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Intensive Care Medicine

, Volume 39, Issue 12, pp 2180–2187 | Cite as

Partial liberalization of visiting policies and ICU staff: a before-and-after study

  • Alberto Giannini
  • Guido Miccinesi
  • Edi Prandi
  • Carlotta Buzzoni
  • Claudia Borreani
  • The ODIN Study Group
Original

Abstract

Purpose

To investigate possible psychological distress among staff after partial liberalization of visiting policies in intensive care units (ICUs).

Methods

We surveyed eight Italian ICUs planning to increase daily visiting to at least 8 h. Participants completed the Maslach–Jackson Burnout Inventory and the State-Trait Anxiety Inventory before policy change (T0), after 6 months (T1) and 12 months (T2). At T0 and T2, their opinions on the new policy were solicited. Analyses were adjusted for main known confounders (age, gender, centre, educational and marital status, experience in ICU, baseline level of burnout or anxiety, and mortality rate).

Results

Baseline response rate was 89 % (230/258); 198 subjects (77 %) responded at T0 and T2, whereas 184 (71 %) participated in all three phases. High burnout levels were identified in 34.5 % of participants at T0 and 42.6 % at T2 (adjusted p = 0.001). All three phases showed a predominance of high burnout among nurses (adjusted p = 0.002). State and trait anxiety scores remained stable (adjusted p = 0.100 and 0.288, respectively). Most participants viewed the change positively at T0 (doctors 81.7 %; nurses 67.7 %) and T2 (doctors 87.0 %; nurses 62.7 %). At T2, 129 participants made comments (180 positive, 136 negative). Subjects with high burnout were more likely to comment negatively (p = 0.011).

Conclusions

Partial liberalization of ICU visiting policies was associated over the course of a year with a small but significant increase in staff members’ burnout levels. Nonetheless, doctors and nurses viewed the policy positively, maintaining this opinion after 1 year. Negative views were strongly correlated with burnout.

Keywords

Intensive care Visiting policies Burnout Anxiety Stress Family 

Notes

Acknowledgments

We thank all doctors and nurses of surveyed ICUs for their cooperation in this study. This study was supported by ABN (Associazione per il Bambino Nefropatico, Milan, Italy) and by Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico (Milan, Italy)

