Psychology draft assignment
nikkieramsey
Samplereviewpaper-hospitalvisitation.pdf
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Restricted Hospital Visitation Policies and their Social Implications: A Systematic Review
First and Last Name
Saint Leo University
PSY 695 Capstone II
Dr. Lara Ault
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Abstract
The idea of restricted visitation, in which family members can only visit a patient during
set times and days, is not a new concept. In fact, restricted visiting hours can be traced back to
the 1800s (Berwick et al., 2004). The goal of this literature review is to help strengthen that idea
and provide evidence for the need for open visitation policies, despite nurses and hospital staff
stating otherwise.
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Restricted Hospital Visitation Policies and their Social Implications: A Systematic Review
Introduction
Imagine you are in the hospital, alone. You haven’t seen a familiar face all day, and you
won’t have the opportunity now, as visiting hours just ended. You feel isolated, depressed, and
lonely, no different than how you were feeling when you first arrived at the hospital a few days
ago.
Such scenario is the case for majority of intensive care units, both in the United States, as
well as across the world (Khaleghparast et al., 2016). The idea of restricted visitation, in which
family members can only visit a patient during set times and days, is not a new concept. In fact,
restricted visiting hours can be traced back to the 1800s (Berwick et al., 2004). Restricted
visitation was utilized as a way to establish order in the general ward, specifically for non-paying
patients (Berwick et al., 2004). Giganti (1998) makes the argument that these policies were put
into place as patients in that time were often alcoholics and sailors, and therefore it was a way for
the hospitals to keep rowdy friends away from causing chaos. Additionally, there was a concern
that sick patients would transmit illness and diseases to the healthy visitors (Giganit, 1998).
The opposite was true for paying patients—they were allowed to have visitors at almost
any time, one of the many benefits of paying for a private room (Berwick, et al., 2004). This
pattern continued, all the way up until 1960’s, when hospitals once again cracked down on
restricted visitation hours. In an effort to reduce exhaustion experienced by both the patient and
family, hospitals once again began to implement visiting hours, for both general wards, and the
newly introduced intensive care units, which is credited to Bjorn Ibsen for establishing the first
one in 1953 (Berwick et al, 2004). In 1962, the United States Public Health Service, otherwise
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known as USPHS, recommended that visitation in the ICU be limited to five minutes every hour,
and to no more than two visitors at a time (Hopping et al., 1992). Three years later, the USPHS
rescinded its prior recommendation of restricting visitation, and recommended that the
parameters of visitation be based upon the patient’s condition and the staff’s ability to “entertain
visitors” (Hopping et al., 1992).
There has not been much change in ICU visiting hours today, with some being as strict as
visiting hours being restricted to immediate family members only, for ten minutes every two
hours, between the hours of 9am and 5pm (Cleveland, 1994). However, it appears that since the
implementation of restricted visitation, there has always been a desire for open visitation, in
which family members can visit a patient at any time or day with no restrictions. When
considering the reason for a patient to be in the ICU, this makes sense. Being in the ICU itself is
a traumatic event, and most likely is a result of something traumatic (Hart et al., 2013).
Therefore, when the patients need the support of their family members the most, they are
isolated. The goal of this literature review is to help strengthen that idea and provide evidence for
the need for open visitation policies, despite nurses and hospital staff stating otherwise.
Methods
Should include Databases here
Eligibility Criteria
This literature review is to understand hospital visitation policies, and whether restricted
visiting hours are helpful or hurtful. There is evidence to support the need for both restricted
visitation hours and open visitation hours. The viewpoints will focus on visitation policies from
the perspectives of the patients, family members, and hospital staff. To help facilitate this
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literature review, only empirical studies were sought out and included. The articles had to be
published and peer-reviewed, and available in its entirety. Studies that included patients in in-
inpatient mental health treatment have been excluded. The reasoning behind this is because in
this case, open visitation might not be the best thing for the patient, for several reasons: one,
the visitors may be a source of discomfort, stress, and mental health for the patient; two, the
patient might thrive with a set routine, and having a visitor pop in may disrupt that
routine. Studies that have COVID-19 as a focal point have also been excluded. I want to
ensure that the views of hospital visitation were not persuaded by a global pandemic.
