From Open to Closed: COVID-19 Restrictions on Previously Unrestricted Visitation Policies in Adult Intensive Care Units.

BACKGROUND: In March 2020, rising numbers of COVID-19 infections contributed to changes in intensive care unit visitation policies, with some facilities allowing no visitors. OBJECTIVE: To compare visitation policies of Magnet and Pathway to Excellence hospitals with prepandemic open visitation in adult intensive care units. METHODS: A mixed-methods study was conducted from January through March 2021. Quantitative data on visitation policies were extracted from websites of 96 Magnet and Pathway to Excellence hospitals that had allowed unrestricted visits in adult intensive care units before the pandemic. Qualitative data were collected via semistructured interviews with 9 nurse leaders from these hospitals. RESULTS: More than 1 year after the start of the pandemic, all of the hospitals had instituted restricted visitation policies. The policies varied, with little to no evidence-based justification. Restrictions included 83% of hospitals (n = 80) allowing just 1 visitor per day and 69% of hospitals (n = 50 of 72) allowing no visits at all for patients with COVID-19 in the intensive care unit. Five themes were found when nurse leaders' interviews were analyzed: visitors not welcome, doing harm, external decisions at system level, visiting within limits, and changes in critical care nursing work. CONCLUSION: Results of the study suggest that despite the vast amount of evidence supporting the benefits of visitation and the harms of restricted visitation and expert recommendations for returning safe visitation to hospitals, Magnet and Pathway to Excellence hospitals continue to enforce restricted visitation policies in intensive care units. Patients, families, and nursing and health care staff must partner to create pandemic-proof visitation policies.

Senior Centers and LGBTQ Participants: Engaging older adults virtually in a pandemic.

Upon the outbreak of Covid-19, recommendations to cease all non-essential in person services were mandated across the United States to prevent transmission to non-infected individuals. As a result, approximately 96% of all senior centers in the United States were closed to in-person programming. Senior centers have had a long history of engaging older adults, maintaining community connections, enhancing social support and reducing social isolation. SAGE, the first publicly funded senior center for LGBT older adults in the US, serves a traditionally under-served population with a vast array of services and programs. This exploratory, cross-sectional study utilized an online survey to evaluate the experiences of 113 SAGE members after the Coronavirus pandemic closed their senior center. Participants reported a relatively easy adaptation to technology, steady participation in programs and services, satisfaction with virtual senior center programming and a stable sense of engagement with their peers. Higher levels of engagement with senior center programs was associated with stronger feelings of social support. Additionally, stronger perceptions of social support and participation in exercise and fitness programming were associated with higher life satisfaction and lower depression and anxiety. Implications and recommendations for other gerontological service providers are offered.

Implementation and sustainment strategies for open visitation in the intensive care unit: A multicentre qualitative study.

OBJECTIVE: Open visitation in adult intensive care units has been associated with improved family and patient outcomes. However, worldwide adoption of this practice has been slow and reasons for this are unclear. This study documents barriers and strategies for implementing and sustaining open visitation in adult intensive care units in the United States experienced by nursing leadership. RESEARCH DESIGN: Qualitative approach using grounded theory. PARTICIPANTS: Nurse leaders in adult intensive care units with open visitation. SETTING: Magnet® or Pathway to Excellence® designated hospitals in the United States. METHODS: Semi structured interviews were conducted with 19 nurse leaders from 15 geographically dispersed hospitals. Interviews were recorded, transcribed and imported into Atlas.ti qualitative software for analysis. Grounded theory constant comparison analysis was used for coding and category development. FINDINGS: The analysis revealed three barriers; nursing attitudes and clinical and nonclinical barriers. Strategies to overcome these barriers were empathy, evidence-based practice, models of care, shared governance, nurse discretion, security and family spaces. CONCLUSION: Intensive care nursing leadership experienced distinct barriers and strategies during pre-implementation, implementation and sustainment of open visitation. Other nursing leaders interested in open visitation can use these findings as they plan this transition in their intensive care units.

