The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit

AUTHORS

Mokhtar Mahmoudi 1 , Parvaneh Asgari 1 , * , Mohammad Khajeh-Goodari 2 , Davood Hekmatpou 1 , Fatemeh Rafiei 3

1 Department of Nursing, Arak University of Medical Sciences, Arak, IR Iran

2 Department of Nursing, Tabriz University of Medical Sciences, Tabriz, IR Iran

3 Thyroid Disorders Research Center, Arak University of Medical Sciences, Arak, IR Iran

How to Cite: Mahmoudi M, Asgari P, Khajeh-Goodari M, Hekmatpou D, Rafiei F. The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit, Jundishapur J Chronic Dis Care. 2016 ; 5(2):e31172. doi: 10.17795/jjcdc-31172.

ARTICLE INFORMATION

Jundishapur Journal of Chronic Disease Care: 5 (2); e31172
Published Online: April 18, 2016
Article Type: Research Article
Received: June 30, 2015
Revised: August 30, 2015
Accepted: September 8, 2015
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Abstract

Background: Most hospitals have restricted visitation time in intensive care units (ICUs) for various reasons. Given the advantages of family presence and positive effect of emotional touching, talking and smiling on nervous system stimulation and vital signs of the patients.

Objectives: The present study aimed to determine the effect of increased visitation time on physiological indices of the patients hospitalized in ICUs.

Materials and Methods: This clinical trial study was conducted in the ICUs of Vail-e-Asr hospital in Arak city, Iran. A total of 60 subjects were randomly assigned to the intervention and control groups with visitation time for 10 minutes 3 times a day and 10 minutes once a day, respectively. Then, the patients’ physiological indices were measured before, during, and 10 and 30 minutes after the hospital visiting hours. Data were analyzed using SPSS version 20.

Results: Findings showed no statistically significant differences among mean values of all physiological indices in measurement stages before, during, and 10 and 30 minutes after the visitation times in the control group (P > 0.05). While, in the intervention group, systolic blood pressure (SBP) measurements at 9 (previous mean: 126.9, 30 minutes later: 111.9), 12:00 PM (previous mean: 126.9, 30 minutes later: 114.9), and 3:00 PM (previous mean: 125.2, 30 minutes later: 105.8), diastolic blood pressure (DBP) measurements at 9:00 AM (previous mean: 87.4, 30 minutes later: 83.2), 12:00 PM (previous mean: 86.6, 30 minutes later: 81.7), and 3:00 PM (previous mean: 87.1, 30 minutes later: 85.0), heart rate (HR) measurements at 9:00 AM (previous mean: 90, 30 minutes later: 78.4), 12:00 PM (previous mean: 89.8, 30 minutes later: 78.6), and 3:00 PM (previous mean: 89.3, 30 minutes later: 78.3), repertory rate (RR) measurements at 9:00 AM (previous mean: 20.9, 30 minutes later: 15.0), 12:00 PM (previous mean: 20.6, 30 minutes later: 15.4), and 3:00 PM (previous mean: 21.0, 30 minutes later: 15.9) showed statistically significant differences (P < 0.05). However, no statistically significant differences were observed among Oxygen saturation (OS) measurements at 9:00 AM, 12:00 PM and 3:00 PM in this latter group as well (P > 0.05).

Conclusions: Increasing visitation time leads to reduced physiological indices’ mean values. Hence, it is recommended to extend hospital visiting times in order to improve the condition of patients admitted to ICU.

Keywords

ICU Physiological Indices Visitation Time

Copyright © 2016, Ahvaz Jundishapur University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Patients hospitalized in intensive care units (ICUs) perceive high levels of stress and anxiety due to fear regarding diagnosis, aggressive treatments, using different devices, sleep deprivation, motor restriction and also restricted hospital visiting hours (1). Visiting patients admitted to the ICU is entirely forbidden even for family members in all ICUs of all hospitals in Iran for different reasons (2) including the nurses’ false beliefs that family members interfere with patient’s care, increase the risk of infection, and disturb patient’s rest causing the patient’s anxiety and stress. However, studies have proven that allowing relatives to visit their beloved ones more are ranked high in the list of important needs of patients hospitalized in ICUs (3). Separating sick people from their beloved ones can cause great suffering for patients just as modern science has concluded (4, 5). Unfortunately, the current knowledge has not been yet successful to change the false beliefs regarding visiting patients in ICUs (6, 7).

