Nursing Made Incredibly Easy!

July/August 2012 - Volume 10 - Issue 4 - p 56
doi: 10.1097/01.NME.0000415012.96320.3e Department: Ask an Expert

Let them in: ICU visitation
Drumright, Kelly BS, BSN, RN, CCRN-CMC, CSC; Julkenbeck, Stephanie BSN, RN

A: For many years, hospitals have restricted the visitation rights of a patient's loved ones—particularly in the ICU setting—because it was thought that visitors interfered with patient care, contributed to the spread of infection, and hindered the healing process. Furthermore, it was believed that unrestricted visitation caused undue stress and increased anxiety and fatigue among patients and their families. Now, current evidence supports unrestricted visitation in the ICU setting. In November 2011, the American Association of Critical-Care Nurses released a practice alert addressing the importance of a support person's unrestricted visitation in the adult ICU. A support person is an individual chosen by the patient and can include a family member, partner, or friend. Evidence shows that the presence of a support person decreases fear and anxiety in patients, lessens confusion and agitation, and can even decrease cardiovascular complications. Unrestricted visitation enhances both patient and family satisfaction, ensures a safer environment, and can reduce the duration of patient stay in the ICU. The presence of a support person enhances communication with patients and their families and allows for a better understanding of patients and their medical problems. Additionally, support persons at the bedside have more opportunities to aid in reinforcing patient education. Knowing all of the benefits that unrestricted visitation can have for both patients and their families, you may ask yourself, what can I do to promote this at my facility? There are several things that you can do as a direct care nurse: * Verify that specific policies are in place to allow a patient's chosen support person unrestricted access to the patient. Remember, you must ensure that the privacy and safety of other patients and staff are protected. * Update signage and educational materials to reflect your unit's unrestricted visitation policy. * Promote the patient's right to choose his or her support person without discriminating against age, sex, sexual orientation, race, ethnicity, or religion. * If possible, determine the support person's level of involvement in care based on the patient's preference. Document patient preferences and communicate them consistently to all involved in the patient's care. * Be proactive by educating staff members, patients, and support persons about the benefits of unrestricted visitation. Provide written materials to patients and support persons detailing their visitation rights and reasons for potential limitations. Visitation may be limited if patient safety and privacy is compromised, if the visitors are abusive or disruptive, or for infection control. * Children shouldn't be denied visitation based on their age; they should be welcomed with adult supervision. Preparing children for the hospital environment and the patient's condition before visitation may be appropriate. As direct care nurses, we're instrumental in promoting the shift toward unrestricted visitation. Many nurses remain resistant to this idea based on past misconceptions; however, providing education about the benefits of unrestricted visitation can help remove barriers and establish better patient- and familycentered care.

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