key: cord-0744034-y3s8li0v authors: Bouchoucha, Stéphane; Bloomer, Melissa J title: Family‐centred care during a pandemic: The hidden impact of restricting family visits date: 2020-06-13 journal: Nurs Health Sci DOI: 10.1111/nhs.12748 sha: 72cc256b9d3a4d16d8b39cdc6f578c292b1ce7d7 doc_id: 744034 cord_uid: y3s8li0v nan potentially long-lasting threat to the family unit (Hart, Turnbull, Oppenheim, & Courtright, 2020) , particularly given that in times of disaster, it is known that the basic needs of humans to feel safe, connected, useful and helpful are intensified (Howe, 2011) . A family-centred approach to care is an important feature of nursing care, grounded in recognition of the family as a social unit connected not just by blood (International Council of Nurses, 2012) and the mutually-beneficial partnerships that form between family and clinicians (Grant & Johnson, 2019) . During the COVID-19 pandemic, family-centred care is more, not less important (Hart et al., 2020) . The role of family members as part of the care team and finding ways for family involvement and collaboration is imperative, as are strategies that work to protect the integrity of the family unit in spite of IPC restrictions (Hart et al., 2020) . When a patient is dying, avoiding separation from their family is a priority (Hart et al., 2020) . Dying is a time of intimacy and poignancy for family; one that is remembered in detail (Donnelly & Dickson, 2013) . Family members of dying patients want to stay close (Slatyer, Pienaar, Williams, Proctor, & Hewitt, 2015) , to keenly observe, to protect and provide comfort for the dying person (Donnelly & Battley, 2010) , and to have an opportunity to say their farewells (Mossin & Landmark, 2011) . When COVID-19 IPC measures mean family presence is not possible, opting for other strategies that address family members' need to be close to the dying person should be considered. Suggestions include the use of mobile phones and other electronic devises to enable video calls (Hart et al., 2020) , or even encouraging families to visit from the other side of an external window (Wilson, 2020) may also provide some comfort. Even when innovative solutions are found to facilitate patients and their families connecting, albeit virtually, patients and their families may only have minutes to share final messages and say goodbye (Goldstein & Weiser, 2020) . When circumstances mean that even virtual visits or connections are not possible, it may be up to nurses to share the patient's final moments (Natarajan, 2020) . Aside from these additional actions to support family presence, necessary because of COVID-19, other components of end-of-life care, deemed most important for dying patients and families must continue. Effective communication, shared decision-making and receiving expert care has been identified as highly important for dying patients and their families (Virdun, Luckett, Davidson, & Phillips, 2015) . Receiving good physical care, which includes being kept clean and having symptoms managed was also important (Virdun et al., 2015) . Addressing the cultural and religious needs of patients and families before and after death and the provision of immediate grief and bereavement support for families is also essential This article is protected by copyright. All rights reserved. Accepted Article (Raymond, Lee, & Bloomer, 2017) , and exemplify the respectful and compassionate care nurses and other health professionals are known for (Virdun et al., 2015) . Another aspect to consider is the potential impact that having to restrict family visits could have on nurses. The potential for compassion fatigue in nurses working in critical care and palliative care settings has been widely studied, identifying that stressful workplace situations was among factors increasing the likelihood of compassion fatigue (Alharbi, Jackson, & Usher, 2019) . Evidence of the adverse impact of working on the COVID-19 frontline are starting to emerge (Alharbi, Jackson, & Usher, 2020) , particularly in relation to the emotional toll of attempting to facilitate family connections to say goodbyes (Natarajan, 2020) . Interestingly, Wu et al. (2020) surveyed frontline workers in China, and surprisingly showed that nurses and medical practitioners working on a ward dedicated to COVID-19 patients had a lower frequency of burnout than those working on their usual wards, suggesting that this may be due to feeling a deeper sense of personal achievement when seeing that the care provided had a positive impact on patients and the pandemic. Whether this sense of personal achievement remains when having to deny visits to a family member, needs to be investigated alongside other potential factors. While it may be too early in the COVID-19 pandemic to realise the potential impact of compassion fatigue and burnout on nurses, evidence collected following the severe acute respiratory syndrome (SARS) epidemic (Maunder et al., 2006) showed that healthcare workers that cared for patients with SARS had higher levels of burnout, psychological distress and post-traumatic stress than other healthcare workers. From what we know about factors that may increase risks of compassion fatigue and burnout, having to limit visits for family members of critical ill and dying patients is likely to also have a negative impact on nurses by increasing their feelings of providing inadequate family-centred care. Nurses have been at the forefront of the response to the COVID-19 pandemic and are facing extraordinary circumstances, where mortality is high, and patients have sometimes been dying alone. Restricting family visits, while a necessary measure to decrease the spread of COVID-19 to vulnerable patients and the community, is likely to have negative effects on families and nurses alike and these impacts need to be carefully considered. In an effort to promote patient and family needs and observe public health measures, a focus on the use of technology to improve communication and enhance patient and family connection may assist to avoid these negative consequences. Given that nurses are known for their ability to provide family-centred care, nurses should lead this work during the COVID-19 pandemic. Family visits could be facilitated by educating and supporting a designated family member in the Compassion fatigue in critical care nurses. An integrative review of the literature The potential for COVID-19 to contribute to compassion fatigue in critical care nurses Position Statement. ACCCN and ACIPC Position Statement on Facilitating Next-of-Kin Presence for Patients Dying from COVID-19 in the ICU. Surrey Hills: Australian College of Critical Care Nurses (ACCCN) Relatives' experience of the moment of death in a tertiary referral hospital Relatives' matched with staff's experience of the moment of death in a tertiary referral hospital 14/04/2020). 'I Cried Multiple Times': Doctors SAy Final Goodbyes for Patients Who Can't. The New Yor Times Advancing the Practice of Patient-and Family-Centered Care: The Central Role of Nursing Leadership Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response A Heart-Wrenching thing: Hospital Bans on Visits Devastate Families. The New York Times Family-Centered Care During the COVID-19 Era How can careproviders most help patients during a disaster? The ICN Code of Ethics for Nurses Life in the pandemic: Some reflections on nursing in the context of COVID-19 Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak Being present in hospital when the patient is dying -A grounded theory study of spouses experiences Coronavirus: 'I spend the final moments with dying patients Understanding the bereavement care roles of nurses within acute care: A systematic review Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area Finding privacy from a public death: a qualitative exploration of how a dedicated space for end-of-life care in an acute hospital impacts on dying patients and their families Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important Visiting loved ones through the window WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 -11 Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages. Interim Guidance A Comparison of Burnout Frequency Among Oncology Physicians and Nurses Working on the Frontline and Usual Wards During the COVID-19 Epidemic in Wuhan