A comprehensive systematic review of visitation models in adult critical care units within the context of patient- and family-centred care.

AIM: The aim of this review was to appraise and synthesise the best available evidence on visitation models used in adult intensive care units in acute care hospitals and to explicate their congruence with the core concepts of patient- and family-centred care (PFCC).

METHODS: The review considered both quantitative and qualitative studies on visitation models developed within the PFCC model in adult intensive care units in acute care hospitals. The search strategy sought published and unpublished research papers limited to English for the years 1988 through 2009. An initial search of the Joanna Briggs Institute for Evidence-Based Nursing and Midwifery, the Cochrane Library, and PubMed's Clinical Inquiry/Find Systematic Review database was conducted, followed by an analysis of key words contained in the title, abstract and index terms. Following this, an extensive three-stage search was conducted using PubMed, CINAHL, HealthStar, ScienceDirect, Dissertation Abstracts International, DARE, PsycINFO, BioMedCentral, TRIP, Pre-CINAHL, PsycARTICLES, Psychology and Behavioural Sciences Collection, ISI Current Contents, Science.gov, Web of Science/Web of Knowledge, Scirus.com website. Included was a hand search of reference lists of identified papers to capture all pertinent material as well as a search of relevant worldwide websites and search engines, such as Google Scholar and the Virginia Henderson Library of Sigma Theta Tau International. Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using the appropriate critical appraisal instrument.

RESULTS: Findings from the qualitative studies were extracted and a synthesis conducted using the QARI (Qualitative Assessment and Review Instrument) software developed by the Joanna Briggs Institute. One synthesis revealed that visiting hours were seen as guidelines for the benefit of nurse and patient, rather than rules or policy. Due to the various types of designs in the available studies, it was not possible to pool quantitative research study results into a statistical meta-analysis. Because statistical pooling was not possible, the findings are presented in a narrative form. Following this, results are presented for their congruence with the principles of PFCC.

CONCLUSION: Flexible visiting policies provide the ability to incorporate the concepts of PFCC into practice. However, nurses believe that while visiting is beneficial to patients, open and/or flexible visiting hours are an impediment to practice and increase their workload. Recommendations for best practice were formulated based on the outcomes and include visiting hours should be used as guidelines, not rules, that allow flexibility dependent upon individual patient/family situation. With regard to congruence with PFCC, patient and family requests for information emerged as an unmet need that needs to be addressed.