Skip to main content
SpringerLink
Log in

Introduction of open visiting policy in intensive care units in Ukraine: policy analysis and the ethical perspective

  • Original Paper
  • Published:
Asian Bioethics Review Aims and scope Submit manuscript

Abstract

Open visiting policy (OVP) in intensive care units (ICU) is considered a favorable visiting regime that may benefit patients and their family members as well as medical staff. The article examines the conditions and causes of OVP-making process in Ukraine and presents the ethical analysis of its implications with respect to the key stakeholders: ICU patients, family members, and medical staff. The OVP, established by the Ministry of Health in June, 2016, changes current approaches to the recognition of the role of families in critically ill patients’ care dramatically; it does, however, have serious shortcomings. The analysis of risks and benefits showed that OVP does not adequately cater to the needs of all the key players—family members, patients, and medical staff. Moreover, there is no clear mechanism to control OVP implementation via feedback from all the key players (particularly patients and their families). These issues give rise to a concern that the implementation of OVP will die on the vine. In order to prevent this, a range of measures is required: the optimization of the ICU facilities and internal procedures, supervision of OVP implementation by policy-makers, training of medical staff, and providing family members with educational programs. Considering current shortcomings, it is crucially important to develop clear and consistent internal guidelines in hospitals that will guarantee the introduction of open ICU visiting and quality of critical care provisions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Adams, S., A. Herrera, L. Mille, and R. Soto. 2011. Visitation in the intensive care unit. Critical Care Nurse Quarterly 34 (1): 3–10. https://doi.org/10.1097/CNQ.0b013e31820480ef.

  • Adelman, R.D., L.L. Tmanova, D. Delgado, S. Dion, and M.S. Lachs. 2014. Caregiver burden: A clinical review. JAMA: The Journal of the American Medical Association 311 (10): 1052–1060. https://doi.org/10.1001/jama.2014.304.

  • Anderson, W.G., R.M. Arnold, D.C. Angus, and C.L. Bryce. 2008. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. Journal of General Internal Medicine 23 (11): 1871–1876. https://doi.org/10.1007/s11606-008-0770-2.

  • Audit Commission. 1999. Critical to success: The place to efficient and effective critical care services within the acute hospital. London: Audit Commission.

    Google Scholar 

  • Azoulay, E., F. Pochard, N. Kentish-Barnes, and B. Schlemmer, 2005. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory and Critical Care Medicine 171 (9): 987–994. https://doi.org/10.1164/rccm.200409-1295OC.

  • Beauchamp, T.L., and J.F. Childress. 2009. Principles of biomedical ethics. Oxford: Oxford University Press.

  • Bell, L. 2011. Family presence: Visitation in the adult ICU. American Association of Critical Care Nurses 32 (4): 76–78.

  • Berwick, D.M., and M. Kotagal. 2004. Restricted visiting hours in ICUs: Time to change. JAMA: The Journal of the American Medical Association 292 (6): 736-737. https://doi.org/10.1001/jama.292.6.736.

  • Bray, K., K. Hill, W. Robson, G. Leaver, N. Walker, M. O'Leary, et al. 2004. British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units. Nursing in Critical Care 9 (5): 199–212. https://doi.org/10.1111/j.1362-1017.2004.00074.

  • Buse, K., N. Mays, and G. Walt. 2005. Making health policy. London: Open University Press.

  • Cook, D. 2006. Open visiting: Does it benefit adult patients in intensive care units? A dissertation submitted in partial fulfillment of the requirements of the Degree of Master of Nursing at Otago Polytechnic, Dunedin, New Zealand, 2006.

  • Craig, R.L., H.C. Felix, J.F. Walker, and M.M. Phillips. 2010. Public health professionals as policy entrepreneurs: Arkansas’s childhood obesity policy experience. American Journal of Public Health 100 (11): 2047–2052. https://doi.org/10.2105/AJPH.2009.183939.

  • Da Silva Ramos, F.J., R.R.L. Fumis, L.C.P. Azevedo, and G. Schettino. 2013. Perceptions of an open visitation policy by intensive care unit workers. Annals of Intensive Care 3: 34. https://doi.org/10.1186/2110-5820-3-34.

  • Davidson, J.E. 2017. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Critical Care Medicine 45 (1): 103–128. https://doi.org/10.1097/CCM.0000000000002169.

  • Deitrick, L., D. Ray, G. Stern, C. Furham, T. Masiado, S.L. Yaich, and T. Wasser. 2005. Evaluation and recommendations from a study of a critical care waiting room. Journal for Healthcare Quality 27 (4): 17–25.