In addition to physical problems, patients in the ICU experience psychological reactions such as stress which may lead to increased treatment costs, delay in recovery, cardiovascular complications and increasing mortality rates (8-11). Also, results of the studies on patients with coronary artery diseases reveal positive impact of talking to, looking at, smiling to and touching conscious patients in stimulating the nervous system, decreasing the heart rate and diastolic blood pressure, and reducing anxiety (12).

Physiological indices (systolic and diastolic blood pressures, mean arterial pressure, respiratory and heart rates) have been recognized as the important factors in improvement of patients’ general condition and that of treatment progress (13). In this regard, improved physiological measures resulting from increased visitation time will accelerate weaning of the patients from mechanical ventilation and may help to reduce its complications, length of stay in ICU, and hospital costs (14).

Since few studies have investigated the impact of extending visitation time on the physiological indices of patients hospitalized in the ICU and the importance of the presence of family members next to these patients for more longer periods (15) and the concept of the family-centered care model has been considered by medical staff as a new therapeutic approach, few such surveys in Iran have been carried out as well, mostly on the patients admitted to cardiac ICUs, and have had conflicting results (16-18).

2. Objectives

Thus, the present study seems to confirm the previous findings and provide new suggestions. Therefore, the present study aimed to evaluate the effect of extending visitation time on the physiological parameters of the patients admitted to ICUs.

3. Materials and Methods

In this clinical trial study, 60 subjects were selected through the convenience method (Equation 1) and then were randomly divided into two groups of intervention and control through the simple random method of assigning odd numbers to one group and even ones to the other group. The subjects were selected from the patients admitted to ICUs of Vali-e-Asr hospital in Arak city (surgical ICU and neurology ICU). The following characteristics were required for the participation in the study: (1) being hospitalized in ICU with consciousness level higher than 7.2, (2) having been hospitalized in ICU for at least 24 hours, (3) aged more than 18 and less than 70, (4) not being under complete isolation, (5) agreement of the first degree relatives of the patient toward their participation in the study, (6) having no hearing deficits. Exclusion criteria were (1) simultaneous participation in another study that can interfere with the present one, (2) being under treatment with sedatives, (3) too much sensitivity of family members toward the patient disturbing the treatment process, and (4) exhaustion of family members due to caring their patient (Figure 1).

Equation 1.

Data were collected using two questionnaires: first including items concerning demographic characteristics and the second including items concerning 6 physiological indices of systolic and diastolic blood pressures, mean arterial pressure, pulse and respiratory rates, and oxygen saturation (O2sat). Since the first questionnaire was demographic and the second one only concerned physiological indices, there was no need to establish their validity and reliability.

In order to prevent bias while gathering the data, the researchers acted in a way that the nurses had no idea of the nature of the study. Thus, the presence of the visitors and its effect on physiological indices was not revealed to the nurses measuring these indices. Double-blind procedure was used in this study to prevent the bias, that is, both patients’ families and nurses measuring the indices were not informed of the importance of increased visitation time in the study.

