Home⇛WVSU Research Journal⇛vol. 10 no. 1 (2021)

Effects of Liberal Visitation on Anxiety, Satisfaction, and Length of Stay Among Intensive Care Unit Patients

Lito Pari-an Rama | Rita Ramos

Discipline: Medicine

 

Abstract:

Several organizations recommended liberalization of ICU visits; however, the majority of the ICUs maintained restrictive visitation causing further lower social support to critically ill patients. The objective of the study is to determine the effects of Patient-Centered Liberal Visitation in the patients’ level of anxiety, satisfaction, and ICU length of stay. The study used a quasi- experimental, non-equivalent control group before-after design. It was conducted in an ICU in North America for a 5-month period using validated instruments. The study utilized consecutive sampling, 30 patients for the control and 30 for the intervention group. The control group had restricted visitation, wherein ICU visits were limited to specific hours per day. Patient- centered liberal visitation based on Levine’s Conservation Principles was implemented on the intervention group where visitations in ICU were more flexible. The study was approved by the Ethical Review Board. Sixty participants were included in the study with no significant difference when control and intervention group were clustered according to age (t=0.591, p=0.557), gender (X2= 0.069, p=0.793), marital status (X2= 5.524, p=0.137) and ethnicity (X2= 1.024, p=0.795). A significant difference within the intervention group’s pre-test and post-test Faces Anxiety Scale (FAS) Score (t=4.287, p=0.000) was noted. Similarly, the study found significant difference within the intervention group’s pre-test and post-test overall 6-item State Anxiety Inventory (SAI) Score (t=4.774, p=0.000). Pre-test anxiety scores in the intervention group were higher compared to post-test anxiety scores. Furthermore, a significant difference (t=3.831, p=0.000) was noted on patient satisfaction. The result showed higher patient satisfaction among the participants in the intervention group (4.73, SD 0.521) compared to the control group (3.97, SD 0.964). Lastly, when measuring the participants’ length of stay, no significant difference (t=-0.397, p=0.693) was noted. Patient-centered liberal visitation in the ICU decreases the patients level of anxiety and improves patient satisfaction. However, liberal visitation does not have a significant effect on the patients’ ICU length of stay.



References:

