Relatives' experiences of visiting restrictions during the COVID-19 pandemic’s first wave: a PREMs study

Relatives' experiences of visiting restrictions during the COVID-19 pandemic’s first wave: a PREMs study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relatives' experiences of visiting restrictions during the COVID-19 pandemic’s first wave: a PREMs study Nadine TACCHINI-JACQUIER, Sévrine MONNAY, Eric BONVIN, Julien DUBUIS, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2047705/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: During the COVID-19 pandemic, most countries introduced temporary visiting restrictions on the relatives of acute care hospital patients, whether or not they were infected with SARS-CoV-2. This affected relatives’ psychological and emotional states and how closely they could be involved in their loved one’s hospitalization. Study Aims: Investigate relatives’ experiences of visiting restrictions during the COVID-19 pandemic’s first wave and of the support offered by Valais Hospital’s healthcare staff. Method: Relatives and patients who had been discharged between February 28 and May 13, 2020, were asked to complete a patient-reported experience measures (PREMs) questionnaire, whether or not they had been infected by SARS-CoV-2. Relatives were asked about how visiting restrictions had affected them, their perceptions of the severity of the COVID-19 pandemic, the quality of communication concerning their loved ones’ health status during their hospitalization, and the information received from healthcare staff. Descriptive and inferential statistics were computed. Results: Of 866 PREMs questionnaires returned, 818 were analyzable, and 543 relatives had experienced visiting restrictions to their loved ones: 92 relatives (87%) of COVID-19 patients and 451 relatives (66%) of non-infected patients, with heterogenous effects on their psychological and affective status. Overall, whether or not relatives were subjected to visiting restrictions, they perceived themselves to be well treated, well informed, and that communication with hospital healthcare staff was satisfactory. However, relatives subjected to visiting restrictions reported significantly lower scores on the quality of communication than other relatives. The relatives of patients in gynecology/obstetrics and internal medicine wards were significantly more affected by visiting restrictions than were the relatives of patients in other wards. Numerous relatives subjected to visiting restrictions reported regular communication with their loved ones or with healthcare staff, at least once a day (n = 179), either via videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® or via mobile phone text messages. Discussion Visiting restrictions affected relatives differently depending on the wards their loved ones were hospitalized in. Healthcare institutions should investigate the utility of visiting restrictions on patients, how they affect relatives, and how to improve personalized patient–relative communications. hospital visiting restrictions relatives PREMs public health Figures Figure 1 Figure 2 Introduction – Background The first cases of COVID-19 struck the Canton of Valais, Switzerland, at the end of February 2020. The Swiss Confederation and the Canton enacted significant measures to limit the virus’ spread throughout the population, including a reorganization of acute hospital care ( 1 ). During the onset of the pandemic, from March 15 to April 30, 2020, the Canton instituted COVID-19-related visiting restrictions on healthcare institutions, prohibited patients from leaving their rooms, and closed hospital restaurants, coffee shops, and other communal areas. All visits were banned, including by relatives, with some exceptions made for parents visiting pediatrics wards ( 2 ). These decisions were made when knowledge about the virus’ spread was not very advanced regarding patient safety ( 3 ). Restricting visits is not only an emotional hardship for patients and relatives, but healthcare staff also perceive the absence of relatives at the bedside to be a hindrance to delivering person- and family-centered care ( 4 , 5 ). The present study defined relatives as the non-professional persons providing physical help and psychological support to patients, and they could be family members, friends, or acquaintances ( 6 ). Healthcare staff reported that—even at hospital admission—there were critical gaps in information gathering after the introduction of visiting restrictions, whereas relatives had contributed significantly before. Without communicating with relatives, healthcare staff found it hard to accurately assess clinical signs and symptoms, pain levels, and mental health status ( 5 , 7 , 8 ). Under normal circumstances, relatives at the bedside can observe how different healthcare staff care for their loved ones ( 9 ). Depending on the patient’s disabilities and unique needs, relatives can learn how to assist their loved ones in the activities of daily living and note whether they are experiencing discomfort. Learning how to react at the bedside enables relatives to become accustomed to the patient’s changing condition and better help manage discharge planning and support needs ( 10 ). Research has shown the significant numbers of medical and nursing tasks performed by relatives at home with limited guidance ( 11 ). However, some care situations could have been exacerbated by COVID-19 visiting restrictions ( 12 ). A relative can help overcome language barriers and health literacy problems caused by clinical jargon ( 13 ) or can assist physically weakened and/or mentally inhibited patients ( 14 , 15 ). Previous studies have also demonstrated that relatives are crucial to the early detection of delirium, a common, often unrecognized condition present in frail older adult inpatients diagnosed with dementia or multiple other chronic conditions and polypharmacy ( 16 , 17 ). The regular presence of relatives at the bedsides of those patients most at risk of delirium can reduce its onset and limit long-term functional decline ( 13 , 17 ). Recent data revealed that the longer the hospital length of stay (LOS), the more relatives were emotionally affected by visiting restrictions ( 18 , 19 ). Relatives also take on an advocacy role when they communicate practical suggestions about patients’ habits or additional needs to healthcare staff, thus facilitating patient–staff communication ( 20 ). Sahoo et al . and Vincent et al . (2021) reported significant associations between additional stress, affect, visiting restrictions, and LOS ( 21 – 23 ). The COVID-19 pandemic also changed patient discharge planning, undermining usual discharge processes. Before the COVID-19 pandemic, healthcare staff used a discharge procedure designed to sit relatives and the patient together to discuss critical information on the support that would be needed at home ( 24 ). This exchange increased the chances of the patient subsequently remaining at home and optimized the discharge process. Under COVID-19 visiting restrictions, these conversations altered dramatically ( 25 ) and may have caused problems in the dialogue between healthcare staff and relatives, reducing the possibilities of ensuring consensus-based care and increasing the risks of unplanned hospital readmissions ( 24 , 26 ). To maintain the links between patients, relatives, and healthcare staff, the Valais Hospital offered a variety of digital and technical means to replace physical visits ( 27 , 28 ). However, recent studies have highlighted that video or telephone meetings with the relatives of patients in acute care settings led to fewer changes to care goals than in-person meetings ( 29 – 32 ). Substitute visiting methods, such as digital and multimedia applications, lowered relatives’ comprehension of the patient’s overall condition, reducing opportunities to maintain social relations ( 25 , 26 ). Recent research has shown that relatives’ experiences during the uncertain context of COVID-19 led to frustrations, especially among older adults ( 33 , 34 ). This was linked to not being able to see how their loved one was being cared for and having to put their trust in healthcare institutions ( 35 ). Unclear information or inconsistencies in institutional policy contributed to these uncertainties and relatives sought efficient face-to-face communication ( 35 ). Hoffman et al . highlighted the need for personal attention from relatives ( 35 – 37 ). To assess inpatients’ relatives’ experiences with regard to the visiting restrictions imposed during COVID-19’s first wave, we distributed a patient-reported experience measures (PREMs) questionnaire to all the patients hospitalized in the Valais Hospital between the end of February and mid-May, 2020, and to their relatives. The following research questions guided this research. How were the relatives subjected to visiting restrictions distributed? How were the relatives subjected to visiting restrictions affected by this situation compared to relatives not subjected to visiting restrictions? How did relatives (whether subjected to visiting restrictions or not) perceive the information they received, communication with staff, and their own involvement in the care of their loved ones? How did relatives maintain contact with their loved ones? Methods Design, research population, and setting Following the approval from the Human Research Ethics Committee of the Canton of Vaud (2020–02025), Valais Hospital’s data science warehouse provided the contact details of all the adult inpatients (18 years and older) discharged alive to their home or a nursing home between February 28 and May 13, 2020. These were extracted from administrative, electronic patient records in the hospital’s patient register. A paper questionnaire was sent out to these patients, including an explanation sheet describing the nature of the survey and a questionnaire for their relative, if appropriate. Patients were free to choose whether to participate. Anonymously returning the questionnaire in the attached postage-paid envelope was considered consent to participate in our study for both patients and relatives. The previously published research protocol describes the PREMs methodology used for our survey ( 38 ). Study framework The Quadruple Aim healthcare framework guided the study, highlighting the medical and social needs of hospitalized patients and their relatives, emphasizing the impacts of their unmet needs, and describing the importance of partnerships between the healthcare system and formal and informal caregivers ( 29 ). Relatives involved in care delivery have also recently become an acknowledged essential component of overall health system performance, based on the principles of patient and public involvement described in PREMs ( 30 , 31 ). PREMs instruments look at the care process’s impact on patients’ and relatives’ experiences, e.g., involvement in care, communication with staff, information sharing, and the overall care experience. Our PREMs questionnaire included open and closed questions to capture patients’ and relatives’ perceptions of their interactions with the healthcare system and the degree to which their needs were considered ( 39 ). This paper reports on the PREMs survey’s written feedback on relatives’ experiences during the COVID-19 pandemic’s first wave and the visiting restrictions imposed on them (Fig. 1). Visiting restrictions during the COVID-19 pandemic Restricting hospital visits during the COVID-19 pandemic’s first wave had the following aims: ( 1 ) preventing the transmission of SARS-CoV-2 from the community into acute hospitals (infecting healthcare staff and patients), ( 2 ) preventing transmission in the other direction (infecting visitors), and ( 3 ) maintaining adequate supplies of personal protective equipment ( 40 ). At the pandemic’s onset, potential visitor-related COVID-19 outbreaks were considered a substantial risk and, thus, all types of visits were restricted, despite a lack of scientific evidence linking visitors to SARS-CoV-2 transmission ( 41 , 42 ). The PREMs instrument Our self-reporting data-collection questionnaire was designed based on a literature review and four semi-structured exploratory interviews with previously hospitalized patients and their relatives ( 18 , 43 , 44 ). A returned questionnaire from the patient and relative served as a proxy for written consent to participate. The first section, including 14 closed questions, asked patients about sociodemographic data, sex, age, marital status, educational level, and their hospital trajectory as a patient, as well as about their stress level ( 45 ), trust in healthcare professionals (nurses and physicians) ( 46 ), feelings of safety ( 47 ), whether they were infected by SARS-CoV-2, and perceptions about the disease’s severity during the hospitalization period ( 48 ). The second section included eight closed questions and one open-ended question for the discharged patient’s relative (if they were directly involved in the patient’s hospitalization) (Additional File 1). Due to legal restrictions covering data protection and confidentiality, we were not allowed to collect sociodemographic data on relatives. These questions were: Were you able to visit your relative in the hospital? [Yes/No]; If not, how did you maintain contact with your loved one? [(i) Telephone with professional caregivers, (ii) email, (iii) other]. If not, how much did this affect you? [(i) I was not affected, (ii) I was slightly affected, (iii) No opinion, (iv) I was moderately affected, (v) I was very affected]; How did you perceive the information you received about the COVID-19 pandemic during your loved one’s hospital stay? [(i) Totally inadequate, ii) Inadequate, iii) Slightly inadequate, iv) No opinion, v) Just good enough, vi) Adequate, vii) Very good)]; How would you rate communication with the staff? [(i) Poor, ii) Passable, (iii) Good, (iv) Very good, (v) Excellent].As a close relative, how did the hospital staff treat you? [(i) I was not taken into consideration at all, (ii) I was moderately taken into consideration, (iii) I was fully taken into consideration]. How serious do you think the COVID-19 pandemic is? [(i) Not at all serious, (ii) Not very serious, (iii) Slightly serious, (iv) Serious, (v) Very serious] ( 48 ). Would you like to add any comments about your experience of your loved one’s hospitalization during the pandemic? Data collection procedure All eligible participants received a letter by post inviting them to participate in the survey. This was followed by a reminder two weeks later. Besides the paper questionnaire, an information sheet explained the study’s background, the data sought, and our participant data protection strategy. Participants were asked to complete the paper questionnaire and return it in the prepaid envelope provided. Waiting for ethics clearance and heavy workloads meant that the data warehouse only started its information gathering in August and finished in December 2020 (Fig. 2). Data analyses Data were anonymised to ensure participant anonymity and respect good research practice in this type of study, as per the Declaration of Helsinki ( 35 ). Data from the self-reported questionnaires returned were extracted into an Excel© spreadsheet (Microsoft, Redmond, Washington, USA), cleaned, and imported into IBM SPSS® software, version 28 (IBM Corp, Armonk, New York, USA), for analyses. Two critical issues in large-sample surveys are the response rate and the management of missing values. We analyzed the number of responses and missing values for each variable and reported them in our tables (n = answers). To ensure scientific rigor and avoid any bias, missing values were not replaced using a missing value strategy (e.g., multiple imputations, mean score) ( 43 ). Parametric properties were analyzed for the normality of their distributions and the equality of their variances using the Kolmogorov–Smirnov test. Non-parametric tests were performed for variables with non-normal distributions to compare relatives who were and were not affected by visiting restrictions. The population was described using descriptive statistics with frequencies, distributions, and leading trends. Data collected using Likert scales were analyzed using descriptive and inferential statistics. LOS was recoded as a dichotomous variable of 1–14 days and ≥ 15 days, based on the median patient LOS ( 21 , 23 ). Bivariate analyses were conducted using cross-tabulations between relatives impacted and not impacted by visiting restrictions during their loved one’s hospitalization. Associations were calculated between types of contact with loved ones, levels of affect, the information received about the COVID-19 pandemic, the quality of communication, healthcare staff’s consideration of relatives, how serious the COVID-19 pandemic was perceived to be, and comments about relatives’ experiences of their loved one’s hospitalization. Spearman’s rank correlation measures were computed between sociodemographic variables and the closed questions. We computed a linear multivariate regression model to analyze how visiting restrictions predicted relatives’ affects, their satisfaction with information received about the COVID-19 pandemic, satisfaction with communication with staff, how well healthcare staff considered relatives, and perceptions of how serious the COVID-19 pandemic was. The model estimated each predictor’s net impact, other things being equal. The model gave predictions for the entire sample, not just specific individuals. Results were considered statistically significant when p < 0.01. All p -values were based on two-tailed tests, and all the analyses were supervised and reviewed