Additionally, studies that involve minors have also been excluded. Lastly, I have tried to
make sure that all articles have been written in the past thirty years. Any article written prior
to 1990 has been excluded. This is to ensure that the opinions about policies are relevant to
today’s times.
Table 1: Inclusion/Exclusion Criteria Inclusion Exclusion
• Empirical studies
• Studies within the last 30 years
• Any region of the world
• Mainly focusing on ICU’s
• Peer-reviewed
• Available in its entirety
• Articles that were older than 30 years
• Articles that were not empirical studies
• Articles that involved minors
• Articles that focused on COVID-19
• Articles that involved substance abuse or
mental health treatment
Search Terms
I have utilized Google Scholar, EBSCO, ResearchGate, ScienceDirect, and the Saint
Leo University library to assist with the search of articles. Search terms to help find articles
included: “open visitation”, “restricted visitation”, “open versus restricted visitation”,
“hospital visitation”, “hospital visitation policies”, “social support in hospitals”, “views on
hospital visitations”, “family and hospital visits”, “hospital staff and hospital visits”, “patients
and hospital visits”.
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Results
Table 2 Box Score Table of studies and outcomes
Researchers Subjects Method/IV’s DV’s Outcomes
Green, Raymond,
Peardon, Fox,
Hawkes, Cornes
Not just grapes
and flowers (2012)
9 focal groups,
age
requirement-50
and older
Commentary by
the older
population,
either as visitors
or as the patients
Flexible
visitation
policies
-Difficulties traveling
to and from hospitals
-As visitors: exhausting
traveling every day
-There is value in visits
Khaleghparast,
Joolaee, Ghanbari,
Maleki, Peyrovi,
Bahrani
A review of
visiting policies in
ICU (2016)
42 articles from
1997-2013
Narrative
review,
overlook of
visiting policies
The benefits of
limited versus
restricted
visitation
policies
-Open: Prescence of
family helps with
recovery
-Can help with
communication of
treatment plan
-Preferred by patients
and can decrease stress
-Restricted: nurses feel
pressured by constant
familial presence
-Families are always
disrupting and asking
questions
Hopping, Sickbert,
Ruth
A study of factors
associated with
CCU visiting
policies (1992)
Not empirical
study, but has
lots of good
information to
offer
-History of ICU
-Limitations imposed
by USPHS
Rego Lins Fumis,
Ranzani, Paglia
Faria, Schettino
Anxiety,
depression, and
satisfaction (2015)
All family
members with
more than 48
hours of ICU
stay (471
families were
actually
interviewed)
-Interviews
-Hospital
Anxiety and
Depression
Scale (HADS)
-Critical Care
Family Needs
Inventory
(CCFNI)
Range of
anxiety,
depression, and
emotional
distress (entire
scale)
-Significant association
between satisfaction
and HADS score
-More severe diseases
has more symptoms of
anxiety and depression
-Visiting hours up to 10
hours/day showed a
positive association
between visiting hours
and satisfaction
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Table 2.2: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Duran, Oman,
Abel, Koziel,
Szymanski
Attitudes towards
and beliefs about
family presence
300 bed hospital
202 clinicians
72 family
members
62 patients
Surveys Family presence -Clinicians had positive
views, but were
apprehensive about
safety and patient
emotional responses
-Nurses were more
favorable towards
visitors
-Patients and family
both reported positive
attitudes towards visits
Berti, Ferdinande,
Moons
Beliefs and
attitudes of ICU
nurses (2007)
Nurses and head
nurses in ICUS
(531 nurses
participated)
-Two
questionnaires
*Current
visitation
