Visitation and Caregiver Presence in the Adult ICU

Situation

B.W., a new RN, is undergoing orientation in the surgical ICU. He

asks his preceptor why the patients’ families are allowed on the unit

throughout the day and even the night. B.W. states that, in his last

position, visiting hours in the ICU were 10 AM to 12 PM and 4 PM to 6

PM. He adds that families make him nervous when they watch what

he is doing and ask him many questions. B.W. says that he plans to

tell the visitors to leave the patient’s room when he is giving care.

Ethical/Legal Points for Consideration

• We used to think that visitation caused the patient stress,

interfered with care, was mentally exhausting to patients and

caregivers, and contributed to increased infection rates. Evidence

does not support any of these beliefs.

1,2

• Evidence suggests several positive benefits of flexible visitation

for the patient: decreased anxiety, confusion, and agitation; fewer

cardiovascular complications; shorter ICU length of stay; and

reports that patients feel more secure and satisfied with care.

1

• Similar evidence exists for the benefits of flexible visitation for

caregivers: increased satisfaction, decreased anxiety, better

communication, and increased opportunities for patient and

caregiver teaching as caregivers are more involved in care.

1

• Some conditions may require restricting visitation: a documented

legal reason; visitor behavior presents a risk to the patient, staff,

or others; visitor behavior disrupts the functioning of the unit;

visitor has a contagious illness or has been exposed to a

contagious disease that could endanger the patient’s health; or

the patient requests fewer or no visitors.

Discussion Questions

1. How should the preceptor respond to B.W.’s statement of his

intentions?

2. Does B.W. have an ethical or legal obligation to allow visitation

regardless of his personal concerns? Defend your position.