by a biostatistician. Results Study participants Of 4,523 eligible participants hospitalized during the COVID-19 pandemic’s first wave, 1,341 (29.6%) returned the questionnaire. Of these, 1,312 were valid (> 50% of questions completed), with 866 relatives completing the section dedicated to them, 818 of which were analyzable (> 50% of questions completed), representing 65.5% of the valid patient responses (Figure 2). Sociodemographic characteristics of patients and their relatives Participants – hospitalized patients Median participant age was 64 years old (IQR 1–3 = 45–76). During the study period, 141 (10.9%) respondents were tested positive for a SARS-CoV-2 infection by the hospital laboratory, and 1,148 (89.1%) were uninfected. Discharged patients’ sociodemographic data are detailed in Table 1. Table 1. Participating patients’ sociodemographic and hospitalization characteristics Characteristics Participants Age (years) (n = 1,195) Mean (SD) Median (IQR 1–3) Min–Max 60.3 (19.4) 64 (45–76) 18–99 Age groups (years) (n = 1,195) 18–34 (%) 35–55 (%) 56–64 (%) 65–74 (%) 75 or more (%) 185 (15.5) 238 (19.9) 183 (15.3) 253 (21.2) 336 (28.1) Sex (n = 1,291) Male (%) / Female (%) 619 (47.9) / 672 (52.1) Marital status (n = 1,161) Single (%) Married (%) Divorced/separated (%) Widowed (%) 451 (34.3) 579 (44.1) 131 (10.0) 84 (6.4) Educational level (n = 1,211) Compulsory education (%) Secondary education (%) Higher education/university (%) 375 (28.6) 547 (41.7) 289 (22.0) Length of stay (days) (n = 1,080) Mean (SD) Min–Max 15.1 (26.7) 1–280 SARS-CoV-2-infected (n = 1,289) Yes (%) / No (%) 141 (10.9) / 1,148 (89.1) Hospitalization ward (n = 1,312) Surgery (%) General Medicine (%) Gynecology/obstetrics (%) Intermediate care & ICUs (%) Psychiatry (%) Rehabilitation/geriatrics (%) Other units (%) Complex trajectory* (%) 300 (22.9) 240 (18.3) 169 (12.9) 230 (17.5) 44 (3.4) 24 (1.8) 228 (17.4) 77 (5.9) *Two hospital units or more Responding relatives Of 866 PREMs questionnaires completed by patients’ relatives, 818 (95%) were analyzable, including 106 (75%) relatives of the 141 SARS-CoV-2-infected participants. Among the 1,086 non-COVID-19 participants, 712 (87%) relatives responded to the PREMs questionnaire’s second section (Table 2). We found significantly higher survey participation rates among the relatives of: patients infected with SARS-CoV-2 ( p < 0.001); older patient age groups ( p = 0.008); patients with longer LOS ( p < 0.001); and patients in certain hospital wards (intermediate care and ICU) ( p < 0.001). Table 2. Distribution of relatives based on SARS-CoV-2-infected and non-infected patients and their age groups, LOS, and hospitalization ward. Variables Relative n (%) No relative n (%) P -value SARS-CoV-2-infected patients (n = 133) 106 (79.7) 27 (20.3) < 0.001* Non-infected patients (n = 1,093) 695 (63.6) 398 (36.4) Inpatient age group (years) 18–34 (n = 179) 129 (72.1) 50 (27.9) 0.008 * 35–55 (n = 229) 153 (66.8) 76 (33.2) 56–64 (n = 175) 101 (57.1) 74 (42.3) 65–74 (n = 242) 146 (60.6) 96 (39.7) 75 or more (n = 313) 219 (70.0) 94 (30.0) Length of stay (days) 1–14 (n = 783) ≥ 15 days (n = 225) 493 (63.0) 170 (75.6) 290(37.0) 55 (24.4) < 0.001* Hospitalization ward Surgery (n = 295) 152 (51.5) 143 (48.5) < 0.001* General Medicine (n = 226) 153 (67.7) 73 (32.3) Gynecology/obstetrics (n = 165) 130 (78.8) 35 (21.2) Intermediate care/ICU (n = 220) 157 (71.4) 63 (28.6) Unknown trajectory (n = 207) 133(64.3) 74 (35.7) Psychiatry (n = 43) 26 (60.5) 17 (39.5) Rehabilitation/geriatrics (n = 20) 16 (80.0) 4 (20.0) Multiple wards other than ICU (n = 73) 51 (69.9) 22 (30.1) Note. * Chi-squared exact test Visiting restrictions A total of 543 relatives were subjected—either entirely or partially—to visiting restrictions during their loved one’s hospitalization, including 92 (87%) relatives of SARS-CoV-2-infected patients and 451 (63%) relatives of non-infected patients. Almost two-thirds of all responding relatives were at least moderately emotionally affected by the sudden onset of visiting restrictions. However, the relatives of SARS-CoV-2-infected patients were significantly more emotionally affected than the relatives on non-infected patients (81% vs. 61% at least moderately affected, respectively; p < 0.001) (Table 3). Contrarily, no significant differences were found between how strongly relatives subjected to visiting restrictions were affected according to age group ( p = 0.815) and LOS ( p = 0.185) (Table 3). Table 3. How strongly relatives were affected by visiting restrictions during their loved one’s hospitalization. Variables No opinion n (%) Not affected n (%) Mildly affected n (%) Moderately affected n (%) Strongly Affected n (%) Median (IQR 1–3) p -value Visiting restrictions (n = 531 relatives) 51 (9.6) 83 (15.6) 54 (10.2) 96 (18.1) 247 (46.5) 4 (2–5) SARS-CoV-2-infected patients (n = 91) Non-infected patients (n = 430) 7 (7.7) 44 (10.2) 5 (5.5) 75 (17.4) 5 (5.5) 48 (11.2) 14 (15.4) 79 (18.4) 60 (65.9) 184 (42.8) 5 (4–5) 4 (2–5) < 0.001* Inpatient age group (years) 18–34 (n = 71) 35–55 (n = 92) 56–64 (n = 72) 65–74 (n = 107) 75 or more (n = 145) 6 (8.5) 8 (8.7) 6 (8.3) 11 (10.3) 10 (6.9) 11 (15.5) 12 (13) 11 (15.3) 13 (12.1) 30 (20.7) 6 (8.5) 9 (9.8) 9 (12.5) 14 (13.1) 10 (6.9) 9 (12.7) 18 (19.6) 16 (22.2) 18 (16.8) 27 (18.6) 39 (54.9) 45 (48.9) 30 (41.7) 51 (47.7) 68 (46.9) 5 (3–5) 4 (3–5) 4 (3–5) 4 (3–5) 4 (2–5) 0.815** Hospitalization ward Surgery (n = 88) General Medicine (n = 119) Gynecology/obstetrics. (n = 64) Intermediate care & ICU (n = 115) Unknown trajectory (n = 87) Psychiatry (n = 14) Rehabilitation/geriatrics (n = 9) Multiple wards other than ICU (n = 35) 9 (10.2) 14 (11.8) 3 (4.7) 5 (4.3) 16 (18.4) 2 (14.3) 0 2 (5.7) 21 (23.9) 12 (10.1) 9 (14.1) 10 (8.7) 23 (26.4) 2 (4.3) 0 6 (17.1) 14 (15.9) 13 (10.9) 2 (3.1) 15 (13) 5 (5.7) 0 0 5 (14.3) 22 (25.0) 22 (18.5) 8 (12.5 23 (20) 8 (9.2) 4 (28.6) 3 (33.3) 6 (17.1) 22 (25.0) 58 (48.7) 42 (65.6) 62 (53.9 35 (40.2) 6 (42.9) 6 (66.7) 16 (45.7) 4 (2–5) 4 (3–5) 5 (4–5) 5 (3–5) 3 (2–5) 4 (2–5) 4 (4–5) 4 (3–5) < 0.001** Length of stay (days) 1–14 (n = 321) ≥ 15 (n = 124) 29 (9) 9 (7.3) 53 (16.5) 14 (11.3) 37 (11.5) 9 (7.3) 37 (11.5) 22 (17.7) 143 (44.5) 70 (56.5) 4 (2–5) 5 (3–5) 0.185* Note. * Non-parametric Mann–Whitney U test; **Kruskal–Wallis test Relatives’ perceptions of the severity of the COVID-19 pandemic The overall median score for relatives’ perceived severity of a SARS-CoV-2 infection scale, taken from the standard questionnaire on risk perception of an infectious disease outbreak by the Municipal Public Health Service of Rotterdam-Rijnmond (48), was 4 (IQR 1–3 = 3–5). No significant differences were found between relatives subjected to visiting restrictions (median 4; IQR 1–3 = 3–5) and those not (median 4; IQR = 1–3 = 3–5) ( p = 0.085). Relatives’ involvement in care Consideration of relatives in the care process Overall, most relatives felt well-considered by healthcare staff (n = 406; 54.4%) when it came to involvement in the provision of care. Given the exceptional public health situation caused by the COVID-19 pandemic, relatives waiting to hear from their loved ones felt stressed and disturbed. A smaller fraction felt less well considered (n = 218; 29.1%) and 124 (16.6%) did not feel considered at all in the provision of care. A small fraction (< 5%) reported hospital healthcare staff to be unavailable to inform them of their loved one’s health status. Significant differences were found between patient age groups ( p < 0.001) and between relatives subjected and not subjected to visiting restrictions ( p < 0.001). No significant differences were found regarding LOS ( p = 0.060) or hospitalization ward ( p = 0.316) (Table 4). Table 4. Relatives’ perceptions of being considered as care partners Relatives Not considered n (%) Partially considered n (%) Fully considered n (%) P -value Overall (n = 748) 124 (16.6) 218 (29.1) 406 (54.4) Subjected to visiting restrictions (n = 464) 109 (23.5) 138 (29.7) 217 (46.8) < 0.001* Not subjected to visiting restriction (n = 284) 15 (5.3) 80 (28.2) 189 (66.5) SARS-CoV-2 SARS-CoV-2-infected patients (n = 98) 20 (20.4) 23 (23.5) 55 (56.1) 0.350* Non-infected patients (n = 638) 103 (16.1) 189 (29.6) 346 (54.2) Inpatient age group (years) 18–34 (n = 124) 23 (18.5) 50 (40.3) 51 (41.1) < 0.001* 35–55 (n = 145) 29 (20) 37 (25.5) 79 (54.5) 56–64 (n = 93) 18 (19.4) 33(35.5) 42 (45.2) 65–74 (n = 139) 28 (20.1) 34 (24.5) 77 (55.4) 75 or more (n = 195) 19 (9.7) 52 (25.7) 124 (63.6) Length of stay (days) (n = 619) 1–14 (n = 458) 89 (19.4) 134 (29.3) 235 (51.3) 0.060* ≥ 15 (n = 161) 21 (13) 41 (25.5) 99 (61.5) Hospitalization ward Surgery (n = 126) 28 (22.2) 39 (31) 59(46.8) 0.316* General Medicine (n = 145) 30(20.7) 40 (27.6) 75 (51.7) Gynecology/obstetrics (n = 128) 14 (10.9) 46 (35.9) 68 (53.1) Intermediate care/ICU (n = 147) 21 (14.3) 41 (27.9) 85 (57.8) Unknown trajectory (n = 115) 18 (15.7) 30 (26.1) 67 (58.3) Psychiatry (n = 23) 2 (8.7) 8 (34.8) 13(56.5) Rehabilitation/geriatrics (n = 16) 4 (25) 4 (25) 8 (50) Multiple wards other than ICU (n = 48) 7 (14.6) 10 (20.8) 31 (64.6) Note. * Chi-squared exact test; Sharing information and communication between healthcare staff and relatives Despite healthcare staff’s poor availability due to extremely high workloads, most relatives felt well informed by them (n = 426; 53.0%), with an overall median score of 6 (IQR 1–3 = 1–6). Fewer respondents felt moderately well informed (n = 68; 8.5%) or poorly informed (n = 309; 38.5%) by healthcare staff. Among relatives subjected to visiting restrictions, no significant differences were found regarding perceived levels of information between males and females ( p = 0.080), between SARS-CoV-2-infected or non-infected patients ( p = 0.254), between age groups ( p = 0.248), and between different LOS ( p = 0.220). Contrarily, significant differences were found between hospitalization wards ( p < 0.001) (Additional File 2). Relatives reported a reasonable overall median score of 3 out of 5 (IQR 1–3 = 3–4) on the quality of their communication with hospital healthcare staff, although relatives subjected to visiting restrictions reported significantly lower scores than those not subjected to them ( p < 0.001). One-fifth of relatives found communication poor or acceptable. No significant differences were found between relatives subjected to visiting restrictions and those not regarding communication, LOS, and hospitalization wards (Additional File 3). Among the full sample of relatives (n = 818), 563 (69%) reported regularly communicating with their hospitalized loved ones (at least once a day), and 179 (22%) reported having at least one telephone contact with Valais Hospital staff. A small number of relatives (n = 6) communicated with the patient by email. Other methods for maintaining contact between relatives and patients were videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® (n = 25), mobile phone and SMS text messages (n = 9), exchanges at the hospital window or outside the ward (n = 9), being hospitalized in the same hospital room (n = 1), or communication through the family physician (n = 3). Multivariate linear regressions of affect scores Simultaneous multiple linear regressions were calculated to investigate the best predictors of affect scores among relatives subjected to visiting restrictions. The combination of patient age in years, sex, LOS and the hospitalization wards of medicine, surgery, psychiatry, gynecology, intermediate care/ICU, and rehabilitation/geriatrics significantly predicted affect scores ( F (9, 4.421) = 7.294; p < 0.001). The hospitalization wards of medicine ( p = 0.027) and gynecology/obstetrics ( p = 0.028) also significantly predicted relatives’ affect scores (Table 5). The adjusted R 2 value was 0.105, indicating that the model explained 10.5% of the variance in the affect scores. According to Cohen, this is a mild-to-moderate effect (49). Table 5 . Multivariate linear regression analyses of patient age in years, sex, LOS, and the hospitalization wards of medicine, surgery, psychiatry, gynecology/obstetrics, intermediate care/ICU, and rehabilitation/geriatrics, and their predictions of relatives’ affect scores. Variables B Std. Error Exp(B) t Sig 95% Confidence Interval Beta Under limit Upper limit Patient age in years -.0003 0.004 -0.047 -0.767 0.444 -0.011 0.005 Sex 0.006 0.146 0.002 0.039 0.969 -0.282 0.293 Surgery dpt 0.216 0.160 0.074 1.355 0.176 -0.098 0.530 General medicine dpt -0.348 0.157 -0.124 -2.215 0.027* -0.656 -0.039 Psychiatry dpt -.0010 0.399 -0.001 -0.024 0.981 -0.795 0.776 Gynecology/obstetrics dpt -0.528 0.239 -0.145 -2.207 0.028* -0.999 -0.058 Intermediate care/ICU -0.132 0.195 -0.036 -0.675 0.500 -0.516 0.252 Rehabilitation/geriatrics dpt -0.536 0.243 -0.123 -2.202 0.028 -1.014 -0.057 Length of stay 0.005 0.003 0.091 1.650 0.100 -0.001 -0.011 Intercept 7.607 1.305 5.831 < 0.001 5.042 10.172 Note. R 2 = 0.105; F (9, 4.421) = 7.294; p < 0.001; dept = department. Relatives’ freely expressed experiences of visiting restrictions One-fifth of the relatives subjected to visiting restrictions described their lived experiences in our open-ended question. The relatives of patients hospitalized in the maternity and neonatology wards and those admitted into the emergency department had strong opinions on visiting restrictions. Relatives of patients hospitalized in gynecology/obstetrics Fathers were initially excluded from attending the mother’s initial labor, causing a lot of frustration and stress for both. Relatives understood the need for preventive measures against the SARS-CoV-2 virus, but they did not consider their loved ones as sick patients, finding the prohibition on visiting too extreme. Limitations and even prohibitions on visits by fathers were not well received, especially the time limit of 30 minutes. Being deprived of this unique life experience, unable to provide support to the mother or see the child’s birth and their first days of life was a very bad experience for fathers, filled with intense regrets. The following comment summed up the disagreements with maternity ward visiting restrictions: “In the case of childbirth, the father’s place—who could have been tested before—is next to the mother and the child. Don’t you think?” (Patient-223) Neonatology Limitations and even prohibitions on visiting the neonatology ward were very badly received by relatives. They did not understand that the measures for limiting SARS-CoV-2 infection concerned all the Valais Hospital’s wards. Relatives prohibited from visiting the neonatology unit stated the following: “Understanding the state of stress of the hospital sector… I had expected a different sense of priorities... For me, hospitalization in neonatology should ensure the right to visits no matter what.” (Relative-345) Emergency department visits and the hospitalization of frail subjects The prohibition on visits also affected relatives accompanying their loved ones to urgent admissions to the emergency department. The moment of this imposed separation—leaving their loved one to the unknown—aroused very strong emotions, including worry, anxiety, stress, the fear of not seeing them again, and intense apprehension while waiting for news. Not being able to support the patient suffering in the hospital was perceived as very difficult, and relatives would have liked to have had a waiting area on site. They expressed these emotions as follows: “The ban on visits is traumatic for all relatives.” (R-87) “It is tough to leave a loved one—especially my sick wife—outside the door without accompanying her or supporting her during these difficult moments, but I understand the measures taken.” (R-340) Visiting restrictions were very badly received by relatives and frail patients alike, especially when involving patients with cognitive disorders or at the end of life, with whom video calls were complicated or impossible. Relatives mentioned the feelings of abandonment or loneliness expressed to them by patients. Families reported the physical and psychological regression they observed in their loved ones due to the lack of stimulation usually provided during visits. For other patients, compensating for the prohibition on visits via video calls, telephone calls, and text messages was greatly appreciated. Discussion To the best of our knowledge, this research was the first to use a PREMs questionnaire to examine the impact of visiting restrictions on patients and their relatives in a hospital setting during the COVID-19 pandemic’s first wave in Switzerland. The Valais Hospital’s values, and those of its healthcare staff, recognize relatives’ important role in their loved one’s healthcare and hospital discharge trajectories. However, this was a very challenging period for patients, relatives, and staff, with unforeseen and unpredictable events, daily changes, and many restrictions. The sudden implementation of visiting restrictions destabilized the hospitalization process and relatives’ roles within that process. Obtaining an elevated response rate (75%) from the responding patients’ relatives was, therefore, not surprising as it offered them a chance to express both their positive and negative lived experiences of these extreme health circumstances. This study was specifically conducted during the COVID-19 pandemic’s first wave, , considering relatives as essential partners in care—and not just as visitors—is part of the Valais Hospital staff’s mission. Relatives of a SARS-CoV-2-infected patient were more likely to have revealed how affected they were by the visiting restrictions than were relatives of non-infected patients. Relatives expressed their perceptions of ethical and clinical issues in their responses to the open-ended