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Peer-reviewedCC BY 4.0JAMA Network Open

Family Presence Policies in Pediatric Intensive Care Units

  • Laurie A. Lee1,2,3
  • Jennifer R. Foster4,5
  • Karla D. Krewulak6
  • Dana Rhyno4
  • Molly J. Ryan4
  • Corey Slumkoski7
  • Martha Walls7
  • Neda Zafranchi-Moghadam7
  • Jamie A. Seabrook8,9,10,11,12
  • Daniel Garros13,14
  • Stacy Burgess15
  • Karen Choong16
10 more authors
  • Jeannette L. Comeau17
  • Janet Curran18
  • Srinvas Murthy19
  • Laura Betts15
  • Franco A. Carnevale20,21
  • Patricia S. Fontela22
  • Kristina Krmpotic4
  • Sangeeta Mehta23
  • Katie O’Hearn24
  • Kirsten M. Fiest25,26
26 affiliations
  1. 1Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
  4. 4Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada
  5. 5Department of Pediatric Critical Care, IWK Health, Halifax, Nova Scotia, Canada
  6. 6Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  7. 7Patient and Family Partners Program, IWK Health, Halifax, Nova Scotia, Canada
  8. 8Brescia School of Food and Nutritional Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
  9. 9Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  10. 10Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
  11. 11Children’s Health Research Institute, London, Ontario, Canada
  12. 12Lawson Research Institute, London, Ontario, Canada
  13. 13Stollery Children’s Hospital Pediatric Intensive Care Unit, Edmonton, Alberta, Canada
  14. 14Division of Critical Care Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  15. 15IWK Health, Halifax, Nova Scotia, Canada
  16. 16Division of Pediatric Critical Care Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  17. 17Division of Infectious Diseases, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
  18. 18School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
  19. 19Division of Critical Care, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
  20. 20Pediatric Intensive Care Unit, Montreal Children’s Hospital, Montreal, Québec, Canada
  21. 21Ingram School of Nursing, McGill University, Montreal, Québec, Canada
  22. 22Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Québec, Canada
  23. 23Department of Medicine, Sinai Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
  24. 24Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  25. 25Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  26. 26O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Open at sourceDOICite

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.

Objective: To generate evidence-informed and knowledge user–informed recommendations for family presence policies in PICUs.

Design, 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.

Main Outcomes and Measures: The main outcome was consensus-derived policy priorities and recommendations for PICU family presence during baseline operations and emergency situations.

Results: 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.

Conclusions 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.

Related

  1. Informing Meaningful Family Presence Policies in Pediatric Critical Care—From Presence to Partnership
    Mallory A. Perry, Elizabeth G. Broden Arciprete
    JAMA Network OpenPeer-reviewedCC BY 4.0General medicineCrossref
  2. Death by neurologic criteria and organ donation in German pediatric intensive care units—data from the PIA network
    Nadine Mand, Carolin Donath, Franziska König +8
    Frontiers in PediatricsPeer-reviewedCC BYFull textEpidemiology & public healthDOAJEurope PMCPMC
  3. Conflict in intensive care units: a conceptual framework for patient, family, team, and inter-service disagreement
    Craig S. Jabaley, Zoe Brummell, Dominique D. Benoit +2
    Critical CarePeer-reviewedCC BY 4.0Full textGeneral medicinePMC
  4. Family experiences with genetic/genomic testing in the pediatric intensive care unit
    Sunu Kim, Srinivas Murthy, Sylvie Langlois +17
    European Journal of PediatricsPeer-reviewedCC BY-NC-ND 4.0Full textObstetrics, gynaecology & paediatricsPMC
  5. Effect of Virtual Reality Relaxation on Alarm Fatigue and Professional Quality of Life Among Nurses in Intensive Care Units
    Fatemeh Mirzahosseini, Mahlagha Dehghan, Moazame Jazinizade +1
    Health science reportsPeer-reviewedCC BYFull textGeneral medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{lee2026family,
  title = {{Family Presence Policies in Pediatric Intensive Care Units}},
  author = {Laurie A. Lee and Jennifer R. Foster and Karla D. Krewulak and Dana Rhyno and Molly J. Ryan and Corey Slumkoski and Martha Walls and Neda Zafranchi-Moghadam and Jamie A. Seabrook and Daniel Garros and Stacy Burgess and Karen Choong and Jeannette L. Comeau and Janet Curran and Srinvas Murthy and Laura Betts and Franco A. Carnevale and Patricia S. Fontela and Kristina Krmpotic and Sangeeta Mehta and Katie O’Hearn and Kirsten M. Fiest},
  journal = {JAMA Network Open},
  year = {2026},
  month = nov,
  doi = {10.1001/jamanetworkopen.2026.43825},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856571},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Family Presence Policies in Pediatric Intensive Care Units
AU  - Laurie A. Lee
AU  - Jennifer R. Foster
AU  - Karla D. Krewulak
AU  - Dana Rhyno
AU  - Molly J. Ryan
AU  - Corey Slumkoski
AU  - Martha Walls
AU  - Neda Zafranchi-Moghadam
AU  - Jamie A. Seabrook
AU  - Daniel Garros
AU  - Stacy Burgess
AU  - Karen Choong
AU  - Jeannette L. Comeau
AU  - Janet Curran
AU  - Srinvas Murthy
AU  - Laura Betts
AU  - Franco A. Carnevale
AU  - Patricia S. Fontela
AU  - Kristina Krmpotic
AU  - Sangeeta Mehta
AU  - Katie O’Hearn
AU  - Kirsten M. Fiest
PY  - 2026
DA  - 2026/11/12
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.43825
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856571
AB  - 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.  Objective: To generate evidence-informed and knowledge user–informed recommendations for family presence policies in PICUs.  Design, 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.  Main Outcomes and Measures: The main outcome was consensus-derived policy priorities and recommendations for PICU family presence during baseline operations and emergency situations.  Results: 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.  Conclusions 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.
SN  - 2574-3805
ER  -