The questionnaire of demographic characteristics and health monitoring checklist were used for gathering the data. The cardiac monitoring system’s validity was confirmed referring to the manufacture’s manual, using standard tools (audio and visual settings and annual control of thermal and pressure sensors using analyzers), selecting devices from leading brands, and calibration certificate issued by a medical equipment engineer before starting sampling. To ensure valid and reliable measurements of the physiological parameters, a single monitoring device, Data Ohmeda (GIMM Company), was used for all participants. The blood pressure of the participants was measured by non-invasive monitoring on the right arm (and on the left arm for amputees, paralyzed patients, etc.) in supine position and 30-degree head-up state and recorded automatically on the cardiac monitor. In order to determine the arterial oxygen saturation, the index finger of the patient’s right hand was completely placed into the probe and the digit on the monitor was recorded. Heart and respiratory rates were observed and recorded using cardiac monitoring device and Chest Lead. Sampling was performed during morning and afternoon working shifts. In this study, the ICU patients were considered as the control group and visitors were allowed to visit the patients during the routine hospital visiting time at 3:00 PM in the afternoon for 10 minutes. The patients in neurological ICU were considered as the intervention group and visiting times were at 9:00 AM, 12:00 PM, and 3:00 PM each for 10 minutes. Using a questionnaire, the effect of visitation by relatives on the physiological indices of the patients in both control and intervention groups were recorded and assessed 10 minutes before starting the visitation time, during visitation, and 10 and 30 minutes after the visitation. Then, the obtained data were analyzed using SPSS version 20 and descriptive statistic tests (mean and standard deviation) and qualitative data using chi-square test and the means were compared using the independent t-test and repeated measure test.

This study was approved by the ethical code of 93-164-2 in 2 July 2014 and its IRCT code is 2014052617873N1.

4. Results

The chi-square test results showed that the two groups were homogenous in terms of socio-demographic characteristics including age, sex, marital status, hospitalization background, income, etc. before the study (P > 0.05).

The results of the repeated measure in the control group (visitation time according to hospital routines) in different times showed that there was no significant difference among physiological statuses measured at 15 pm (P < 0.05).

The results of Mauchly’s test of sphericity 2 with P < 0.05 rejected the sphericity conditions. Therefore, given that sphericity assumption is not held, Greenhouse-Geisser correction 3 was used for conducting the repeated measure test in 4 different measurements for intra-rater effects. The result of the test showed that in the intervention group there was a significant difference among the mean values of the measured indices in three times (9:00 AM, 12:00 PM, and 3:00 PM) and in 4 different measurements (P < 0.0001).

Following revealing the significance of the measured indices’ mean values in 4 measuring times at 9:00 AM, 12:00 PM, and 3:00 PM, mutual assessing of significant difference among these 4 means was conducted using paired comparisons (means difference (I - J)) through the Bonferroni post hoc test, as shown in the following tables representing the change occurred in the means of the studied indices.

As the Table 1 indicates, physiological indices of the patients in the control group were evaluated just before 9:00 AM, while these indices of those in the intervention group were measured before, during and 10 minutes and then 30 minutes after visitation. The results suggested that blood pressure parameters (the mean systolic blood pressure: 114.40, mean diastolic blood pressure: 90.4, mean arterial pressure: 113.60, mean heart rate: 99.7, and mean respiratory rate: 25.7) had the highest mean values during the hospital visitation and means’ differences were statistically significant in 4 different measurements (P < 0.05). No increase, however, was reported in arterial oxygen index during the visitation compared to before visitation (mean difference = -0.34). Given the results of repeated measures, changes in these indices at 9:00 AM in the intervention group suggested improvement in physiological status of the patients after planned hospital visitations (Figure 2, Tables 2 and 3).

Table 1. The Results of Comparison of the Mean Values of Physiological Indices in the Intervention and Control Groups at 9:00 AM
Measure/TimeMean ± Std. Error95% Confidence Interval
Lower BoundUpper Bound
SBP
Before124.033 ± 2.096119.746128.321
During133.033 ± 1.506129.953136.113
10114.400 ± 1.744110.834117.966
30111.900 ± 1.722108.379115.421
DBP
Before87.400 ± 0.58186.21388.587
During90.400 ± 0.59089.19391.607
1082.867 ± 0.65581.52784.207
3083.233 ± 0.59282.02284.445
MAP
Before108.433 ± 0.886106.621110.246
During113.600 ± 0.954111.650115.550
1094.900 ± 0.84293.17896.622
3093.133 ± 0.73191.63794.629
PR
Before90.033 ± 1.18987.60192.466
During99.767 ± 1.66196.369103.165
1078.233 ± 0.86076.47579.992
3078.400 ± 0.74476.87979.921
RR
Before20.900 ± 0.45119.97821.822
During25.767 ± 0.44924.84826.685
1015.633 ± 0.26015.10116.166
3015.033 ± 0.24214.53815.528
O2sat
Before88.033 ± 0.52086.97089.096
During84.767 ± 0.55883.62485.909
1088.167 ± 0.50887.12889.205
3088.667 ± 0.56487.51389.820