question. This was not surprising and was in line with Jaswaney et al. ’s (2022) findings that visiting restrictions can be problematic, creating many ethical issues related to who can and cannot visit (50). The impossibility of being physically present for their hospitalized loved ones created worry, anxiety, sadness, and a perceived greater need for more information and updates on the relative’s condition, as expressed in relatives’ comments and in line with the findings of Rottenburg et al . and Sahoo et al . (22, 23). Many relatives reported stress due to uncertainty, and not being allowed into the hospital created emotional worries and feelings of failing to support and protect their kin. Being present at the patient’s bedside, on the other hand, helped relatives to understand and cope with situations, as reported in the recent study by Hochendoner et al . of the relatives of ICU patients (51). Our findings revealed significant differences between the high impact of visiting restrictions perceived by the relatives of SARS-CoV-2-infected patients and the lower impact perceived by relatives of non-infected patients, and this effect was similar across ward types. As one might imagine, visiting restrictions strongly affected the relatives of patients in the gynecology/obstetrics, maternity, geriatrics and general medicine wards, more so than in other hospitalization wards and in line with Hochendoner et al .’s study (51). This was independent of patient age group or LOS and of relatives’ perceptions of the severity of a SARS-CoV-2 infection. Hoffman et al . used the example of oxygen supplementation to express how crucial contact is with healthcare staff who can explain the patient’s situation. The COVID-19 pandemic and the stresses involved were highly disturbing for relatives waiting for news on their loved ones. Although the majority of our participating relatives did feel considered by healthcare staff, not all of them did; some expressed concerns about visiting restrictions and felt less considered or not at all considered regarding involvement in the care provided. A more detailed analysis of each hospitalization would clarify those concerns, but that was beyond this paper’s scope. In opposition to some free comments criticizing a lack of information, our quantitative results showed that most relatives felt well informed by healthcare staff, with no difference between the relatives subjected to visiting restrictions and those not. However, some hospitalization wards showed significant differences, such as maternity/obstetrics, which was unsurprising and in line with recent publications by Venkatesh et al . and Hugelius et al . (52, 53). Our linear regression model confirmed this, explaining the mild to moderate variance in the affect scores of relatives whose loved ones were hospitalized in general medicine and gynecology/obstetrics wards. The Valais Hospital tried to replace physical visits with various digital and technical means, but these had clear limitations. Relatives subjected to visiting restrictions reported lower scores for the quality of communication than relatives who could visit. Unfortunately, relatives’ video or telephone meetings with patients in acute care settings led to fewer agreed changes to care goals with staff than did in-person meetings, as was confirmed in the recent studies by Reitzle et al ., Lin et al ., Sken et al ., and Rose et al . (29-32). Also, despite these substitute visiting methods, in-person visiting restrictions reduced relatives’ comprehension of the patient’s overall condition, reducing the possibilities for maintaining social relations, as confirmed by Mahery et al . (25). Based on relatives’ free comments, visiting restrictions were also a source of emotional distress and increased workloads for healthcare staff, who may not have agreed with hospital policies resulting in them spending a lot of time informing and communicating with relatives. This may have caused problems in the dialogue between healthcare staff and relatives and thus reduced the possibilities of ensuring consensus-based care (22). The Valais Hospital regularly updated its visiting restrictions, referring closely to Swiss federal and cantonal public health policies concerning SARS-CoV-2 infection risk–benefit assessment—the cornerstone of medical and pandemic policy decision-making. It nevertheless remains difficult to determine whether those visiting restrictions were effective in limiting the spread of COVID-19. Although it might be reasonable to speculate that these policies slowed its spread, based on a mechanistic understanding of the disease, visiting restrictions should be weighed against the potential harm to patients. Our study highlighted the complexities associated with the numerous factors impacted by hospital visiting restrictions. Our results advocate for a more tailored, adaptable, and patient-centered approach to visiting restrictions depending on the clinical situation. Reasonable exceptions might include allowing fathers to visit labor and delivery rooms, pediatrics wards, and ICU units. The authors endorse a nuanced approach to hospital visiting restrictions, taking into account the patient population, visitors’ use of personal protective equipment, screening measures, community disease prevalence, and other circumstances. Visiting restrictions should be clearly and transparently communicated to relatives. Patient discharge during periods with visiting restrictions is another concern as healthcare staff are tasked with establishing a critical partnership with relatives to organize discharge planning (54, 55). The Valais Hospital and its staff worked to maintain strong relationships between patients and relatives, convinced that these improve the patient experience, safety, and outcomes. Visiting restrictions aimed to protect patients and staff, but some relatives felt that they were no longer essential partners in care. Most relatives understood the rapid shift to strict visiting restrictions given the nature of the COVID-19 crisis. Nevertheless, these policies proved very difficult for relatives, causing significant emotional stress, concerns for patient safety, and the inability to support loved ones at the bedside. Relatives and healthcare staff must remain partners in care, even when challenging circumstances put that partnership under stress. The COVID-19 pandemic evolved rapidly and continues to do so. Many directives and shifts in policy were implemented without the opportunity to engage with relatives, including a shift in language that returned relatives to their roles as visitors rather than as partners in care. Effective and appropriate communication about policy changes and how relatives and healthcare staff can continue to work together as partners in care is essential to establishing trust and positive collaboration. Study strengths and limitations This study presents numerous strengths but also some limitations. To the best of our knowledge, this was the first PREMs carried out in Switzerland to include hospitalized patients’ relatives within the context of the COVID-19 pandemic. The study employed as many psychometrically validated questions as possible to investigate PREMs appropriately among relatives. A first limitation of this study, however, is the inability to interpret it outside the context of the COVID-19 pandemic’s first wave. Valais Hospital had never conducted a PREM survey and, to the best of our knowledge, no similar studies of relatives’ experiences were conducted during this period, making comparisons with our results difficult. The self-reporting questionnaire was designed especially for this survey, and its overall psychometric properties (including sensitivity analysis) could not be tested within the time available. Another limitation was the delay of 4 to 6 months between patients’ hospitalization and their self-reported survey responses. Furthermore, since well before the COVID-19 pandemic, the Valais Hospital had systematically invited patients to share their opinions and rate their satisfaction of the hospital’s organization and performance; the present survey did not investigate relatives’ satisfaction so as to avoid redundancies, and this could be considered a limitation. Studies based on PREMs are usually regarded as a low level of evidence, as survey completion may lack rigor and the accuracy of information provided cannot be verified. In addition, the content of the concepts explored has still not been standardized, and we could have missed some relevant experiences among relatives. To respect healthcare’s Quadruple Aim, further research among healthcare professionals should complement this study. Recommendations Based on our results and in line with the existing international literature published after the COVID-19 pandemic’s first-wave visiting restrictions, restricting visits by all the relatives of hospitalized patients is not recommendable. The literature supports making a distinction between general visitors and relatives. Future policies must clearly incorporate patients’ and relatives’ insights. Transparent, clear processes for identifying key relatives are strongly recommended. Detailed evaluations of restrictions based on hospital settings (e.g., emergency departments, maternity, psychiatry, surgery wards) are needed to quantify the relevant risks of visitor absence. Despite a context of public healthcare system staff shortages and financial restrictions, more human and financial resources must be made available to enable hospitals to accompany patients and informal caregivers with patient and family-centered care. Indeed, an informal caregivers or relatives charter is being set up between the Valais Hospital and the canton’s caregivers’ association in order to identify the caregivers who should be involved in that care. The literature demonstrates the feasibility and acceptability of digital communication, but not all our patients and relatives were willing or capable of doing so, preferring telephone calls or visits on balconies, for example, and this warrants further evaluation. We recommend dedicated digital communication teams to overcome the limited technological knowledge of older adults, for example. Where feasible, outdoor spaces can be used to facilitate relatives’ visits. Finally, digital communication cannot replace the essential care and human interaction often provided by relatives at the bedside. More data is needed to quantify the relative risks of general visitors and relatives, risks to patients, and the extra burden put on healthcare staff when relatives are absent. A comprehensive, balanced approach to assessing risks is needed to develop future policies for patient–visitor interactions. Conclusion The present study described relatives’ experiences of visiting restrictions, how they were affected by these, and their perceptions of the severity of a SARS-CoV-2 infection and of information flow and communication during the COVID-19 pandemic’s first wave. About two-thirds of responding relatives were moderately emotionally affected by the visiting restrictions, and most felt well-considered by the healthcare staff. Responses to our survey’s open question showed the unique aspects of each relative’s experiences of their loved one’s hospitalization. This highlights the importance of considering each patient’s family situation individually. Our patient-reported experience measures survey (PREMs) data revealed COVID-19’s impact on the social determinants of health among patients’ relatives, helping to identify opportunities for improving patient centered care throughout the following waves of this ongoing crisis and perhaps after it. This will help the Valais Hospital’s management to develop new care approaches, co-designed and co-produced with patients and their relatives. It will help to ensure that consensus care preferences are understood and respected, if possible. Future research will need to focus on embedding the collection of PREMs more broadly throughout healthcare institutions, increasing the use of their findings by patients/relatives, clinicians, and policymakers, and facilitating comparisons of patient-reported experiences internationally. Declarations Authors’ contributions: NTJ, SM, and HV had the original idea and provided the conceptual and methodological expertise to design the study. EB, NTJ, SM, and HV were significant contributors to the writing of the manuscript. All the authors read, edited, and approved the final manuscript and consent to publish the manuscript. Consent to publication Not applicable Ethical approval statement: The Human Research Ethics Committee of the Canton of Vaud (2020-02025) authorized the survey and the extraction of the population-based cohort’s data from administrative, electronic patient records in the hospital’s patient register (Additional file 4). Invited participants who completed the paper questionnaire and return it in the prepaid envelope provided were considered as consent to participate in the study. All participants or their legal guardian give their informed consent to participate in the study. All methods were carried out in accordance with relevant guidelines et regulations. Research protocol statement The research protocols were approved by the Valais Hospital, the Valais Family Caregivers’ Association and the HES-SO Valais/Wallis, Sion, Valais and the Human Research Ethics Committee of the Canton of Vaud (Additional file 4). Funding statement: This research was funded via a public grant from the Valais Hospitals’ COVID Committee with co-financing by the University of Applied Sciences and Arts Western Switzerland’s Institute of Health, HES-SO Valais/Wallis (Sagex: 101205). Competing interests statement: None declared. 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Twelve-month systemic consequences of COVID-19 in patients discharged from hospital: a prospective cohort study in Wuhan, China. Clin Infect Dis. 2021. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx Additionalfile2.docx Additionalfile3.docx Additionalfile4.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2047705","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":137419568,"identity":"bfac915e-f11f-4cfb-a5e6-dd262697a4c0","order_by":0,"name":"Nadine TACCHINI-JACQUIER","email":"","orcid":"","institution":"Valais Hospitals","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nadine","middleName":"","lastName":"TACCHINI-JACQUIER","suffix":""},{"id":137419569,"identity":"ebf1dc18-d22d-4b49-b32d-7f7a0ae04bcd","order_by":1,"name":"Sévrine MONNAY","email":"","orcid":"","institution":"Valais 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VERLOO","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIie3OvQrCMBDA8StCslztWuhLBAKKUOyrpBQ6FRVcCjoUCpl093EqgbpEZ8HBwdVBcPerLk6Nbg75T3chPzgAm+0PYwCdZugCOKf3G35JyHPgPxMSfEX6dKmYI8MxoWU9m+QqArqtWslgsUuEI9OBxDo9rLSKCxyJ9sP2Ga9AK0b8rHdwZSrAR9ZOjucXuTdk6t7SyEz2yAXkVUM6bhE6hZHojDORJ4xgnQRYh7HEzEA2mvsXNmQeLddXnPuRR3U7aRKfCzH/t9lsNpupBzynOLCjDDF1AAAAAElFTkSuQmCC","orcid":"","institution":"University of Applied Sciences and Arts Western Switzerland","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Henk","middleName":"","lastName":"VERLOO","suffix":""}],"badges":[],"createdAt":"2022-09-09 06:59:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2047705/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2047705/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":26829169,"identity":"036e7688-9030-4c3a-a0b9-f761a625c4c0","added_by":"auto","created_at":"2022-09-22 15:14:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43964,"visible":true,"origin":"","legend":"\u003cp\u003eThe study’s patient-reported experience measures (PREMs) framework and the reported data inside the blue frame.\u003c/p\u003e","description":"","filename":"ModelPREMSpublicationrestvisit002.png","url":"https://assets-eu.researchsquare.com/files/rs-2047705/v1/5e8b319143c1446b213fccc2.png"},{"id":26829171,"identity":"20bbb622-7049-4899-a405-63a5770ae30f","added_by":"auto","created_at":"2022-09-22 15:14:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":42514,"visible":true,"origin":"","legend":"\u003cp\u003eStrategy for data collection from patients and relatives\u003c/p\u003e","description":"","filename":"Slide1.png","url":"https://assets-eu.researchsquare.com/files/rs-2047705/v1/d17d8cbdc40b41f4781ec276.png"},{"id":31477146,"identity":"4b57b012-08eb-44e3-a0a4-b0ec22e7f95d","added_by":"auto","created_at":"2023-01-12 13:14:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":779544,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2047705/v1/7ce0719c-5a29-46ca-8b75-57fc39500cd4.pdf"},{"id":26830262,"identity":"f7e467cb-3c0d-4167-8907-e4e456b6e1b5","added_by":"auto","created_at":"2022-09-22 15:19:12","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":51280,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-2047705/v1/fdc4d14e1e23fae1f93cd102.docx"},{"id":26829172,"identity":"e610629a-5974-4dbd-90bb-08ff31b63d0e","added_by":"auto","created_at":"2022-09-22 15:14:13","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":39915,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-2047705/v1/0775b9eb1fc391f95031f948.docx"},{"id":26829173,"identity":"959f2d0d-ac63-4bb0-8e4b-1ee15afc016f","added_by":"auto","created_at":"2022-09-22 15:14:13","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":43871,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-2047705/v1/1b89b2b53fa1844686b2238e.docx"},{"id":26829174,"identity":"668e1a16-5379-4fd2-9441-1007ea60482b","added_by":"auto","created_at":"2022-09-22 15:14:13","extension":"pdf","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":239378,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile4.