policies
*Beliefs and
Attitudes
towards
Visitation in
ICU (BAVIQ)
Beliefs of
visitation
-Most nurses believed
that visitation was
beneficial
-Did not believe open
visitation was helpful
-Open visitation can
interfere with nursing
care
-Open visitation can
cause nurses to
spending more time
providing information
to families
-Against giving patient
control of time of visits,
duration of visits, and
number of visitors
Venkataraman,
Ranganathan,
Rajnibala,
Abraham,
Rajagopalan,
Ramakrishnan
Critical Care: are
we customer
friendly (2015)
200 patients,
who stayed in
the ICU for
more than 3
days
Survey
questionnaire
(Likert scale)
Satisfaction of 5
key aspects:
treatment,
communication,
visiting hours,
atmosphere,
overall
experience
-Visiting hours were
inadequate and
inconvenient
-Lowest satisfaction
score was for visiting
hours
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Table 2.3: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Hart, Hardin,
Townsend,
Mahrle-Henson
Critical Care
Visitation:
Nurse and Family
Preference (2013)
5 critical care
units
Family and
nurses
Questionnaires Restriction of
visiting hours
-Nurses wanted to keep
visiting hours to 9am-
5pm
-Believed that visitation
could add on stress to
patients
-Most convenient times
for families to visit are
4pm-8pm
-Families didn’t want
restrictions on how
many times to visit,
how long to visit, and
number of visitors
Simon, Phillips,
Badalamenti,
Ohlert,
Krumberger
Current practices
(1997)
201 nurses Surveys Perceptions of
open vs
restricted
visitation
-Restricted visitation
were more beneficial
for patients, in that it
gave them more rest
-Less work on nurses
-Could see how open
visitation would
decrease patient’s
anxiety
Shulkin, O’Keefe,
Trish, Robinson,
Rooke, Neigher
Eliminating
Visiting Hour
Retrictions (2014)
690 bed tertiary
acute care
facility/78 bed
rehab hospital
Input forms Implementation
of new open
visitation policy
-Increased patient
satisfaction
-No new security
threats
-Fewer phone calls to
staff for patient updates
Vincent
Encouraging
family visiting
(2020)
Not empirical
study, but has
lots of good
information to
offer
-Reason for restriction:
lessens the chances of
disease transmission
-Visitors may
negatively interfere
with patient rest and
medical care
-Positive for open
visitation: visiting is
more flexible, less
guilty for visitors
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Table 2.4: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Au, Ordons, Soo,
Guienguere,
Stelfox
Family
participating in
ICU rounds
(2017)
63 family
members
258 providers
Surveys
Interviews
Whether family
members should
participate in
rounds
-Most providers agreed
that family members
should be given the
option of attending
rounds
-Family members
reported a positive
experience in
participating/felt like
they had an active role
-Familial participation
improved relationships
between family and
provider
Wong, Redley,
Digby, Correya,
Bucknall
Families’
perspectives of
participation
(2020)
26 bed medical
surgical unit
45 bed medical
surigical unit
Observations
Interviews
Family
participation in
patient care
-Families had a better
understanding of
treatment plan, and
could make more
informed decisions
-Supported the patients
more, which lessen the
work for medical
providers
-Provided comfort for
patients
Agard, Lomborg
Flexible family
visitation (2010)
Nurses (11) Interviews Exploring
everyday
decision making
about family
visitation
-Unaware of hospital
policies about visitation
-Decisions were based
on visitor’s relationship
to patient as well as
patient’s response to
visitor
Mitchell, Aitken
Flexible visiting
positively
impacted (2016)
12 patients
