Flexible visiting positively impacted on patients, families and staff in an Australian Intensive Care Unit: A before-after mixed method study

Background The admission of a relative to intensive care is stressful for families. To help them support the patient, families need assurance, information and an ability to be near their sick relative. Flexible visiting enables patient access but the impact of this on patients, families and staff is not clear. Objective To assess the impact of flexible visiting from the perspective of patients, families, and Intensive Care Unit (ICU) staff. Methods A before-after mixed method study was used with interviews, focus groups and surveys. Patients were interviewed, family members completed the Family Satisfaction in ICU survey and ICU staff completed a survey and participated in focus groups following the introduction of 21 h per day visiting in a tertiary ICU. The study was conducted within a philosophy of family-centred care. Results All interviewed patients (n = 12) positively evaluated the concept of extended visiting hours. Family members’ (n = 181) overall ‘satisfaction with care’ did not change; however 85% were ‘very satisfied’ with increased visiting flexibility. Seventy-six percent of family visits continued to occur within the previous visiting hours (11 am–8 pm) with the remaining 24% taking place during the newly available visiting hours. Families recognised the priority of patient care with their personal needs being secondary. Three-quarters of ICU staff were ‘satisfied’ with flexible visiting and suggested any barriers could be overcome by role modelling family inclusion. Conclusion Patients, families and ICU staff positively evaluated flexible visiting hours in this ICU. Although only a minority of families took advantage of the increased hours they indicated appreciation for the additional opportunities. Junior staff may benefit from peer-support to develop family inclusion skills. More flexible visiting times can be incorporated into usual ICU practice in a manner that is viewed positively by all stakeholders

Impact of Family Presence in the Healthcare Setting

Family presence at the patient’s bed side is promoted and encouraged within the healthcare arena. Healthcare staff strive for reports of satisfaction from patients and families. Positive and negative outcomes of family presence on units within the hospital have been assessed, with suggestions for visitation practices and solutions for common concerns. Positive patient outcomes, including accelerated recovery time, increased reports of comfort, and decreased duration of hospital stay are the ultimate goals of hospital care. Research shows that patient outcomes are impacted greatly by family presence. Patient- and family-centered care represent the future model of healthcare. Knowledge of these policies and potential consequences of their implementation will guide the practice of nurses and other healthcare professionals

Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units : a cluster-randomised, crossover trial (The ICU Visits Study)

Introduction Flexible intensive care unit (ICU) visiting hours have been proposed as a means to improve patient-centred and family-centred care. However, randomised trials evaluating the effects of flexible family visitation models (FFVMs) are scarce. This study aims to compare the effectiveness and safety of an FFVM versus a restrictive family visitation model (RFVM) on delirium prevention among ICU patients, as well as to analyse its potential effects on family members and ICU professionals. Methods and analysis A cluster-randomised crossover trial involving adult ICU patients, family members and ICU professionals will be conducted. Forty medical-surgical Brazilian ICUs with RFVMs (<4.5 hours/day) will be randomly assigned to either an RFVM (visits according to local policies) or an FFVM (visitation during 12 consecutive hours per day) group at a 1:1 ratio. After enrolment and follow-up of 25 patients, each ICU will be switched over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome will be the cumulative incidence of delirium among ICU patients, measured twice a day using the Confusion Assessment Method for the ICU. Secondary outcome measures will include daily hazard of delirium, ventilator-free days, any ICU-acquired infections, ICU length of stay and hospital mortality among the patients; symptoms of anxiety and depression and satisfaction among the family members; and prevalence of burnout symptoms among the ICU professionals. Tertiary outcomes will include need for antipsychotic agents and/or mechanical restraints, coma-free days, unplanned loss of invasive devices and ICU-acquired pneumonia, urinary tract infection or bloodstream infection among the patients; self-perception of involvement in patient care among the family members; and satisfaction among the ICU professionals