  • DeLeon, P. 1999. The stages approach in the policy process: What has it done? Where is it going? In Theories of the policy process, ed. Paul A. Sabatier. Boulder: Westview.

  • Farrell, M.E., J.D. Hunt, and D. Schwartz-Barcott. 2005. Visiting hours in the ICU: Finding the balance among patient, visitor and staff needs. Nursing Forum 40 (1): 18-28. https://doi.org/10.1111/j.1744-6198.2005.00001.x.

  • Fumagalli, S., L. Boncinelli, A. Lo Nostro, P. Valoti, G. Baldereschi, M. Di Bari, et al. 2006. Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit –results from a pilot, randomized trial. Circulation 113 (7): 946-952. https://doi.org/10.1161/CIRCULATIONAHA.105.572537.

  • Gerritsen, R.T., C.S. Hartog, and J.R. Curtis. 2017. New developments in the provision of family-centered care in the intensive care unit. Intensive Care Medicine 43 (4): 550–553. https://doi.org/10.1007/s00134-017-4684-5.

  • Gillon, R. 1994. Medical ethics: Four principles plus attention to scope. BMJ: British Medical Journal 309 (6948): 184–188. https://doi.org/10.1136/bmj.309.6948.184.

  • Guldbrandsson, K., and B. Fossum. 2009. An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena. Health Promotion International 24 (4): 434–444. https://doi.org/10.1093/heapro/dap033.

  • Gurley, M.J. 1995. Determining ICU visitation hours. Medsurg Nursing 4: 40–43.

  • Gurses, A.P., and P. Carayon. 2007. Performance obstacles of intensive care nurses. Nursing Research 56 (3): 185–194. https://doi.org/10.1097/01.NNR.0000270028.75112.00.

  • Haghbin, S., Z. Tayebi, A. Abbasian, and H. Haghbin. 2011. Visiting hour policies in intensive care units, southern Iran. Iran Red Crescent Medical Journal 13 (9): 684–686. https://doi.org/10.5812/kowsar.20741804.2242.

  • Henneman, E., and S. Cardin. 2002. Family-centered critical care: A practical approach to making it happen. Critical Care Nurse 22 (6): 12–19.

  • Henrich, N.J., P.M. Dodek, E. Gladstone, L. Alden, S.P. Keenan, S. Reynolds, and P. Rodney. 2017. Consequences of moral distress in the intensive care unit: A qualitative study. American Journal of Critical Care 26 (4): e48–e57. https://doi.org/10.4037/ajcc2017786.

  • Holden, J., L. Harrison, and M. Johnson. 2002. Family, nurses and intensive care patients: A review of the literature. Journal of Clinical Nursing 11 (2): 140–148.

  • Hunter, J., C. Goddard, M. Rothwell, S. Ketharaju, and H. Cooper. 2010 A survey of intensive care unit visiting policies in the United Kingdom. Anaesthesia 65 (11): 1101–1105. https://doi.org/10.1111/j.1365-2044.2010.06506.

  • Kingdon, J.W. 1984. Agendas, alternatives, and public policies. Boston: Little, Brown.

  • Kleinpell, R.M., and M.D. Power. 1992. Needs of family original articles members of intensive care unit patients. Applied Nursing Research 5 (1): 2–8.

  • Kunytska K. 2017. Reanimation 24/7: Did they open the units’ doors for visitors? Media portal Hromadske. https://hromadske.ua/posts/vidkriti-reanimacii-ukraina. Accessed 9 April 2018.

  • Kutash, M., and L. Northrop. 2007. Family members experiences of the intensive care unit waiting room. Journal of Advanced Nursing 60 (4): 384-388. https://doi.org/10.1111/j.1365-2648.2007.04388.

  • Let Us into Reanimation. 2016. At another side of the doors: Views of anesthesiologists about opening of ICUs. http://reanimation.in.ua/po-toj-bik-dverej-dumki-anesteziologiv-pro-vidkrittya-viddilen-intensivnoyi-terapiyi/. Accessed 9 April 2018.

  • Levy, M.M. 2007. A view from the other side. Critical Care Medicine 35 (2): 603-604.

    Article  Google Scholar 

  • LikarInfo. 2016. Family members have been allowed to visit ICUs: What’s next? Media-portal LikarInfo. https://ukrhealth.net/rodychiv-pustyly-v-reanimaciyu-shho-dali-chastyna-1/. http://uacrisis.org/ua/44808-reanimation-2. Accessed 9 April 2018.

  • Longest, B.B. 2010. Health policymaking in the United States. Chicago: Health Administration Press.

  • Lychovyd, I. 2016. Reanimation 24/7. Media portal Day. http://day.kyiv.ua/uk/article/cuspilstvo/reanimaciya-247. Accessed 9 April 2017.