References

  1. 1.
    Burchardi H (2002) Let’s open the door! Intensive Care Med 28:1371–1372PubMedCrossRefGoogle Scholar
  2. 2.
    Berwick DM, Kotagal M (2004) Restricted visiting hours in ICUs: time to change. JAMA 292:736–737PubMedCrossRefGoogle Scholar
  3. 3.
    Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D, American College of Critical Care Medicine Task Force 2004–2005, Society of Critical Care Medicine (2007) Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004–2005. Crit Care Med 35:605–622PubMedCrossRefGoogle Scholar
  4. 4.
    American Association of Critical Care Nurses (2011) Family presence: visitation in the adult ICU. http://www.aacn.org/WD/practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf. Accessed 31 Aug 2012
  5. 5.
    Gibson V, Plowright C, Collins T, Dawson D, Evans S, Gibb P, Lynch F, Mitchell K, Page P, Sturmey G (2012) Position statement on visiting in adult critical care units in the UK. Nurs Crit Care 17:213–218PubMedCrossRefGoogle Scholar
  6. 6.
    Knutsson SE, Otterberg CL, Bergbom IL (2004) Visits of children to patients being cared for in adult ICUs: policies, guidelines and recommendations. Intensive Crit Care Nurs 20:264–274PubMedCrossRefGoogle Scholar
  7. 7.
    Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM (2007) Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med 35:497–501PubMedCrossRefGoogle Scholar
  8. 8.
    Hunter JD, Goddard C, Rothwell M, Ketharaju S, Cooper H (2010) A survey of intensive care unit visiting policies in the United Kingdom. Anaesthesia 65:1101–1105PubMedCrossRefGoogle Scholar
  9. 9.
    Spreen AE, Schuurmans MJ (2011) Visiting policies in the adult intensive care units: a complete survey of Dutch ICUs. Intensive Crit Care Nurs 27:27–30PubMedCrossRefGoogle Scholar
  10. 10.
    Soury-Lavergne A, Hauchard I, Dray S, Baillot ML, Bertholet E, Clabault K, Jeune S, Ledroit C, Lelias I, Lombardo V, Maetens Y, Meziani F, Reignier J, Souweine B, Tabah A, Barrau K, Roch A, Société de Réanimation de Langue Française (SRLF) (2012) Survey of caregiver opinions on the practicalities of family-centred care in intensive care units. J Clin Nurs 21:1060–1067PubMedCrossRefGoogle Scholar
  11. 11.
    Vandijck DM, Labeau SO, Geerinckx CE, De Puydt E, Bolders AC, Claes B, Blot SI, 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 39:137–146PubMedCrossRefGoogle Scholar
  12. 12.
    Giannini A, Marchesi T, Miccinesi G (2011) “Andante moderato”: signs of change in visiting policies for Italian ICUs. Intensive Care Med 37:1890PubMedCrossRefGoogle Scholar
  13. 13.
    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 113:946–952PubMedCrossRefGoogle Scholar
  14. 14.
    Garrouste-Orgeas M, Philippart F, Timsit JF, Diaw F, Willems V, Tabah A, Bretteville G, Verdavainne A, Misset B, Carlet J (2008) Perceptions of a 24-hour visiting policy in the intensive care unit. Crit Care Med 36:30–35PubMedCrossRefGoogle Scholar
  15. 15.
    Proctor DL (1987) Relationship between visitation policy in a pediatric intensive unit and parental anxiety. Child Health Care 16:13–17PubMedCrossRefGoogle Scholar
  16. 16.
    Malacarne P, Corini M, Petri D (2011) Health care-associated infections and visiting policy in an intensive care unit. Am J Infect Control 39:898–900PubMedCrossRefGoogle Scholar
  17. 17.
    Berti D, Ferdinande P, Moons P (2007) Beliefs and attitudes of intensive care nurses toward visits and open visiting policy. Intensive Care Med 33:1060–1065PubMedCrossRefGoogle Scholar
  18. 18.
    Marco L, Bermejillo I, Garayalde N, Sarrate I, Margall MA, Asiain MC (2006) Intensive care nurses’ beliefs and attitudes towards the effect of open visiting on patients, family and nurses. Nurs Crit Care 11:33–41PubMedCrossRefGoogle Scholar
  19. 19.
    Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E (2007) Burnout syndrome among critical care healthcare workers. Curr Opin Crit Care 13:482–488PubMedCrossRefGoogle Scholar
  20. 20.
    Giannini A, Miccinesi G, Leoncino S (2008) Visiting policies in Italian intensive care units: a nationwide survey. Intensive Care Med 34:1256–1262PubMedCrossRefGoogle Scholar
  21. 21.
    Maslach C, Jackson S, Leiter MP (1996) Maslach Burnout Inventory manual. Consulting Psychologists, Palo AltoGoogle Scholar
  22. 22.
    Sirigatti S, Stefanile C (1993) Adattamento italiano MBI—Maslach Burnout Inventory. Organizzazioni Speciali, FirenzeGoogle Scholar
  23. 23.
    Embriaco N, Azoulay E, Barrau K, Kentish N, Pochard F, Loundou A, Papazian L (2007) High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med 175:686–692PubMedCrossRefGoogle Scholar
