NICU Nurses in Saudi Arabia Back Open Visiting in Theory but Half Resist in Practice

In neonatal intensive care units around the world, a quiet revolution has been underway for years: the shift from restrictive, fixed-hour visiting schedules toward open visiting policies that allow parents to be at their baby’s bedside whenever they wish. The clinical logic is compelling. Family-centered care models, which treat parents as partners rather than visitors, have been linked to stronger parent-infant bonding, better breastfeeding rates, shorter hospital stays, and improved outcomes for fragile newborns. Yet the transition has been uneven, and nowhere more so than in the Middle East, where concerns about infection control, nursing workload, and professional autonomy have slowed adoption. A new cross-sectional study from Saudi Arabia’s Eastern Province now offers one of the clearest snapshots yet of where frontline neonatal nurses actually stand on the question, and the results reveal a striking gap between what nurses believe and what they are willing to endorse.

The study, published in BMC Nursing by researchers at Imam Abdulrahman Bin Faisal University in Dammam, surveyed 350 nurses working in neonatal intensive care units across four hospitals in the Eastern Province of Saudi Arabia. Led by Hajar Al-Sulaimi, Khlood Bubshait, Latifa AlDossary and Vinoth Raman, the team used a descriptive cross-sectional, correlational design with convenience sampling, supplemented by snowball recruitment through professional networks. Participants completed a structured online questionnaire adapted from the validated Beliefs and Attitudes Toward Visitation in NICU Questionnaire, known as BAVNIQ, an instrument designed specifically to disentangle what nurses think is true about open visitation from how they feel about implementing it. The researchers then applied descriptive statistics and regression analysis to identify which demographic and professional characteristics shaped the responses.

The headline numbers are nuanced. A substantial majority of the nurses, 80.6 percent, demonstrated moderate beliefs about open visiting, and every single participant, 100 percent, landed in the moderate range for attitudes. On the attitudes scale, which comprises 52 items scored from 0 to 208, the mean score came in at 104.64 with a standard deviation of 6.74, almost exactly the midpoint of the possible range. In other words, the nursing workforce is neither enthusiastic nor hostile; it sits squarely on the fence. Most nurses in the study recognized the benefits that open visiting policies can bring to families and infants, acknowledging the evidence on bonding and family-centered care. But recognition did not translate into endorsement: 52 percent of participants did not support implementing an open visiting policy in their own units.

That split between belief and support is the study’s most consequential finding, because it suggests the barrier is not ignorance of the evidence. Nurses in the survey largely accepted that unrestricted parental presence benefits babies. What they resisted was the operational reality of making it work. The authors identify perceived workload and logistical challenges as the primary drivers of resistance, a pattern consistent with the broader international literature on visitation policy reform. In a neonatal intensive care unit, an open policy means more people at the bedside during procedures, more questions to answer, more opportunities for parents to witness and question care decisions, and more pressure on staffing ratios that are often already stretched thin. Resistance, in this framing, is less an ideological objection than a rational response to resource constraints.

The regression analyses added a layer of complexity that the authors themselves describe as intriguing. In the first model, marital status, number of children, and shift type emerged as significant predictors of nurses’ attitudes toward open visitation, with standardized beta coefficients of -0.212, 0.231, and -0.222 respectively, all significant at p less than .001. That model accounted for a modest but meaningful share of the variance, with an R-squared of 0.18 and an adjusted R-squared of 0.16, and an F statistic of 10.72 on 7 and 342 degrees of freedom. The pattern points toward personal life circumstances, rather than professional variables, as the stronger influence on how nurses feel about letting families in.

