ICUs in order to provide an overview of current practice of visiting policies in the Netherlands. At the same time we investigated if ICUs work with guidelines for family-centred care in visiting policies or not, if the visiting policy is an issue for nurses, how nurses inform family about the visiting hours, the difference in policy between ICUs having a single room for each patient and the ones that do not and the difference between ICUs in university hospitals, large teaching hospitals and general hospitals.

Section snippets

Methods

In the spring and summer of 2008 all Dutch hospitals with intensive care units were telephoned by the researchers. Telephone numbers were obtained using the hospital websites. Using a telephone-based questionnaire the ICUs (n = 105) were questioned about their visiting policies. When the (head)nurse had no time at that moment, they were phoned back at a mutually convenient time.

The questionnaire consisted of nine general multiple-choice questions, ICU level, number of beds, number of single rooms

Results

For this survey a 100% response rate of Dutch ICUs (n = 105) was accomplished. Included were 27 level 3 ICUs (university hospitals and large teaching hospitals), 27 level 2 ICUs (small teaching hospitals) and 51 level 1 ICUs (regional general hospitals).

None of the ICUs have an open visiting policy, defined as a policy that imposes no restrictions on the visits hours, duration of visits and/or number of visitors. Seventy-eight ICUs (74.3%) have restricted visiting policies allowing visits during

Discussion

Based on a nation-wide survey, it is possible to provide a complete assessment of the current status of visiting policies on the Dutch ICUs. The results of this study show that none of the ICUs have an open visiting policy, defined as a policy that imposes no restrictions on time and duration of visits and/or number of visitors. The majority of the Dutch ICUs (85.7%) have restricted visiting policies, although family centred care guidelines underline the importance of unrestricted visiting

Conclusions

Despite several international guidelines, research and literature about open visiting policies on the ICUs, none of the Dutch ICUs in this study has such a visiting policy. If we want to change the current visiting policy to an open visiting policy we have to inform the intensive care nurses about the results of research, the benefits for the patients and their family and the effects on nursing care delivery. Next start the dialogue and develop and implement a visiting policy that tailors the

Acknowledgements

The authors would like to thank the interviewed ICU (head)nurses and the research nurses of the UMC Utrecht for collecting the data.

The authors declare that they have no competing interests.

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