I have been involved in critical care nursing for over 25 years. For this same 25 years, I find many are still grappling with the issue of families and critical care visitation. When I began my career as a staff nurse in a coronary care unit, visitation was very restrictive. Families could visit only at specific times during the day and only for periods of 15 to 20 minutes. There were no exceptions. I allowed a family to remain at the bedside of a dying man who had a "do not resuscitate" order. He died peacefully, his family at his side. He had asked that his family be allowed to stay and his family was grateful that I had bent the rules. I knew it was the right thing to do; however, I was counseled the next day for having broken the visitation policy. I resigned soon after that incident and have taken the need for less restrictive visitation as a personal crusade.

Having a loved one in a critical care unit (CCU) is a stressful event for family members. These family members have many needs during this crisis. Many studies have identified the needs of families of critically ill patients and measures nurses can take to decrease this stress. Molter led the work with her seminal study in 1979. 1 Molter developed the Critical Care Family Needs Inventory to identify specific needs of significant others. The top five needs were to: (1) have hope, (2) feel that the hospital staff cares for the patient; (3) be near the patient; (4) be informed of any change in the patient status; and (5) know the staff. Molter's work has been replicated by several researchers. 2-5 As you read the references, you will see that much of this work was done in the 1970s and 1980s.

In the mid 1980s, I began to notice a change in visitation policies for CCUs. Visitation was more open, more flexible. The nursing staff realized that family members are very important to the recovery of a patient. Visiting hours became much more flexible with many units having no set visiting times. Visitation was dependent on the needs of the patient. Typically, patients wanted significant others near. Family members were able to remain with the patient or choose a time to visit and not be restrained by a strict, unrelenting visitation schedule. I was aware of several units that had open visitation at the discretion of the nurse. Visitation was decided upon by the patient, family, and nursing staff to meet the needs of everyone. The importance of flexible visitation was presented at many local, regional, and national meetings of critical care nurses. Nursing staff members were educated on the needs of families and patients and interventions to help meet these needs. Nurses were informed of methods to help the family cope during times of crisis (eg, talking with the family, keeping the family informed, providing a comfortable waiting room atmosphere close to the CCU). Establishing open lines of communication and developing a relationship of trust is critical. 5

Unfortunately over the past few years, I have noticed a change in visitation policies in CCUs. I recently had a friend who was a patient in an intensive care unit. When I visited, I noticed the hospital had changed its policy to reflect visiting at four times during the day and for 30 minute intervals only. No exceptions. When I asked why, the nurse said that families sometimes interfere with nursing care and interrupt the patient's rest. While I am sure that sometimes families may interfere with the patient's rest, the nurse should take the initiative and explain the necessity of rest to the family and develop a schedule to meet the needs of the patient, family, and nursing staff. This is, by far, a more favorable response than strictly limiting visitation. Each patient will be different as will each family. Visitation should be individualized to meet the needs of all involved.

A recent article identified the same frustrations felt by nurses, families, and patients in CCUs concerning visitation. 6 This article listed several of the reasons nurses give to limit visitation as well as reasons visitation should be less restrictive. I encourage all of you to become involved with this issue in your units. Consider your employer's current policy on visitation and determine if any change is needed. Remember, one day you or a family member may be a patient in a CCU. What would you want the visiting policy to be?

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