Running head: ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

Gian Karla Isidro, Ka Man Hui and Maria Kristina Camille Munar

Post Degree Diploma In Nursing Practice in Canada

NURS 5130-W02: Professional Communication

Dr. Lauren Vedal

March 25, 2022

ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

Abstract

Visitor restriction policies have been implemented in many healthcare settings due to the

COVID-19 pandemic. The rationale behind the policies that mandate restriction family

members’ visitation is to help limit the spread of COVID. However, these policies are

reported to have significant consequences on patients, families and healthcare professionals

among emotional distress, quality of life and decision-making. The objective of the literature

reviews is to identify the impacts of restricted visitation policies in healthcare settings and

recommend strategies to refine the ambiguity of the guidelines. A clear policy statement

provides a better communication stream to patients, families, and healthcare staff about

visitor restrictions that may prevent clinical and ethical issues in healthcare settings.
ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

Visitation Restrictions

Restrictions for visitations in the healthcare settings became a traditional approach for

controlling the spread of infectious diseases. Medical facilities are weighing their option on

formulating policies that identify the visitors’ duty to provide support to the patient while

balancing the risk and benefits of visitation. According to the Special Bulletin by the

Department of Health from North Carolina, patients with intellectual disabilities should have

“adequate support for decision making and treatment,” including “visiting caregivers” when

they require physical or emotional support. In a social context, a visitor represents immediate

family members, personal caregivers or loved ones who provide emotional support to the

patient but are not involved in the client’s medical care (Jaswanet et al. 2022).

Isolation for nursing home residents.

Nursing home residents were confined inside their bedrooms for months, causing

detrimental effects on their psychological well-being such as loneliness, anxiety, depression

and worsening confusion resulting in a diminished functional ability and a significantly poor

quality of life (Hartigan et al., 2021).

Poor communication

Lack of explanation from the nursing home staff had significantly affected the relationship

between the participating resident and family. As families serve as socio-emotional support and a

sense of belonging, their sudden absence had caused the resident to feel withdrawn. Although the

resident cannot make decisions for themselves due to dementia, inclusion in decision-making, the

right to be informed, and proper understanding of the situation must still be respected (Hartigan et

al., 2021).

 Promoting Autonomy on Decision-Making

ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

Inclusion, self-determination and involvement in decision-making should be encouraged for

people with diminished capacity as much as possible, as specified by the Irish DoH. Although

the resident’s level of capacity has declined (due to dementia), autonomous role in decision-

making must not be disregarded, which also includes the acknowledgement of the family’s

role as advocates for the resident’s will and preferences, which is in line with the Health

Service Executive’s National Policy and the Irish Assisted Decision-Making (Capacity) Act

2015. Furthermore, care facilities should be fully accountable and committed to protecting

vulnerable adults instead of contributing to their susceptibility (Hartigan et al., 2021).

Regaining Trust

To re-establish the trust that was damaged after the lack of communication, Hartigan

et al. (2021) suggests several strategies on how to compensate for the damages starting from

the nursing home’s accountability for the committed mistakes, amending the relationship by

reassuring the family about the nursing home’s devotion to standards of care and proposition

of appropriate modifications on isolation and visitation guidelines. Families and residents

should also receive consistent, veracious and clear communication regarding the public health

measures and its future significance to care. (Hartigan et al., 2021).

Ambiguity of language

The majority of the hospitals were using the front-facing policies that relay messages

to the general public, such as no-visitors allowed but offers exemptions, and limited visitors

allowed on a case-to-case basis. The lack of language precision of the public-facing hospital

policies increased concern among the family members who wish to visit their loved ones and

resulted in policy confusion among staff trying to implement the rules. (Jaswanet et al.

2022).For example, there is no clear policy intended on how many visitors are allowed to be

at the patient’s bedside in an end-of-life setting, placing the family members in a distressful
ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

situation. Limitations of visitors to a dying patient are attributed to ethical dilemmas in the

workplace. In addition, a vague policy statement may affect the clinician’s judgement on

when to enforce visitation rules when a patient’s condition is starting to deteriorate. Jaswanet

et al. (2022) suggested five recommendations to improve visitor restriction policies in

healthcare settings utilizing a clear, transparent and unbiased policy-making approach to meet

the needs and interests of patients and their families. To improve the ambiguity of policies,

the researcher recommends the following strategies: identifying the types of visitors that

need to be prioritized for visitations; rule-makers should provide clear guidelines and list for

confusing parts of the policy such as defining case by case exemptions; the significant role of

loved ones in the care of intellectually and physically challenged patients should be part of

the policy; provide accurate information if a COVID-positive patient may receive visitors or

not, and lastly to reference the policymaker authorities to guide the hospital staff in

explaining and reinforcing the existing policy for visitations.

