The Impact of COVID-19 Visitor Restrictions on Clinical Cancer Nurses

OBJECTIVES

To explore the impact of visitor restrictions on clinical cancer nurses, their roles and duties, and the coping strategies used to address the impact.

DATA SOURCES

Semistructured qualitative interviews were conducted through purposive sampling with nurses working in a clinical role within cancer services at the study site for at least 1 year. Interviews were recorded and transcribed. Textual data transcribed from interviews were analyzed for themes using NVivo version 12 software, following Braun and Clarke's six phases of thematic analysis.

CONCLUSION

Visitor restrictions implemented due to COVID-19 had a significant impact on clinical cancer nurses. The study found evidence of moral injury and conflict-within the role of the nurse, the implementation of organizational policies, and nurses' professional identity and personal beliefs. Despite this adversity, nurses remained committed to their clinical practice.

IMPLICATIONS FOR NURSING PRACTICE

Changes to nurses' roles and the practice environment have potentially significant impact on well-being and retention. To ensure that nurses can continue to provide high-quality nursing care in challenging environments, organizations must minimize this impact. Consistent communication and support activities, including recognizing and responding appropriately to situations, may be used in the reduction of potential moral injury and stress.

Visitation restriction and decision making: Healthcare surrogate experiences

OBJECTIVES

We sought to discover whether hospital visitation restrictions imposed during COVID, and remaining at some institutions, influenced surrogate decision-making.

METHODS

Thematic analysis of semi-structured interviews of people who served as healthcare surrogates for patients admitted to the intensive care unit with a palliative care consultation in January of 2021 at a large tertiary care hospital.

RESULTS

Thirteen healthcare surrogates agreed to be interviewed out of the fifty-six who were identified and invited to participate. The following themes emerged: 1) Decision-making was delayed as surrogates desire to make decisions in conjunction with the patient; 2) visitation restriction disrupted processes of grief and end-of-life rituals; 3) it prevented healing that occurs with closeness to loved ones; 4) visitation permission was poorly communicated and inconsistent; 5) virtual connection was inconsistent and proved ineffective in context; 6) communication was often stressful and confusing.

CONCLUSION

From the point of view of healthcare surrogates, visitation restriction disrupted the normal process of decision-making by impeding important healing and grief rituals, and making connection difficult, despite policies and technology that was meant to assist.

PRACTICE IMPLICATIONS

Visitation restriction carries risk such as delaying decision-making and the perceived healing benefits of visitation.

Relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave: a PREMs study in Valais Hospital, Switzerland

BACKGROUND

During the COVID-19 pandemic, most countries introduced temporary visiting restrictions on the relatives of acute care hospital patients, whether or not they were infected with SARS-CoV-2. This affected relatives' psychological and emotional states and how closely they could be involved in their loved one's hospitalization.

STUDY AIMS

Investigate relatives' experiences of visiting restrictions during the COVID-19 pandemic's first wave and the support offered by Valais Hospital's healthcare staff.

METHODS

Relatives and patients who had been discharged between February 28 and May 13, 2020, were asked to complete a patient-reported experience measures (PREMs) questionnaire, whether or not they had been infected by SARS-CoV-2. Relatives were asked about how visiting restrictions had affected them, their perceptions of the severity of the COVID-19 pandemic, the quality of communication concerning their loved ones' health status during their hospitalization, and the information received from healthcare staff. Descriptive and inferential statistics were computed.

RESULTS

Of 866 PREMs questionnaires returned, 818 were analyzable, and 543 relatives had experienced visiting restrictions to their loved ones: 92 relatives (87%) of COVID-19 patients and 451 relatives (66%) of non-infected patients, with heterogenous effects on their psychological and affective status. Overall, whether or not relatives were subjected to visiting restrictions, they perceived themselves to be well treated, well informed, and that communication with hospital healthcare staff was satisfactory. However, relatives subjected to visiting restrictions reported significantly lower scores on the quality of communication than other relatives. The relatives of patients in gynecology/obstetrics and internal medicine wards were significantly more affected by visiting restrictions than were the relatives of patients in other wards. Numerous relatives subjected to visiting restrictions reported regular communication with their loved ones or with healthcare staff, at least once a day (n = 179), either via videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® or via mobile phone text messages.

CONCLUSION

Visiting restrictions affected relatives differently depending on the wards their loved ones were hospitalized. Healthcare institutions should investigate the utility of visiting restrictions on patients, how they affect relatives, and how to improve personalized patient-relative communications. Future research should attempt to develop reliable, validated measurement instruments of relatives' experiences of acute-care visiting restrictions during pandemics.

Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East

PURPOSE

The coronavirus disease-2019 (COVID-19) pandemic had affected the visiting or communicating policies for family members. We surveyed the intensive care units (ICUs) in South Asia and the Middle East to assess the impact of the COVID-19 pandemic on visiting and communication policies.

MATERIALS AND METHOD

A web-based cross-sectional survey was used to collect data between March 22, 2021, and April 7, 2021, from healthcare professionals (HCP) working in COVID and non-COVID ICUs (one response per ICU). The topics of the questionnaire included current and pre-pandemic policies on visiting, communication, informed consent, and end-of-life care in ICUs.