181 family
members
260 ICU staff
members
Interviews
Surveys
Open visitation -Family members had
an overall satisfied
score
-Patients felt supported
by their family
members visits
-ICU actually
appreciated the
flexibility of visits
10
Table 2.5: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Griffith
Hospital, visiting
hours: time for
improvement
Administrative
departments of
430 hospitals
Surveys Hours of
visitation
-25% have 2 hours or
less of visitation
-Mean visitation: 3-5
hours
-Reasons why not to
extend: unwelcome
interference with
hospital routine
Cleveland
ICU visitation
policies (1994)
20 year old, 12
bed ICU-44
nurses
Surveys Restricted vs
open visitation
-Restricted visitation
policies isolate patients
from families
-Can positively
influence a patient’s
recovery
-Can potentially
decrease future
hospitalization
Dobrinic, Rezic
ICU Nurses’
Perception (2020)
44 nurses Questionnaire Perception of
visits
-Believe that visits
increase stress for
patient
-Contribute to mental
exhaustion for patients
-Interupt medical care
-Can contribute to
spread of diseases
-Lack of resources to
assist with child visits
Milner, Marmo,
Goncalves
Implementation
and sustainment
strategies (2021)
Nurses in
leadership
positions-40 in
total
Interviews Protocols to
implement open
visitation
-Discussed barriers of
switching from
restricted to open
overnight
-Came up with
strategies on how to
implement open
visitation
Marco, Bermejillo,
Garayalde,
Sarrate, Margall,
Asiain
ICU nurses
belief’s towards
the effects of open
visiting (2006)
16 bed ICU-46
nurses
Surveys-Likert
scale
-Attitude
questionnaire
Open visitation
beliefs
-Positive attitude
toward open visitation:
the longer the patient is
with a family, the better
-Open visitation, but
not at night: don’t want
to be disruptive to other
patients
-Visitors are direct link
to outside world
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Table 2.6: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Agard, Hofhuis,
Koopmans,
Gerritsen, Spronk,
Engelberg, Curtis,
Jensen
Identifying
improvement
opportunities
(2019)
21 different
ICUS
1077 family
members
Questionnaire Participation -Didn’t appreciate not
being allowed to visit
when they wanted, and
were often told to stand
out of the room
-Got the impression
from staff members that
they were not wanted
there
-Not told information
from medical staff,
questions unanswered
Azoulay, Pochard,
Chevret, Lemaire,
Mokhtari, Le Gall,
Dhainaut,
Schlemmer
Meeting the needs
(2001)
72 French ICUs,
15 patients from
each (637
patients in total)
Questionnaires Satisfaction of
information
provided and
visiting hours
-Desired time low
-Appropriateness of
information high
Hinkle, Fitzpatrick
Needs of American
relatives of ICU
patients (2011)
101 patients
109 nurses
CCFNI
questionnaire
Needs of ICU
patients as
viewed by their
familes
-Need better ICU open
visitation policies
-Unable to
communicate with
doctor when needed
Maxwell,
Stuenkel, Saylor
Needs of family
members of
critically ill
patients (2007)
16 bed critical
care unit
30 nurses
20 family
members
Surveys Involvement -Family members
wanted to be more
involved and to be able
to assist the patients
-Nurses didn’t want to
have to deal with the
families and just
wanted to focus on the
patients
Winkleman,
Kerber,
Zangmeister,
McNett
One Team’s
Experience (2020)
28 visitors
MICU staff
Surveys Implementation
of flexible
visitation
-Staff had negative
views towards flexible
hours, reporting that it
created more work
-Staff reported no quiet
time
-Family members had
positive experiences
12
Table 2.7: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Schnell, Abadie,
Toullic, Chize,
Souppart, Poncet,