Abbreviations: DBP, diastolic blood pressure; O2sat, oxygen saturation; RR, repertory rate; SBP, systolic blood pressure.

The Physiological Indicators in the Intervention Group at 9:00 AM
Figure 2. The Physiological Indicators in the Intervention Group at 9:00 AM
Table 2. [Part 1] The Results of Paired Bonferroni Comparisons of Mean Values of the Physiological Indices in the Intervention and Control Groups at 12:00 PM
Measure/Factor 1 (I)/Factor 1 (J)Mean Difference (I - J)Std. ErrorP Value95% Confidence Interval for Difference
Lower BoundUpper Bound
SBP
Before
During-9.000a1.3130.0001-12.718-5.282
109.633a0.9920.00016.82312.444
3012.133a1.6500.00017.46216.804
During
1018.633a1.1500.000115.37621.890
3021.133a1.4070.000117.14825.119
10
302.5001.3140.402-1.2206.220
DBP
Before
During-3.000a0.3980.0001-4.128-1.872
104.533a0.6210.00012.7756.292
304.167a0.6380.00012.3605.973
During
107.533a0.6690.00015.6399.428
307.167a0.6920.00015.2089.125
10
30-0.3670.3471.000-1.3500.617
MAP
Before
During-5.167a0.8750.0001-7.644-2.689
1013.533a0.9660.000110.79916.268
3015.300a0.9830.000112.51718.083
During
1018.700a1.0150.000115.82621.574
3020.467a0.9690.000117.72223.211
10
301.7670.6640.075-0.1133.646

Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure.

aSignificant.

Table 3. [Part 2] The Results of Paired Bonferroni Comparisons of Mean Values of the Physiological Indices in the Intervention and Control Groups at 12:00 PM
Measure/Factor 1 (I)/Factor 1 (J)Mean Difference (I - J)Std. ErrorP Value95% Confidence Interval for Difference
Lower BoundUpper Bound
PR
Before
During-9.733a1.0730.0001-12.772-6.695
1011.800a0.9720.00019.04614.554
3011.633a1.0020.00018.79714.470
During
1021.533a1.4980.000117.29325.774
3021.367a1.4250.000117.33125.402
10
30-0.1670.4131.000-1.3351.002
RR
Before
During-4.867a0.3420.0001-5.834-3.900
105.267a0.4470.00014.0016.532
305.867a0.5440.00014.3267.407
During
1010.133a0.4390.00018.89111.376
3010.733a0.5140.00019.27812.189
10
300.6000.2740.219-0.1751.375
O2sat
Before
During3.267a0.3710.00012.2164.318
10-0.1330.3981.000-1.2590.992
30-0.6330.4140.820-1.8050.538
During
10-3.400a0.4510.0001-4.678-2.122
30-3.900a0.4270.0001-5.109-2.691
10
30-0.5000.2830.524-1.3000.300

Abbreviations: O2sat, oxygen saturation; RR, repertory rate.

aSignificant.

Evaluating indices for patients in the control and intervention groups at 12:00 PM indicated that, like the case in 9:00 AM, blood pressure indices (the mean systolic blood pressure: 132.5, mean diastolic blood pressure: 89.6, mean arterial pressure: 113.7, mean heart rate: 103.73) had the highest mean values during visitation. However, the arterial oxygen saturation level was not significantly increased compared to before visitation (mean difference: -0.34) (P > 0.05). These kinds of changes can be due to the patient’s emotions associated with visiting her/ his relatives (Table 4 for 12:00 PM; Tables 5 and 6 and Figure 3).

