Virtual Visiting in ICU: Benefits and Ethical Issues Assignment

Introduction

Virtual visiting has appeared as an important assistant to in-person family visitation, especially in Intensive Care Units (ICUs) throughout the period of the COVID-19 pandemic. The usage of technology, with limited physical access, to promote remote communication has become vital for retaining patient-family relationships. This innovation has the possibility to evolve as a long-term segment of ICU care, enhancing emotional support as well as family-centred decision-making.

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Patient Diaries

These are personal journals held during a stay of patient in the ICU. They are typically written by patients (if capable), healthcare staff, or family associates, recording the day-to-day events, emotional, and treatment experiences during acute illness (Mickelson et al., 2021).

Purpose of the Diaries

The primary purpose of diaries is

• To aid patients in understanding and emotionally processing their ICU experience, particularly when they hold memory gaps because of delirium or sedation.
• Diaries reinforce psychological recovery, relieve indications of depression, Post-Traumatic Stress Disorder (PTSD), and anxiety (Bosco et al., 2023).
• Improve communication between families, the healthcare group, and patients.

Benefits

● For Patient

Virtual visiting permits critically sick patients to uphold meaningful connections with their homes, particularly when biological visits are unattainable because of illness severity, geographical limitations or sedation. According to Paul et al. (2024), patients underwent enhanced emotional comfort and autonomy through non-verbal exchanges or the easy presence of adored ones on screen. In a few end-of-life cases, patients shared final messages via written or mouthing gestures, sustaining an emotionally and dignified supportive death venture.

● For Families

Families are aided by dwelling emotionally attached to their adored ones, achieving understanding of their situation and care setting. Virtual visits allow family associates to participate in spiritual care, patient orientation, non-verbal communication, and rehabilitation encouragement (Xyrichis et al., 2022). The capability to visit their families, even when ventilated or sedated, supported families in making meaning of the condition, contributing to decreasing senses of helplessness and psychological processing.

Implications for clinical practice

Virtual visiting integration into regular ICU care needs comprehensive technological, communicational, and ethical frameworks. Healthcare experts need systematic training in emotional support and virtual communication techniques, addressing privacy matters and guiding families.

● Current evidence

Clarke et al. (2024) and Xyrichis et al. (2022) deliver a qualitative understanding of the ethical, emotional, and practical extents of virtual visiting in the ICU. There is strong support for its advantages, but acknowledged infrastructure limitations, emotional strain, and staff burden on healthcare experts, encouraging such visits.

● Potential benefits

• Enhances patient dignity and autonomy.
• Enhances family understanding and participation in ICU care.
• Bridges voids for families diverged by illness or distance.
• Advances family-centred care in inclusive and diverse ways.

● Consideration

• Emotional distress risks for staff and families.
• Technology inaccessibility and language barriers.
• Problems surrounding dignity and consent when patients are unconscious or sedated.
• Staff may undergo emotional burnout because of exposure to personal family exchanges.

● Rationale for ICU diaries

ICU diaries show support for psychological recuperation by delivering the ICU experience’s narrative for families and patients (Flahault et al., 2021). Parallel to virtual visiting, the diaries support piecing together fragmented remembrances and decrease symptoms related to Post-Intensive Care Syndrome (PICS) as well as Post-Intensive Care Syndrome-Family (PICS-F).

Research paper 1: Ethical considerations related to virtual visiting for families and critically ill patients in intensive care: a qualitative descriptive study (Clarke et al., 2024)

Purpose

To explore the unanticipated or anticipated ethical problems raised by utilising virtual visiting in ICU situations throughout the COVID-19, such that the healthcare experts can be informed regarding how to transmit virtual visits productively, safely, and ethically.

Method

• Descriptive qualitative exploratory research strategy.
• Recruiting a convenience sample of 8 newly graduated junior doctors (aged 23–27)
• Semi-structured interviews
• The inductive thematic coding approach is utilised for data understanding by analysing transcripts.

Inclusion criteria

• 8 newly graduated junior doctors (7 male and 1 female) working as a virtual visiting group at UK’s central London teaching hospital.
• Involved actively in promoting virtual visits throughout the foremost upsurge of the pandemic (COVID-19) in the UK.

Exclusion criteria

• Not stated explicitly, however, participants not engage in virtual visiting are not included in this study.

Outcome

• Five significant ethical themes are specified:
  • Fulfilling an honest instinct to join families
  • Promoting autonomy
  • Preserving privacy and dignity
  • Addressing emotional distress
  • Equitable credentials for virtual visiting technology
• The research emphasises both favourable impacts as well as ethical difficulties of virtual visiting.

Research paper 2: Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members (Xyrichis et al., 2022)

Purpose

To comprehend the virtual visiting’s perceived benefits and experiences from the viewpoints of ICU-experienced clinicians as well as non-ICU-experienced family liaison group members.