Schlemmer,
Azoulay
Open visitation
policies in the ICU
(2013)
35 relatives CCFNI
questionnaire
Open visitation -Familial presence
promotes beneficial
factors
-Does not result in
adverse events
-Nurses reported less
family flooding
McAdam, Puntillo
Open visitation
policies and
practices (2013)
11 patients Interviews Open visitation -Patients report feeling
less anxious
-Family members took
an active role in
treatment plans
-Nurses reported
feeling loss of control
Burns, Misak,
Herridge, Meade,
Oczkowski
Patient and family
engagement
(2018)
Not empirical
study, but has
lots of good
information to
offer
-Increased patient
engagement can
improve self-care and
accountability with
treatment plans
-Less stress on
caregivers
-Easier to build honest
relationships with
providers
-Increased family
engagement can
improve adherence to
treatment plans
-Can provide more
accurate accounts to
providers
-Can help calm patients
Garrouste-Orgeas,
Philippart, Timsit,
Diaw, Willems,
Tabah, Bretteville,
Verdavainne,
Misset, Carlet
Perceptions of a
24-hour visiting
policy (2008)
460 tertiary-care
hospital in
France
326 patients
30 nurses, 13
physicians
Questionnaire Visitation -High family
satisfaction
-Less traffic in the
rooms (shorter length
of visits)
-Can come and go as
they please
-Participation in care
-Moderate symptoms of
anxiety and depression
-No substantial
interference of medical
care
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Table 2.8: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
De Silva Ramos,
Rego Lins Fumis,
Pontes Azevedo,
Schettino
Perceptions of
open visitation
(2013)
-All physicians,
nurses, and RTS
from the ICU
-Patients in ICU
Questionnaire Feelings about
open visitation
-ICU workers: open
visitation impairs the
organization of patient
care; work suffers from
more interruptions;
hinders a patient’s rest
-Patients: wants open
visitation; less anxiety
and stress
Moss, Rosgen,
Lucini, Krewulak,
Soo, Doig, Patten,
Stelfox, Fiest
Psychiatric
Outcomes in ICU
Patients (2022)
Any patient
admitted to 1 of
14 hospitals
from 1/1/14-
5/31/17
=14,344 patients
Psychiatric
outcomes
-Having an in-person
visit was associated
with a decreased risk of
psychiatric disorder in
1st year of hospital
discharge
Ramsey, Cathelyn,
Gugliotta, Glenn
Restricted vs Open
ICUs (2000)
52 nurses, 53
visitors
Surveys Open vs
restricted
visitation
-Families got to spend
more time with patients
-Nurses felt like they
didn’t have enough
time with patients
Berwick, Kotagal
Restricted visiting
hours (2004)
Not empirical
study, but has
lots of good
information to
offer
-Restricted visitation
began in the late 1800s
for nonpaying patients
-Hospitals implemented
restricted visitation for
all patients in 1960s
-Visitation based on
patient: if too stressful,
restrictive, if not, open
Chapman,
Collingridge,
Mitchell, Wright,
Hopkins, Butler,
Brown
Satisfaction with
Elimination of all
Visitation
Restriction(2016)
24 bed ICU
103 family
members
128 nurses
Surveys Unrestricted
visitation
-Improved family
members satisfaction
with convenience of
visiting hours
-Patients were more
comfortable
-Nurses’ satisfaction
did not change
Carlson, Riegel,
Thomason
Visitation: Policy
vs Practice (1998)
Nurses caring
for AMI
patients
Questionnaire How long
visitation hours
are, and do they
agree with it
-Some nurses deviated
from the visitation
policies for the needs of
their patients
-Could see the benefit
factor of reducing stress
and anxiety
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Table 2.9: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Farrell, Joseph,
Schwartz-Barcott
Visiting Hours:
Finding the
Balance (2005)
8 ICU nurses Surveys,
observations.