Is Open Visitation Really "Open" in Adult Intensive Care Units in the United States?

BACKGROUND: Evidence indicates that open visitation in adult intensive care units is a best practice for patient- and family-centered care, and nurses substantially influence such visitation patterns. However, it is unclear whether intensive care units in Magnet and Pathway to Excellence (MPE) facilities nationwide implement this in practice. OBJECTIVE: To describe current national visitation practices in adult intensive care units and determine whether they have changed since the last national study, which used data from 2008 to 2009. METHODS: From February through April 2018, websites of MPE hospitals were reviewed in order to identify their adult intensive care unit visitation policy. If this information was unavailable online, the hospital was telephoned to obtain the policy. From May through August 2018, follow-up telephone calls were made to hospitals that reported open visitation, during which intensive care unit nurses at the hospitals were asked to verify that the policy did not restrict visiting hours or the number, type, or age of visitors. RESULTS: Among the 536 MPE hospitals contacted, 51% (n = 274) indicated that they allowed open visitation. Further examination, however, revealed that 64% (n = 175) restricted the number (68.2%), age (59.5%), or type (4.4%) of visitors, or visiting hours (19.8%). Only 18.5% of MPE hospitals (n = 99) allowed unrestricted visitation. CONCLUSION: This study suggests a lack of progress toward implementing open visitation in adult intensive care units nationwide. Research on MPE hospitals that have adopted truly open visitation policies is needed to identify successful methods for implementing and sustaining open visitation.

Hospice social workers' perception of being valued by the interdisciplinary team and the association with job satisfaction.

Being valued and respected by colleagues is an important contributor to job satisfaction in hospice and other health care settings. The purpose of this study was to examine how the perception of feeling valued by different members of the interdisciplinary team and interdependence of team members are related to hospice social workers' job satisfaction. The study aims were to examine: (1) the degree to which hospice social workers feel valued by other members of the interdisciplinary team; and 2) whether this is associated with job satisfaction. A nonprobability sample of 203 hospice social workers completed an online survey assessing job satisfaction, perception of feeling valued by each of the professionals on the interdisciplinary hospice team, interdependence of team members, and professional and personal characteristics. The final regression model for intrinsic job satisfaction included feeling valued by doctors and by other social workers, and interdisciplinary interdependence. The final model for extrinsic job satisfaction did not include any of the perception of feeling valued by others on the interdisciplinary team, although interdependence and the number of social workers at the hospice were significant in this model. Reasons for the difference in these models and the practice and policy implications are discussed.

Social Workers' Perceptions of Job Satisfaction, Interdisciplinary Collaboration, and Organizational Leadership.

To address job satisfaction, and therefore employment retention, of hospice social workers, this study examined how relationships with other members of the interdisciplinary hospice team and perceptions of hospice leadership may be associated with job satisfaction of hospice social workers. The sample of 203 hospice social workers was recruited by e-mailing invitations to hospice social workers identified by hospice directors in three states, use of online social media sites accessed by hospice social workers, and snowball sampling. Study measures included professional experience, hospice characteristics, interdisciplinary collaboration, perception of servant leadership, and intrinsic and extrinsic job satisfaction. Variables significant in the model for intrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, and feeling valued by the hospice physician. Variables significant in the model for extrinsic satisfaction were perception of servant leadership, interdisciplinary collaboration, feeling valued by the hospice physician, and number of social workers at the hospice. Interdisciplinary collaboration was more important for intrinsic job satisfaction and leadership style was more important for extrinsic job satisfaction. Profit status of the hospice, experience of the social worker, caseload size, and other variables were not significant in either model. These results support previous findings that leadership style of the hospice director and relationships with hospice colleagues are important for hospice social workers' job satisfaction. Such low-cost modifications to the hospice work environment, albeit not simple, may improve job satisfaction of hospice social workers.

Recommendations for hospice care to terminally ill cancer patients: a phenomenological study of oncologists' experiences.