The COVISIT international survey

Funding Information: This project was conducted without funding. Guy Francois is an employee of the European Society of Intensive Care Medicine (ESICM) and as such his time working on the project and access to SurveyMonkey platform was supported by ESICM.Alexis Tabah has nothing to disclose, Muhammed Elhadi has nothing to disclose, Emma Ballard has nothing to disclose, Andrea Cortegiani has nothing to disclose, Maurizio Cecconi reports personal fees from Edwards Lifesciences, Directed Systems, Takeshi Unoki has nothing to disclose, Laurą Galarza has nothing to disclose, Regis Goulart Rosa has received research grants from the Brazilian Ministry of Health to conduct studies on the topic of ICU visiting policies, Francois Barbier reported consulting and lecture fees, conference invitation from MSD and lecture fees from BioMérieux, Elie Azoulay reports receiving fees for lectures from Gilead, Pfizer, Baxter, and Alexion. His research group has been supported by Ablynx, Fisher & Payckle, Jazz Pharma, and MSD, outside the submitted work, Kevin B Laupland has nothing to disclose, Nathalie Ssi Yan Kai has nothing to disclose, Marlies Ostermann has nothing to disclose, Guy Francois has nothing to disclose, Jan J De Waele reports grants from Research Foundation Flanders, during the conduct of the study; other from Pfizer, other from MSD, outside the submitted work, Kirsten Fiest has nothing to disclose, Peter Spronk has nothing to disclose, Julie Benbenishty has nothing to disclose, Mariangela Pellegrini has nothing to disclose, Louise Rose is a co-founder of Life Lines, a philanthropic COVID-19 rapid response project that received charitable donations to enable provision of 4G enabled Android tablets and a bespoke virtual visiting solution to ICUs across the UK. LR has no financial or commercial interests in Life Lines or the virtual visiting solution. Major philanthropic contributors to Life Lines include Google, True Colours and the Gatsby Trust. British Telecom contributed in-kind time and resources to facilitate the supply of 4G enabled tablets to UK ICUs. Funding Information: Alexis Tabah has nothing to disclose, Muhammed Elhadi has nothing to disclose, Emma Ballard has nothing to disclose, Andrea Cortegiani has nothing to disclose, Maurizio Cecconi reports personal fees from Edwards Lifesciences, Directed Systems, Takeshi Unoki has nothing to disclose, Laurą Galarza has nothing to disclose, Regis Goulart Rosa has received research grants from the Brazilian Ministry of Health to conduct studies on the topic of ICU visiting policies, Francois Barbier reported consulting and lecture fees, conference invitation from MSD and lecture fees from BioMérieux, Elie Azoulay reports receiving fees for lectures from Gilead, Pfizer, Baxter, and Alexion. His research group has been supported by Ablynx , Fisher & Payckle, Jazz Pharma, and MSD, outside the submitted work, Kevin B Laupland has nothing to disclose, Nathalie Ssi Yan Kai has nothing to disclose, Marlies Ostermann has nothing to disclose, Guy Francois has nothing to disclose, Jan J De Waele reports grants from Research Foundation Flanders, during the conduct of the study; other from Pfizer, other from MSD, outside the submitted work, Kirsten Fiest has nothing to disclose, Peter Spronk has nothing to disclose, Julie Benbenishty has nothing to disclose, Mariangela Pellegrini has nothing to disclose, Louise Rose is a co-founder of Life Lines, a philanthropic COVID-19 rapid response project that received charitable donations to enable provision of 4G enabled Android tablets and a bespoke virtual visiting solution to ICUs across the UK. LR has no financial or commercial interests in Life Lines or the virtual visiting solution. Major philanthropic contributors to Life Lines include Google, True Colours and the Gatsby Trust. British Telecom contributed in-kind time and resources to facilitate the supply of 4G enabled tablets to UK ICUs. Publisher Copyright: © 2022 Elsevier Inc.Background: During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. Methods: We conducted a web-based survey (March–July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting policies and communication modes including use of virtual visiting (videoconferencing). Results: We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/525) had unrestricted visiting hours; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. Conclusions: Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.publishersversionpublishe

Let Them In: Family Presence During Intensive Care Unit Procedures

Families have for decades advocated for full access to intensive care units (ICUs) and meaningful partnership with clinicians, resulting in gradual improvements in family access and collaboration with ICU clinicians. Despite such advances, family members in adult ICUs are still commonly asked to leave the patient’s room during invasive bedside procedures, regardless of whether the patient would prefer family to be present. Physicians may be resistant to having family members at the bedside due to concerns about trainee education, medicolegal implications, possible effects on the technical quality of procedures due to distractions, and procedural sterility. Limited evidence from parallel settings does not support these concerns. Family presence during ICU procedures, when the patient and family member both desire it, fulfills the mandates of patient-centered care. We anticipate that such inclusion will increase family engagement, improve patient and family satisfaction, and may, on the basis of studies of open visitation, pediatric ICU experience, and family presence during cardiopulmonary resuscitation, decrease psychological distress in patients and family members. We believe these goals can be achieved without compromising the quality of patient care, increasing provider burden significantly, or increasing risks of litigation. In this article, we weigh current evidence, consider historical objections to family presence at ICU procedures, and report our clinical experience with the practice. An outline for implementing family procedural presence in the ICU is also presented

Percepcija medicinskih sestara na odjelima intenzivne skrbi o posjetima bolesnicima

