Child Visitation in the Cardiothoracic/Coronary Care ICU

 Mary Friel Fanning, RN, C, EdD(c), MSN, CCRN
Director, Adult Cardiac Nursing Units
West Virginia University Hospitals

Problem:
Child Visitation within the Cardiothoracic/Coronary Care ICU was both restrictive and limiting. The current policy states that children under 14 years of age are not allowed to visit. Nursing staff have witnessed the need for children to visit either a parent or grandparent during their stay in ICU. The reverse has also been witnessed. Patients request to visit their children and grandchildren during their illness and deserve to say good-bye if their illness is terminal. The patient and the child have a common need to be together and to be a family unit during times of crisis.

In addition the enforcement of current practice is inconsistent. Nurses have varied beliefs and experiences related to child visitation which impacts their willingness to bend the current rules.

Finally, societal expectations are changing in which all family members are seen to be integral part of patient care.

Evidence:
An extensive review of the research literature was conducted using the key words child visitation, visiting and adult ICU, children’s needs, family visitation, patient needs and visitation, critical care visitation, visitation policies and ICU visitation. Twelve relevant articles were found. All articles recommended and supported a facilitated approach to child visitation.

Strategy:
A facilitated approach to child visitation was designed, implemented and evaluated.

Practice Change:
The practice change was designed to allow child visitation for children over 12 months of age. The implementation consisted of formalized education of nurses and support staff, compiling of a self-screening packet to assess appropriateness for visit based on immunization record, current health status, etc., development of an ICU coloring book, purchasing of child size rocking chairs to use when visiting and stickers for the children after the visit, and developing a postcard to obtain feedback regarding the experience.

Evaluation:
Feedback from nurses, support staff, parents/guardians and children has all been positive. In addition, the program has expanded to the Medical and Surgical Intensive Care Units at WVUH.

Recommendations:
A facilitated approach to child visitation can provide a positive experience that allows children and a critically ill family member to be together during times of crisis. 

References:
Baker, C. Neiswiadomy, R.M., Arnold, W. K. Nursing Interventions for Children with a Parent in the Intensive
         Care Unit. Heart and Lung. 1998: 17 (4): 441-446.

Biley, F.C., Millar, B.J., Wilson, A.M. Issues in Intensive Care Visiting. Intensive and Critical Care Nursing.
         1993: 9: 75-81.

Clarke, C.M. Children Visiting Family and Friends on Adult Intensive Care Units: The Nurses Perspective. The
         Journal of Advanced Nursing. 2000; 31 (2): 330-338.

Clarke, C.M., Harrison, D., The Needs of Children Visiting on Adult Intensive Care Units: Review of the Literature
         and Recommendations for Practice. The Journal of Advanced Nursing. 2001; 34 (1): 61-68.

Johnson, D.L., Preparing Children for Visiting Parents in the Adult ICU. Dimensions of Critical Care Nursing.
         1994; 13 (3): 152-165.

Johnstone, M. Children Visiting Members of Their Family Receiving Treatments in ICUs: A Literature Review.
         Intensive and Critical Care Nursing. 1994; 10: 289-292.

Lewandowski, L.A. Needs of Children During the Critical Illness of a Parent or Sibling. Critical Care Nursing
         Clinics of North America. 1992: 4(4): 573-585.

McIvor, D. Should Children Be Restricted from Visiting A Relative in Intensive Care? Nursing in Critical Care.
         1998; 3(1): 36-40.

Nicholson, A.C., Titler, M., Montgomery, L., Kleiver, C., Craft, M.J., Halm, M., Buckwalter, K. & Johnson, S. Effects
         of Child Visitation in Adult Critical Care Units: A Pilot Study. Heart and Lung. 1993: 22 (1): 36-45.

Pierce, B. Children Visiting in the Adult ICU: A Facilitated Approach. Critical Care Nurse. 1998; 18 (2): 85-90.

Plowright, C.I. Revisiting Visiting in Intensive Therapy Units. Intensive and Critical Care Nursing. 1996: 12:
         231-238.

Titler, M.G., Cohen, M.Z., Craft, M.J., Impact of Adult Critical Care Hospitalization: Perceptions of Patients,
         Spouses, Children, and Nurses. Heart and Lung. 1991; 20 (2): 174-181.