  • Lynn, J. 2014. Strategies to ease the burden of family caregivers. JAMA: The Journal of the American Medical Association 311 (10): 1021–1022. https://doi.org/10.1001/jama.2014.1769.

  • Lytvyn, O. 2016. Scandal Order about access to reanimation. Media portal Today. https://ukr.segodnya.ua/lifestyle/food_wellness/za-zakrytoy-dveryu-reanimacii-kak-novovvedenie-moz-povliyalo-na-ukraincev--739117.html. Accessed 9 April 2018.

  • Marco, L., I. Bermejillo, N. Garayalde, I. Sarrate, M. Margall, and M. Asiain. 2006. Intensive care nurses’ beliefs and attitudes towards the effect of open visiting on patients, family and nurses. Nursing in Critical Care 11 (1): 33–41.

  • Marfell, J.A., and J.S. Garcia. 1995. Contracted visiting hours in the coronary care unit: A patient-centered quality improvement project. Nursing Clinics of North America 30: 87–96.

  • Mealer, M., and M. Moss. 2016. Moral distress in ICU nurses. Intensive Care Medicine 42 (10): 1615–1617. https://doi.org/10.1007/s00134-016-4441-1.

  • Milton, K., and J. Grix. 2015. Public health policy and walking in England-analysis of the 2008 ‘policy window’. BMC Public Health 15: 614. https://doi.org/10.1186/s12889-015-1915-y.

  • Moon, J.Y., and J.O. Kim. 2008. Ethics in the Intensive Care Unit. Journal of General Internal Medicine 23 (11): 1871–1876. https://doi.org/10.1007/s11606-008-0770-2.

  • Nelson, R.M. 1997. Ethics in the intensive care unit. Creating an ethical environment. Critical Care Clinics 13 (3): 691–701.

  • Odom-Forren, J., and E.J. Hahn. 2006. Mandatory reporting of health care-associated infections: Kingdon’s multiple streams approach. Policy Politics Nursing Practice 7: 64–72. https://doi.org/10.1177/1527154406286203.

  • Olsen, K.D., E. Dysvik, and B.S. Hansenand. 2009. The meaning of family member’s presence during intensive care stay: A qualitative study. Intensive and Critical Care Nursing 25 (4): 190–198. https://doi.org/10.1016/j.iccn.2009.04.004.

  • Pochard, F., E. Azoulay, S. Chevret, F Lemaire, P Hubert, P. Canoui, J.R. le Gall, J.F. Dhainaut, B. Schlemmer, and French FAMIREA Group. 2001. Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Critical Care Medicine 29 (10): 1893–1897.

  • Poncet, M.C., P. Toullic, L. Papazian, N. Kentish-Barnes, J.F. Timsit, F. Pochard, S. Chevret, B. Schlemmer, and E. Azoulay. 2006. Burnout syndrome in critical care nursing staff. American Journal of Respiratory and Critical Care Medicine 175 (7): 698–704. https://doi.org/10.1164/rccm.200606-806OC.

  • Quinio, P., C. Savry, A. Deghelt, M. Guilloux, J. Catineau, and A. de Tinténiac. 2002. A multicenter survey of visiting policies in French intensive care units. Intensive Care Medicine 28 (10): 1389–1394. https://doi.org/10.1007/s00134-002-1402-7.

  • Rashid, M. 2006. A decade of adult intensive care unit design: A study of the physical design features of the best-practice examples. Critical Care Nursing Quarterly 29 (4): 282–314.

  • Rawat, P., and J.C. Morris. 2016. Kingdon’s streams model at thirty: Still relevant in the 21st century? Politics and Policy 44: 608–638. https://doi.org/10.1111/polp.12168.

  • Ricci, E.M., G.A. Huber, M.A. Potter, J.L. Lenkey, and L. Weissberg. 2011. A method to enhance public health faculty participation in health policy formation. Public Health Reports 126 (5): 757–762. https://doi.org/10.1177/003335491112600520.

  • Schernhammer, E.S., and G.A. Colditz. 2004. Suicide rates among physicians: A quantitative and gender assessment (meta-analysis). American Journal of Psychiatry 161: 2295–2302. https://doi.org/10.1176/appi.ajp.161.12.2295.

  • Shiva, K., S. Joolaee, B. Ghanbari, M. Maleki, H. Peyrovi, and N. Bahrani. 2016. A review of visiting policies in intensive care units. Global Journal of Health Science 8 (6): 267–276. https://doi.org/10.5539/gjhs.v8n6p267.

