The Experience of Picu Leaders with Restricted Family Presence during the Covid-19 Pandemic: A Qualitative Descriptive Interview Study

ABSTRACT

BACKGROUND AND AIM: Due to the COVID-19 pandemic, restricted family presence (RFP) policies were rapidly developed and implemented. PICU leadership was instrumental in dissemination, clarification, and policy enforcement. However, the experience of PICU leaders has not been explored. This study examines the lived experience of physician leads and operational/clinical managers with RFP policies and practices in the PICU. METHOD(S) Qualitative descriptive study. We invited physician leads and managers from all Canadian PICUs to participate in telephone or virtual, audio-recorded, semi-structured interviews, which were transcribed. We performed inductive content analysis: three researchers generated a codebook, two independent coders met regularly to compare codes and refine the codebook, and three researchers organized the data into themes. RESULT(S) We interviewed 9 managers and 15 physician leads from 13 Canadian PICUs. We identified 6 main themes. (1) Operationalizing the policies required enhancement and adaptation of usual leadership roles while (2) working in the middle of organizational hierarchy. (3) The RFP policies made explicit the need to balance stakeholder safety with compassion in caring for the sickest children. (4) Most PICU leaders perceived unintended effects of the RFP policies as having a negative impact on families, healthcare providers, and family centered care. (5) Implementing, communicating, and enforcing restrictions took personal tolls on many of the leaders. (6) Leaders recognized multiple opportunities for policy improvements. CONCLUSION(S) RFP policies had significant professional and personal impacts on PICU leaders, who identified both unintended consequences of and future opportunities for restricted presence policies.