Method

• Qualitative descriptive research design.
• 36 interviews were performed with 17 ICU-experienced clinicians and 19 non-ICU-experienced family liaison team members.
• Participants included ICU-experienced clinicians as well as non-ICU-experienced family liaison team members across 14 UK NHS hospitals.
• Semi-structured video/telephone interviews were performed with ICU clinicians.
• Thematic analysis of interview transcripts utilising NVivo software.

Inclusion criteria

• Non-ICU-experienced as well as ICU-experienced staff engaged in virtual visiting.
• Setting: Adult intensive care framework across 14 clinics in the UK NHS.
• Participants deployed to or working in an adult ICU throughout the first UK COVID-19 pandemic wave (March–June 2020).

Exclusion criteria

• Not specified explicitly in the study, but workers not engaged in virtual visiting are excluded.

Outcome

• Three key advantages of virtual visiting have been identified:
  • Restoring the family unit: Virtual visits having numerous family members together restored a feeling of family.
  • Promoting involvement of family in care: Involvement in orientation activities, communication, and rehabilitation, highlighted virtual visiting’s aid in family-centred care.
  • Boosting emotional sensemaking: Virtual visits are emotionally difficulties for multiple family members; however, also liberating in helping them make essence of their experience and feelings by imagining their loved ones within the ICU.
• Virtual visiting was discovered to facilitate family-centred care as well as help clinical communication throughout restricted visitation.

Critical Appraisal using CASP Checklist

Research Paper 1: Ethical considerations related to virtual visiting for families and critically ill patients in intensive care: a qualitative descriptive study (Clarke et al., 2024)
Are the results valid? (A)	What are the results? (B)	Will the results help locally? (C)
1. Was there a clear statement of the aims of the research? ✔ Yes ● To explore the unanticipated or anticipated ethical problems raised by utilising virtual visiting in ICU situations throughout the COVID-19. ● Important because of the virtual visits’ widespread use and narrow ethical direction. ● Applicable to inform policy and practice.	7. Have ethical issues been taken into consideration? ✔ Yes ● Ethical approval received. ● Consent was obtained from participants. ● Ethical considerations, such as data handling and confidentiality, were addressed.	10. How valuable is the research? ✔ Yes ● Delivers valuable ethical wisdom for prospective ICU practices in virtual visiting settings. ● Highlights the demand for policy development, communication training, and additional research.
2. Is a qualitative methodology appropriate? ✔ Yes ● Aimed to investigate junior doctors’ ethical reflections on subjective experiences. ● Qualitative descriptive research methodology was suitable.	8. Was the data analysis sufficiently rigorous? ✔ Yes ● Inductive thematic coding analysis conducted. ● Themes emanated from transcription. ● Co-analysis and member checking improved credibility.
3. Was the research design appropriate to address the aims of the research? ✔ Yes ● A descriptive exploratory method employing semi-structured interviews was aligned and justified with the study aim.	9. Is there a clear statement of findings? ✔ Yes ● Five precise themes were presented. ● Findings related to the study question as well as reinforced by quotes.
4. Was the recruitment strategy appropriate to the aims of the research? ✔ Yes ● Convenience sampling, including 8 junior doctors, promoted virtual visits. ● Participants were suitable because of their direct involvement within the approach being studied.
5. Was the data collected in a way that addressed the research issue? ✔ Yes ● Semi-structured interviews were conducted remotely. ● Thematic analysis. ● Appropriate and well-documented data collection for the study goal.
6. Has the relationship between researcher and participants been adequately considered? ✔ Can’t Tell ● The report does not examine researcher influence or reflexivity on participants. ● Limited argument on bias or power dynamics.

APPRAISAL SUMMARY
Positive/Methodologically sound	Negative/Relatively poor methodology	Unknowns
● Clear purpose and study design. ● Relevant and convenient. ● Stringent analysis and practical implications.	● Absence of reflexivity regarding researcher-participant dynamics.	● Generalisability because of a small, single-centre sampling.

Table 1: CASP Analysis of Research Paper 1

(Source: Self-Created)