  • Sims, J.M., and V.A. Miracle. 2006. A look at critical care visitation. Dimensions of Critical Care Nursing 25 (4): 175–181. 

  • Spreen, A.E., and M. Schuurmans. 2011. Visiting policies in the adult intensive care units: A complete survey of Dutch ICUs. Intensive Critical Care Nursing. https://doi.org/10.1016/j.iccn.2010.10.002.

  • Strosberg, M.A., E. Gefenas, and A. Famenka. 2014. Research ethics review: Identifying public policy and program gaps. Journal of Empirical Research on Human Research Ethics. https://doi.org/10.1525/jer.2014.9.2.3.

  • Tang, C.S., F.F. Chung, M.C. Lin, and G.H. Wan. 2009. Impact of patient visiting activities on indoor climate in a medical intensive care unit: A 1-year longitudinal study. American Journal of Infection Control 37 (3): 183–188. https://doi.org/10.1016/j.ajic.2008.06.011.

  • The Cabinet of Ministers of Ukraine. 2016. The decree of the cabinet of ministers of Ukraine about approval of the Concept of Health System Financing Reform. Web-portal of Ukrainian government. Accessed 9 April 2017.

  • The Ministry of Health of Ukraine. 1997. Order №303 of the Ministry of Health of Ukraine dated October 10, 1997. About Regulation of Anesthesiology Service in Ukraine. Official web-site of the Ministry of Health of Ukraine. http://old.moz.gov.ua/ua/portal/dn_19980701_183.html. Accessed 9 April 2017.

  • The Ministry of Health of Ukraine. 2016. Order №592 of the Ministry of Health of Ukraine dated June 22, 2016. On Approving the Open Visiting Policy for Patients in Intensive Care Units. Official web-site of the Ministry of Health of Ukraine. http://old.moz.gov.ua/ua/portal/dn_20041202_592.html. Accessed 9 April 2018.

  • Ukrainian Crisis Media Center. 2016. Reanimation has become open. The further step—clarification for staff. Press-release of Ukrainian Crisis Media Center. http://uacrisis.org/ua/44808-reanimation-2. Accessed 9 April 2018.

  • Vandijck, Dominique M., Sonia O. Labeau, Cindy E. Gerinckx SO, Ellen De Puydt, Ann C. Bolders, Brigitte Claes, and Stijn Blot. 2010. An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: A multicenter survey. Heart and Lung 39 (2): 137–146.

    Article  Google Scholar 

  • Verkhovna Rada of Ukraine. 1993. The law of Ukraine. Basis of the Legislation of Ukraine about Health Care. Official web portal of Verkhovna Rada of Ukraine. http://zakon3.rada.gov.ua/laws/show/2801-12. Accessed 9 April 2018.

  • Verkhovna Rada of Ukraine. 2003. The civil code of Ukraine. Official web portal of Verkhovna Rada of Ukraine. http://zakon3.rada.gov.ua/laws/show/435-15. Accessed 9 April 2018.

  • Whitton, S., and L.I. Pittiglio. 2011. Critical care open visiting hours. Critical Care Nursing Quarterly 34 (4): 361–366. https://doi.org/10.1097/CNQ.0b013e31822c9ab1.

  • Wilkinson, R. 1999. Critical to success: The place to efficient and effective critical care services within the acute hospital. London: Audit Commission. https://doi.org/10.1016/S0964-3397(99)80021-4.

  • Zazpe, C., M.A. Margall, C. Otano, M.P. Perochena, and M.C. Asiain. 1997. Meeting needs of family members of critically ill patients in a Spanish intensive care unit. Intensive and Critical Care Nursing 13 (1): 12–16.

    Article  Google Scholar 

Download references

Acknowledgments

We are grateful to the Department of Clinical Pharmacology and Clinical Pharmacy, National University of Pharmacy (Ukraine, Kharkiv) for necessary facilities for research work.

Author information

Authors and Affiliations

  1. National University of Pharmacy, Kharkiv, Ukraine

    Igor A. Zupanets, Viktoriia Ye. Dobrova & Kseniia L. Ratushna

  2. Inyurpolis Law Firm, Kharkiv, Ukraine

    Sergii O. Silchenko

Authors
  1. Igor A. Zupanets
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Viktoriia Ye. Dobrova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kseniia L. Ratushna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sergii O. Silchenko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kseniia L. Ratushna.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zupanets, I.A., Dobrova, V.Y., Ratushna, K.L. et al. Introduction of open visiting policy in intensive care units in Ukraine: policy analysis and the ethical perspective. ABR 10, 105–121 (2018). https://doi.org/10.1007/s41649-018-0057-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41649-018-0057-9

Keywords

Search

Navigation