Table 4. The Results of Comparison of Mean Values of the Physiological Indices in the Intervention and Control Groups at 12:00 PM
Measure/TimeMean ± Std. Error95% Confidence Interval
Lower BoundUpper Bound
SBP
Before126.933 ± 1.744123.367130.500
During132.500 ± 1.806128.806136.194
10112.800 ± 1.979108.752116.848
30114.033 ± 1.817110.318117.749
DBP
Before86.800 ± 0.63185.50988.091
During89.633 ± 0.66588.27390.994
1080.967 ± 0.70479.52782.406
3081.733 ± 0.55180.60782.860
MAP
Before109.133 ± 0.963107.163111.104
During113.700 ± 0.791112.082115.318
1090.933 ± 0.81689.26492.603
3091.000 ± 0.93289.09392.907
PR
Before89.833 ± 1.28487.20792.459
During103.733 ± 1.762100.129107.338
1079.167 ± 0.86777.39380.940
3078.667 ± 0.84376.94280.391
RR
Before20.667 ± 0.46619.71421.619
During25.533 ± 0.55224.40426.663
1015.433 ± 0.36414.68916.178
3015.400 ± 0.29814.79116.009
O2sat
Before87.600 ± 0.49586.58888.612
During84.567 ± 0.66983.19885.935
1088.133 ± 0.50287.10689.161
3088.600 ± 0.43087.72089.480

Abbreviations: DBP, diastolic blood pressure; O2sat, oxygen saturation; RR, repertory rate; SBP, systolic blood pressure.

The Physiological Indicators in the Intervention Group at 12:00 PM
Figure 3. The Physiological Indicators in the Intervention Group at 12:00 PM
Table 5. [Part 1] The Results of Bonferroni Paired Comparison of the Mean Values of the Physiological Indices in the Intervention and Control Groups at 3:00 PM
Measure/Time (I)/Time (J)Mean Difference (I - J)Std. ErrorP Value95% Confidence Interval for Difference
Lower BoundUpper Bound
SBP
Before
During-5.567a0.7610.000-7.122-4.011
1014.133a1.5040.00011.05817.209
3012.900a1.5870.0009.65516.145
During
1019.700a1.5850.00016.45822.942
3018.467a1.6310.00015.13021.803
10
30-1.2330.7710.121-2.8110.344
DBP
Before
During-2.833a0.6220.000-4.105-1.562
105.833a0.7670.0004.2647.403
305.067a0.7850.0003.4626.672
During
108.667a0.6600.0007.31710.016
307.900a0.6800.0006.5099.291
10
30-0.767a0.3450.034-1.472-0.062
MAP
Before
During-4.567a0.5980.000-5.790-3.343
1018.200a1.1740.00015.79920.601
3018.133a1.2110.00015.65720.610
During
1022.767a1.1290.00020.45725.076
3022.700a1.1470.00020.35425.046
10
30-0.0670.5030.895-1.0950.961

Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure.

aSignificant.

Table 6. [Part 2] The Results of Bonferroni Paired Comparison of the Mean Values of the Physiological Indices in the Intervention and Control Groups at 3:00 PM
Measure/Time (I)/Time (J)Mean Difference (I - J)Std. ErrorP Value95% Confidence Interval for Difference
Lower BoundUpper Bound
PR
Before
During-13.900a1.3630.000-16.688-11.112
1010.667a1.6000.0007.39513.939
3011.167a1.5560.0007.98414.349
During
1024.567a1.7560.00020.97528.159
3025.067a1.7860.00021.41528.719
10
300.5000.2700.074-0.0531.053
RR
Before
During-4.867a0.3210.000-5.523-4.211
105.233a0.3060.0004.6085.859
305.267a0.3680.0004.5146.019
During
1010.100a0.4560.0009.16811.032
3010.133a0.4760.0009.15911.108
10
300.0330.1820.856-0.3400.407
O2sat
Before
During3.033a0.6070.0001.7914.276
10-0.5330.4950.290-1.5460.480
30-1.0000.5230.066-2.0700.070
During
10-3.567a0.5290.000-4.648-2.485
30-4.033a0.6070.000-5.276-2.791
10
30-0.4670.2830.109-1.0450.111

Abbreviations: O2sat, oxygen saturation; RR, repertory rate.

aSignificant.