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2047705/v1/656068fa74a9e748bab0db65.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relatives' experiences of visiting restrictions during the COVID-19 pandemic’s first wave: a PREMs study","fulltext":[{"header":"Introduction – Background","content":"\u003cp\u003eThe first cases of COVID-19 struck the Canton of Valais, Switzerland, at the end of February 2020. The Swiss Confederation and the Canton enacted significant measures to limit the virus\u0026rsquo; spread throughout the population, including a reorganization of acute hospital care (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). During the onset of the pandemic, from March 15 to April 30, 2020, the Canton instituted COVID-19-related visiting restrictions on healthcare institutions, prohibited patients from leaving their rooms, and closed hospital restaurants, coffee shops, and other communal areas. All visits were banned, including by relatives, with some exceptions made for parents visiting pediatrics wards (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). These decisions were made when knowledge about the virus\u0026rsquo; spread was not very advanced regarding patient safety (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Restricting visits is not only an emotional hardship for patients and relatives, but healthcare staff also perceive the absence of relatives at the bedside to be a hindrance to delivering person- and family-centered care (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The present study defined relatives as the non-professional persons providing physical help and psychological support to patients, and they could be family members, friends, or acquaintances (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Healthcare staff reported that\u0026mdash;even at hospital admission\u0026mdash;there were critical gaps in information gathering after the introduction of visiting restrictions, whereas relatives had contributed significantly before. Without communicating with relatives, healthcare staff found it hard to accurately assess clinical signs and symptoms, pain levels, and mental health status (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Under normal circumstances, relatives at the bedside can observe how different healthcare staff care for their loved ones (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Depending on the patient\u0026rsquo;s disabilities and unique needs, relatives can learn how to assist their loved ones in the activities of daily living and note whether they are experiencing discomfort. Learning how to react at the bedside enables relatives to become accustomed to the patient\u0026rsquo;s changing condition and better help manage discharge planning and support needs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Research has shown the significant numbers of medical and nursing tasks performed by relatives at home with limited guidance (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, some care situations could have been exacerbated by COVID-19 visiting restrictions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). A relative can help overcome language barriers and health literacy problems caused by clinical jargon (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) or can assist physically weakened and/or mentally inhibited patients (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Previous studies have also demonstrated that relatives are crucial to the early detection of delirium, a common, often unrecognized condition present in frail older adult inpatients diagnosed with dementia or multiple other chronic conditions and polypharmacy (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The regular presence of relatives at the bedsides of those patients most at risk of delirium can reduce its onset and limit long-term functional decline (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Recent data revealed that the longer the hospital length of stay (LOS), the more relatives were emotionally affected by visiting restrictions (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Relatives also take on an advocacy role when they communicate practical suggestions about patients\u0026rsquo; habits or additional needs to healthcare staff, thus facilitating patient\u0026ndash;staff communication (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Sahoo \u003cem\u003eet al\u003c/em\u003e. and Vincent \u003cem\u003eet al\u003c/em\u003e. (2021) reported significant associations between additional stress, affect, visiting restrictions, and LOS (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The COVID-19 pandemic also changed patient discharge planning, undermining usual discharge processes. Before the COVID-19 pandemic, healthcare staff used a discharge procedure designed to sit relatives and the patient together to discuss critical information on the support that would be needed at home (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This exchange increased the chances of the patient subsequently remaining at home and optimized the discharge process. Under COVID-19 visiting restrictions, these conversations altered dramatically (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and may have caused problems in the dialogue between healthcare staff and relatives, reducing the possibilities of ensuring consensus-based care and increasing the risks of unplanned hospital readmissions (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). To maintain the links between patients, relatives, and healthcare staff, the Valais Hospital offered a variety of digital and technical means to replace physical visits (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, recent studies have highlighted that video or telephone meetings with the relatives of patients in acute care settings led to fewer changes to care goals than in-person meetings (\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Substitute visiting methods, such as digital and multimedia applications, lowered relatives\u0026rsquo; comprehension of the patient\u0026rsquo;s overall condition, reducing opportunities to maintain social relations (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Recent research has shown that relatives\u0026rsquo; experiences during the uncertain context of COVID-19 led to frustrations, especially among older adults (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This was linked to not being able to see how their loved one was being cared for and having to put their trust in healthcare institutions (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Unclear information or inconsistencies in institutional policy contributed to these uncertainties and relatives sought efficient face-to-face communication (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Hoffman \u003cem\u003eet al\u003c/em\u003e. highlighted the need for personal attention from relatives (\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). To assess inpatients\u0026rsquo; relatives\u0026rsquo; experiences with regard to the visiting restrictions imposed during COVID-19\u0026rsquo;s first wave, we distributed a patient-reported experience measures (PREMs) questionnaire to all the patients hospitalized in the Valais Hospital between the end of February and mid-May, 2020, and to their relatives. The following research questions guided this research. How were the relatives subjected to visiting restrictions distributed? How were the relatives subjected to visiting restrictions affected by this situation compared to relatives not subjected to visiting restrictions? How did relatives (whether subjected to visiting restrictions or not) perceive the information they received, communication with staff, and their own involvement in the care of their loved ones? How did relatives maintain contact with their loved ones?\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv class=\"Section2\" id=\"Sec3\"\u003e\n \u003ch2\u003eDesign, research population, and setting\u003c/h2\u003e\n \u003cp\u003eFollowing the approval from the Human Research Ethics Committee of the Canton of Vaud (2020\u0026ndash;02025), Valais Hospital\u0026rsquo;s data science warehouse provided the contact details of all the adult inpatients (18 years and older) discharged alive to their home or a nursing home between February 28 and May 13, 2020. These were extracted from administrative, electronic patient records in the hospital\u0026rsquo;s patient register. A paper questionnaire was sent out to these patients, including an explanation sheet describing the nature of the survey and a questionnaire for their relative, if appropriate. Patients were free to choose whether to participate. Anonymously returning the questionnaire in the attached postage-paid envelope was considered consent to participate in our study for both patients and relatives. The previously published research protocol describes the PREMs methodology used for our survey (\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec4\"\u003e\n \u003ch2\u003eStudy framework\u003c/h2\u003e\n \u003cp\u003eThe Quadruple Aim healthcare framework guided the study, highlighting the medical and social needs of hospitalized patients and their relatives, emphasizing the impacts of their unmet needs, and describing the importance of partnerships between the healthcare system and formal and informal caregivers (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). Relatives involved in care delivery have also recently become an acknowledged essential component of overall health system performance, based on the principles of patient and public involvement described in PREMs (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e). PREMs instruments look at the care process\u0026rsquo;s impact on patients\u0026rsquo; and relatives\u0026rsquo; experiences, e.g., involvement in care, communication with staff, information sharing, and the overall care experience. Our PREMs questionnaire included open and closed questions to capture patients\u0026rsquo; and relatives\u0026rsquo; perceptions of their interactions with the healthcare system and the degree to which their needs were considered (\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e). This paper reports on the PREMs survey\u0026rsquo;s written feedback on relatives\u0026rsquo; experiences during the COVID-19 pandemic\u0026rsquo;s first wave and the visiting restrictions imposed on them (Fig. 1).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec5\"\u003e\n \u003ch2\u003eVisiting restrictions during the COVID-19 pandemic\u003c/h2\u003e\n \u003cp\u003eRestricting hospital visits during the COVID-19 pandemic\u0026rsquo;s first wave had the following aims: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) preventing the transmission of SARS-CoV-2 from the community into acute hospitals (infecting healthcare staff and patients), (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) preventing transmission in the other direction (infecting visitors), and (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) maintaining adequate supplies of personal protective equipment (\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e). At the pandemic\u0026rsquo;s onset, potential visitor-related COVID-19 outbreaks were considered a substantial risk and, thus, all types of visits were restricted, despite a lack of scientific evidence linking visitors to SARS-CoV-2 transmission (\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec6\"\u003e\n \u003ch2\u003eThe PREMs instrument\u003c/h2\u003e\n \u003cp\u003eOur self-reporting data-collection questionnaire was designed based on a literature review and four semi-structured exploratory interviews with previously hospitalized patients and their relatives (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e). A returned questionnaire from the patient and relative served as a proxy for written consent to participate. The first section, including 14 closed questions, asked patients about sociodemographic data, sex, age, marital status, educational level, and their hospital trajectory as a patient, as well as about their stress level (\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e), trust in healthcare professionals (nurses and physicians) (\u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e), feelings of safety (\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e), whether they were infected by SARS-CoV-2, and perceptions about the disease\u0026rsquo;s severity during the hospitalization period (\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e). The second section included eight closed questions and one open-ended question for the discharged patient\u0026rsquo;s relative (if they were directly involved in the patient\u0026rsquo;s hospitalization) (Additional File 1). Due to legal restrictions covering data protection and confidentiality, we were not allowed to collect sociodemographic data on relatives. These questions were: Were you able to visit your relative in the hospital? [Yes/No]; If not, how did you maintain contact with your loved one? [(i) Telephone with professional caregivers, (ii) email, (iii) other]. If not, how much did this affect you? [(i) I was not affected, (ii) I was slightly affected, (iii) No opinion, (iv) I was moderately affected, (v) I was very affected]; How did you perceive the information you received about the COVID-19 pandemic during your loved one\u0026rsquo;s hospital stay? [(i) Totally inadequate, ii) Inadequate, iii) Slightly inadequate, iv) No opinion, v) Just good enough, vi) Adequate, vii) Very good)]; How would you rate communication with the staff? [(i) Poor, ii) Passable, (iii) Good, (iv) Very good, (v) Excellent].As a close relative, how did the hospital staff treat you? [(i) I was not taken into consideration at all, (ii) I was moderately taken into consideration, (iii) I was fully taken into consideration]. How serious do you think the COVID-19 pandemic is? [(i) Not at all serious, (ii) Not very serious, (iii) Slightly serious, (iv) Serious, (v) Very serious] (\u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e). Would you like to add any comments about your experience of your loved one\u0026rsquo;s hospitalization during the pandemic?\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003eData collection procedure\u003c/h2\u003e\n \u003cp\u003eAll eligible participants received a letter by post inviting them to participate in the survey. This was followed by a reminder two weeks later. Besides the paper questionnaire, an information sheet explained the study\u0026rsquo;s background, the data sought, and our participant data protection strategy. Participants were asked to complete the paper questionnaire and return it in the prepaid envelope provided. Waiting for ethics clearance and heavy workloads meant that the data warehouse only started its information gathering in August and finished in December 2020 (Fig. 2).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003eData analyses\u003c/h2\u003e\n \u003cp\u003eData were anonymised to ensure participant anonymity and respect good research practice in this type of study, as per the Declaration of Helsinki (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e). Data from the self-reported questionnaires returned were extracted into an Excel\u0026copy; spreadsheet (Microsoft, Redmond, Washington, USA), cleaned, and imported into IBM SPSS\u0026reg; software, version 28 (IBM Corp, Armonk, New York, USA), for analyses. Two critical issues in large-sample surveys are the response rate and the management of missing values. We analyzed the number of responses and missing values for each variable and reported them in our tables (n\u0026thinsp;=\u0026thinsp;answers). To ensure scientific rigor and avoid any bias, missing values were not replaced using a missing value strategy (e.g., multiple imputations, mean score) (\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e). Parametric properties were analyzed for the normality of their distributions and the equality of their variances using the Kolmogorov\u0026ndash;Smirnov test. Non-parametric tests were performed for variables with non-normal distributions to compare relatives who were and were not affected by visiting restrictions. The population was described using descriptive statistics with frequencies, distributions, and leading trends. Data collected using Likert scales were analyzed using descriptive and inferential statistics. LOS was recoded as a dichotomous variable of 1\u0026ndash;14 days and \u0026ge;\u0026thinsp;15 days, based on the median patient LOS (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e). Bivariate analyses were conducted using cross-tabulations between relatives impacted and not impacted by visiting restrictions during their loved one\u0026rsquo;s hospitalization. Associations were calculated between types of contact with loved ones, levels of affect, the information received about the COVID-19 pandemic, the quality of communication, healthcare staff\u0026rsquo;s consideration of relatives, how serious the COVID-19 pandemic was perceived to be, and comments about relatives\u0026rsquo; experiences of their loved one\u0026rsquo;s hospitalization. Spearman\u0026rsquo;s rank correlation measures were computed between sociodemographic variables and the closed questions. We computed a linear multivariate regression model to analyze how visiting restrictions predicted relatives\u0026rsquo; affects, their satisfaction with information received about the COVID-19 pandemic, satisfaction with communication with staff, how well healthcare staff considered relatives, and perceptions of how serious the COVID-19 pandemic was. The model estimated each predictor\u0026rsquo;s net impact, other things being equal. The model gave predictions for the entire sample, not just specific individuals. Results were considered statistically significant when \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01. All \u003cem\u003ep\u003c/em\u003e-values were based on two-tailed tests, and all the analyses were supervised and reviewed by a biostatistician.