Unrestricted family visitation in adult ICU provides wide-reaching benefits

The unrestricted presence and participation of patients' family members and friends provides wide-reaching benefits, both medically and emotionally, according to a new Practice Alert™ from the American Association of Critical-Care Nurses.

Describing family, friends and other supporters as "partners in care," the AACN Practice Alert™ outlines administrative and practical considerations for nurses to implement less-restrictive access to the bedside within adult intensive care units. This Practice Alert™ joins other evidence-based guidelines issued by AACN to standardize the care that patients and families receive and to update nurses on new advances or trends.

Official hospital policies often limit visiting hours in ICUs, but in practice, most nurses in adult critical care units permit unrestricted family visitation. This inconsistency contributes to conflict among staff and confuses families.

Policies that limit visiting hours often presume that family visitation causes stress for the patient, interferes with the provision of care, is mentally exhausting to patients and families or contributes to increased infections. These assumptions are not substantiated by evidence. Instead, evidence suggests that unrestricted presence and participation of a support person improves patient and family satisfaction as it improves safety of care, particularly in the ICU where patients are often intubated and cannot speak for themselves.

Unrestricted visitation of a support person improves communication, facilitates a better understanding of the patient, advances patient- and family-centered care and improves staff satisfaction. Under the guidelines of the Practice Alert™, the nurse remains accountable for ensuring the safety and well-being of the patient and may choose to limit visitation when doing so is in the patient's best interest.

With respect to family visitation, AACN advocates that healthcare facilities:
•Establish policies and procedures that support unrestricted visitation in ICUs, ones that allow for the patient's unrestricted contact with a desired support person while, at the same time, protecting the privacy of other patients and the safety of patients and staff. Policies should support a patient's right to identify individuals who the patient views as "family" and chooses to be "partners in care," without discrimination.
•Provide leadership and support for senior administrators to change restrictive visiting policies and practices, including updating materials to communicate unrestricted policies to patients, families and communities and educate them about the policies' benefits.
•Develop proficiency standards for staff, including documenting patient preferences on visitation and providing guidance to patients, families and other partners in care.
•Welcome a patient's "partners in care" 24 hours a day, based on patient preference.
•Allow children to visit, when supervised by an adult family member.

According to AACN and based on available evidence, the expected practice related to family visitation within the adult ICU setting is to:
•Facilitate unrestricted access of hospitalized patients to a chosen support person e.g., family member, friend or a trusted individual who is integral to the provision of emotional and social support 24 hours a day according to patient preference, unless the support person infringes on the rights of others, affects safety and/or is medically or therapeutically contraindicated.
•Ensure that the facility and/or unit has an approved written practice document (i.e., policy, procedure or standard of care) for allowing the patient's designated support person, who may or may not be the patient's surrogate decision-maker or legally authorized representative, to be at the bedside during the course of the patient's stay, according to the patient's wishes.
•Evaluate policies to ensure that they prohibit discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation, and/or gender identity or expression.
•Confirm there is an approved written practice document (i.e., policy, procedure or standard of care) for limiting visitors whose presence infringes on the rights of others, affects safety and/or is medically or therapeutically contraindicated to support staff in negotiating visiting privileges.