Informal/formal
interviews
Views on
visitation hours
-If unit was quiet,
allowed family to stay
as long as they wished
-Family is useful if
patient speaks another
language
-Lifted all restrictions
on dying patients
Liu, Linderman
Read, Scruth,
Cheng
Visitation policies
and practices in
US ICUs (2013)
606 hospitals Telephone
survey
Hospital and
ICU visitation
restrictions
-463 hospitals had
restrictive visitation
policies
-Most common
restrictions included:
visiting hours, number
of visitors, and vistors’
age
-Most of the open
visitation policies were
in smaller, community
hospitals
Spreen,
Schuurmans
Visiting policies in
the adult ICU
(2010)
105 ICUs Telephone
questionnaire
Implementation
of open
visitation
-None of the hospitals
surveyed had an open
visitation policy, but
restrictions were lifted
upon certain
circumstances (ie a
patient actively dying)
-Most of the medical
staff held negative
views about the
potential of
implementing an open
visitation policy
Gonzalez, Carroll,
Elliott, Fitzgerald,
Vallent
Visiting
preferences (2004)
31 ICU patients
and 31 CCMU
patients
Questionnaire:
Patients’
Perception of
Visits in Critical
Care
Developing
visitation policy
based on their
individual needs
-Allowed for the input
of CCMU patient
opinions on their own
visitation hours
-ICU nurses determined
visiting hours for ICU
patients-higher
satisfaction
15
Table 2.10: Box Score (continued) Researchers Subjects Method/IV’s DV’s Outcomes
Ramsey, Cathelyn,
Gugliotta, Glenn
Visitor and nurse
satisfaction (1999)
102 nurses, 103
visitors
Questionnaire Feelings about
old visitation
policy (15
mins/5 times a
day) versus new
one (15 mins/7
times a day) that
was
implemented
-Visitors felt like they
had enough time to
spend with patients, but
wish they had more
time
-Did not feel in the way
of nurses
-Nurses felt like they
had less time for patient
care
-Nurses felt
comfortable with
visitors assisting patient
care
PRISMA Flow Diagram
Table 3: PRISMA Flow Diagram
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Patient and Family Perspectives
Based on the literature available, if you asked a patient and their family members what
their opinions are regarding restricted visitation, they would tell you to abolish it and switch
over to an open visitation policy. This is because the perspective of the patients and their
families are suggesting positive feelings towards open visitation policies. There are several
reasons for this, including patients reporting feeling less anxious and less isolated.
Additionally, having members of the family around has shown quicker recovery rates, as the
families can help the patient understand what is happening, particularly if the patient speaks
another language, and also can help keep the patient accountable to the treatment plan.
It is no surprise that the critical condition of the patient can be a source of stress for the
patient and the family, with symptoms of anxiety, depression, and posttraumatic stress
disorder being highly prevalent (Fumis et al., 2014). However, having open visitation policies
have shown evidence of reduced cardio-circulatory complications for the patients, due to the
visits reducing the patient’s anxiety (Berti et al., 2006). This is because families tend to have a
calming effect on patients and have the ability to provide support and comfort to the patient in
an otherwise overwhelming and uncomfortable environment (Hart et al., 2013). Furthermore,
since the patient is unable to leave the ICU, their family members are essentially their link to
the outside world, and could provide updates as to what is going on in the world or with other
family members (Marco et al., 2006).
From the family perspective, there are often feelings of guilt and sadness as a result of
not being able to visit their sick loved ones. If visiting hours are 9am to 5pm, but the family
member also has to work 9am to 5pm, that family member will not have the ability to visit
their loved one; and not everyone has the luxury of taking time off from work (Hart et al.,
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2013). Ideally, the most optimal time for a family to visit the ICU patient is 4pm to 8pm (Hart
et al., 2013). Additionally, if hospitals have limitations on how many family members get to
visit at a time, and there are several members in just one family, how it is decided who gets to
proceed with the visitation (Agard et al., 2019). Furthermore, with restricted visitation
policies, families reported concerns of not being at the hospital during rapid decline of health,
and therefore not being able to say goodbye before a patient passes away (Vincent, 2020).
Having family members present at all times in the ICU, especially when doctors are
making their rounds, could present as a collaborative effort with the patient’s medical staff.