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 4,523 eligible participants hospitalized during the COVID-19 pandemic\u0026rsquo;s first wave, 1,341 (29.6%) returned the questionnaire. Of these, 1,312 were valid (\u0026gt;\u0026nbsp;50% of questions completed), with 866 relatives completing the section dedicated to them, 818 of which were analyzable (\u0026gt;\u0026nbsp;50% of questions completed), representing 65.5% of the valid patient responses (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSociodemographic characteristics of patients and their relatives\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eParticipants \u0026ndash; hospitalized patients\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMedian participant age was 64 years old (IQR 1\u0026ndash;3\u0026nbsp;=\u0026nbsp;45\u0026ndash;76). During the study period, 141 (10.9%) respondents were tested positive for a SARS-CoV-2 infection by the hospital laboratory, and 1,148 (89.1%) were uninfected. Discharged patients\u0026rsquo; sociodemographic data are detailed in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Participating patients\u0026rsquo; sociodemographic and hospitalization characteristics\u0026nbsp;\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,195)\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003cp\u003eMedian (IQR 1\u0026ndash;3)\u003c/p\u003e\n \u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60.3 (19.4)\u003c/p\u003e\n \u003cp\u003e64 (45\u0026ndash;76)\u003c/p\u003e\n \u003cp\u003e18\u0026ndash;99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups (years)\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,195)\u003c/p\u003e\n \u003cp\u003e18\u0026ndash;34 (%)\u003c/p\u003e\n \u003cp\u003e35\u0026ndash;55 (%)\u003c/p\u003e\n \u003cp\u003e56\u0026ndash;64 (%)\u003c/p\u003e\n \u003cp\u003e65\u0026ndash;74 (%)\u003c/p\u003e\n \u003cp\u003e75 or more (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e185 (15.5)\u003c/p\u003e\n \u003cp\u003e238 (19.9)\u003c/p\u003e\n \u003cp\u003e183 (15.3)\u003c/p\u003e\n \u003cp\u003e253 (21.2)\u003c/p\u003e\n \u003cp\u003e336 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,291)\u003c/p\u003e\n \u003cp\u003eMale (%) / Female (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e619 (47.9) / 672 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,161)\u003c/p\u003e\n \u003cp\u003eSingle (%)\u003c/p\u003e\n \u003cp\u003eMarried (%)\u003c/p\u003e\n \u003cp\u003eDivorced/separated (%)\u003c/p\u003e\n \u003cp\u003eWidowed (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e451 (34.3)\u003c/p\u003e\n \u003cp\u003e579 (44.1)\u003c/p\u003e\n \u003cp\u003e131 (10.0)\u003c/p\u003e\n \u003cp\u003e84 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,211)\u003c/p\u003e\n \u003cp\u003eCompulsory education (%)\u003c/p\u003e\n \u003cp\u003eSecondary education (%)\u003c/p\u003e\n \u003cp\u003eHigher education/university (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e375 (28.6)\u003c/p\u003e\n \u003cp\u003e547 (41.7)\u003c/p\u003e\n \u003cp\u003e289 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (days)\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,080)\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15.1 (26.7)\u003c/p\u003e\n \u003cp\u003e1\u0026ndash;280\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARS-CoV-2-infected\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,289)\u003c/p\u003e\n \u003cp\u003eYes (%) / No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e141 (10.9) / 1,148 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"58.93223819301848%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization ward\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;1,312)\u003c/p\u003e\n \u003cp\u003eSurgery (%)\u003c/p\u003e\n \u003cp\u003eGeneral Medicine (%)\u003c/p\u003e\n \u003cp\u003eGynecology/obstetrics (%)\u003c/p\u003e\n \u003cp\u003eIntermediate care \u0026amp; ICUs (%)\u003c/p\u003e\n \u003cp\u003ePsychiatry (%)\u003c/p\u003e\n \u003cp\u003eRehabilitation/geriatrics (%)\u003c/p\u003e\n \u003cp\u003eOther units (%)\u003c/p\u003e\n \u003cp\u003eComplex trajectory* (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"41.06776180698152%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e300 (22.9)\u003c/p\u003e\n \u003cp\u003e240 (18.3)\u003c/p\u003e\n \u003cp\u003e169 (12.9)\u003c/p\u003e\n \u003cp\u003e230 (17.5)\u003c/p\u003e\n \u003cp\u003e44 (3.4)\u003c/p\u003e\n \u003cp\u003e24 (1.8)\u003c/p\u003e\n \u003cp\u003e228 (17.4)\u003c/p\u003e\n \u003cp\u003e77 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Two hospital units or more\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eResponding relatives\u0026nbsp;\u003c/u\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOf 866 PREMs questionnaires completed by patients\u0026rsquo; relatives, 818 (95%) were analyzable, including 106 (75%)\u0026nbsp;relatives of the 141\u0026nbsp;SARS-CoV-2-infected participants. Among the 1,086 non-COVID-19 participants, 712 (87%) relatives responded to the PREMs questionnaire\u0026rsquo;s second section (Table 2). We found significantly higher survey participation rates among the relatives of: patients infected with SARS-CoV-2 (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001); older patient age groups (\u003cem\u003ep\u003c/em\u003e = 0.008); patients with longer LOS (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001); and patients in certain hospital wards (intermediate care and ICU) (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eTable 2. Distribution of relatives based on\u0026nbsp;SARS-CoV-2-infected and non-infected patients and their age groups, LOS, and hospitalization ward.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.631178707224336%\"\u003e\n \u003cp\u003eRelative\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.011406844106464%\"\u003e\n \u003cp\u003eNo relative\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eSARS-CoV-2-infected patients (n\u0026nbsp;=\u0026nbsp;133)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.631178707224336%\"\u003e\n \u003cp\u003e106 (79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.011406844106464%\"\u003e\n \u003cp\u003e27 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.47908745247148%\"\u003e\n \u003cp\u003eNon-infected patients (n\u0026nbsp;=\u0026nbsp;1,093)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.631178707224336%\"\u003e\n \u003cp\u003e695 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.011406844106464%\"\u003e\n \u003cp\u003e398 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInpatient age group (years)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.631178707224336%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.011406844106464%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e18\u0026ndash;34 (n\u0026nbsp;=\u0026nbsp;179)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.631178707224336%\"\u003e\n \u003cp\u003e129 (72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.011406844106464%\"\u003e\n \u003cp\u003e50 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e0.008\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e35\u0026ndash;55 (n\u0026nbsp;=\u0026nbsp;229)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.631178707224336%\"\u003e\n \u003cp\u003e153 (66.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.011406844106464%\"\u003e\n \u003cp\u003e76 (33.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e56\u0026ndash;64 (n\u0026nbsp;=\u0026nbsp;175)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e101 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e74 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e65\u0026ndash;74 (n\u0026nbsp;=\u0026nbsp;242)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e146 (60.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e96 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e75 or more (n\u0026nbsp;=\u0026nbsp;313)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e219 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e94 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1\u0026ndash;14 (n\u0026nbsp;=\u0026nbsp;783)\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026nbsp;15 days (n\u0026nbsp;=\u0026nbsp;225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e493 (63.0)\u003c/p\u003e\n \u003cp\u003e170 (75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e290(37.0)\u003c/p\u003e\n \u003cp\u003e55 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001*\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization ward\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eSurgery (n\u0026nbsp;=\u0026nbsp;295)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e152 (51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e143 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eGeneral Medicine (n\u0026nbsp;=\u0026nbsp;226)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e153 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e73 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eGynecology/obstetrics (n\u0026nbsp;=\u0026nbsp;165)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e130 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e35 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eIntermediate care/ICU (n\u0026nbsp;=\u0026nbsp;220)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e157 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e63 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eUnknown trajectory (n\u0026nbsp;=\u0026nbsp;207)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e133(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e74 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003ePsychiatry (n\u0026nbsp;=\u0026nbsp;43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e26 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e17 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eRehabilitation/geriatrics (n\u0026nbsp;=\u0026nbsp;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e16 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e4 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.47908745247148%\"\u003e\n \u003cp\u003eMultiple wards other than ICU (n\u0026nbsp;=\u0026nbsp;73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"18.631178707224336%\"\u003e\n \u003cp\u003e51 (69.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.011406844106464%\"\u003e\n \u003cp\u003e22 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"13.87832699619772%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. * Chi-squared exact test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003cu\u003eVisiting restrictions\u0026nbsp;\u003c/u\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 543 relatives were subjected\u0026mdash;either entirely or partially\u0026mdash;to visiting restrictions during their loved one\u0026rsquo;s hospitalization, including 92 (87%) relatives of\u0026nbsp;SARS-CoV-2-infected patients and 451 (63%) relatives of non-infected patients. Almost two-thirds of all responding relatives were at least moderately emotionally affected by the sudden onset of visiting restrictions. However, the relatives of SARS-CoV-2-infected patients were significantly more emotionally affected than the relatives on non-infected patients (81% vs. 61% at least moderately affected, respectively; p\u0026nbsp;\u0026lt;\u0026nbsp;0.001) (Table 3). Contrarily, no significant differences were found between how strongly relatives subjected to visiting restrictions were affected according to age group (\u003cem\u003ep\u003c/em\u003e = 0.815) and LOS (\u003cem\u003ep\u003c/em\u003e = 0.185) (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3. How strongly relatives were affected by visiting restrictions during their loved one\u0026rsquo;s hospitalization.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.07570977917981%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.725552050473187%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo opinion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.305993690851736%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot affected\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.936908517350158%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMildly\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eaffected\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerately affected\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25236593059937%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly Affected\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(IQR 1\u0026ndash;3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.46372239747634%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.07570977917981%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVisiting restrictions\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;531 relatives)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.725552050473187%\"\u003e\n \u003cp\u003e51 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.305993690851736%\"\u003e\n \u003cp\u003e83 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.936908517350158%\"\u003e\n \u003cp\u003e54 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.198738170347003%\"\u003e\n \u003cp\u003e96 (18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.25236593059937%\"\u003e\n \u003cp\u003e247 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.041009463722398%\"\u003e\n \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.46372239747634%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.07570977917981%\"\u003e\n \u003cp\u003eSARS-CoV-2-infected patients (n\u0026nbsp;=\u0026nbsp;91)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNon-infected patients (n\u0026nbsp;=\u0026nbsp;430)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.725552050473187%\"\u003e\n \u003cp\u003e7 (7.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (10.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.305993690851736%\"\u003e\n \u003cp\u003e5 (5.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.936908517350158%\"\u003e\n \u003cp\u003e5 (5.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e14 (15.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e79 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.25236593059937%\"\u003e\n \u003cp\u003e60 (65.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e184 (42.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e5 (4\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.46372239747634%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.07570977917981%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInpatient age group (years)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e18\u0026ndash;34 (n\u0026nbsp;=\u0026nbsp;71)\u003c/p\u003e\n \u003cp\u003e35\u0026ndash;55 (n\u0026nbsp;=\u0026nbsp;92)\u003c/p\u003e\n \u003cp\u003e56\u0026ndash;64 (n\u0026nbsp;=\u0026nbsp;72)\u003c/p\u003e\n \u003cp\u003e65\u0026ndash;74 (n\u0026nbsp;=\u0026nbsp;107)\u003c/p\u003e\n \u003cp\u003e75 or more (n\u0026nbsp;=\u0026nbsp;145)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.725552050473187%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (8.5)\u003c/p\u003e\n \u003cp\u003e8 (8.7)\u003c/p\u003e\n \u003cp\u003e6 (8.3)\u003c/p\u003e\n \u003cp\u003e11 (10.3)\u003c/p\u003e\n \u003cp\u003e10 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.305993690851736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (15.5)\u003c/p\u003e\n \u003cp\u003e12 (13)\u003c/p\u003e\n \u003cp\u003e11 (15.3)\u003c/p\u003e\n \u003cp\u003e13 (12.1)\u003c/p\u003e\n \u003cp\u003e30 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.936908517350158%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (8.5)\u003c/p\u003e\n \u003cp\u003e9 (9.8)\u003c/p\u003e\n \u003cp\u003e9 (12.5)\u003c/p\u003e\n \u003cp\u003e14 (13.1)\u003c/p\u003e\n \u003cp\u003e10 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (12.7)\u003c/p\u003e\n \u003cp\u003e18 (19.6)\u003c/p\u003e\n \u003cp\u003e16 (22.2)\u003c/p\u003e\n \u003cp\u003e18 (16.8)\u003c/p\u003e\n \u003cp\u003e27 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.25236593059937%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e39 (54.9)\u003c/p\u003e\n \u003cp\u003e45 (48.9)\u003c/p\u003e\n \u003cp\u003e30 (41.7)\u003c/p\u003e\n \u003cp\u003e51 (47.7)\u003c/p\u003e\n \u003cp\u003e68 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (3\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.46372239747634%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.815**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.07570977917981%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization ward\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSurgery (n\u0026nbsp;=\u0026nbsp;88)\u003c/p\u003e\n \u003cp\u003eGeneral Medicine (n\u0026nbsp;=\u0026nbsp;119)\u003c/p\u003e\n \u003cp\u003eGynecology/obstetrics. (n\u0026nbsp;=\u0026nbsp;64)\u003c/p\u003e\n \u003cp\u003eIntermediate care \u0026amp; ICU (n\u0026nbsp;=\u0026nbsp;115)\u003c/p\u003e\n \u003cp\u003eUnknown trajectory (n\u0026nbsp;=\u0026nbsp;87)\u003c/p\u003e\n \u003cp\u003ePsychiatry (n\u0026nbsp;=\u0026nbsp;14)\u003c/p\u003e\n \u003cp\u003eRehabilitation/geriatrics (n\u0026nbsp;=\u0026nbsp;9)\u003c/p\u003e\n \u003cp\u003eMultiple wards other than ICU (n\u0026nbsp;=\u0026nbsp;35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.725552050473187%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (10.2)\u003c/p\u003e\n \u003cp\u003e14 (11.8)\u003c/p\u003e\n \u003cp\u003e3 (4.7)\u003c/p\u003e\n \u003cp\u003e5 (4.3)\u003c/p\u003e\n \u003cp\u003e16 (18.4)\u003c/p\u003e\n \u003cp\u003e2 (14.3)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.305993690851736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (23.9)\u003c/p\u003e\n \u003cp\u003e12 (10.1)\u003c/p\u003e\n \u003cp\u003e9 (14.1)\u003c/p\u003e\n \u003cp\u003e10 (8.7)\u003c/p\u003e\n \u003cp\u003e23 (26.4)\u003c/p\u003e\n \u003cp\u003e2 (4.3)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e6 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.936908517350158%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (15.9)\u003c/p\u003e\n \u003cp\u003e13 (10.9)\u003c/p\u003e\n \u003cp\u003e2 (3.1)\u003c/p\u003e\n \u003cp\u003e15 (13)\u003c/p\u003e\n \u003cp\u003e5 (5.7)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e5 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (25.0)\u003c/p\u003e\n \u003cp\u003e22 (18.5)\u003c/p\u003e\n \u003cp\u003e8 (12.5\u003c/p\u003e\n \u003cp\u003e23 (20)\u003c/p\u003e\n \u003cp\u003e8 (9.2)\u003c/p\u003e\n \u003cp\u003e4 (28.6)\u003c/p\u003e\n \u003cp\u003e3 (33.3)\u003c/p\u003e\n \u003cp\u003e6 (17.