RESULTS

A total of 292 ICUs (73% of COVID ICUs) from 18 countries were included in the final analysis. Most (92%) of ICUs restricted their visiting hours, and nearly one-third (32.3%) followed a "no-visitor" policy. There was a significant change in the daily visiting duration in COVID ICUs compared to the pre-pandemic times (p = 0.011). There was also a significant change (p <0.001) in the process of informed consent and end-of-life discussions during the ongoing pandemic compared to pre-pandemic times.

CONCLUSION

Visiting and communication policies of the ICUs had significantly changed during the COVID-19 pandemic. Future studies are needed to understand the sociopsychological and medicolegal implications of revised policies.

HOW TO CITE THIS ARTICLE

Chanchalani G, Arora N, Nasa P, Sodhi K, Al Bahrani MJ, Al Tayar A, et al. Visiting and Communication Policy in Intensive Care Units during COVID-19 Pandemic: A Cross-sectional Survey from South Asia and the Middle East. Indian J Crit Care Med 2022;26(3):268-275.

Practice of family-centred care in intensive care units before the COVID-19-pandemic: A cross-sectional analysis in German-speaking countries

OBJECTIVES

To provide insights into visiting policies and family-centred care practices with a focus on children as visitors in Intensive Care Units in German-speaking countries.

METHODS/DESIGN

Online-survey with a mixed methods approach. Leading clinicians (n = 1943) from German-speaking countries were invited to participate. Outcomes included the percentage of intensive care units with open visiting policies, age restrictions, family-centred care activities and barriers.

SETTING

Paediatric, mixed and adult units RESULTS: In total, 19.8% (n = 385) of the clinicians responded. Open visiting times were reported by 36.3% (n = 117), with significant differences between paediatric (79.2%), adult (21.3%) and mixed-age (41.2%) units (p < 0.01). Two-thirds of clinicians stated that their units had no age restrictions for children as visitors (n = 221, 68.4%). The family-centred care activities most frequently implemented were open visiting times and dissemination of information. Significantly more German units have open visiting policies and more Swiss units allow children as visitors, compared to the other countries (both p < 0.001). Barriers to family-centred care were concerns about children being traumatized, infection and workload.

CONCLUSION

The majority reported that family-centred care policies had been implemented in their units, including open visiting policies, allowing children as visitors without age restriction and other family-centred care activities.

Visit of minors in an intensive care unit. What is the opinion of health staff?

AIM

To determine the opinion of healthcare staff (HS) on the presence of minors in an adult intensive care unit.

METHOD

Transversal descriptive research study in an adult intensive care unit with 62 people, between September/December 2017. The Knutsson questionnaire was used with 10 closed questions with space for comments, and 2 open questions. Selection of the respondents was by means of convenience sampling. Descriptive statistics with absolute frequencies and percentages. Chi-squared-test or Fisher. Significance p<.05.

RESULTS

61 questionnaires were collected: 70.5% nursing staff (NS). Fifty percent of medical staff (MS) would restrict the entry of 0 to 6-year old minors versus 76.2% NS (p=.04). Of the MS, 16.7% would restrict the visits of minors between the ages of 7 and 12 versus 46.5% NS (p=.02). Seventy-five percent of HS thought that minors' access could entail a risk of infection for the children. Of the survey respondents, 60% believed that the environment could intimidate the minor, and 66.7% thought that the patient's condition could affect the child. They would permit 0-6-year-old minors to access the ICU if the patient was dying (70.6% MS/41% NS, p=.04), awake and alert (77.8% MS/57.5% NE) and close relatives (parents) (66.7% MS/60% NS).

CONCLUSIONS

HS support minors visiting an adult adult intensive care unit if they are>6 years old. HS show a more positive attitude towards visits in special circumstances such as close relatives, awake patient, and death regardless of their age. The reasons for restriction of visits are: environment, patient's condition and risk of infection. NS show a less positive attitude in relation to visits.

Reducing infection transmission in the playroom: Balancing patient safety and family-centered care

BACKGROUND

Family-centered care requires that institutions develop strategies to allow sibling visitors to hospitalized children while reducing risks of infectious disease transmission. Most guidelines recommend that siblings not be permitted to visit playrooms. This approach was not seen as consistent with family-centered care in our setting; therefore, in a pilot project we developed an approach for screening siblings with cooperation of families, child life specialists, the care team, and the infection prevention and control service.

METHODS

A literature review using CINAHL and PubMed databases (Medical Subject Heading terms: visitors to patients, child, infection, nosocomial, and siblings) from 2004-2014 did not uncover formal established methods for reducing playroom infectious disease exposures. Benchmarking with other Canadian centers revealed a diversity of approaches. Child life, the ward staff, and infection prevention and control at this center collaborated to develop a sibling screening strategy.

RESULTS

The collaborative approach led to a process based on a screening form that is introduced to the family during admission. The process requires the cooperation of the admitting nurse, parents, and child life staff. In the first 2 years of the project, approximately 10% of screened siblings had a potentially communicable illness.

CONCLUSION

A collaborative multidisciplinary approach based on family center care principles led to a process whereby siblings of hospitalized children can be allowed to visit playrooms, while reducing risk of infectious disease transmission.