UNASSIGNED: Visitation plays a number of positive roles for critically ill patients and their families. It reduces the physical and mental stress of intensive care unit (ICU) patients and their families and allows family members to participate in patient care. Visit prohibition during the COVID-19 pandemic has raised unprecedented challenges to patients, family members, and health care providers.
UNASSIGNED: This qualitative study aimed to explore the experiences of families of patients in the ICU with no-visitor policies due to COVID-19.
UNASSIGNED: Data collection was conducted through 8 individual in-depth semi-structured interviews conducted between October 2021 and March 2022. Data analysis was performed following the qualitative method proposed by Colaizzi. The researchers independently analyzed the data, checked the findings, derived subthemes, and categorized them into overarching themes.
UNASSIGNED: Four themes emerged from the data analysis: (a) experiencing emotional distress, (b) being fearful of in-person patient contact, (c) being dissatisfied with the access control policy in the ICU, and (d) making efforts to reach the patient.
UNASSIGNED: It is critical to provide support and develop interventions for families denied visitation with loved ones in ICUs. Since in-person visits are crucial for families, hospitals should establish clear and reasonable visitation guidelines, communicate effectively with families, and offer alternative methods for them to connect with loved ones in the ICU.

OBJECTIVE: The aim of this study was to assess the effects of flexible intensive care unit (ICU) visitation on the 1-year prevalence of post-traumatic stress, anxiety and depression symptoms among family members of critically ill patients.
METHODS: This is a long-term outcome analysis of a cluster-crossover randomized clinical trial that evaluated a flexible visitation model in the ICU (12 h/day) compared to a restrictive visitation model (median 1.5 h/day) in 36 Brazilian ICUs. In this analysis, family members were assessed 12 months after patient discharge from the ICU for the following outcomes: post-traumatic stress symptoms measured by the Impact Event Scale-6 and anxiety and depression symptoms measured by the Hospital Anxiety and Depression Scale.
RESULTS: A total of 519 family members were analyzed (288 in the flexible visitation group and 231 in the restrictive visitation group). Three-hundred sixty-nine (71.1%) were women, and the mean age was 46.6 years. Compared to family members in the restrictive visitation group, family members in the flexible visitation group had a significantly lower prevalence of post-traumatic stress symptoms (21% vs. 30.5%; adjusted prevalence ratio [aPR], 0.91; 95% confidence interval [CI] 0.85-0.98; p = 0.01). The prevalence of anxiety (28.9% vs. 33.2%; aPR 0.93; 95% CI 0.72-1.21; p = 0.59) and depression symptoms (19.2% vs. 25%; aPR, 0.78; 95% CI 0.60-1.02; p = 0.07) did not differ significantly between the groups.
CONCLUSIONS: Flexible ICU visitation, compared to the restrictive visitation, was associated with a significant reduction in the 1-year prevalence of post-traumatic stress symptoms in family members.

BACKGROUND: We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs.
METHODS: We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools.
RESULTS: We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported.
CONCLUSIONS: This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises.
BACKGROUND: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .

暂无摘要。

OBJECTIVE: To characterize nurses\' experiences of restrictive visitation during the COVID-19 pandemic.
METHODS: In early 2023, an exploratory study investigated professional RNs\' perceptions of restrictive visitation policies and end-of-life care during the COVID-19 pandemic, focusing on experiences between March and September 2020. An 11-question online survey containing qualitative and quantitative elements was sent to postlicensure nursing students and alumni of American Public University System (American Military University/American Public University).
RESULTS: Among the 41 survey respondents (response rate of 4%), 75.6% observed patients dying alone due to visitation restrictions during March-September 2020, with 87.8% noting strict no-visitation policies, yet only 10% found it effective. A majority (68.3%) supported allowing some family presence, reflecting negative sentiments toward strict policies; suggestions for enhancing family involvement included technology (78%) and employing volunteers or liaisons (34.1%) to improve patient/family well-being and alleviate nurse burden.
CONCLUSIONS: The findings revealed insights into nurses\' experiences and perspectives on end-of-life care and visitation limitations during the pandemic. While the isolation of patients during times of strict visitation restrictions has some merit, exploring options for modified family visitation at the end of life is critical.

暂无摘要。

Federal authorities banned nursing home visitation in the early days of the coronavirus disease 2019 (COVID-19) pandemic. However, there was growing concern that physical isolation may have unintended harms on nursing home residents. Thus, nursing homes and policymakers faced a tradeoff between minimizing COVID-19 outbreaks and limiting the unintended harms. Between June 2020 and January 2021, 17 states implemented Essential Caregiver policies (ECPs) allowing nursing home visitation by designated family members or friends under controlled circumstances. Using the Nursing Home COVID-19 Public File and other relevant data, we analyze the effects of ECPs on deaths among nursing home residents. We exploit variation in the existence of ECPs across states and over time, finding that these policies effectively reduce both non-COVID-19 and COVID-19 deaths, resulting in a decrease in total deaths. These effects are larger for states that implemented policies mandatorily or without restrictions, indicating a dose-response relationship. These policies reduce non-COVID-19 deaths in facilities with higher quality or staffing levels, while reducing COVID-19 deaths in facilities with lower quality or staffing levels. Our findings support the use and expansion of ECPs to balance resident safety and the need for social interaction and informal care during future pandemics.

