Visitation during detox?

[garnetgirl29, BSN, RN]

Do you think it's a good idea for a detox clinic to have visitation?

Our clients are with us 7 days max. Phone times are twice a day and visitation twice a week. Our facility is VERY small and during visitation, gets VERY crowded. It's impossible to monitor everything going on & there's typically 3-5 staff members on during visitation hours (up to 16 clients, each of whom can have 2 visitors).

Our building is owned by the county, so there's no smoking. We give out nicotine patches to help. But, someone usually sneaks in cigarettes during visitation. Since we cannot properly monitor clients and visitors, this has been a problem. clients will try to smoke in the bathrooms, and we often don't know who who did it. My concern is the fire hazard (small, enclosed space) and nicotine overdose, since they wear nicotine patches.

In addition to the smoking, some have had visitors bring them xanax, or other substances. I then, continue to give these clients scheduled and PRN meds, not knowing what/if they've taken anything else.

I feel like the small space, chaos with so many people, and inability to properly monitor creates a risky situation.

Last week, one client became very angry with her visitor and threw a chair at her. Well, she missed her intended person and instead hit an elderly lady. Thankfully, she wasn't harmed, but what a potential for lawsuit or injury!

I've also seen many clients who's visitors were less than supportive, and left the client feeling pretty low about their chances for recovery. On the other hand, I have seen some who were very encouraged and motivated by their visitors. And, not to mention, there's always the clients who watch longingly as their peers enjoy their visitors, while they have none.

But, I feel like our facility is too small to allow for visitation & in most cases and creates too many potential risks. All of our staff feels this way - except for our superiors, who by the way, have never been in our facility during visitations times.

I've sent my kids away to summer camp & was instructed not to call or visit for the entire 2 weeks because it made the children more homesick. All our clients are over 18, and spend 5-7 days with us. I personally don't think visitation is necessary for that short of a stay & that given our small facility & minimal staff, it's too much of a liability.

We do visitation 2x a week. If we don't do away with visitation, I think we should at least tell the clients to choose which day they want to visit, so we can split the visitors between the two days & not have so many people in the facility at one time.

What are your thoughts?

[jeanetteatrnm]

I think that having visitors during a 7 day detox is unwarranted, and distracts from the work at hand. It is only 7 days! They were probably out on the streets and away from their families/and friends for much longer than that when they were actively using, and now all of a sudden they are worried about visitors? No, this is a time when they should really be focused on their sobriety, and getting their head straight. Seven days is barely enough time for an addict to land. Plus there is too much opportunity for visitors to bring drugs in. Seven days of detox is nothing, I mean its a start but, their journey is only just beginning. Having visitors coming in at such a precarious time adds too much emotional baggage into the mix at a time when, they should be focused on their recovery. I've worked at drug rehabs where there was no contact with the outside for the first 30 days and up to six months. Like I said before when they were active in their addiction family was the last thing on their mind. Visits were a reward for positive behavior and progress.

[Meriwhen, ASN, BSN, MSN, RN]

Another point of view...I think daily visitation is a bad idea, especially since the visitors are likely to see the patient at their worst--both physiologically and psychologically--during the first few days of detox. They're going to be a mess and visitors not familiar with detox and withdrawal aren't going to understand. They're going to wonder why we're not giving someone Librium to calm them down or why we're not medicating a patient to the gills to take care of every single little symptom they have.

The reality is: detox is supposed to be uncomfortable. Do we intentionally make patients uncomfortable? No, not at all. But getting off a drug that you've grown physically and emotionally dependent on isn't a walk in the park. They're going to have to deal with aches, pains, discomforts, feelings, emotions...a lot of which they had self-medicated themselves for to deal with in the first place.

The patient really needs those first few days to stabilize, and we need the first few days to stabilize the patient without well-meaning visitors trying to Monday morning quarterback with us/MDs about what treatment they think the patient should get.

[garnetgirl29, BSN, RN]

I agree with both of you! I just wish my superiors would get more serious about actually trying to help people and be less concerned with making the clients happy. They seem completely ignorant to all the risks it represents.

[Been there,done that, ASN, RN]

Isn't visitation considered a legal right of the patient ?

I agree visiting times are chaotic and potentially problematic!

Maybe legally, there are no options.

[Whispera, MSN, RN]

When I worked CD, the patients had visitors a couple of nights per week, but only family members, and the family members had to attend a family group with their in-treatment family member, in order to come visit afterwards.

[MiaLyse, APRN]

We do not have visitation at all. I agree, it is a time to focus on getting sober. It also is not a comfortable time, it is a vulnerable time and no visitations also is best for the safety of our patients.

[garnetgirl29, BSN, RN]

We have a new site director and some of us were discussing this with her and telling her what we've witnessed during visitations and the risks involved. She agreed that visitation is not a good idea, but said that because she is new and has already implemented some other changes, she would put this one on the back burner for now. We have a mandatory next week and are going to discuss the procedures for strip searching all new admits. We currently search their belongings but not the person. I'm a little nervous about how this will play out.

[MiaLyse, APRN]

On our mental health units, we have patients change into a gown and search their clothing. We check hair, backs of glasses and inside shoes. I think visitors are the worst offenders for bringing in things that are not allowed.

[brittwitt]

I believe that there is no need to have visitation. The patients are only in for a short amount of time therefore visitors can wait. It only causes more problems for patients and if visitors are bringing in other drugs it does not help the patient. The chaos is overwhelming for everyone and that is not only frustrating for nurses but other patients in the facility as well.

[WillyNilly]

In a mental health setting the client is changed in to a gown, belongings are searched, recorded an locked in a cabinet until discharge. For visitation, we can not deny visitors. It is a legal right. Visitors empty pockets and lock all belongings in a set of lockers prior to entering the facility-all cell phones, keys, wallets,etc are locked in individual lockers which a staff member keeps the key until the visit is over . Staff escorts them in and out. All visiting is done in one room, no visiting in client rooms. For safety, we need to keep eyes on visitors and client interactions. A staff member is always present in the main room. Our hours are limited suggested hours that can be adjusted with permission/appointment with dr approval if needed. 2 visitors at a time in limited hour blocks between meals