Discussion

Policies that mandate restricted significant family member visitation in healthcare

settings have been imposed throughout the COVID-19 pandemic. The policy intends to help

limit the spread of the COVID virus and protect vulnerable people, including the elderly in

nursing home facilities and frail patients susceptible to infectious disease. Despite intentions

to ensure patient, family, and healthcare safety, the restrictions result in consequences for

patients and families alike, such as emotional distress and worsening cognitive abilities,

declining quality of life, and general well-being.

Family members of hospitalized patients are crucial to the delivery of patient-and

family-centered care. Family members have an active role in improving processes of care

associated with socio-emotional support and are often act as advocates or proxies for patient

treatment decisions. Family members are the vital intermediary between patients and
ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

healthcare providers in order to try to bring about an agreement on medical issues. As the

presence of family members is essential in inpatient care, policymakers are discussing the

criteria for family members to grant a compassionate visitor exemption in some exceptional

circumstances, for instance, allowance to stay with the terminal patient in an end-of-life

setting or accompanying patient who is in a distressful situation.

Existing evidence revealed that visitor restriction policies varied significantly among

healthcare settings. These variances lead to challenges in that their proper application may be

problematic and ethical considerations related to the application may happen. The abrupt

policy shift has imposed extra tension on healthcare workers who are trying to implement the

rules. Healthcare providers add additional burdens by spending more time on communication

and changing established ways to provide psychological support. A study by Jaswanet et al.

(2022) stated that the policy should focus on identifying the types of visitors that need to be

prioritized for visitations, clarifying the confusing parts of the guidelines, making clear

definitions for case by case exemptions, defining the role of significant others in caring for

intellectually and physically disabled patients, clarifying the visiting policy for COVID

positive patients and defining the associated authority for frontline staff in policy

implementation.

On the other hand, separating hospitalized patients from their family caregivers during

the pandemic can be highly distressing for both patient and family and healthcare providers.

A study by Hartigan et al. (2021) looked at the solutions to rebuild and re-establish the

rapport between healthcare providers, patients and family members. It is recommended that

even patient's level of capacity has declined, patients should be given autonomy in making

decisions over bodily integrity. They should be given the information in a manner that they

can understand. Inclusion, self-determination and involvement in decision-making should be

ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

encouraged. Care facilities should be fully accountable and committed to protecting

vulnerable adults instead of contributing to their susceptibility. Care facilities can further

reconstruct trustful relationships by reinforcing the institute's devotion to the standard of care

and proposition of appropriate modifications on isolation and visitation guidelines, informing

families with updated public health measures.

As the pandemic has unfolded, medical facilities should focus on managing the

present harm and preventing harm in the future. Implementing visitor restriction policies in a

healthcare setting requires balancing optimizing family-centered care and decreasing

potential sources of transmission of COVID-19. Different strategies regarding 'visitors'

should be flexible and consider all parties. Furthermore, additional support from government

health agencies is deemed to be helpful.

ANALYSIS OF VISITOR RESTRICTION IN HEALTHCARE SETTING

References

Jaswaney, R., Davis, A., Cadigan, R. J., Waltz, M., Brassfield, E. R., Forcier, B., & Joyner

Jr, B. L. (2022). Hospital Policies During COVID-19: An Analysis of Visitor

Restrictions. Journal of Public Health Management & Practice, 28(1), E299–

E306. https://doi-org.ezproxy.langara.ca/10.1097/PHH.0000000000001320

Hartigan, I., Kelleher, A., McCarthy, J., & Cornally, N. (2021). Visitor restrictions during

the COVID-19 pandemic: An ethical case study. Nursing Ethics, 28(7/8), 1111–

1123. https://doi-org.ezproxy.langara.ca/10.1177/09697330211005078