Research Paper 2: Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members (Xyrichis et al., 2022)
Are the results valid? (A)	What are the results? (B)	Will the results help locally? (C)
1. Was there a clear statement of the aims of the research? ✔ Yes ● Aimed to comprehend the virtual visiting’s perceived benefits and experiences from the viewpoints of ICU-experienced clinicians as well as non-ICU-experienced family liaison group members. ● Important because of the sudden and general commission during COVID-19. ● Applicable to enhancing family-centred ICU supervision.	7. Have ethical issues been taken into consideration? ✔ Yes ● Ethical approval given. ● Informed consent was conveyed. ● Data confidentiality guidelines were followed.	10. How valuable is the research? ✔ Yes ● Emphasises the emotional and practical impact of virtual visiting. ● Informs prospective ICU communication and policy practices. ● Supports wider adoption of different digital means in family-centred supervision.
2. Is a qualitative methodology appropriate? ✔ Yes ● Research concentrated on apprehending professional and personal experiences. ● The qualitative descriptive technique was appropriate.	8. Was the data analysis sufficiently rigorous? ✔ Yes ● NVivo is used for the management of data. ● Themes recognised through thematic analysis. ● Codebook designed and refined via team review. ● Quotes sustain themes.
3. Was the research design appropriate to address the aims of the research? ✔ Yes ● Multi-site interview analysis utilising semi-structured interviews. ● An inductive thematic approach sustained the research goals.	9. Is there a clear statement of findings? ✔ Yes ● Three major themes were noted with sub-themes and instances. ● Findings discussed the research purpose and connected to the theoretical frameworks.
4. Was the recruitment strategy appropriate to the aims of the research? ✔ Yes ● Recruited 36 candidates across 14 UK NHS clinics (liaison staff and ICU). ● Sampling is desired for the greatest variation in geography and clinical roles.
5. Was the data collected in a way that addressed the research issue? ✔ Yes ● Data gathered via remote (video/telephone) interviews. ● Usefulness of a consultation guide. ● Dual coding is employed to improve data reliability. ● Data saturation achieved.
6. Has the relationship between researcher and participants been adequately considered? ✔ Can’t Tell ● Limited arguments on researcher influence or reflexivity. ● Relationship dynamics are not discussed explicitly.

APPRAISAL SUMMARY
Positive/Methodologically sound	Negative/Relatively poor methodology	Unknowns
● Large, semi-structured sample. ● Affluent thematic analysis. ● High relevancy for clinical training.	● Lack of immediate patient/family information. ● Minimal reflexivity back-and-forth.	● Transferability over pandemic setting.

Table 2: CASP Analysis of Research Paper 2

Conclusion

Virtual visiting has been demonstrated to be a significant intervention during troubles such as COVID-19 and has possibilities beyond it. Critically appraised analyses confirm its favourable effect on patient grace, family relationships, and healthcare experience. However, they likewise emphasise challenges like emotional burden, equity of credentials, and privacy concerns. Training and authorisation procedures must be designated for virtual visiting to establish a definitive care practice with strong ethical guidelines. Alike ICU diaries, virtual visiting shows a humanising contact to critical supervision, helping families and patients through vulnerable stages of life.

References

Bosco, V., Froio, A., Mercuri, C., Sansone, V., Garofalo, E., Bruni, A., Guillari, A., Bruno, D., Talarico, M., Mastrangelo, H. and Longhini, F., 2023, September. The impact of an intensive care diary on the psychological well-being of patients and their family members: longitudinal study protocol. In Healthcare (Vol. 11, No. 18, p. 2583). MDPI.

casp-uk.net, (2025). CASP Checklists. Available at: https://casp-uk.net/casp-tools-checklists/ (Accessed on 27.6.2025)

Clarke, K., Borges, K., Hatab, S., Richardson, L., Taylor, J., Evans, R., Chung, B., Cleverdon, H., Xyrichis, A., Cook, A. and Meyer, J., 2024. Ethical considerations related to virtual visiting for families and critically ill patients in intensive care: a qualitative descriptive study. BMC Medical Ethics, 25(1), p.126.

Flahault, C., Trosdorf, M., Sonrier, M., Vioulac, C., Fasse, L., Timsit, J.F., Bailly, S. and Garrouste-Orgeas, M., 2021. ICU survivors experience of ICU diaries: an ancillary qualitative analysis of the ICU diary study. Critical care explorations, 3(5), p.e0384.

Geen, Olivia & Rochwerg, Bram & Wang, Xuyi. (2021). Optimizing care for critically ill older adults. Canadian Medical Association Journal. 193. E1525-E1533. 10.1503/cmaj.210652.

Grewal, A., 2024. Bridging the gap: the impact of post intensive care syndrome-family on intensive care unit family caregivers.

istockphoto.com, (2025). family visit hospital. Available at: https://www.istockphoto.com/illustrations/family-visit-hospital (Accessed on 27.6.2025)

Mickelson, R.S., Piras, S.E., Brown, L., Carlile, C., Drumright, K.S. and Boehm, L., 2021. The use and usefulness of ICU diaries to support family members of critically ill patients. Journal of critical care, 61, pp.168-176.

ottawahospital.on.ca, (2025). eVisit. Available at: https://www.ottawahospital.on.ca/en/patients-visitors/evisit/ (Accessed on 27.6.2025)

Paul, G., Mahajan, R.K., Gautam, P.L., Kaur, G., Paul, S.S. and Paul, B., 2024. Voices from the ICU: Perspectives on humanization in critical care settings. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 28(10), p.923.

Xyrichis, A., Pattison, N., Ramsay, P., Saha, S., Cook, A., Metaxa, V., Meyer, J. and Rose, L., 2022. Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members. BMJ open, 12(4), p.e055679.