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.25236593059937%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (25.0)\u003c/p\u003e\n \u003cp\u003e58 (48.7)\u003c/p\u003e\n \u003cp\u003e42 (65.6)\u003c/p\u003e\n \u003cp\u003e62 (53.9\u003c/p\u003e\n \u003cp\u003e35 (40.2)\u003c/p\u003e\n \u003cp\u003e6 (42.9)\u003c/p\u003e\n \u003cp\u003e6 (66.7)\u003c/p\u003e\n \u003cp\u003e16 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e5 (4\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e5 (3\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e3 (2\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e4 (3\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.46372239747634%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"28.07570977917981%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1\u0026ndash;14 (n\u0026nbsp;=\u0026nbsp;321)\u003c/p\u003e\n \u003cp\u003e\u0026ge;\u0026nbsp;15 (n\u0026nbsp;=\u0026nbsp;124)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.725552050473187%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (9)\u003c/p\u003e\n \u003cp\u003e9 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.305993690851736%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53 (16.5)\u003c/p\u003e\n \u003cp\u003e14 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.936908517350158%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (11.5)\u003c/p\u003e\n \u003cp\u003e9 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.198738170347003%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (11.5)\u003c/p\u003e\n \u003cp\u003e22 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.25236593059937%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e143 (44.5)\u003c/p\u003e\n \u003cp\u003e70 (56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.041009463722398%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (2\u0026ndash;5)\u003c/p\u003e\n \u003cp\u003e5 (3\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.46372239747634%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.185*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. * Non-parametric Mann\u0026ndash;Whitney U test; **Kruskal\u0026ndash;Wallis test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRelatives\u0026rsquo; perceptions of the severity of the COVID-19 pandemic\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall median score for relatives\u0026rsquo; perceived severity of a SARS-CoV-2 infection scale, taken from the standard questionnaire on risk perception of an infectious disease outbreak by the Municipal Public Health Service of Rotterdam-Rijnmond\u0026nbsp;(48), was 4 (IQR 1\u0026ndash;3\u0026nbsp;=\u0026nbsp;3\u0026ndash;5). No significant differences were found between relatives subjected to visiting restrictions (median 4; IQR 1\u0026ndash;3\u0026nbsp;=\u0026nbsp;3\u0026ndash;5) and those not (median 4; IQR\u0026nbsp;=\u0026nbsp;1\u0026ndash;3\u0026nbsp;=\u0026nbsp;3\u0026ndash;5) (\u003cem\u003ep\u003c/em\u003e = 0.085).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRelatives\u0026rsquo; involvement in care\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsideration of relatives in the care process\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOverall, most relatives felt well-considered by healthcare staff (n\u0026nbsp;=\u0026nbsp;406; 54.4%) when it came to involvement in the provision of care.\u0026nbsp;Given the exceptional public health situation caused by the COVID-19 pandemic, relatives waiting to hear from their loved ones felt stressed and disturbed. A smaller fraction felt less well considered (n = 218; 29.1%) and\u0026nbsp;124 (16.6%) did not feel considered at all in the provision of care. A small fraction (\u0026lt;\u0026nbsp;5%) reported hospital healthcare staff to be unavailable to inform them of their loved one\u0026rsquo;s health status. Significant differences were found between patient age groups (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and between relatives subjected and not subjected to visiting restrictions (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). No significant differences were found regarding LOS (\u003cem\u003ep\u003c/em\u003e = 0.060) or hospitalization ward (\u003cem\u003ep\u003c/em\u003e = 0.316) (Table 4).\u003c/p\u003e\n\u003cp\u003eTable 4. Relatives\u0026rsquo; perceptions of being considered as care partners\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelatives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot considered\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartially considered\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFully considered\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.16498316498316%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;748)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e124 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e218 (29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e406 (54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eSubjected to visiting restrictions (n\u0026nbsp;=\u0026nbsp;464)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e109 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e138 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e217 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eNot subjected to visiting restriction (n\u0026nbsp;=\u0026nbsp;284)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e15 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e80 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e189 (66.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARS-CoV-2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSARS-CoV-2-infected patients (n\u0026nbsp;=\u0026nbsp;98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55 (56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e0.350*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eNon-infected patients (n\u0026nbsp;=\u0026nbsp;638)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e103 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e189 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e346 (54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.16498316498316%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eInpatient age group (years)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e18\u0026ndash;34 (n\u0026nbsp;=\u0026nbsp;124)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e23 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e50 (40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e51 (41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;\u0026nbsp;\u003c/em\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e35\u0026ndash;55 (n\u0026nbsp;=\u0026nbsp;145)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e29 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e37 (25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e79 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e56\u0026ndash;64 (n\u0026nbsp;=\u0026nbsp;93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e18 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e33(35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e42 (45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e65\u0026ndash;74 (n\u0026nbsp;=\u0026nbsp;139)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e28 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e34 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e77 (55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e75 or more (n\u0026nbsp;=\u0026nbsp;195)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e19 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e52 (25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e124 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stay (days)\u0026nbsp;\u003c/strong\u003e(n\u0026nbsp;=\u0026nbsp;619)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e1\u0026ndash;14 (n\u0026nbsp;=\u0026nbsp;458)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e89 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e134 (29.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e235 (51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e0.060*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e\u0026ge;\u0026nbsp;15 (n\u0026nbsp;=\u0026nbsp;161)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e21 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e41 (25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e99 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHospitalization ward\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eSurgery (n\u0026nbsp;=\u0026nbsp;126)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e28 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e39 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e59(46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e0.316*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eGeneral Medicine (n\u0026nbsp;=\u0026nbsp;145)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e30(20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e40 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e75 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eGynecology/obstetrics (n\u0026nbsp;=\u0026nbsp;128)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e14 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e46 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e68 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eIntermediate care/ICU (n\u0026nbsp;=\u0026nbsp;147)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e21 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e41 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e85 (57.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eUnknown trajectory (n\u0026nbsp;=\u0026nbsp;115)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e18 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e30 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e67 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003ePsychiatry (n\u0026nbsp;=\u0026nbsp;23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e8 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e13(56.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eRehabilitation/geriatrics (n\u0026nbsp;=\u0026nbsp;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e4 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e4 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e8 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"33.16498316498316%\"\u003e\n \u003cp\u003eMultiple wards other than ICU (n\u0026nbsp;=\u0026nbsp;48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e7 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e10 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.023569023569024%\"\u003e\n \u003cp\u003e31 (64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.764309764309765%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. * Chi-squared exact test;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSharing information and communication between healthcare staff and relatives\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDespite healthcare staff\u0026rsquo;s poor availability due to extremely high workloads, most relatives felt well informed by them (n\u0026nbsp;=\u0026nbsp;426; 53.0%), with an overall median score of 6 (IQR 1\u0026ndash;3\u0026nbsp;=\u0026nbsp;1\u0026ndash;6). Fewer respondents felt moderately well informed (n\u0026nbsp;=\u0026nbsp;68; 8.5%) or poorly informed (n\u0026nbsp;=\u0026nbsp;309; 38.5%) by healthcare staff. Among relatives subjected to visiting restrictions, no significant differences were found regarding perceived levels of information between males and females (\u003cem\u003ep\u003c/em\u003e = 0.080), between SARS-CoV-2-infected or non-infected patients (\u003cem\u003ep\u003c/em\u003e = 0.254), between age groups (\u003cem\u003ep\u003c/em\u003e = 0.248), and between different LOS (\u003cem\u003ep\u003c/em\u003e = 0.220). Contrarily, significant differences were found between hospitalization wards (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) (Additional File 2).\u003c/p\u003e\n\u003cp\u003eRelatives reported a reasonable overall median score of 3 out of 5 (IQR 1\u0026ndash;3\u0026nbsp;=\u0026nbsp;3\u0026ndash;4) on the quality of their communication with hospital healthcare staff, although relatives subjected to visiting restrictions reported significantly lower scores than those not subjected to them (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). One-fifth of relatives found communication poor or acceptable. No significant differences were found between relatives subjected to visiting restrictions and those not regarding communication, LOS, and hospitalization wards (Additional File 3). Among the full sample of relatives (n = 818), 563 (69%) reported regularly communicating with their hospitalized loved ones (at least once a day), and 179 (22%) reported having at least one telephone contact with Valais Hospital staff. A small number of relatives (n = 6) communicated with the patient by email. Other methods for maintaining contact between relatives and patients were videoconferences using FaceTime\u0026reg;, WhatsApp\u0026reg;, Zoom\u0026reg;, or Skype\u0026reg; (n = 25), mobile phone and SMS text messages (n = 9), exchanges at the hospital window or outside the ward (n = 9), being hospitalized in the same hospital room (n = 1), or communication through the family physician (n = 3).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMultivariate linear regressions of affect scores\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSimultaneous multiple linear regressions were calculated to investigate the best predictors of affect scores among relatives subjected to visiting restrictions.\u0026nbsp;The combination of patient age in years, sex, LOS and the hospitalization wards of medicine, surgery, psychiatry, gynecology, intermediate care/ICU, and rehabilitation/geriatrics\u0026nbsp;significantly predicted affect scores (\u003cem\u003eF\u0026nbsp;\u003c/em\u003e(9, 4.421) = 7.294; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). The hospitalization wards of medicine (\u003cem\u003ep\u003c/em\u003e = 0.027) and gynecology/obstetrics (\u003cem\u003ep\u003c/em\u003e = 0.028) also significantly predicted relatives\u0026rsquo; affect scores (Table 5). The adjusted R\u003csup\u003e2\u003c/sup\u003e value was 0.105, indicating that the model explained 10.5% of the variance in the affect scores. According to Cohen, this is a mild-to-moderate effect (49).\u003c/p\u003e\n\u003cp\u003eTable 5\u003cem\u003e.\u003c/em\u003e Multivariate linear regression analyses of patient age in years, sex, LOS, and the hospitalization wards of medicine, surgery, psychiatry, gynecology/obstetrics, intermediate care/ICU, and rehabilitation/geriatrics, and their predictions of relatives\u0026rsquo; affect scores.\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExp(B)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"19.478527607361965%\"\u003e\n \u003cp\u003e95% Confidence Interval Beta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"48.031496062992126%\"\u003e\n \u003cp\u003eUnder\u003c/p\u003e\n \u003cp\u003elimit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"51.968503937007874%\"\u003e\n \u003cp\u003eUpper limit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003ePatient age in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e-.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e-0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eSurgery dpt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e1.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eGeneral medicine dpt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e-0.