Point of View

Why ICU visitors are critical to patient care

December 24, 2013 

What do you do if your mother, sister, husband or father lands in an ICU? Do you stay or do you go?

There are more that 5 million patients admitted to an ICU a year. The ICU is a special unit where patients who have severe and life threatening illnesses are given care by specialized doctors and nurses. These patients require constant monitoring and support with special equipment and medications to maintain normal bodily functions. The majority of U.S. hospitals have restrictions on visitation. Families need open visitation because it decreases patient anxiety and increases their comfort.

Most adult intensive care units have some type of restricted visiting hours that limit the number of family members who can visit and length of time they can stay at the bedside. Across ICUs there is no standardization in visiting policies. In addition, there may even be different visitation policies in various ICUs in the same hospital! Families can be restricted to 10 minutes of visitation every hour or be allowed to visit any time they want. Also, how hospital staff enforce and interpret the same visitation policies can be dissimilar.

This variability is a cause of stress for nurses, families and patients. Hospitals are striving for excellence and are now focused on family-centered care. Families play an important role in the ICU patient’s recovery, so an important role of family center care is open visitation. Patients place a high value on having family at their bedside offering them a sense of security in a highly technology driven atmosphere.

The ICU is a stressful place full of noises, strangers and equipment. Having a familiar face at the bedside can decrease patient stress and length of stay and help answer questions in the ICU. Also, it increases patient quality, safety and satisfaction. For the family, it increases communication with medical staff, allows family to be involved with care and contributes to better understanding of the medical world.

But families have to understand there are times when visitation is restricted. Families cannot camp out in the ICU rooms. ICU rooms are small and can accommodate only one or two visitors at a time. Also ICU rooms are full of equipment and technology. ICUs have patients in them who are very seriously ill; therefore, it is not a place for a family reunion.

In addition, families cannot disrupt the functioning of the ICU. Infection disease precautions may be needed that can restrict visitation. If an ICU patient is in a shared room – and this can happen – visitors may be asked to leave temporarily if immediate lifesaving measures are required or sensitive discussions need to occur with another patient.

Being a nurse with over 25 years of experience in the ICU, I know hospitals need to let families stay as long as they want to at their loved ones bedside even during lifesaving circumstances. In a 2011 study, almost 80 percent of nurses said they wanted unrestricted visiting policies. Families are a big help at the bedside. Many help with turning, bathing and feeding.

The Joint Commission that accredits hospitals based on medical and safety standards urges families to stay at the patient’s bedside to help ensure correct treatments are given and to be the patient’s advocate. This experience is positive, bringing staff and families together working toward a common goal of taking care of their loved one. With the increased use of the Internet, families are becoming very knowledgeable about disease and medical care, so leaving them out of the picture should not be accepted. Communication would be more open and frequent with families at the bedside.

Research makes clear that unrestricted presence of a support person at the bedside can increase communication, improve patient- and family-centered care and advance staff satisfaction. The message to families is that the hospital, ICU staff and family need to provide a positive ICU experience to that critically ill patient.

If you have a loved one in an ICU, stay with him, but remember to take care of yourself, eat and sleep.

Darla Topley, R.N., of Chapel Hill is a doctorate of nursing practice student at Duke University.

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