暂无摘要。

BACKGROUND: Falls with harms (FWH) in hospitalized patients increase costs and lengths of stay. The COVID-19 pandemic has resulted in more FWH. Additionally, the COVID-19 pandemic has resulted in increased patients in isolation with fewer visitors. Their relationship with falls has not been previously studied.
METHODS: This is a retrospective, single-site, 12-month before pandemic-12-month after pandemic, observational study. Multiple logistic regression analysis was used to model FWH outcome and associations with isolation and visitor restrictions.
RESULTS: There were 4369 isolation events and 385 FWH among 22,505 admissions during the study period. Unadjusted analysis demonstrated a FWH risk of 1.33% (95% CI 0.99, 1.67) in those who were placed in isolation compared to 1.80% (95% CI 1.60, 2.00) in those without an isolation event ( χ2 = 4.73, P = 0.03). The FWH risk during the different visitor restriction periods was significantly higher compared to the prepandemic period ( χ2 = 20.81, P < 0.001), ranging from 1.28% (95% CI 1.06, 2.50) in the prepandemic period to 2.03% (95% 1.66, 2.40) with no visitors permitted (phase A) in the pandemic period. After adjusting for potential confounders and selection bias, only phase A visitor restrictions were associated with an increased FWH risk of 0.75% (95% CI 0.32, 1.18) compared to no visitor restrictions.
CONCLUSIONS: Our results suggest a moderately strong association between hospitalized patient FWH risk and severe visitor restrictions. This association was muted in phases with even minor allowances for visitation. This represents the first report of the adverse effects of visitor restriction policies on patients\' FWH risks.
What is already known on this topic – Patient accidents in hospitals account for 4% of all hospital-related harmful events. There are many risk factors that contribute to these accidents, but few interventions that reduce their risk. During the COVID-19 pandemic period, the number of patient accidents has increased. While the reasons for this association are unclear, they may be related to COVID-19-related interventions such as patient isolation and visitor restrictions. What this study adds – This exploratory study is the first to demonstrate that visitor restrictions may be associated with an increased risk of patient accidents. How this study might affect research, practice or policy – The potential harmful effects of visitor restrictions should be taken into consideration whenever these interventions are being implemented as part of a bundled strategy for prevention of infectious diseases transmission and protection. Patient accidents in hospitals resulting in harm requiring either treatment or prolonged hospital stay are of great interest to health care, policy makers and the general public. 1 They account for 4% of all hospital-related harmful events and are included as an indicator in the new Hospital Harm Measure instituted across Canada as a patient safety quality measure of acute hospital care. 2 Since the declaration of the COVID-19 pandemic in Canada on March 13, 2020, there were 0.26 patient trauma events per 100 hospitalizations reported in both 2020–2021 and 2021–2022, a 13% increase from 2019 to 2020. 3 In a population-based observational study conducted among Ontario patients hospitalized in 2015–2016, patient accidents were estimated to increase the index hospitalization length of stay by 17.3 days (95% CI 17.0, 17.6) and costs by $47824 (95% CI 47,383, 48,266) (CDN). 4 There have been over 400 clinical factors identified as being associated with an increased risk of falls in hospitalized patients. 5 Risk mitigation strategies have been implemented in many hospitals to prevent anticipatory falls defined as potentially preventable through early identification of patients that exhibit clinical signs associated with increased risk of falls. These anticipatory falls make up approximately 30% of all falls, with the remainder being nonpreventable and due to unanticipated or accidental falls. 5 In a recent systematic review and meta-analysis of the effects of falls prevention interventions on fall outcomes for adults in hospital settings, patient and staff education was the only intervention that reduced the fall rate risk ratio (RR) 0.70 (95% CI 0.51, 0.96) and the fall odds ratio 0.62 (95% 0.47, 0.83) with a high level of certainty, while early stratification using fall risk screening tools, rehabilitation and exercise therapies, assistive and alarm devices, system changes such as hourly rounding, and environmental modifications demonstrated no benefit. 6 One particular program, the Fall TIPS program, 7,8 which leverages visitor engagement to ensure that patients are compliant with fall prevention recommendations printed on a laminated poster or visual aid, demonstrated a 34% reduction in falls with harm, suggesting a potential mechanism through which patient visitation might reduce patient harm. On March 11, 2020, the World Health Organization (WHO) declared a COVID-19 pandemic. 9 In an attempt to prevent the introduction and spread of COVID-19 in Canadian hospitals and prevent transmission from patients and healthcare providers to visitors, regional and local public health authorities advised acute care hospitals to cancel elective clinic visits, treatments, and surgical procedures and implement visitor restrictions and enhanced COVID-19 screening and isolation protocols. These recommendations resulted in increased numbers of patients in contact/droplet isolation precautions and more severe patient visitor restrictions. Many of these recommendations were revised during the subsequent pandemic waves, as some were considered by many to be ineffective and potentially harmful. 10–12 For example, some have argued that patient visitors are unlikely to be an important source of hospital-acquired COVID-19 infection. 12 The authors concluded that severe patient visitor restrictions may have prevented few COVID-19 infections, while contributing to low staff morale and worse patient outcomes. In a retrospective before-after ecological study conducted at 32 hospitals within the Beryl Institute community in the United States from 2019 to 2020, the unadjusted in-hospital fall with hip fracture rates increased from 0.03 events (per 1000 hospital discharges) in 2019 in hospitals with no visitor restrictions, to 0.07 in hospitals with partial limited visitation in 2020, and to 0.14 in hospitals with absolute visitor restriction policies in 2020, 13 possibly suggesting a signal for patient harm associated with different levels of visitor restrictions. As for increased numbers of hospitalized patients in isolation, a systematic review noted that isolation practices are associated with less patient-healthcare worker interaction, delays in care, and increased symptoms of depression and anxiety. 14 The impact of either visitor restrictions or patient isolation on FWH risks has not been reported. 10,11,14 This is an exploratory study to determine if there is an association between either isolation precautions or visitor restrictions and increased falls with harm risk in adult patients hospitalized in an acute care community hospital.

暂无摘要。