The aim of this exploratory study was to better understand oncologists' experiences and their perceptions of hospice care as an end-of-life treatment choice for terminally ill cancer patients. To describe this experience, semi-structured qualitative interviews were conducted using phenomenological methods with nine oncologists. Four themes emerged from the data analysis: (a) feelings of discomfort and relief, (b) being different from others, (c) experience with nonhospice patients, and (d) factors influencing the decision to recommend hospice. Future research and a flexible interdisciplinary practice model are suggested to better assist with end-of-life care decision making and recommendations for hospice care with oncologists and their terminally ill cancer patients are presented.

Palliative and end-of-life care in prisons: a content analysis of the literature.

PURPOSE: The growing numbers of terminally ill and dying in prison has high economic and moral costs as global correctional systems and the society at large. However, to date little is known about the extent to which palliative and end-of-life care is infused within global prison health care systems. The purpose of this paper is to fill a gap in the literature by reviewing and critically appraising the methods and major findings of the international peer-reviewed literature on palliative and end-of-life care in prison, identify the common elements of promising palliative and end-of-life services in prison, and what factors facilitate or create barrier to implementation. DESIGN/METHODOLOGY/APPROACH: A content analysis was conducted of the existing peer-reviewed literature on palliative and end-of-life care in prison. English-language articles were located through a comprehensive search of peer-reviewed journals, such as Academic Search Premier Literature databases using differing combinations of key word search terms, "prison," "palliative care," and "end-of-life care." A total of 49 studies published between 1991 and 2013 met criteria for sample inclusion. Deductive and inductive analysis techniques were used to generate frequency counts and common themes related to the methods and major findings. FINDINGS: The majority (n=39) of studies were published between 2001-2013 in the USA (n=40) and the UK (n=7). Most were about US prison hospice programs (n=16) or barriers to providing palliative and end of life care in prisons (n=10). The results of the inductive analysis identified common elements of promising practices, which included the use of peer volunteers, multi-disciplinary teams, staff training, and partnerships with community hospices. Obstacles identified for infusing palliative and end-of-life care in prison included ethical dilemmas based on custody vs care, mistrust between staff and prisoners, safety concerns, concern over prisoners' potential misuse of pain medication, and institutional, staff, and public apathy toward terminally ill prisoners and their human rights to health in the form of compassionate and palliative care, including the use of compassionate release laws. RESEARCH LIMITATIONS/IMPLICATIONS: Implications for future research that foster human rights and public awareness of the economic and moral costs of housing the sick and dying in prisons. More research is needed to document human rights violations as well as best practices and evidence-based practices in palliative and end-of-life care in prisons. Future studies should incorporate data from the terminally ill in prison, peer supports, and family members. Future studies also should employ more rigorous research designs to evaluate human rights violations, staff and public attitudes, laws and policies, and best practices. Quantitative studies that use experimental designs, longitudinal data, and multiple informants are needed. Qualitative data would allow for thick descriptions of key stakeholders experiences, especially of the facilitators and barriers for implementing policy reform efforts and palliative care in prisons. Practical implications - This review provides a foundation on which to build on about what is known thus far about the human right to health, especially parole policy reform and infusing palliative and end-of-life care for the terminally ill and dying in prisons. This information can be used to develop or improve a new generation research, practice, policy, and advocacy efforts for that target terminally ill and dying in prison and their families and communities. SOCIAL IMPLICATIONS: There are significant social implications to this review. From a human rights perspective, the right to freedom from torture and cruel and unusual punishment is a fundamental human right along with prisoners' rights for an appropriate level of health care. These rights should be guaranteed regardless of the nature of their crime or whether they are in a prison placement. The information provided in this review can be used to educate and possible transform individual's and society's views toward the terminally ill and dying who are involved in the criminal justice system. ORIGINALITY/VALUE: This paper extends the extant literature by using both quantitative and qualitative analysis methods to organize, summarize, and critically analyze the international literature on palliative care and end of life care in prison. This review is designed to increase awareness among the international community of the pain and suffering of the terminally ill in prison and the facilitators and barriers to providing them compassionate care while in custody.