In response to “Intensive care nurse perspectives on open visiting in an ICU”

Dear Editor,

The paper entitled “Perspectives of intensive care nurses on open visits in an ICU” by Alonso Rodríguez et al.¹ was recently published in this journal. Open visits are part of the changes in model that are taking place in intensive care units (ICU), where the focus of attention is shifting from technology to the patient. In this context, visiting hours are becoming more flexible; however, there are still few units that have implemented what is known as an open-door policy,² and there is little information on the subject.

The article provides very interesting information as it reflects the opinion of professionals in a unit with experience of extended visiting hours. The study concludes that most of the health professionals have a negative opinion towards the open-door policy, although they acknowledge that it can be beneficial for patients and families.

Do these results currently correspond to most units in our setting?

An open visiting regime was implemented in December 2019 in our unit (ICU Hospital del Mar, Barcelona), allowing one visitor to stay with the patient 24 h a day if they wish, in addition to 2 shifts of 2 h in the morning and afternoon for 2 other visitors. Unfortunately, in March 2020 this was interrupted by COVID-19. Our experience with the absence of family members in the units has made us even more aware of their importance.

Before this regimen was started, the opinion of all the healthcare staff in the unit (nurses, nursing assistants (TCAE), doctors, physiotherapists, porters) was sought through an informal survey. The survey found that most (69%) of the health professionals agreed with the regimen’s implementation, because they considered it beneficial for both the patient and the family. However, in agreement with the data from the study by Alonso Rodríguez et al.,¹ they believed that the presence of the family added to the workload and could create problems of privacy for patients, and issues with space in the rooms.

The above prompts us to make some observations.

Firstly, we work in an environment with complex emotional situations, and we need to incorporate communication skills into our training, as Alonso Rodríguez et al.¹ state. This will help us improve our relationship with patients and families, provide better emotional support and enhance our professional satisfaction.

Secondly, ICUs were designed for the monitoring and care of patients, but not their wellbeing. We must rethink physical spaces that facilitate our work and that are also pleasant, more spacious and allow us to safeguard privacy.

Finally, if we assume that open visiting is beneficial for the patient³ and the family, we must be able to provide it. Families also require care and as such cause an increase in workload. Would this make us stop providing a therapy?

The nurse-to-patient ratio having been shown to affect mortality and patient safety,⁴ we need to demonstrate to managers the importance of this ratio on the quality of care we provide, for example, that caring for the family does not compromise patient care. We should convince them (and ourselves) that care to ensure the emotional wellbeing of patients and their families is also therapy.