Territoriality of the ICU: visiting experiences and perceptions of nurses and family members in a Chinese adult intensive care unit: a focused ethnographic study

Abstract

BACKGROUND: The implementation of flexible visiting policies remains a topic of ongoing debate in adult intensive care units (ICUs) worldwide. Visiting policies vary widely across different settings, ranging from 24 hours to 30 minutes of visiting time. These policies significantly affect the visiting experiences of family members. In China, most ICUs restrict visits to 30 minutes per day. However, limited research has explored how the restricted visiting policy is experienced by nurses and family members in China and how it impacts their visiting experiences.

AIM: This focused ethnographic study aims to explore nurses’ and family members’ experiences and perceptions of family visiting in the ICU.

METHODOLOGY AND RESEARCH METHODS: A focused ethnographic approach was employed. Data were collected in a general adult ICU at a tertiary hospital in China from April 2021 to December 2021. The study involved 39 observation sessions totalling 65.3 hours, 19 individual interviews with family members, and three focus groups with 11 nurses. Policy documents related to family visiting were also examined. Thematic analysis was used to help systematically and thoroughly analyse the data, identify patterns, and develop theoretical ideas to illuminate the phenomenon of family visiting in the ICU. The analysis applied inductive-abductive reasoning, drawing on Delaney’s (2005; 2009) concept of territoriality and territory, Giddens’s (1984) proposition on “duality of structure” in structuration theory, and Merton’s (1972) structural conceptions of outsiders and insiders. NVivo 13 was used for data management and to facilitate analysis.

FINDINGS: ‘Territoriality of the ICU’ emerged as the overarching theme from the nurses’ data, representing how nurses constructed the ICU as their territory under the restricted visiting policy. The construction of territory was implicated in nurses’ interactions with family members, including controlling the ICU space, distancing from family members, and viewing family members as outsiders. From the family members’ data, ‘being an outsider’ and ‘being an insider’ were two overarching themes. ‘Being an outsider’ captures how family members navigated the territory of the ICU, a space over which they had no control. The restricted access of the ICU left family members’ visiting needs for proximity, information, and assurance unmet. The interactions with nurses highlighted the power differentials, where nurses acted as the gatekeeper of access and information. ‘Being an insider’ captures family members’ experiences of waiting outside the ICU, where support from their own family and connections built with other patients’ families constructed their insider status.

CONCLUSION: The current restricted visiting policy reinforces power differentials between nurses and family members, hindering nurses’ perceptions of family members as insiders. These findings highlight the need to reflect on the prolonged practice of restricted visiting policies in Chinese adult ICUs, advocating for more flexible policies. The study also suggests that nurses have an important role in supporting family members’ visiting experiences. A supportive work environment is essential to enhance nurses’ engagement in interacting with family members.