Ethical and political issues in healthcare choices in the pandemic era: the right to visit hospitalized

Main Article Content

Linda Alfano
Romina Ciaccia
Rosagemma Ciliberti

Keywords

COVID-19, solitude, vulnerability, family assistance, caregivers, visiting restrictions, health policies, recovery, security management

Abstract

Background The loneliness of hospitalized in healthcare facilities caused by the suspension of relations with their family members has been a characterizing aspect of the Covid 19 pandemic which still calls for delicate ethical reflections. Based on the implications that the interdictions and/or severe limitations on visits have had on the health of patients and their families, the paper aims to propose possible intervention strategies to reorganize places of care so that individual and collective good can be reconciled without ever compromising the principle of assistance centered on the person and his emotional references.


Materials and Methods: An analysis of the literature of interest has been conducted also through electronic databases including PubMed, Scopus and Web of Science, integrated with data obtained from Web search engines.


Results: To restrain the transmission of the COVID-19 infection in the hospital environment, the administrators of healthcare facilities have adopted highly restrictive measures which, by excluding the family circle from assisting the relative, have negatively affected the fragility and vulnerability of the same people who they wanted to protect and accompany them in the care pathways, neglecting possible alternative strategies that could have guaranteed both care and respect for the person and their emotions.


Conclusions: The organizational models of hospital facilities should become flexible enough to give due prominence, even in emergency situations, to the transformative capabilities of staff in promoting the humanization and personalization of care.