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e-0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e-2.215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.027*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e-0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003ePsychiatry dpt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e-.0010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e-0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e0.776\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eGynecology/obstetrics dpt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e-0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e-0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e-2.207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.028*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e-0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eIntermediate care/ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e-0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e-0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eRehabilitation/geriatrics dpt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e-0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e-0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e-2.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e-0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eLength of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"12.269938650306749%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e1.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e-0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"26.226993865030675%\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.276073619631902%\"\u003e\n \u003cp\u003e7.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e1.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"11.042944785276074%\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.889570552147239%\"\u003e\n \u003cp\u003e5.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.815950920245399%\"\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.355828220858896%\"\u003e\n \u003cp\u003e5.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.122699386503067%\"\u003e\n \u003cp\u003e10.172\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote.\u0026nbsp;R\u003csup\u003e2\u003c/sup\u003e = 0.105; \u003cem\u003eF\u0026nbsp;\u003c/em\u003e(9, 4.421) = 7.294; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001; dept = department.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRelatives\u0026rsquo; freely expressed experiences of visiting restrictions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOne-fifth of the relatives subjected to visiting restrictions described their lived experiences in our open-ended question. The relatives of patients hospitalized in the maternity and neonatology wards and those admitted into the emergency department had strong opinions on visiting restrictions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRelatives of patients hospitalized in gynecology/obstetrics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFathers were initially excluded from attending the mother\u0026rsquo;s initial labor, causing a lot of frustration and stress for both. Relatives understood the need for preventive measures against the SARS-CoV-2 virus, but they did not consider their loved ones as sick patients, finding the prohibition on visiting too extreme. Limitations and even prohibitions on visits by fathers were not well received, especially the time limit of 30 minutes. Being deprived of this unique life experience, unable to provide support to the mother or see the child\u0026rsquo;s birth and their first days of life was a very bad experience for fathers, filled with intense regrets. The following comment summed up the disagreements with maternity ward visiting restrictions: \u0026ldquo;In the case of childbirth, the father\u0026rsquo;s place\u0026mdash;who could have been tested before\u0026mdash;is next to the mother and the child. Don\u0026rsquo;t you think?\u0026rdquo; (Patient-223)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNeonatology\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eLimitations and even prohibitions on visiting the neonatology ward were very badly received by relatives. They did not understand that the measures for limiting SARS-CoV-2 infection concerned all the Valais Hospital\u0026rsquo;s wards. Relatives prohibited from visiting the neonatology unit stated the following:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Understanding the state of stress of the hospital sector\u0026hellip; I had expected a different sense of priorities... For me, hospitalization in neonatology should ensure the right to visits no matter what.\u0026rdquo; (Relative-345)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEmergency department visits and the hospitalization of frail subjects\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe prohibition on visits also affected relatives accompanying their loved ones to urgent admissions to the emergency department. The moment of this imposed separation\u0026mdash;leaving their loved one to the unknown\u0026mdash;aroused very strong emotions, including worry, anxiety, stress, the fear of not seeing them again, and intense apprehension while waiting for news. Not being able to support the patient suffering in the hospital was perceived as very difficult, and relatives would have liked to have had a waiting area on site. They expressed these emotions as follows:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The ban on visits is traumatic for all relatives.\u0026rdquo; (R-87)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;It is tough to leave a loved one\u0026mdash;especially my sick wife\u0026mdash;outside the door without accompanying her or supporting her during these difficult moments, but I understand the measures taken.\u0026rdquo; (R-340)\u003c/p\u003e\n\u003cp\u003eVisiting restrictions were very badly received by relatives and frail patients alike, especially when involving patients with cognitive disorders or at the end of life, with whom video calls were complicated or impossible. Relatives mentioned the feelings of abandonment or loneliness expressed to them by patients. Families reported the physical and psychological regression they observed in their loved ones due to the lack of stimulation usually provided during visits. For other patients, compensating for the prohibition on visits via video calls, telephone calls, and text messages was greatly appreciated.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo the best of our knowledge, this research was the first to use a PREMs questionnaire to examine the impact of visiting restrictions on patients and their relatives in a hospital setting during the COVID-19 pandemic\u0026rsquo;s first wave in Switzerland. The Valais Hospital\u0026rsquo;s values, and those of its healthcare staff, recognize relatives\u0026rsquo; important role in their loved one\u0026rsquo;s healthcare and hospital discharge trajectories. However, this was a very challenging period for patients, relatives, and staff, with unforeseen and unpredictable events, daily changes, and many restrictions. The sudden implementation of visiting restrictions destabilized the hospitalization process and relatives\u0026rsquo; roles within that process. Obtaining an elevated response rate (75%) from the responding patients\u0026rsquo; relatives was, therefore, not surprising as it offered them a chance to express both their positive and negative lived experiences of these extreme health circumstances.\u003c/p\u003e\n\u003cp\u003eThis study was specifically conducted during the COVID-19 pandemic\u0026rsquo;s first wave, , considering relatives as essential partners in care\u0026mdash;and not just as visitors\u0026mdash;is part of the Valais Hospital staff\u0026rsquo;s mission. Relatives of a SARS-CoV-2-infected patient were more likely to have revealed how affected they were by the visiting restrictions than were relatives of non-infected patients. Relatives expressed their perceptions of ethical and clinical issues in their responses to the open-ended question. This was not surprising and was in line with Jaswaney \u003cem\u003eet al.\u003c/em\u003e\u0026rsquo;s (2022) findings that visiting restrictions can be problematic, creating many ethical issues related to who can and cannot visit\u0026nbsp;(50). The impossibility of being physically present for their hospitalized loved ones created worry, anxiety, sadness, and a perceived greater need for more information and updates on the relative\u0026rsquo;s condition, as expressed in relatives\u0026rsquo; comments and in line with the findings of Rottenburg \u003cem\u003eet al\u003c/em\u003e. and Sahoo \u003cem\u003eet al\u003c/em\u003e. (22, 23). Many relatives reported stress due to uncertainty, and not being allowed into the hospital created emotional worries and feelings of failing to support and protect their kin. Being present at the patient\u0026rsquo;s bedside, on the other hand, helped relatives to understand and cope with situations, as reported in the recent study by Hochendoner \u003cem\u003eet al\u003c/em\u003e. of the relatives of ICU patients\u0026nbsp;(51). Our findings revealed significant differences between the high impact of visiting restrictions perceived by the relatives of SARS-CoV-2-infected patients and the lower impact perceived by relatives of non-infected patients, and this effect was similar across ward types. As one might imagine, visiting restrictions strongly affected the relatives of patients in the gynecology/obstetrics, maternity, geriatrics and general medicine wards, more so than in other hospitalization wards and in line with Hochendoner \u003cem\u003eet al\u003c/em\u003e.\u0026rsquo;s study\u0026nbsp;(51). This was independent of patient age group or LOS and of relatives\u0026rsquo; perceptions of the severity of a SARS-CoV-2 infection. Hoffman \u003cem\u003eet al\u003c/em\u003e. used the example of oxygen supplementation to express how crucial contact is with healthcare staff who can explain the patient\u0026rsquo;s situation. The COVID-19 pandemic and the stresses involved were highly disturbing for relatives waiting for news on their loved ones. Although the majority of our participating relatives did feel considered by healthcare staff, not all of them did; some expressed concerns about visiting restrictions and felt less considered or not at all considered regarding involvement in the care provided. A more detailed analysis of each hospitalization would clarify those concerns, but that was beyond this paper\u0026rsquo;s scope.\u0026nbsp;In opposition to some free comments criticizing a lack of information, our quantitative results showed that most relatives felt well informed by healthcare staff, with no difference between the relatives subjected to visiting restrictions and those not. However, some hospitalization wards showed significant differences, such as maternity/obstetrics, which was unsurprising and in line with recent publications by Venkatesh \u003cem\u003eet al\u003c/em\u003e. and Hugelius \u003cem\u003eet al\u003c/em\u003e.\u0026nbsp;(52, 53). Our linear regression model confirmed this, explaining the mild to moderate variance in the affect scores of relatives whose loved ones were hospitalized in general medicine and gynecology/obstetrics wards.\u003c/p\u003e\n\u003cp\u003eThe Valais Hospital tried to replace physical visits with various digital and technical means, but these had clear limitations.\u0026nbsp;Relatives subjected to visiting restrictions reported lower scores for the quality of communication than relatives who could visit.\u0026nbsp;Unfortunately, relatives\u0026rsquo; video or telephone meetings with patients in acute care settings led to fewer agreed changes to care goals with staff than did in-person meetings, as was confirmed in the recent studies by Reitzle \u003cem\u003eet al\u003c/em\u003e., Lin \u003cem\u003eet al\u003c/em\u003e., Sken \u003cem\u003eet al\u003c/em\u003e., and Rose \u003cem\u003eet al\u003c/em\u003e.\u0026nbsp;(29-32). Also, despite these substitute visiting methods, in-person visiting restrictions reduced relatives\u0026rsquo; comprehension of the patient\u0026rsquo;s overall condition, reducing the possibilities for maintaining social relations, as confirmed by Mahery \u003cem\u003eet al\u003c/em\u003e.\u0026nbsp;(25). Based on relatives\u0026rsquo; free comments, visiting restrictions were also a source of emotional distress and increased workloads for healthcare staff, who may not have agreed with hospital policies resulting in them spending a lot of time informing and communicating with relatives. This may have caused problems in the dialogue between healthcare staff and relatives and thus reduced the possibilities of ensuring consensus-based care (22).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Valais Hospital regularly updated its visiting restrictions, referring closely to Swiss federal and cantonal public health policies concerning SARS-CoV-2 infection risk\u0026ndash;benefit assessment\u0026mdash;the cornerstone of medical and pandemic policy decision-making. It nevertheless remains difficult to determine whether those visiting restrictions were effective in limiting the spread of COVID-19. Although it might be reasonable to speculate that these policies slowed its spread, based on a mechanistic understanding of the disease, visiting restrictions should be weighed against the potential harm to patients. Our study highlighted the complexities associated with the numerous factors impacted by hospital visiting restrictions. Our results advocate for a more tailored, adaptable, and patient-centered approach to visiting restrictions depending on the clinical situation. Reasonable exceptions might include allowing fathers to visit labor and delivery rooms, pediatrics wards, and ICU units. The authors endorse a nuanced approach to hospital visiting restrictions, taking into account the patient population, visitors\u0026rsquo; use of personal protective equipment, screening measures, community disease prevalence, and other circumstances. Visiting restrictions should be clearly and transparently communicated to relatives. Patient discharge during periods with visiting restrictions is another concern as healthcare staff are tasked with establishing a critical partnership with relatives to organize discharge planning\u0026nbsp;(54, 55).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Valais Hospital and its staff worked to maintain strong relationships between patients and relatives, convinced that these improve the patient experience, safety, and outcomes. Visiting restrictions aimed to protect patients and staff, but some relatives felt that they were no longer essential partners in care. Most relatives understood the rapid shift to strict visiting restrictions given the nature of the COVID-19 crisis. Nevertheless, these policies proved very difficult for relatives, causing significant emotional stress, concerns for patient safety, and the inability to support loved ones at the bedside. Relatives and healthcare staff must remain partners in care, even when challenging circumstances put that partnership under stress. The COVID-19 pandemic evolved rapidly and continues to do so. Many directives and shifts in policy were implemented without the opportunity to engage with relatives, including a shift in language that returned relatives to their roles as visitors rather than as partners in care. Effective and appropriate communication about policy changes and how relatives and healthcare staff can continue to work together as partners in care is essential to establishing trust and positive collaboration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy strengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study presents numerous strengths but also some limitations. To the best of our knowledge, this was the first PREMs carried out in Switzerland to include hospitalized patients\u0026rsquo; relatives within the context of the COVID-19 pandemic. The study employed as many psychometrically validated questions as possible to investigate PREMs appropriately among relatives.\u003c/p\u003e\n\u003cp\u003eA first limitation of this study, however, is the inability to interpret it outside the context of the COVID-19 pandemic\u0026rsquo;s first wave. Valais Hospital had never conducted a PREM survey and, to the best of our knowledge, no similar studies of relatives\u0026rsquo; experiences were conducted during this period, making comparisons with our results difficult. The self-reporting questionnaire was designed especially for this survey, and its overall psychometric properties (including sensitivity analysis) could not be tested within the time available. Another limitation was the delay of 4 to 6 months between patients\u0026rsquo; hospitalization and their self-reported survey responses. Furthermore, since well before the COVID-19 pandemic, the Valais Hospital had systematically invited patients to share their opinions and rate their satisfaction of the hospital\u0026rsquo;s organization and performance; the present survey did not investigate relatives\u0026rsquo; satisfaction so as to avoid redundancies, and this could be considered a limitation. Studies based on PREMs are usually regarded as a low level of evidence, as survey completion may lack rigor and the accuracy of information provided cannot be verified. In addition, the content of the concepts explored has still not been standardized, and we could have missed some relevant experiences among relatives. To respect healthcare\u0026rsquo;s Quadruple Aim, further research among healthcare professionals should complement this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on our results and in line with the existing international literature published after the COVID-19 pandemic\u0026rsquo;s first-wave visiting restrictions, restricting visits by all the relatives of hospitalized patients is not recommendable. The literature supports making a distinction between general visitors and relatives. Future policies must clearly incorporate patients\u0026rsquo; and relatives\u0026rsquo; insights. Transparent, clear processes for identifying key relatives are strongly recommended. Detailed evaluations of restrictions based on hospital settings (e.g., emergency departments, maternity, psychiatry, surgery wards) are needed to quantify the relevant risks of visitor absence.