  24. 24.
    Poncet MC, Toullic P, Papazian L, Kentish-Barnes N, Timsit JF, Pochard F, Chevret S, Schlemmer B, Azoulay E (2007) Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 175:698–704PubMedCrossRefGoogle Scholar
  25. 25.
    Merlani P, Verdon M, Businger A, Domenighetti G, Pargger H, Ricou B, STRESI + Group (2011) Burnout in ICU caregivers: a multicenter study of factors associated to centers. Am J Respir Crit Care Med 184:1140–1146PubMedCrossRefGoogle Scholar
  26. 26.
    Spielberger CD, Gorsuch RL, Lushene RE (1970) STAI manual for the state-trait anxiety inventory. Consulting Psychologists, CaliforniaGoogle Scholar
  27. 27.
    Spielberger CD (1989) STAI (State-Trait Anxiety Inventory). Inventario per l’ansia di stato e di tratto. Forma Y. Organizzazioni Speciali, FirenzeGoogle Scholar
  28. 28.
    Liang KY, Zeger SL (1993) Regression analysis for correlated data. Annu Rev Public Health 14:43–68PubMedCrossRefGoogle Scholar
  29. 29.
    Raggio B, Malacarne P (2007) Burnout in intensive care unit. Minerva Anestesiol 73:195–200PubMedGoogle Scholar
  30. 30.
    Karanikola MN, Papathanassoglou ED, Mpouzika M, Lemonidou C (2012) Burnout syndrome indices in Greek intensive care nursing personnel. Dimens Crit Care Nurs 31:94–101PubMedCrossRefGoogle Scholar
  31. 31.
    Coomber S, Todd C, Park G, Baxter P, Firth-Cozens J, Shore S (2002) Stress in UK intensive care unit doctors. Br J Anaesth 89:873–881PubMedCrossRefGoogle Scholar
  32. 32.
    Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinová K, Lafabrie A, Abizanda R, Svantesson M, Rubulotta F, Ricou B, Benoit D, Heyland D, Joynt G, Français A, Azeivedo-Maia P, Owczuk R, Benbenishty J, de Vita M, Valentin A, Ksomos A, Cohen S, Kompan L, Ho K, Abroug F, Kaarlola A, Gerlach H, Kyprianou T, Michalsen A, Chevret S, Schlemmer B, Conflicus Study Investigators and for the Ethics Section of the European Society of Intensive Care Medicine (2009) Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med 180:853–860PubMedCrossRefGoogle Scholar
  33. 33.
    Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, Michalsen A, Maia PA, Owczuk R, Rubulotta F, Depuydt P, Meert AP, Reyners AK, Aquilina A, Bekaert M, Van den Noortgate NJ, Schrauwen WJ, Benoit DD, APPROPRICUS Study Group of the Ethics Section of the ESICM (2011) Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA 306:2694–2703PubMedCrossRefGoogle Scholar
  34. 34.
    Hickey M, Lewandowski L (1988) Critical care nurses’ role with families: a descriptive study. Heart Lung 17:670–676PubMedGoogle Scholar
  35. 35.
    Plowright C (2007) Visiting practices in hospitals. Nurs Crit Care 12:61–63PubMedCrossRefGoogle Scholar
  36. 36.
    Biancofiore G, Bindi LM, Barsotti E, Menichini S, Baldini S (2010) Open intensive care units: a regional survey about the beliefs and attitudes of healthcare professionals. Minerva Anestesiol 76:93–99PubMedGoogle Scholar
  37. 37.
    Ciufo 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-centred care. Int J Evid Based Healthc 9:362–387PubMedCrossRefGoogle Scholar
  38. 38.
    Weaver JL, Bradley CT, Brasel KJ (2012) Family engagement regarding the critically ill patient. Surg Clin N Am 92:1637–1647PubMedCrossRefGoogle Scholar
  39. 39.
    Lavoie-Tremblay M, Bonin JP, Lesage AD, Bonneville-Roussy A, Lavigne GL, Laroche D (2010) Contribution of the psychosocial work environment to psychological distress among health care professionals before and during a major organizational change. Health Care Manag (Frederick) 29:293–304CrossRefGoogle Scholar
  40. 40.
    Donald B, Fedor DB, Caldwell S, Herold DM (2006) The effects of organizational changes on employee commitment: a multilevel investigation. Pers Psychol 59:1–29CrossRefGoogle Scholar
  41. 41.
    Roland P, Russell J, Richards KC, Sullivan SC (2001) Visitation in critical care: processes and outcomes of a performance improvement initiative. J Nurs Care Qual 15:18–26PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Alberto Giannini
    • 1
  • Guido Miccinesi
    • 2
  • Edi Prandi
    • 1
  • Carlotta Buzzoni
    • 2
  • Claudia Borreani
    • 3
  • The ODIN Study Group
  1. 1.Pediatric Intensive Care UnitFondazione IRCCS Ca’ Granda—Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Unit of Clinical and Descriptive EpidemiologyIstituto per lo Studio e la Prevenzione Oncologica—ISPOFlorenceItaly
  3. 3.Unit of Clinical PsychologyFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly

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