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References

1. World Health Organization (WHO). Maintaining Essential Health Services: Operational Guidance for the COVID-19 Context: Interim Guidance, 1 June 2020; Geneva, Switzerland.
2. Mooney G, Reinarz J. Hospital and asylum visiting in historical perspective: themes and issues. Clio Med. 2009; 86:7–30.
3. Bellou P. Gerogianni K. The contribution of family in the care of patient in the hospital. Health Sci. J. 2010; 1: 4–9.
4. Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections - an overview. Infect Drug Resist. 2018; 15(11):232–33.
5. Rhee C, Baker M, Vaidya V, Tucker R, Resnick A, Morris CA, Klompas M, Program CDCPE. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open. 2020; 3:e2020498.
6. Ciliberti R, Gulino M, Gorini I. New Italian law about end of life: Self-determination and shared care pathway. Recenti Prog Med 2018; 109(5): 267–71.
7. Hugelius K, Harada N, Marutani M, Consequences of visiting restrictions during the COVID‐19 pandemic: An integrative review. Int J Nurs Stud 2021; 121: 104000, ISSN 0020-7489.
8. Correia TSP, Martins MMFPS, Barroso FF, Pinho LG, Fonseca C, Valentim O, Lopes M. The Implications of Family Members' Absence from Hospital Visits during the COVID-19 Pandemic: Nurses' Perceptions. Int J Environ Res Public Health 2022; 19(15):8991.
9. Hugelius K, Harada N, Marutani M. Consequences of visiting restrictions during the COVID-19 pandemic: an integrative review. Int J Nurs Stud 2021; 121:104000.
10. Moss SJ, Krewulak KD, Stelfox HT, Ahmed SB, Anglin MC, Bagshaw SM, Burns KEA et al. Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review. Crit Care 2021; 25:347.
11. Ning J, Cope V. Open visiting in adult intensive care units. A structured literature review. Intensive Crit Care Nurs 2020; 56:102763.
12. Chapman DK, Collingridge DS, Mitchell LA, Wright ES, Hopkins RO, Butler JM, Brown SM Satisfaction with elimination of all visitation restrictions in a mixed-profile Intensive Care Unit. Am J Crit Care 2016; 25(1):46–50.
13. Shahin W. Kennedy GA. Stupans I. The association between social support and medication adherence in patients with hypertension: A systematic review. Pharm Pract 2021; 19, 2300.
14. Sukartini T. Mulyasari P. Wahyuni ED. The Relationship of Family Support and Patients’ Knowledge with The Treatment Adherence of Hypertension Patients. Sys Rev Pharm 2020; 11:1108-10.
15. Hugelius, K.; Harada, N.; Marutani, M. Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. Int J Nurs Stud 2021; 121:104000.
16. Zeh RD, Santry HP, Monsour C, Sumski AA, Bridges JFP, Tsung A, Pawlik TM, Cloyd JM. Impact of visitor restriction rules on the postoperative experience of COVID-19 negative patients undergoing surgery. Surgery 2020; 168: 770–6.
17. Bispo BHR, Santos DLd, Macedo AN A. despersonalização do paciente e da sua história: Uma visão holística da literatura. Int J Health Educ 2020; 4, 105–8.
18. Cacioppo JT, Hawkley LC. Social isolation and health, with an emphasis on underlying mechanisms. Perspect Biol Med 2003; 46, 39–52.
19. Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient's perspective. Ther Clin Risk Manag 2008;4(1):269-86.
20. Comitato Nazionale di Bioetica (CNB) Parere del 24 luglio 2013 Terapia intensiva “aperta” alle visite dei familiari in https://bioetica.governo.it/it/pareri/pareri-e-risposte/terapia-intensiva-aperta-alle-visite-dei-familiari/
21. Comitato Nazionale di Bioetica mozione La solitudine dei malati nelle strutture sanitarie in tempi di pandemia, 26 gennaio 2021. https://bioetica.governo.it/media/4442/25-pareri-e-mozioni-2021.pdf
22. European Centre for Disease Prevention and Control. Increase in fatal cases of COVID-19 among long-term care facility residents in the EU/EEA and the UK. 19 November 2020. ECDC: Stockholm; 2020
23. Bélanger L, Bussières S, Rainville F, Coulombe M, Desmartis M. Hospital visiting policies-impacts on patients, families and staff: a review of the literature to inform decision making. J Hosp Admin 2017; 6:51–62.
24. Halim Babbu A. “Flexibility”: A key concept in Hospital Design. International Journal of Application or Innovation in Engineering & Management (IJAIEM) 2016; 5(5): 24–28.
25. Barnard CJI. Le funzioni del dirigente: organizzazione e direzione. Torino: Unione tipografico-editrice torinese; 1970
26. Crozier M, Thoenig JC. The Regulation of Complex Organized Systems. Adm Sci Q 1976; 21(4):547–70.
27. Butera F. Organizzazione in Nuovo Manuale Di Sociologia. 2015. Accessed January 23, 2022.
28. Schneider B, Bowen DE. The Service Organization: Human Resources Management Is Crucial. Organ Dyn 1993; 21(4):39–52.
29. Normann R. La gestione strategica dei servizi. 2. ed. italiana. ETAS libri; 1999.
30. Capranico S. In che cosa posso servirla. Idee e cultura per le organizzazioni di servizio. 3° edizione. Guerini e Associati; 1992.
31. Laperuta L. Il Management Pubblico. Edizioni Giuridiche Simone; 2006. Accessed October 12, 2022. https://www.hoepli.it/libro/il-management-pubblico-/9788824472500.html
32. Bonazzi G. Storia del pensiero organizzativo; 2004.
33. si vedano Selznick e Gouldner in Bonazzi, 2004
34. Selznick P. Foundations of the Theory of Organization. Am Sociol Rev 1948;13(1):25-35. 2
35. Gouldner A. W. Organizational Analyses in R.K. Merton, L. Brown an L.S. Cotterell (eds), Sociology Today, New York: Basic Book, 1959
36. Ashkanasy N, Humphrey R. Current Emotion Research in Organizational Behavior. Emot Rev 2011; 3:214–24.
37. Federighi P L'azione formativa nelle organizzazioni January 2017 Quaderni di economia del lavoro DOI: 10.3280/QUA2016-105005
38. Gentry S, Badrinath P. Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems. Cureus 2017;9(3):e1079.
39. Taleb, N. Antifragile: How to Live in a World we don't Understand: London: Allen Lane; 2012
40. Molinelli A, Bonsignore A, Rocca G, Ciliberti R. Medical treatment and patient decisional power: The Italian state of the art. Minerva Med 2009; 100(5):429–34.
41. Collomb H. La mise a mort de la famille in La Psychiatrie de l’enfant, 20, 1: 245–98; 1977
42. Bélanger L, Bussières S, Rainville F, Coulombe M, Desmartis M. Hospital visiting policies-impacts on patients, families and staff: a review of the literature to inform decision making. J Hosp Admin 2017; 6:51–62.

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