\u003c/p\u003e\n\u003cp\u003eDespite a context of public healthcare system staff shortages and financial restrictions, more human and financial resources must be made available to enable hospitals to accompany patients and informal caregivers with patient and family-centered care. Indeed, an informal caregivers or relatives charter is being set up between the Valais Hospital and the canton\u0026rsquo;s caregivers\u0026rsquo; association in order to identify the caregivers who should be involved in that care.\u003c/p\u003e\n\u003cp\u003eThe literature demonstrates the feasibility and acceptability of digital communication, but not all our patients and relatives were willing or capable of doing so, preferring telephone calls or visits on balconies, for example, and this warrants further evaluation. We recommend dedicated digital communication teams to overcome the limited technological knowledge of older adults, for example. Where feasible, outdoor spaces can be used to facilitate relatives\u0026rsquo; visits. Finally, digital communication cannot replace the essential care and human interaction often provided by relatives at the bedside. More data is needed to quantify the relative risks of general visitors and relatives, risks to patients, and the extra burden put on healthcare staff when relatives are absent. A comprehensive, balanced approach to assessing risks is needed to develop future policies for patient\u0026ndash;visitor interactions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study described relatives\u0026rsquo; experiences of visiting restrictions, how they were affected by these, and their perceptions of the severity of a SARS-CoV-2 infection and of information flow and communication during the COVID-19 pandemic\u0026rsquo;s first wave. About two-thirds of responding relatives were moderately emotionally affected by the visiting restrictions, and most felt well-considered by the healthcare staff.\u003c/p\u003e \u003cp\u003eResponses to our survey\u0026rsquo;s open question showed the unique aspects of each relative\u0026rsquo;s experiences of their loved one\u0026rsquo;s hospitalization. This highlights the importance of considering each patient\u0026rsquo;s family situation individually. Our patient-reported experience measures survey (PREMs) data revealed COVID-19\u0026rsquo;s impact on the social determinants of health among patients\u0026rsquo; relatives, helping to identify opportunities for improving patient centered care throughout the following waves of this ongoing crisis and perhaps after it. This will help the Valais Hospital\u0026rsquo;s management to develop new care approaches, co-designed and co-produced with patients and their relatives. It will help to ensure that consensus care preferences are understood and respected, if possible. Future research will need to focus on embedding the collection of PREMs more broadly throughout healthcare institutions, increasing the use of their findings by patients/relatives, clinicians, and policymakers, and facilitating comparisons of patient-reported experiences internationally.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNTJ, SM, and HV had the original idea and provided the conceptual and methodological expertise to design the study. EB, NTJ, SM, and HV were significant contributors to the writing of the manuscript. All the authors read, edited, and approved the final manuscript and consent to publish the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Human Research Ethics Committee of the Canton of Vaud (2020-02025) authorized the survey and the extraction of\u0026nbsp;the population-based cohort\u0026rsquo;s data from administrative, electronic patient records in the\u0026nbsp;hospital\u0026rsquo;s patient register (Additional file 4). Invited participants who completed the paper questionnaire and return it in the prepaid envelope provided were considered as consent to participate in the study. All participants or their legal guardian give their informed consent to participate in the study. All methods were carried out in accordance with relevant guidelines et regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch protocol statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocols were approved by the Valais Hospital,\u0026nbsp;the Valais Family Caregivers\u0026rsquo; Association and the HES-SO Valais/Wallis, Sion, Valais and the\u0026nbsp;Human Research Ethics Committee of the Canton of Vaud (Additional file 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded via a public grant from the Valais Hospitals\u0026rsquo; COVID Committee with co-financing by the University of Applied Sciences and Arts Western Switzerland\u0026rsquo;s Institute of Health, HES-SO Valais/Wallis (Sagex: 101205).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used and analysed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodological approach statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAll methods were carried out in accordance with relevant guidelines and regulations.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research team thanks the respondents who took the time to complete the questionnaire.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePublic_Health_Office. Monitorage de l'execution COVID-19. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValais_Hospital. Visit restrictions Valais: Valais Hospital; 2020 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hopitalduvalais.ch/lhopital-du-valais/actualites/en-detail/2022/1/14/restriction-des-visites\u003c/span\u003e\u003cspan address=\"https://www.hopitalduvalais.ch/lhopital-du-valais/actualites/en-detail/2022/1/14/restriction-des-visites\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeiner HS, Firn JI, Hogikyan ND, Jagsi R, Laventhal N, Marks A, et al. Hospital Visitation Policies During the SARS-CoV-2 Pandemic. Am J Infect Control. 2021;49(4):516\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoss SJ, Stelfox HT, Krewulak KD, Ahmed S, Anglin MC, Bagshaw SM, et al. Impact of restricted visitation policies in hospitals on patients, family members and healthcare providers during the COVID-19 pandemic: a scoping review protocol. BMJ Open. 2021;11(9):e048227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGwaza E, Msiska G. Family Involvement in Caring for Inpatients in Acute Care Hospital Settings: A Systematic Review of Literature. SAGE Open Nursing. 2022;8:237796082210895.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSivertsen DM, Lawson-Smith L, Lindhardt T. What relatives of older medical patients want us to know - a mixed-methods study. BMC Nursing. 2018;17(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarreto MDS, Garcia-Vivar C, Matsuda LM, Angelo M, Oliveira MLFD, Marcon SS. PRESENCE OF THE FAMILY DURING EMERGENCY CARE: PATIENT AND FAMILY LIVING. Texto \u0026amp; Contexto - Enfermagem. 2019;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaphael JL, Kessel W, Patel M. 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Managing Visitor and Patient Flow During the COVID-19 Pandemic: ExpectingU App. Stud Health Technol Inform. 2021;281:53\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubin GA, Wan EY, Saluja D, Thomas G, Slotwiner DJ, Goldbarg S, et al. Restructuring Electrophysiology During the COVID-19 Pandemic: A Practical Guide From a New York City Hospital Network. Crit Pathw Cardiol. 2020;19(3):105\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVincent A, Beck K, Becker C, Zumbrunn S, Ramin-Wright M, Urben T, et al. Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: A prospective observational cohort study. J Psychosom Res. 2021;147:110526.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSahoo S, Mehra A, Dua D, Suri V, Malhotra P, Yaddanapudi LN, et al. Psychological experience of patients admitted with SARS-CoV-2 infection. Asian J Psychiatr. 2020;54:102355.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRottenberg Y, Goldzweig G, Baider L. Geriatric patient-centered care during the COVID-19: Provision of interactions vs. the imposition of isolation. J Geriatric Oncol. 2020;11(8):1316\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEden C, Fowler SB. Family perceptions related to isolation during COVID-19 hospitalization. Nursing. 2021;51(8):56\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e25.\u0026lt;/number\u0026amp;gt\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCen\u0026eacute; CW, Johnson BH, Wells N, Baker B, Davis R, Turchi R. A Narrative Review of Patient and Family Engagement. Med Care. 2016;54(7):697\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNittas V, von Wyl V. COVID-19 and telehealth: a window of opportunity and its challenges. Swiss Med Wkly. 2020;150:w20284.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRasmussen B, Perry R, Hickey M, Hua X, Wong ZW, Guy L, et al. Patient preferences using telehealth during the \u0026lt; scp \u0026gt; COVID\u0026lt;/scp\u0026gt; -19 pandemic in four Victorian tertiary hospital services. Intern Med J. 2022;52(5):763\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReitzle L, Schmidt C, F\u0026auml;rber F, Huebl L, Wieler LH, Ziese T, et al. Perceived Access to Health Care Services and Relevance of Telemedicine during the COVID-19 Pandemic in Germany. Int J Environ Res Public Health. 2021;18(14).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin Z, Sim TB, Ong VYK, Bin Ab Hamid Z, Ho WH. Telemedicine in the acute care setting during the COVID-19 pandemic. Intern Emerg Med. 2020;15(8):1591\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen Y-T, Chen L, Yue W-W, Xu H-X. Digital Technology-Based Telemedicine for the COVID-19 Pandemic. Frontiers in Medicine. 2021;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRose L, Yu L, Casey J, Cook A, Metaxa V, Pattison N, et al. Communication and Virtual Visiting for Families of Patients in Intensive Care during the COVID-19 Pandemic: A UK National Survey. Annals of the American Thoracic Society. 2021;18(10):1685\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurray PD, Swanson JR. Visitation restrictions: is it right and how do we support families in the NICU during COVID-19? J Perinatol. 2020;40(10):1576\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu YC, Liu YA, Lin MH, Lee HW, Chen TJ, Chou LF, et al. Visiting Policies of Hospice Wards during the COVID-19 Pandemic: An Environmental Scan in Taiwan. Int J Environ Res Public Health. 2020;17(8).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoffmann E, Specht K, Elkj\u0026aelig;r M, Kj\u0026aelig;r M, Primdahl J. Relatives\u0026rsquo; experiences of the hospitalisation of older people with COVID-19: A qualitative interview study. International Journal of Older People Nursing. 2022;17(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChew C-C, Lim X-J, Chang C-T, Rajan P, Nasir N, Low W-Y. Experiences of social stigma among patients tested positive for COVID-19 and their family members: a qualitative study. BMC Public Health. 2021;21(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulaudzi FM, Anokwuru RA, Du-Plessis MAR, Lebese RT. Reflections on the Concomitants of the Restrictive Visitation Policy During the COVID-19 Pandemic: An Ubuntu Perspective. Frontiers in Sociology. 2022;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonvin E, Tacchini-Jacquier N, Monnay S, Verloo H. Protocol for a patient-reported experience measures (PREMs) survey of patients discharged during the COVID-19 pandemic and their family caregivers. BMJ Open. 2021;11(2):e047033.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStefanacci RG. Impact of COVID-19 on the Quadruple Aim. Popul Health Manag. 2021;24(5):540\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunshi L, Odutayo A, Evans GA, Keresteci M, Drury J, Kain D, et al. Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic. Sci Briefs Ont COVID-19 Sci Advisory Table. 2021;2:31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePassarelli VC, Faico-Filho K, Moreira LVL, Cunha AP, Carvalho JMA, Barbosa GR, et al. Asymptomatic COVID-19 in hospital visitors: The underestimated potential of viral shedding. Int J Infect Dis. 2021;102:412\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWee LE, Conceicao EP, Sim JX-Y, Aung MK, Venkatachalam I. The impact of visitor restrictions on health care-associated respiratory viral infections during the COVID-19 pandemic: Experience of a tertiary hospital in Singapore. Am J Infect Control. 2021;49(1):134\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeder S, Smith D, Griffin H, Shreve ST, Kinder D, Kutney-Lee A, et al. \"Why Couldn't I Go in To See Him?\" Bereaved Families' Perceptions of End-of-Life Communication During COVID-19. J Am Geriatr Soc. 2021;69(3):587\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones-Bonofiglio K, Nortj\u0026eacute; N, Webster L, Garros D. A Practical Approach to Hospital Visitation During a Pandemic: Responding With Compassion to Unjustified Restrictions. 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Letter to the Editor on \"Visitation restrictions: is it right and how do we support families in the NICU during COVID 19?\". J Perinatol. 2021;41(5):1187\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHugelius K, Harada N, Marutani M. Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review. Int J Nurs Stud. 2021;121:104000.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreysen SR, Auerbach AD, Mitchell MD, Goldstein JN, Weiss R, Esmaili A, et al. Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers. J Gen Intern Med. 2021;36(6):1715\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu T, Wu D, Yan W, Wang X, Zhang X, Ma K, et al. Twelve-month systemic consequences of COVID-19 in patients discharged from hospital: a prospective cohort study in Wuhan, China. Clin Infect Dis. 2021.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"hospital, visiting, restrictions, relatives, PREMs, public health ","lastPublishedDoi":"10.21203/rs.3.rs-2047705/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2047705/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the COVID-19 pandemic, most countries introduced temporary visiting restrictions on the relatives of acute care hospital patients, whether or not they were infected with SARS-CoV-2. This affected relatives’ psychological and emotional states and how closely they could be involved in their loved one’s hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Aims:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInvestigate relatives’ experiences of visiting restrictions during the COVID-19 pandemic’s first wave and of the support offered by Valais Hospital’s healthcare staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRelatives and patients who had been discharged between February 28 and May 13, 2020, were asked to complete a patient-reported experience measures (PREMs) questionnaire, whether or not they had been infected by SARS-CoV-2. Relatives were asked about how visiting restrictions had affected them, their perceptions of the severity of the COVID-19 pandemic, the quality of communication concerning their loved ones’ health status during their hospitalization, and the information received from healthcare staff. Descriptive and inferential statistics were computed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 866 PREMs questionnaires returned, 818 were analyzable, and 543 relatives had experienced visiting restrictions to their loved ones: 92 relatives (87%) of COVID-19 patients and 451 relatives (66%) of non-infected patients, with heterogenous effects on their psychological and affective status. Overall, whether or not relatives were subjected to visiting restrictions, they perceived themselves to be well treated, well informed, and that communication with hospital healthcare staff was satisfactory. However, relatives subjected to visiting restrictions reported significantly lower scores on the quality of communication than other relatives. The relatives of patients in gynecology/obstetrics and internal medicine wards were significantly more affected by visiting restrictions than were the relatives of patients in other wards. Numerous relatives subjected to visiting restrictions reported regular communication with their loved ones or with healthcare staff, at least once a day (n = 179), either via videoconferences using FaceTime®, WhatsApp®, Zoom®, or Skype® or via mobile phone text messages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVisiting restrictions affected relatives differently depending on the wards their loved ones were hospitalized in. Healthcare institutions should investigate the utility of visiting restrictions on patients, how they affect relatives, and how to improve personalized patient–relative communications.\u003c/p\u003e","manuscriptTitle":"Relatives' experiences of visiting restrictions during the COVID-19 pandemic’s first wave: a PREMs study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-22 15:14:10","doi":"10.21203/rs.3.rs-2047705/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27e72434-7354-44ca-a448-60a5e747ef37","owner":[],"postedDate":"September 22nd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-01-30T10:44:38+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-22 15:14:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2047705","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2047705","identity":"rs-2047705","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}