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It relates to the perception among many providers that ICU patients' families can simply be exhausting, for all the reasons in the comments below: emotional heaviness, denial, endless questioning, interruptions to the flow of care delivery, etc. The next reason is, I think, the one with primacy, but its discussion does require a good deal of candor, perhaps because it has been made taboo by those who are setting the agenda. Its popularity stems from the fact that it is hardest to argue against - nurses are simply concerned with patient safety and quality of care, how can you have a problem with that? Like all reasons proffered to justify a position, this one has threads of truth in it, but I do think it rings as mostly pretextual. The most convenient reason requires the least candor: it is a patient safety and patient care issue. The previous post and the comments it generated point to two major categories of reasons that are offered in support of limiting visitation. If some physicians and nurses don't want open visitation, maybe that too is the symptom of a deeper underlying disease that likewise could be addressed in other specific ways - and it thus follows that restricted visitation is not necessarily the solution that their symptoms demand either. That is, desire for unrestricted visitation may be the symptom of an underlying disease and treating the underlying cause (such as poor communication) may cure both the disease and its symptoms.Įven if these considerations are cogent, reasonable and rational (which does not mean that they lead to the correct conclusions), there was a significant omission from my train of thought, small hints of which were peeking through from the text. Finally, it was and is my view that if open visitation is the stated goal, there may be subgoals that are driving the desire for open visitation, and satisfaction of these subgoals through other means may be superior to open visitation for making everybody happy. Next, it was and is my belief that because of the agenda, nurses' (and physicians') dissenting voices are being shamed into a collective hush by The Man, as it were, and that this censorship needed redress on this blog (it got redressed in 60,000 views and over 100 comments to the original post, still visible below.) Furthermore, this institutionalized censorship may cause pervasive Hawthorne effects in any nursing survey that is done on the topic.
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Related to this, I sensed (and still sense) an agenda - open visitation is being pushed for ideological or financial reasons (yes, the almighty dollar - patient satisfaction scores are tied to Medicare reimbursement), professional associations such as the AACN are pushing the issue, and substandard data are being touted to support this agenda. First, I'm a heretic and an iconoclast, and I believe that free thinking, rationality, and good judgment and decision making require all angles of a debate to receive their due - my goal is to keep the dialogue fire stoked. The previous post took on the heretical task of making the case against wide open visitation in the ICU without restrictions.
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