UNDERSTANDING THE NEEDS AND EXPERIENCES OF FAMILIES Flexible family visitation in the intensive care unit: nurses’ decision-making Anne Sophie A ˚ ga ˚ rd and Kirsten Lomborg Aims and objectives. To identify and explore general strategies used by Danish intensive care unit nurses in everyday decision- making about family visitation. Background. In the intensive care unit, relatives experience a strong commitment to watch over and protect the patient. Relatives can provide important help and support to their loved one. To do so, relatives need to be able to stay, preferably at the bedside. Managing a flexible visitation policy, nurses play an important role as gate-keepers at the bedside requiring strong discretionary power. Little is known about the rationale for nurses’ decision making when allowing family members to stay by the patient’s bedside or asking them to leave the unit. Design. Explorative qualitative interview study. Method. In 2005 and 2008, we conducted a grounded theory study based on 11 semi-structured interviews with intensive care unit nurses. Results. In the constantly shifting social context of the intensive care unit, nurses practiced clinical leadership balancing the needs of all parties involved, being mindful that the patient is their primary concern. To do so, they used three general strategies: Clarifying relations, Defining the situation and Guiding relatives in a concurrent and ongoing process, assessing when visiting is appropriate on a minute-to-minute basis. Conclusion. The study identifies and describes important professional considerations and values embedded in the nurses’ decision making about visitation. Detailed knowledge in this area will provide a concrete basis for internal discussion on specific everyday interactions with visiting relatives, as well as more general discussions on the possibilities for and implications of enhancing flexible family visitation. Relevance to clinical practice. To practice a contemporary visitation policy, the complexity of the task, the shifting context of the intensive care unit, the physical surroundings as well as possible limitations given by the staffing level should be acknowledged. The training of intensive care unit nurses should support adaptation to the clinical leadership role. Key words: family, grounded theory, intensive care, nursing, research report, visitors to patients Accepted for publication: 16 March 2010 Introduction Admittance to an intensive care unit (ICU) often involves uncertainty as to the patient’s prospect of survival and potential short- or long-term disabilities following the critical illness. Both patients and relatives are in a stressful situation, not knowing the outcome of the situation and the perspec- tives for their future lives with or without the patient (Kirchhoff et al. 2004, Hughes et al. 2005). This agonising situation can result in psychosocial problems for the relatives (A ˚ ga ˚rd & Harder 2007, Paul & Rattray 2008, Plakas et al. 2009). Although the ICU nurse caters mainly for the Authors: Anne Sophie A ˚ ga ˚rd, MScN, RN, CCRN, Doctoral Student, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby; Kirsten Lomborg, PhD, RN, Associate Professor, Department of Nursing Science, School of Public Health, Aarhus University, Aarhus, Denmark Correspondence: Anne Sophie A ˚ ga ˚ rd, Doctoral Student, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Skejby, Brendstrupga ˚ rdsvej 100, 8200 Aarhus N, Denmark. Telephone: +45 8949 8833. E-mail: anne.agard@reher-langberg.dk 1106 Ó 2010 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 1106–1114 doi: 10.1111/j.1365-2702.2010.03360.x