  1. Athanasiou, A., Papathanassoglou, E.D.E., Patiraki, E., McCarthy, M.S., Giannakopoulou, M. (2014). Family visitation in Greek intensive care units: Nurses’ perspective. American Journal of Critical Care, 23(4), 326-333. https://doi.org/10.4037/ajcc2014986
  2. Arde, B. O. (2017). Consonance theory: A proposed theory of patient satisfaction. Philippine Journal of Nursing, 87(2), 74-79.
  3. Azzil, R., Bambi, S., (2009). Open intensive care units: A feasible option? The opinions of patients, relatives and health care workers. Assistenza Infermieristica e Ricerca 2009, 28(2), 89-95.
  4. Ayllón Garrido, N., Montero Rus, P., Acebes Fernández, M. I., & Sánchez Zugazua, J. (2014). Open door intensive care unit: Perspective of the professionals. Enfermeria Intensiva, 25(2), 72–77. https://doi.org/10.1016/j.enfi.2013.11.007
  5. Baumgarten, M. & Poulsen, I. (2015). Patients’experiences of being mechanically ventilated in an ICU: A qualitative metasynthesis. Scandinavian Journal of Caring Sciences, 29; 205-214. https://doi.org/10.1111/scs.12177
  6. Biancofiore, G., Bindi, L.M., Menichin, S., Baldini, S. (2010). Open intensive care units: A regional survey about the beliefs and attitudes of healthcare professionals. Minerva Anestesiologica, 76(2), 93-99.
  7. Brodsky-Israeli, M. & De Keyser Ganz, F. (2011). Risk factors associated with transfer anxiety among patients transferring from the intensive care unit to the ward. Journal of Advance Nursing, 67(3), 510-518. https://doi.org/10.1111/j.1365-2648.2010.05497.x
  8. Castillo, M., Cooke, M., MacFarlane, B., & Aitken, L. (2015). Anxiety and depression in survivors of critical illness: What role does anxiety in ICU play? Australian Critical Care, 28, 38. https://doi.org/10.1016/j.aucc.2014.10.004
  9. Chapman, D.K., Collingridge, D.S., Mitchell, L.A., Wright, E.S., Hopkins, R.O., Butler, J.M., Brown, S.M. (2016). Satisfaction with elimination of all visitation restriction in a mixed-profile intensive care unit. American Journal of Critical Care, 25(1), 46-50. https://doi.org/10.4037/ajcc2016789
  10. Chlan, L (2003). Description of anxiety levels by individual differences and clinical factors in patients receiving mechanical ventilatory support. Heart Lung, 32(4): 275-82. https://doi.org/10.1016/s0147-9563(03)00096-7
  11. Ciuffo, D., Hader, R., Holly, C. (2011). A comprehensive systematic review of visitation models in adult critical care units within the context of patient- and family-centered care. International Journal of Evidence-Based Healthcare, 9(4), 362-387. https://doi.org/10.1111/j.1744-1609.2011.00229.x
  12. Da Silva Ramos, F.J., Fumis, R.R., Azevedo, L.C., Schettino, G. (2013). Perceptions of an open visitation policy by intensive care unit workers. Annals of Intensive Care, 17, 31-34. https://doi.org/10.1186/2110-5820-3-34
  13. Da Silva Ramos, F.J., Fumis, R.R.L., De Azevedo, L.C.P., Schettino, G. (2014). Intensive care unit visitation policies in Brazil: A multicenter survey. Revista Brasileira de Terapia Intensiva, 26(4), 339-346. https://doi.org/10.5935/0103-507X.20140052
  14. Deja, M., Denke, C., Weber-Carstens, S., Schröder, J., Pille, C. E., Hokema, F., Falke, K. J., & Kaisers, U. (2006). Social support during intensive care unit stay might improve mental impairment and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome. Critical care (London, England), 10(5), R147. https://doi.org/10.1186/cc5070
  15. De Jong, M.J., Chung, M.L., Roser, L.P., Jensen, L.A., Kelso, L.A. et al. A five-country comparison of anxiety early after acute myocardial infarction. European Journal of Cardiovascular Nursing, 3(2), 129-134. https://doi.org/10.1016/j.ejcnurse.2004.01.004
  16. Errasti-Ibarrondo, B., Tricas-Sauras, S. (2012). Benefits of flexible visitation in the intensive care units for the family of critical patients. Enfermeria Intensiva, 23(4),179-188. https://doi.org/10.1016/j.enfi.2012.08.001
  17. Fumagalli, S., Boncinelli, L., Lo Nostro, A., Valoti, P., Baldereschi, G., Di Bari, M., Ungar, A., Baldasseroni, S., Geppetti, P., Masotti, G., Pini, R., & Marchionni, N. (2006). Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot, randomized trial. Circulation, 113(7), 946–952. https://doi.org/10.1161/CIRCULATIONAHA.105.572537
  18. Gibson, V., Plowright, C., Collins, T., Dawson, D. , Evans, S. , Gibb, P. , Lynch, F. , Mitchell, K. , Page, P. and Sturmey, G. (2012). Position statement on visiting in adult critical care unit in the UK. Nursing in Critical Care, 17:213-218. https://doi.org/10.1111/j.1478-5153.2012.00513.x
  19. Gonzalez, C.E., Carroll, D.L., Elliott, J.S., Fitzgerald, P.A., Vallent, H.J. (2004). Visiting preferences of patients in the intensive care unit and in a complex care medical unit. American Journal of Critical Care, 13(3), 194-198.
  20. Gruenberg, D. A.; Shelton, W.; Rose, S. L.; Rutter, A. E.; Socaris, S.; McGee, G. (2006). Factors influencing length of stay in the intensive care unit. American Journal of Critical Care, 15(5):502-509
  21. Gustad, L.T., Chaboyer, W., & Wallis, M. (2005). Performance of the faces anxiety scale in patients transferred from the ICU. Intensive and Critical Care Nursing, 21, 355-360. https://doi.org/10.1016/j.iccn.2005.06.006
  22. Herrera-Espiñeira, C., Aguila, M., Castillo, M.R. (2009). Relationship between anxiety level of patients and their satisfaction with different aspects of healthcare. Health Policy, 89 (1), 37-45. https://doi.org/10.1016/j.healthpol.2008.04.012
  23. Hunter, J.D., Goddard, C., Rothwell, M., Ketharaju, S., Cooper, H. (2010). A survey of intensive care unit visiting policies in the United Kingdom. Anaesthesia, 65(11), 1101-1105. https://doi.org/10.1111/j.1365-2044.2010.06506.x
