{ "abstract": "Importance: Family presence supports critically ill children, yet pediatric intensive care unit (PICU) policies remain inconsistent, creating inequities in access to parents or caregivers. Clear guidance is needed to support equitable, child-centered policy development.\n\nObjective: To generate evidence-informed and knowledge user–informed recommendations for family presence policies in PICUs.\n\nDesign, Setting, and Participants: This survey study, conducted through surveys and virtual meetings, used a modified Delphi consensus process. Candidate items were derived from family presence guidance documents and PICU family presence research (environmental scan; scoping review; surveys and interviews with patients, families, and health care professionals; and focus groups). Items were organized into themes covering policy priorities; policy-making responsibilities; baseline and emergency policies; and policy communication, enforcement, and revision. From February 2024 to February 2025, panelists completed 2 rating rounds and 1 virtual meeting, with follow-up meetings and member-checking to incorporate input across knowledge user groups. Knowledge users included former PICU patients, family members, clinicians, and policymakers (hospital and PICU administrators and infection prevention and control specialists) from across Canada.\n\nMain Outcomes and Measures: The main outcome was consensus-derived policy priorities and recommendations for PICU family presence during baseline operations and emergency situations.\n\nResults: Forty-three knowledge users, including 5 patients, 12 family members, 21 clinicians, and 5 policymakers (35 self-reported women or girls [81.4%]), agreed on 10 policy priorities and 44 recommendations. Key messages included that children should be at the center of policy-related decision-making and always have access to at least 2 primary caregivers; families should determine sibling presence and assume responsibility for it; policies should recognize the importance of visitors beyond family for the child’s well-being; and policies should be flexible, adapting to different situations while adhering to core priorities. Recommendations addressed who should make policies; communication, enforcement, and change processes; number, type (eg, parents or caregivers, siblings, and visitors), and timing of bedside presence; family movement and supports; and approaches to personal protective equipment and infectious symptoms to preserve family presence, including during emergencies.\n\nConclusions and Relevance: This survey study with consensus-based recommendations for PICU family presence provided a framework for policy design in routine and emergency contexts. The recommendations emphasized the patient’s best interest and continued access to at least 2 primary caregivers. They supported context-specific and unit-specific policy design and may be broadly applicable across children’s hospitals.", "abstract_shown": true, "affiliations": [ "Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada", "Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada", "Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada", "Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada", "Department of Pediatric Critical Care, IWK Health, Halifax, Nova Scotia, Canada", "Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada", "Patient and Family Partners Program, IWK Health, Halifax, Nova Scotia, Canada", "Brescia School of Food and Nutritional Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada", "Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada", "Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada", "Children’s Health Research Institute, London, Ontario, Canada", "Lawson Research Institute, London, Ontario, Canada", "Stollery Children’s Hospital Pediatric Intensive Care Unit, Edmonton, Alberta, Canada", "Division of Critical Care Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada", "IWK Health, Halifax, Nova Scotia, Canada", "Division of Pediatric Critical Care Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada", "Division of Infectious Diseases, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada", "School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada", "Division of Critical Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada", "Pediatric Intensive Care Unit, Montreal Children’s Hospital, Montreal, Québec, Canada", "Ingram School of Nursing, McGill University, Montreal, Québec, Canada", "Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Québec, Canada", "Department of Medicine, Sinai Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada", "Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada", "Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada", "O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada" ], "article_type": null, "arxiv": null, "author_total": 22, "authors": [ { "affs": [ 0, 1, 2 ], "name": "Laurie A. Lee" }, { "affs": [ 3, 4 ], "name": "Jennifer R. Foster" }, { "affs": [ 5 ], "name": "Karla D. Krewulak" }, { "affs": [ 3 ], "name": "Dana Rhyno" }, { "affs": [ 3 ], "name": "Molly J. Ryan" }, { "affs": [ 6 ], "name": "Corey Slumkoski" }, { "affs": [ 6 ], "name": "Martha Walls" }, { "affs": [ 6 ], "name": "Neda Zafranchi-Moghadam" }, { "affs": [ 7, 8, 9, 10, 11 ], "name": "Jamie A. Seabrook" }, { "affs": [ 12, 13 ], "name": "Daniel Garros" }, { "affs": [ 14 ], "name": "Stacy Burgess" }, { "affs": [ 15 ], "name": "Karen Choong" }, { "affs": [ 16 ], "name": "Jeannette L. Comeau" }, { "affs": [ 17 ], "name": "Janet Curran" }, { "affs": [ 18 ], "name": "Srinvas Murthy" }, { "affs": [ 14 ], "name": "Laura Betts" }, { "affs": [ 19, 20 ], "name": "Franco A. Carnevale" }, { "affs": [ 21 ], "name": "Patricia S. Fontela" }, { "affs": [ 3 ], "name": "Kristina Krmpotic" }, { "affs": [ 22 ], "name": "Sangeeta Mehta" }, { "affs": [ 23 ], "name": "Katie O’Hearn" }, { "affs": [ 24, 25 ], "name": "Kirsten M. Fiest" } ], "bibtex": "https://research.draconitic.com/paper/fg7txyv9e0av7.bib", "cited_by": 1, "doi": "10.1001/jamanetworkopen.2026.43825", "fulltext_url": null, "id": "fg7txyv9e0av7", "issns": [ "2574-3805" ], "landing_url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856571", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [], "openalex": null, "pdf_url": null, "pmcid": null, "pmid": null, "published": "2026-11-12", "publisher": "American Medical Association (AMA)", "ris": "https://research.draconitic.com/paper/fg7txyv9e0av7.ris", "sources": [ { "first_seen": "2026-11-13T00:21:23Z", "native_id": "10.1001/jamanetworkopen.2026.43825", "source": "crossref", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856571" } ], "subjects": [ { "field": "medicine", "origin": "issn:2574-3805", "subfield": "general" } ], "title": "Family Presence Policies in Pediatric Intensive Care Units", "title_text": "Family Presence Policies in Pediatric Intensive Care Units", "type": "peer-reviewed", "updated_at": "2026-11-14T00:21:02Z", "url": "https://research.draconitic.com/paper/fg7txyv9e0av7", "venue": "JAMA Network Open", "versions": [] }