Comparison of the patients’ physiological indices in the control and intervention groups assessed at 3:00 PM showed that no statistically significant difference was observed in any of the visiting hours (P > 0.05), that is, unplanned and limited visitation times did not have much impact on improving patient’s physiological characteristics. However, despite increasing the indices in the subjects of intervention group during visitation times, these parameters showed a significant reduction 10 and 30 minutes after the visitation time (P < 0.05) (Figure 4, Tables 7 and 8).

A, The Physiological Indicators in the Control Group at 15 o Clock; B, the Physiological Indicators in the Intervention Group at 15 o Clock
Figure 4. A, The Physiological Indicators in the Control Group at 15 o Clock; B, the Physiological Indicators in the Intervention Group at 15 o Clock
Table 7. The Results of Comparison of the Mean Values of the Physiological Indices in the Control and Intervention Groups at 9:00 AM
Measure/GroupMean ± Std. Error95% Confidence Interval
Lower BoundUpper Bound
SBP
Control127.350 ± 1.233124.883129.817
Intervention119.600 ± 1.233117.133122.067
DBP
Control86.350 ± 0.73584.87987.821
Intervention86.392 ± 0.73584.92187.862
MAP
Control110.483 ± 0.492109.498111.469
Intervention105.158 ± 0.492104.173106.144
PR
Control90.517 ± 1.16588.18592.848
Intervention87.925 ± 1.16585.59490.256
RR
Control21.808 ± 0.39021.02822.588
Intervention20.075 ± 0.39019.29520.855
O2sat
Control88.442 ± 0.39887.64489.239
Intervention88.783 ± 0.39887.98689.581

Abbreviations: DBP, diastolic blood pressure; O2sat, oxygen saturation; RR, repertory rate; SBP, systolic blood pressure.

Table 8. The Results of Bonferroni Paired Comparisons the Mean Values of the Physiological Indices in the Control and Intervention Groups at 3:00 PMa
Source/MeasureType III Sum of SquaresdfMean SquareFP Value
Group
SBP900.9381900.93819.7640.0001
DBP0.02610.0260.0020.968
MAP425.3341425.33458.5200.0001
PR100.7511100.7512.4760.121
RR45.067145.0679.8970.003
O2sat1.75111.7510.3680.547
Error
SBP2643.9005845.584--
DBP939.1605816.192--
MAP421.552587.268--
PR2360.0105840.690--
RR264.104584.554--
O2sat276.177584.762--

Abbreviations: DBP, diastolic blood pressure; df, degree of freedom; O2sat, oxygen saturation; RR, repertory rate; SBP, systolic blood pressure.

aTests of between-subjects effects.

The results of the mean values of the measured indices in 4 different times in both groups at 3:00 PM showed that the mean values of SBP, MAP, and RR were significantly different between the two groups (P < 0.05), while O2sat, PR, and DBP were significantly different between the two groups. The results of paired comparison based on post hoc LSD test are provided in Table 9.

Table 9. The Results of LSD Paired Comparisons of the Mean Values of the Physiological Indices in the Control and Intervention Groups at 3:00 PM
Measure(I) Group(J) GroupMean Difference (I - J)Std. ErrorP Value95% Confidence Interval for Differenceb
Lower BoundUpper Bound
SBPControlIntervention7.7501.7430.00014.26011.240
DBPControlIntervention-0.0421.0390.968-2.1212.038
MAPControlIntervention5.3250.6960.00013.9326.718
PRControlIntervention2.5921.6470.121-0.7055.889
RRControlIntervention1.7330.5510.0030.6302.836
O2satControlIntervention-0.3420.5630.547-1.4690.786

Abbreviations: DBP, diastolic blood pressure; O2sat, oxygen saturation; RR, repertory rate; SBP, systolic blood pressure.

