Nurse Family Presence Beliefs and Decisions in Adult Intensive Care Unit

Background:  Hospitals continue to have restrictive hospital and ICU visiting policies (Lui, Read, Scruth & Cheng, 2013).  Intensive care units are places of complex quaternary and tertiary care for which most families give thanks and also fear.  Medical and nursing innovations along with patient response to treatment are remarkably improved however; in the midst of progress the ICU experience continues to be anxiety-producing and overwhelming for families.  In addition to the emotional upheaval for patients, families experience fear because of required separation from loved ones at a time of potential or actual physiological and hemodynamic instability and possibly death.  The combination of psychological and physiological effects related to the unexpected admission, separation, and uncertain outcomes, have been known to evoke feelings of chaos and helplessness for families.  The patient-centered care philosophy and mounting interest in associated outcomes heightens the importance of open family presence (FP) in adult ICUs.  Yet, families of adult intensive care patients continue to be relegated to restrictive bedside visitation practices. 

To positively impact this unpleasant issue for families requires better understanding of the involved factors and behaviors.  Because nurses are pivotal to quality care, are at the center of family care in ICUs and, are the actual “gatekeepers” who regulate family presence at the bedside, it is imperative to understand how their beliefs and attitudes influence FP decisions (Agard & Lomborg, 2010, pp 1107).  Exploring influences experienced by ICU nurses related to decision-making regarding open FP is important to uncovering knowledge pertinent to behavioral determinants and opportunities for change.  Additionally, it is important to examine factors that are perceived as the basis for nurse beliefs, expectations related to FP that come from those who are identified by the nurse as important and to understand perceptions about obstacles that may prevent the performance of a given behavioral outcome.  Beliefs and attitudes of nurses regarding family presence in intensive care units (ICU) are fundamental to ICU visiting practices.  Examination of nurse beliefs, as well as social and personal variables can uncover information regarding the impact of influences on decisions and held knowledge that can ultimately be used to target changes in FP nurse practices. 

Purpose:  The purpose of this study was to examine the influence of nurse beliefs on the relations between social, personal and situational variables and nurse decisions regarding FP in adult ICUs. 

Methods:  A cross-sectional research design guided by The Theory of Planned Behavior (Ajzen, 2011) was utilized to examine relations and the extent to which nurse beliefs mediated relations between nurse’s social, personal, situational predictor and outcome variables (FP decisions in adult ICUs).  The Adult Intensive Care Nurses’ Family Presence Questionnaire (AICFPQ) was used to measure nurse beliefs, attitudes, and other influential variables and behaviors related to ICU nurse FP decisions.

Results:  Ten factors emerged from the factor analysis of the AICFPQ.  The four factors with the highest internal consistency reliability were used for analysis (a = 0.67- 0.94). Of the 680 nurse respondents 91% were female, 40% were 50 years or older and 15% were non-Caucasian.  Statistical significant relations were identified between nurse variables, beliefs and decisions.  Over half of the nurses agreed that open FP increased patient and family satisfaction however, a majority (60%) of nurses did not routinely permit open FP.    

Conclusions: Select variables were influential in ICU nurse FP decisions.  Positive and negative nurse beliefs effected the magnitude of relations.  Findings provide new knowledge for practice change interventions.