Flexible family visitation in the intensive care unit: nurses' decision-making.

Aims and objectives. To identify and explore general strategies used by Danish intensive care unit nurses in everyday decision-making about family visitation. Background. In the intensive care unit, relatives experience a strong commitment to watch over and protect the patient. Relatives can provide important help and support to their loved one. To do so, relatives need to be able to stay, preferably at the bedside. Managing a flexible visitation policy, nurses play an important role as gate-keepers at the bedside requiring strong discretionary power. Little is known about the rationale for nurses' decision making when allowing family members to stay by the patient's bedside or asking them to leave the unit. Design. Explorative qualitative interview study. Method. In 2005 and 2008, we conducted a grounded theory study based on 11 semi-structured interviews with intensive care unit nurses. Results. In the constantly shifting social context of the intensive care unit, nurses practiced clinical leadership balancing the needs of all parties involved, being mindful that the patient is their primary concern. To do so, they used three general strategies: Clarifying relations, Defining the situation and Guiding relatives in a concurrent and ongoing process, assessing when visiting is appropriate on a minute-to-minute basis. Conclusion. The study identifies and describes important professional considerations and values embedded in the nurses' decision making about visitation. Detailed knowledge in this area will provide a concrete basis for internal discussion on specific everyday interactions with visiting relatives, as well as more general discussions on the possibilities for and implications of enhancing flexible family visitation. Relevance to clinical practice. To practice a contemporary visitation policy, the complexity of the task, the shifting context of the intensive care unit, the physical surroundings as well as possible limitations given by the staffing level should be acknowledged. The training of intensive care unit nurses should support adaptation to the clinical leadership role.