Repeated measures analysis of the intervention group’s variances at different hours indicated a significant difference in the measured parameters in various hours (9:00 AM, 12:00 PM, 3:00 PM) (the Greenhouse- Geisser test, P < 0.001).

5. Discussion

The results of the present study showed that the two studied groups were homogenous before performing the study regarding age, marital status, life style, education, occupation, income level, sex, diagnosis, underlying diseases, smoking, and alcohol and drugs abuse.

Our results suggested no significant difference in physiological indices of the patients before applying visitation plans in both control and intervention groups (P > 0.05) that was consistent with the findings of Comruni (16).

According to the results of the evaluations during the first (9:00 AM), second (12:00 PM) and third visitation stages (3:00 PM), the participants in the intervention group showed improvements in physiological indices (including heart rate, respiratory rate, systolic and diastolic blood pressures, and mean arterial pressure) during the visitation (P < 0.05), but no significant effect was reported on arterial oxygen saturation, namely, the difference was not statistically significant (P > 0.05). In the control group, however, mean values of all physiological indices showed no significant difference during the first visitation stage (9:00 AM), the second one (12:00 PM) where visitation was not allowed, and even in the third step where visitation was allowed (P > 0.05). Thus, no remarkable improvement was observed in physiological indices of the patients.

Rahmani et al. (17) concluded that scheduled visitation may decrease physiological parameters and improve treatment results (P < 0.05). However, Salavati and Oshvandi (18) found that scheduling time for families and friends to visit the patient makes no clinical significant improvement in cardiovascular indices (P > 0.05). In their study, no statistically significant difference was observed between the control and intervention groups, which is completely opposing the results of the present study. Also, findings of the study by Comruni et al. (16) suggested significant improvement in physiological indices of the patients in the intervention group.

In addition, physiological indices of the participants showed statistically significant differences 10 and 30 minutes after visitation (P < 0.05) as these parameters decreased, that is, increasing visitation time improved physiological indices of the patients. However, the difference was not significant in the control group.

In the study of Azimi Lolaty et al. (19), increased visitation time significantly improved the feel of comfort, decreased anxiety and enhanced patient’s physiological indices (including systolic and diastolic blood pressure, heart and respiratory rates, and O2sat) (P < 0.001) that is consistent with the findings of the present study.

Also, the research carried out by Zwernman (20) suggested no statistically significant difference among mean arterial pressures measured before, during and after visitation (P > 0.05), while the above-mentioned study proved the positive effect of visiting of relatives on the patient’s mean arterial pressure. In addition, Gerber (21) revealed that respiratory rates showed no statistically significant difference in measurements before, during, and after visitation (P > 0.05) that was due to the differences in the duration of visitation times. While, increased duration of visitation times significantly improved the respiratory status of the patients in this study.

5.1. Conclusions

Findings of the present study show that increased visitation time can lower the mean values of the physiological indices. Therefore, it is recommended that nurses working in the ICUs plan and schedule visitation times focusing on individual, social, and patient-related factors and do not merely consider the hospital principles. Rather, they can help accelerate the patient’s recovery seeking help of their family members.

Although the results of similar studies confirm the results of the present study to a large extent, the indices studied here including systolic and diastolic blood pressure, mean arterial pressure, heart rate, respiratory rate, and O2sat have not been investigated in previous research.

5.2. Limitations

Since intervention studies are conducted on a limited number of subjects, one of the limitations of this study, like other intervention studies, was low number of subjects. Another limitation of the present study was the reluctance of some nursing staff of the ward to participate in this study. However, they were persuaded to participate in the program being explained the importance of the study and illustrating its benefits for patients and health providers. Therefore, it is recommended that the research be carried out in other ICUs such as CCU to achieve more definitive results.

Acknowledgements

Footnote

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