Corona virus-related visitation restrictions enforced in ICUs in the Scandinavian countries – what can we learn to meet future challenges?

Critical illness not only dramatically affects the life of the patient, but also the lives of the close relatives. When a patient is admitted to the ICU for medical or surgical conditions, their relatives

suddenly have to deal with acute, critical illness and perhaps the fear of losing a loved one. During the corona virus pandemic, it is estimated that in the Scandinavian countries alone, thousands of the

hospitalized Covid-19 patients will become critically ill requiring ICU admission and mechanical ventilation. Based on experiences from China and Italy, it is currently expected that the Covid-19

patients will need critical care in the ICU for a period of one week and up to several weeks due to complications to their initial lung infection.

For the ICU patient, close relatives play a vital role during the ICU admission and throughout convalescence, and patients treasure their love and support. Also, family presence seems to reduce ICU delirium and increase both patient and family satisfaction.

During times in the ICU when the patient is unconscious due to illness or medical sedation, besides providing love and support relatives also take on an important role of advocating for the patient. Consequently, in the Scandinavian countries today relatives are welcomed in the ICU as important partners in the care of the critically ill patient.

The relatives are personally affected by experiences of critical illness and are vulnerable and anxious. The ongoing critical situation may be experienced as a breakdown altering familial constellations. Research has shown that for relatives, critical illness and ICU admission may cause anxiety, depression, insomnia and post-traumatic stress disorder (PTSD), and for those who experience the loss of the patient grief or perhaps also even symptoms of complicated grief. Therefore, health professionals have

increasingly involved relatives under the concept of patient, family-centred care (PFCC) acknowledging the research-based evidence suggesting that in critical care the focus should be on the family as a whole.

International literature point to three overall needs of relatives in the ICU: First a need to be informed about the patient’s situation; second, a need to be with the patient, and third, to be involved in the care of the patient.

An open visitation policy is a cornerstone for relatives to be able to visit and be involved in the care of their critically ill loved one. Consequently, the newly enforced corona virus-related restrictions upon visitation in hospitals including ICUs in Denmark, Sweden and Norway represent a historic break with a strong tradition in the Scandinavian countries to involve ICU patients’ relatives as vital partners in ICU care. Family researchers fear that for relatives the visitation restrictions will cause a high level of worry, anxiety and frustration, which again may lead to longterm psychological health problems. From colleagues in Italy we have learned that for ICU professionals, the unfamiliar practice of trying to keep relatives informed through the phone or trying to connect the patient and relatives using digital communication devices alone is a new and demanding task.

The aim is to study the strategies developed by staff and relatives to meet the challenges related to the Corona-related visitation restrictions in the ICU.

Project leader:

Hanne Birgit Alfheim

 
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