"These Rules Are So Cruel": Bedside Picu Healthcare Providers' Impactful Experiences Associated with Covid-19- Related Restricted Family Presence: A Qualitative Analysis of Free Text

ABSTRACT

BACKGROUND AND AIM: Family centered care is a core value adopted by most healthcare providers (HCPs) working in North American PICUs. Restricted family presence (RFP) policies adopted during the COVID-19 pandemic threatened this value, with the potential for significant impact. This study explores how implementing and enforcing RFP policies impacted bedside HCPs in PICUs. METHOD(S) We conducted a national, online, selfadministered cross-sectional survey of bedside HCPs from all 19 Canadian PICUs about their experience with RFP. The Impact of Event Scale (IES), an existing validated scale, was included as a survey instrument. Prior to completing the scale, respondents were asked to describe the impactful experience(s) that they planned to reference. The resulting free-text responses were inductively coded for emergent themes, which were discussed for consensus. RESULT(S) 146/388 survey respondents completed the IES (94% English speaking;62% RN, 18% MD, 15% RT;87% self-identified women). Six themes related to impactful situations or events emerged from the event descriptions 1. Concern about the impact on the patient and family (n=57);2. Non-family centered end-of-life situations (n=43, including 5 who reported family members unable to be present for a death);3. Separating families and denying access (n=36);4. The general, overall experience (n=25), a subtheme of which was "RFP was a positive or neutral experience" (n=13);5. Policies and enforcement felt unjust and unfair (n=23);and 6. Family member non-compliance and aggressive reactions (n=15). CONCLUSION(S) Bedside HCPs experienced multiple impactful, potentially trauma-inducing situations related to RFP.