Introduction. Visits to patients are part of a positive and effective strategy of helping patients and their families to better adapt to the stress caused by a patient’s admission to an intensive care unit (ICU). Aim. To determine the ICU nurses’ perception of visits to patients. Methods. The study was conducted at the University Hospital Centre Zagreb (UHC). The cross-sectional study included nurses who work in ICUs. An anonymous, self-designed questionnaire was used and filled in by 44 respondents. The questionnaire consisted of 17 closed-ended questions pertaining to demographic data, questions related to information on visits and questions about the concept of open visits. Results. Out of the total number of 44 respondents, 25 respondents stated that their ICU has booklets about the manner of visits and visiting hours, and that they hand them out to families, while 19 respondents stated that they do not have such booklets. 61% of the respondents feel they have sufficient training to communicate with the patient’s family. 41% of the respondents said that the visits had a positive effect on the patient’s condition and only 2% stated that the visits had no positive effect. 57 % of the respondents think that visits sometimes have a positive effect on the patient’s condition. Of the total number of respondents, 84% feel that visiting hours should be limited. Respondents feel that visits sometimes impede them in their work (66%), while 59% of the respondents feel that visits help spread infections. Out of the total number of respondents, only 32% of them stated that they were familiar with the open ICU concept. Conclusion. More than half of the respondents stated that they have a written visiting policy on ICU wards, and that they are trained to communicate with the family members of patients. Most respondents feel that visits contribute to the spread of infections and that they would limit children’s visits to the ICU. The respondents’ poor knowledge of the open ICU concept creates one of the barriers to introducing it in their wards.Uvod. Posjeti bolesnicima dio su pozitivne i učinkovite strategije koja pomaže bolesnicima i njihovim obiteljima da se bolje prilagode stresu koji nastaje prilikom prijama na odjel intenzivnog liječenja. Cilj. Cilj je rada utvrditi percepciju medicinskih sestara na odjelima intenzivne skrbi o posjetima bolesnicima. Metode. Istraživanje je provedeno u KBC-u Zagreb. Presječno istraživanje uključivalo je medicinske sestre koje rade na odjelima intenzivne skrbi. Primijenjena je anonimna anketa kreirana za ovo istraživanje, koju je ispunilo četrdeset i četiri ispitanika. Anketa se sastojala od 17 pitanja zatvorenog tipa koja su se odnosila na demografske podatke, pitanja povezana s informacijama o posjetima te pitanja o konceptu otvorenih posjeta. Rezultati. Od ukupnog broja od 44 ispitanika, 25 ispitanika navodi da postoje brošure o načinu i vremenu posjeta koje daju obitelji, dok 19 ispitanika navodi kako kod njih ne postoje takve brošure. Dovoljnu edukaciju za komunikaciju s obitelji bolesnika navodi da ima 61 % ispitanika. Da posjeti imaju pozitivan učinak na stanje bolesnika odgovorilo je 41 % ispitanika, a samo 2 % ispitanika smatra da posjeti nemaju pozitivan učinak. 57 % ispitanika smatra da posjeti ponekad imaju pozitivan učinak na stanje bolesnika. Od ukupnog broja ispitanika čak ih 84 % smatra da bi vrijeme posjeta trebalo biti ograničeno. Ispitanici smatraju da posjeti ponekad ometaju njihov rad (66 %), a 59 % ispitanika smatra da posjeti pridonose širenju infekcija. Od ukupnog broja ispitanika samo 32 % navodi kako im je poznat koncept otvorenog JIL-a. Zaključak. Više od pola ispitanika navodi kako imaju pisanu politiku posjeta na odjelima jedinice za intenzivno liječenje te da su educirani za komunikaciju s članovima obitelji bolesnika. Većina ispitanika smatra kako posjeti pridonose širenju infekcija te bi ograničili posjete djece u JIL-u. Slabo poznavanje ispitanika o konceptu otvorenog JIL-a stvara jednu od barijera za njegovo uvođenje na njihovim odjelima

Worldwide Survey of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment" (ABCDEF) Bundle

OBJECTIVES: To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines. DESIGN: Worldwide online survey. SETTING: Intensive care. INTERVENTION: A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle. MEASUREMENT AND MAIN RESULTS: There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was "prescribed" by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits. CONCLUSIONS: The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines

Perspectives of Intensive Care patients and family members on competencies for Advanced Intensive Care nurses in Europe

BackgroundOne output from the International Nursing Advanced Competency-based Training for Intensive Care (INACTIC) collaboration is a set of core competencies for advanced practice Intensive Care Unit (ICU) nurses across Europe. Some European countries, such as the UK, have identified such competencies, however, these advanced practice roles are rarely practiced across the rest of Europe. The INACTIC competencies were developed with an expert panel of 184 ICU nurses from 20 countries. It is also important to examine what patients and relatives with experience of intensive care felt about these competencies. AimTo examine the views of recovered ICU patients and relatives regarding the INACTIC competencies.MethodsThree patient and relative focus groups were conducted in England (n=5), Scotland (n=4) and Greece (n=4) to discuss a lay version of the INACTIC competencies. Discussions were open ended, followed a topic guide, recorded and transcribed verbatim. Analysis followed a conventional thematic approach, with the findings discussed iteratively among the authors.ResultsThe feedback from across the focus groups resulted in three themes: 1) the importance of nurses being empowered to advocate for the patient; 2) the centrality of communication; and, 3) the impact of variability in ICU practices. There was a notable difference with the Greek focus group; because of restricted family visiting policies, relatives did not feel encouraged to participate in patient care.ConclusionsThe perspectives of patients and relatives largely aligned with the consensus of the INACTIC expert panel. Local differences in ICU experience highlight the changes that some ICUs would need to make for the INACTIC competencies to be embedded