These family members could provide additional information that the doctors would not
otherwise have access to (Au et al., 2017). They would also be able to assist with decision-
making in treatment plans. Additionally, since there is a chance that the patient could be in a
sedated state during their time in the ICU, the family members would be able to pass along
important information to the patient when they awake and hold the patient accountable to the
treatment plan (Au et al., 2017). They could support the patient more, which in the long term,
could lessen the work load for the medical providers (Wong et al., 2020). Lastly, the family
members could translate if there are any language barriers or development delays present
(Khaleghparast et al., 2016).
Medical Providers Perspectives
On the other hand, nurses, doctors, and other hospital staff often show resistance
towards an open visitation policy (Berti et al., 2006). Nurses especially often report that they
feel pressured by constant familial presence. They did not believe that open visitation was
beneficial for the patients, as it could be disruptive to the patients’ care (Duran, et al., 2007).
They also had to spend more time answering questions for the families, which again could be
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disruptive in their routines (Maxwell et al., 2007). They also argue that having families
around may not always be in the patients’ best interests and could in turn cause more stress to
the patient (Dobrinic & Rezic, 2020).
Nurses and medical staff are firm believers that open visitation policies disrupt the
patient’s rest, as the visitors can come and go as they please (Berti et al., 2007). There is also
a concern that if visitors are coming at all hours of the night, it could be disruptive to the other
patients in the ICU ward (Marco et al., 2006). In the same vein, there would be no quiet time
or downtime for the medical staff, as open visitation would allow the family members to come
at any time (Winkleman et al., 2020). There is also the concern that with visitors coming and
going with no control, the healthy family members could be exposed to infections from the
hospital, or bring in new infections from the outside world and destroy the sterile environment
in the ICU (Hart et al., 2013).
The biggest complaint that the nurses and medical staff have with open visitation
policies is that they believe that the family members would simply get in the way. Open
visitation would cause nurses to spend more time providing information to families on the
treatment plans, and would allow the families more opportunities to interrupt the medical staff
(Simon et al., 1997). Since open visitation would allow the opportunity for a family member
to always be present, the medical staff had concerns that the visitors would not respect the
wishes of the patient if they wanted to be alone for a few hours (Vincent, 2020). There is also
the concern that the visitors would be in the way if the patient was experiencing a code, and
the medical staff would not have adequate room to work on the patient (Vincent, 2020).
Essentially, the nurses and medical staff reported feeling loss of control if they were to switch
over to open visitation policies (McAdam & Puntillo, 2013). Additionally, since many ICU’s
19
are understaff enough as it is, there is a concern about the lack of resources available for the
families, particularly when children come to visit (Dobrinic & Rezic, 2020).
Discussion
If you look at what the families and patients want versus what the nurses and medical
staff want when it comes to hospital visitation policies, it would appear that they are exact
opposites of each other. Patients and families advocate for open visitation policies, whereas the
nurses and medical staff are content with keeping restricted visitation policies in place. From a
patient and family perspective, there are positive associations with open visitation policies and
levels of satisfaction (Fumis et al., 2015). There are less periods of isolation for the patient, less
stress about the diagnosis, and even quicker recovery rates (Cleveland, 1994). There is even a
potential for open visitation to decrease future hospitalization stays (Cleveland, 1994). However,
from the nurses and medical staff perspective, there are negative associations with open
visitation policies, and more reports of stress on the staff (Winkleman et al., 2020). The medical
staff were not able to care for the patient as effectively with visitors always present in the ICU
(Ramos et al., 2013).
Conclusion
As evident by this literature review, both sides are going to think that they are in the
right, and their opinion is the one that should be considered when looking at the pros and cons of
restricted versus open visitation policies in the hospital. However, ultimately the decision should
come down to what has the greatest impact on the patient’s health and ability to recover. As the
studies suggest, open visitation policies can lead to decreased feelings of anxiety and stress, and
can have the potential for the patient to recover fast. Therefore, it is imperative to keep the
patient’s health in mind, and do what is best for the patient and by the patient. So if that means
20
the open visitation would cause more stress to the medical staff, but provide a greater advantage
to the patient, it might be time to consider implementing open visitation policies across all
ICU’s.
21
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