The second model sharpened that picture further. When the researchers examined predictors of attitudes in more detail, they found that the number of children a nurse has negatively predicted attitude scores, with a beta of -0.333 at p less than .001, while educational level exerted a positive influence, with a beta of 0.134 at p equal to .016. This model yielded an R-squared of 0.15, an adjusted R-squared of 0.13, and an F statistic of 8.63. The negative coefficient for number of children is the kind of counterintuitive result that invites interpretation: one might expect nurses who are parents themselves to be more sympathetic to parental presence, yet the data suggest the opposite, perhaps because nurses raising children have a keener appreciation of the demands and unpredictability that families bring to a clinical environment, or because their own caregiving burdens heighten sensitivity to workload.

The positive association between education and support for open visiting is more straightforward and more encouraging for policymakers. Higher educational attainment has repeatedly been linked in the nursing literature to greater receptiveness to evidence-based practice changes, and this study is consistent with that trend. Nurses with more advanced preparation appear better positioned to integrate the research on family-centered care into their professional outlook, even when the day-to-day logistics remain daunting. Taken together, the two regression models explain a moderate amount of variance, which the authors note candidly, and they point toward interventions that are tailored rather than one-size-fits-all: a nurse’s position on open visiting may depend as much on whether she is married, how many children she has, and which shifts she works as on any formal position of her institution.

The implications for practice are concrete. The study’s conclusion calls for targeted interventions, including staff training, policy restructuring, and administrative support, as essential prerequisites for successful implementation. Training can address the knowledge gaps and communication skills that make parental presence feel manageable rather than threatening. Policy restructuring can define the boundaries of an open policy in ways that protect both infants and staff, for instance by clarifying when families may be present during procedures and how infection control protocols apply. Administrative support, arguably the most important of the three, addresses the workload problem directly, because no amount of persuasion will change attitudes among nurses who are already stretched beyond capacity. The Eastern Province findings suggest that hospitals attempting to liberalize visiting rules without investing in these supports should expect the kind of ambivalence the survey documented.

The study also has limitations that frame how its results should be used. The cross-sectional design captures a single moment in time and cannot establish causal relationships between demographic characteristics and attitudes. Convenience sampling supplemented by snowball recruitment, while pragmatic for reaching 350 nurses across four hospitals, may limit the generalizability of the findings to the broader population of neonatal nurses in Saudi Arabia or the wider region. The reliance on a self-report questionnaire means the data reflect what nurses are willing to express on a survey rather than observed behavior at the bedside. And, as the authors themselves emphasize, the study did not include the perspectives of parents, whose opinions are ultimately central to any family-centered care reform.

That gap points directly to the research agenda the authors propose. Future studies, they write, should incorporate parental opinion and explore qualitative insights into the institutional barriers and facilitators that shape how visiting policies function in practice. Numbers can show that half of a nursing workforce withholds support; only qualitative work can reveal why a particular unit’s culture resists change, what nurses fear will happen when parents witness a difficult procedure, and which accommodations would convert skeptics into allies. For the neonatal intensive care units of the Eastern Province, and for hospitals across the Middle East facing similar decisions, the message of this study is that open visiting is neither inevitable nor impossible. It is a policy whose success depends on reading the workforce accurately, investing in the people who must deliver it, and treating nurses’ ambivalence not as an obstacle to be overcome but as data about what a genuine transition will require.

Subject of Research: Nurses' beliefs and attitudes toward open visiting policies in neonatal intensive care units in Saudi Arabia

Article Title: Nurses’ beliefs and attitudes regarding an open visiting policy in the neonatal intensive care unit in the Eastern Province of Saudi Arabia: a cross-sectional study

Article References: Al-Sulaimi, H., Bubshait, K., AlDossary, L., & Raman, V. (2026). Nurses’ beliefs and attitudes regarding an open visiting policy in the neonatal intensive care unit in the Eastern Province of Saudi Arabia: a cross-sectional study. BMC Nursing. https://doi.org/10.1186/s12912-026-05360-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05360-x

Keywords: NICU, open visiting policy, neonatal intensive care, nurses' attitudes, family-centered care, Saudi Arabia, BAVNIQ, cross-sectional study, nursing workload, parent-infant bonding, regression analysis, health policy