Open Visitation Policies: The Importance Of Family Presence For A Patient

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There are over 36 million admissions to hospitals in the United States annually according to a 2012 study conducted by the American Hospital Association, nurses make up the largest percentage of the healthcare team and provide bedside care around the clock to every patient.

Caring for a patient also involves caring for that patient’s entire family. A major focus of healthcare providers is family-centered care. All patients within the hospital can be affected by family presence through open visitation policies. The results of these policies can also affect the healthcare staff and medical facility. There are many positive outcomes from having a strong family presence at the bedside through open visitation policies. Family members who remain at the hospital provide vital information about the patient, and their presence increases communication and the continuity of care. Present family members also ensure a greater level of accountability demanded from the healthcare providers. Studies have shown that when the patient and family desire open visitation, an increase in comfort and morale is observed in both the family and the patient, and the patient experiences more positive outcomes.

Many challenges are raised by the practice of open visitation as well, and these issues must be evaluated and compared with the positive outcomes. Considerations of open visitation may incorporate how the role of the nurse must be expanded to include educating, involving, and comforting the family members at the bedside. Facilities must have the capacity to accommodate additional people, being family members, on the hospital units. Overcrowded rooms impair the staff’s ability to work and perform procedures, and increase the stress level within the room. Nurses must also be ready to address the questions and concerns of patients’ children visiting a foreign and stressful environment. Safety considerations must be evaluated and implemented to avoid exposing vulnerable immunocompromised patients to infections brought in by visiting family members. Privacy and periods of rest for the patients must also be provided.

Remaining at the bedside during procedures could be traumatic for some patients or visitors, and every visitor should be given the option to either stay in the room or leave during the treatment provided that the patient gives consent. Patient care is the core of nursing.

Evidence-based practice supports positive patient outcomes when family is included and involved at the bedside. Challenges to this practice must be evaluated and resolutions established. Patient-centered care and family presence is relevant to every unit in every hospital. Positive patient outcomes include rapid recovery times, decreased length of stay on the hospital unit, and increased morale and satisfaction reported by the patients and their families. Studies have shown that open visitation policies contribute to these positive outcomes.

Throughout this review open visitation will denote that patient-approved visitors of any age may remain with the patient at all hours of the day, although guidelines may restrict visitors with active infections or other safety considerations from staying with immunocompromised patients. This integrative literature review will explore the many positive outcomes, as well as the challenges, of these open visitation policies. The implications of open visitation policies will also be discussed.

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Through this review, 19 scholarly peer reviewed articles were compiled and analyzed. Articles published outside of scholarly journals, and those published prior to2008 were excluded from the literature review. Search keywords used to locate the articles in EBSCO host included open visitation, family presence in the hospital, patient and family centered care (PFCC) model, and patient-centered care. All articles were published between 2008 and 2013 and presented information concerning the links between family presence and patient care. Similar themes and conclusions were identified and compiled from among the aggregate of information.

Promoting Family Presence

Facilitating family presence and providing exceptional patient care involves many groups of people. The patient must desire the presence of visitors and give consent. The family must come to the bedside and stay with the patient. The nurses and medical staffare integral to the process and are required to ensure that the patient has given consent and to include the family within the care of the patient. Evidence has shown the effectiveness of PFCC can be dependent upon the attitudes and beliefs of the nurses.

Fisher et al. (2008) reported on the attitudes and behaviors of nurses regarding family presence in the hospital. A questionnaire was completed by 89 nurses in order to survey their views on visitation and family presence. A four or five point Likert scale was used for 18 items on the questionnaire, and two open ended questions were included concerning management of family presence and the perceived effect that family presence had on the delivery of care to the patient. The nurses who were surveyed agreed that family should be allowed to remain at the bedside of their relative during daily routine care, and that the presence of family was usually positive and comforting to the patient.

The nurses expressed the belief that family members should also be included in the daily care of the patient. While the majority of nurses agreed that family should be allowed to visit any time the patient wanted them present, close to a third of the nurses expressed disagreement and wanted to retain the ability to limit visitation when they thought it would be beneficial to the patient’s care. Overall this study showed that nurses held a positive view of family visitation and presence at the bedside. Because nurses and hospitals recognize that family visitation is important, hospitals now hold the responsibility to enable and encourage family presence.

Evaluating the experiences of parents visiting infants in the neonatal intensive care unit (NICU) gives unique insight into the factors that promote or inhibit visitation. When the patient is a prematurely born infant, there are no conflicts that arise from the patient preference, and the facilitation of visitation becomes more fully dependent upon the facility, care of the staff, and limitations on the family members. Wigert, Berg, and Hellstrom (2010) conducted research to assess the visitation patterns of parents and identify visitation-friendly practices. The two NICUs involved within this study had an open visitation policy. The time spent in the NICU by each of the 67 parents of 42 infants involved was logged and tracked. The 67 parents also participated in structured interviews to discuss the factors that affected the time they spent on the unit. The main factors affecting the time spent visiting by the family were identified as accommodations, care provided by the staff, environment, and other personal responsibilities.

The hospitals included in this study were equipped with parent rooms adjacent to the NICU. One hospital had two rooms where parents could stay while remaining close to their infant. That hospital also had additional housing offered in a family hotel that was located on the hospital property. This convenience allowed the parents more time to spend in the NICU. This hospital also had the NICU located in the same building as the maternity ward which facilitated easy visiting for newly post-partum mothers still receiving treatment. The second hospital had five family rooms for parents but did not offer other on-property housing and the maternity ward was located in a different building of the hospital.

The survey completed by the parents in the study identified good treatment by the staff and a family-friendly environment as the best influences for facilitating family presence. Coming and going freely, as well as getting regular information, were also cited as positive influences on their visiting experiences. Common reasons why parents spent time away from their child were to care for their other children and homes. The findings of this study, in relation to factors promoting the accessibility of family presence, can be applied to hospital units of any specialty. To provide PFCC, family visitation must be facilitated. Patient and family centered care can be accomplished through providing a family-friendly environment with adequate accommodations, open or flexible visitation hours, high quality care, and regular, accurate information.

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