  24. Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E. (1985). APACHE II: a severity of disease classification system. Critical care medicine, 13(10), 818–829.
  25. Khaleghparast, S., Joolaee, S., Ghanbari, B., Maleki, M., Peyrovi, H., & Bahrani, N. (2015). A Review of Visiting Policies in Intensive Care Units. Global journal of health science, 8(6), 267–276. https://doi.org/10.5539/gjhs.v8n6p267
  26. Kohrt, B.A., & Worthman, C.M. (2009). Gender and anxiety in Nepal: the role of social support, stressful life events, and structural violence. CNS Neurocience & Therapeutics, 15(3), 237-248. https://doi.org/10.1111/j.1755-5949.2009.00096.x
  27. Soh, K. L., Soh, K. G., Ahmad, Z., Abdul Raman, R., & Japar, S. (2008). Perception of intensive care unit stressors in Malaysian Federal Territory hospitals. Contemporary nurse, 31(1), 86–93. https://doi.org/10.5172/conu.673.31.1.86
  28. Lee, M.D., Friedenberg, A.S., Mukpo, D.H., Conray, K., Palmisciano, A., Levy, M.M. (2007). Visiting hours policies in New England intensive care units: Strategies for improvement. Critical Care Medicine, 35(2), 497-501. https://doi.org/10.1097/01.CCM.0000254338.87182.AC
  29. Liu, V., Read, J.L., Scruth, E. & Cheng, E. (2013). Visitation policies and practices in US ICUs. Critical Care, 17, R71. https://doi.org/10.1186/cc12677
  30. McAdam, J.L., Arai, S. & Puntillo, K.A. (2008). Unrecognized contributions of families in the intensive care unit. Intensive Care Medicine, 34(6), 1097-1101. https://doi.org/10.1007/s00134-008-1066-z
  31. McAdam, J.L. & Puntillo, K.A. (2013). Open visitation policies and practices in US ICUs: Can we ever get there? Critical Care, 17, 171. https://doi.org/10.1186/cc12763
  32. McKinley, S., Coote, K., Stein-Parbury, J. (2003). Development and testing of a faces scale for the assessment of anxiety in critically ill patients. Journal of Advance Nursing, 41 (1), 73-79. https://doi.org/10.1046/j.1365-2648.2003.02508.x
  33. McKinley, S. & Elliott, R.M. (2008). Implications for Australian practice of North American guidelines for the support of the family in patient-centred intensive care. Collegian, 15(1), 11-17. https://doi.org/10.1016/j.colegn.2007.11.001
  34. McKinley, S., Stein-Parbury, J., Chehelnabi, A., Lovas, J. (2004). Assessment of anxiety in intensive care patients by using the faces anxiety scale. American Journal of Critical Care, 13, 146-152.
  35. Noordermeer, K.; Rijpstra, T. A.; Newhall, D.; Pelle, A. J. M.; van der Meer, N. J. M. (2013). Visiting policies in the adult intensive care units in the Netherlands: Survey among ICU directors, International Scholarly Research Notices. https://doi.org/10.5402/2013/137045
  36. Pochard, F. (2011). Psychiatric issues during and after intensive care (ICU) stays. Bulletin De L’academie Nationale De Medecine, 195(2), 377-385.
  37. Roland, P., Russell, J., Richards, K.C., Sullivan, S.C. (2001). Visitation in critical care: Processes and outcomes of a performance improvement initiative. Journal of Nursing Care Quality,15(2),18-26. https://doi.org/10.1097/00001786-200115020-00004
  38. Rosa, R. G., Falavigna, M., Robinson, C. C., da Silva, D. B., Kochhann, R., de Moura, R. M., Santos, M. M. S., Sganzerla, D., Giordani, N. E., Eugênio, C., Ribeiro, T., Cavalcanti, A. B., Bozza, F., Azevedo, L. C. P., Machado, F. R., Salluh, J. I. F., Pellegrini, J. A. S., Moraes, R. B., Hochegger, T., Amaral, A., ICU Visits Study Group Investigators and the BRICNet. (2018). 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). BMJ open, 8(4), e021193. https://doi.org/10.1136/bmjopen-2017-021193
  39. Sharma B. G., Maben EVS, & Ganaraja B. (2014). Psychological evaluation of patients in critical care/intensive care unit and patients admitted in wards. Journal of Clinical and Diagnostic Research, 8(12),1-3. https://doi.org/10.7860/JCDR/2014/10293.5297
  40. Sukantarat, K., Greer, S., Brett, S., & Williamson, R. (2007). Physical and psychological sequelae of critical illness. British Journal of Health Psychology, 12(1), 65-74. https://doi.org/10.1348/135910706X94096
  41. Sukantarat, K., Williamson, R.C.N., & Brett, S.J. (2007). Psychological assessment of ICU survivors: A comparison between the Hospital Anxiety and Depression scale and the Depression, Anxiety and Stress scale. Anaesthesia, 62(3), 239-243. https://doi.org/10.1111/j.1365-2044.2006.04948.x
  42. Tate, J.A., Dabbs, A.D., Hoffman, L., Milbrandt, E. & Happ, M.B. (2012). Anxiety and agitation in mechanically ventilated patients. Qualitative Health Research, 22(2), 157–173. https://doi.org/10.1177/1049732311421616
  43. Usher, B & Hill, K. (2016). AACN Practice Alert: Family visitation in the adult ICU. Critical Care Nurse, 36(1): e15-e19.
  44. Vandijck, D. M., Labeau, S. O., Geerinckx, C. E., De Puydt, E., Bolders, A. C., Claes, B., Blot, S. I., & Executive Board of the Flemish Society for Critical Care Nurses, Ghent and Edegem, Belgium (2010). An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: A multicenter survey. Heart & Lung: The Journal of Critical Care, 39(2), 137–146. https://doi.org/10.1016/j.hrtlng.2009.06.001
  45. Wenham, T., & Pittard, A. (2009) Intensive care unit environment. Continuing Education in Anaesthesia Critical Care & Pain, 9(6): 178–183. https://doi.org/10.1093/bjaceaccp/mkp036
  46. Whitcomb, J.J., Roy, D., Blackman, V.S. (2010). Evidence-based practice in a military intensive care unit family visitation. Nursing Research, 59(1),S32-39. https://doi.org/10.1097/NNR.0b013e3181c3c028

Tools


Copyright © 2024  KITE Digital Educational Solutions |  Exclusively distributed by CE-Logic