FIVE family members in a crowded ICU rm all night long! - page 2
Last night I took care of a very young adult patient who is basically donor material now because of a rather unfortunate combination of cocaine and a heart condition. The family was approached... Read More
Nov 18, '08I'm like JanRN, working in a PICU with a tragic situation like that, we tend to let anyone and everyone in to say good-bye and spend their last hours together. I sympathize with you, I can imagine how busy you were trying to provide excellent care around the feet and bodies in your path.
Your lead nurse? It is ludicrous for her to say such a thing. Good grief, I agree the better response from her should have been to say that you look taxed and how can she help? Good grief.
Nov 19, '08If the person was a possible brain death/donor candidate, I feel the family should be allowed to stay. Normally im with you on limiting visitation if its disruptive and the pt is fine/stable, but if the person in dying/going to die, the family needs to be able to spend time. What you could have done is asked the family to switch off 2 at a time only in the room, and keep switching off. Provide chairs and ask them to stay out of the way if your very busy and explain why you need quick and easy access to the pt. How would you feel if you had a loved one who was going to die, and the nurses told you you could visit for 30 minutes 4 times a day and this was the last time you would see your family member. Overnight stays I feel are fine in this situation. 5 at one time is excessive. It should have been limited to 2 at a time.
Nov 19, '08Quote from CreamsodaIf I understand planeflyer correctly, the issue is that the family had not come to grips with the gravity of the situation, and all heroic measures were being made. If that is the case, stepping over 5 family members is ridiculous.How would you feel if you had a loved one who was going to die, and the nurses told you you could visit for 30 minutes 4 times a day and this was the last time you would see your family member.
If, however, the family had come to some kind of decision, and I don't have to run my tail off to keep your loved one alive...then I don't care if the entire family is in the room.
There is nothing a family member can do or help the patient while he/she is in the ICU.
Me personally, being on both sides, I have no problem letting the nurse do her work--there is nothing I can do to help...especially if my loved one is unstable. I would want my father/mother's nurse to have her entire focus on my parent..not jumping over my brother to do her job.
And, if this was the last time I would see my family member, I would have made the end of life decision for my parent and planeflyer would have not been put in the situation she was forced into. :wink2:
Nov 19, '08thank you all for your insight. i feel so much better now with your help.
update: just to let you know....a nurse with more 'gravity-prone ovaries' (read - testes) than myself nipped the family reunion around the icu bed in the bud during the day shift yesterday. a family conference had been held and they decided to make the patient an organ donor after the docs declared the patient officially brain dead. they now come in pairs around the clock in shifts so that family ( which is really massive ) can be with the patient and each can say good bye. i was still really busy with my patient, (donor patients are really intense!) but the smaller numbers were much more manageable and i was able to 'do my thing' without having to wait for three or four people to move away from hovering over the patient.
i just hafta add - please don't think that i'm against having family there especially when death is so imminent. my only fear is patient impact related - as when something goes south because i'm more distracted by the family than i should be. kinda like when you're trying to make that really complicated favorite receipe for a special occasion and you keep getting interruptions while you're measuring out the ingredients and mixing stuff together.....except that when your dish flops, nobody dies.
i think that family should be with the patient as much as possible in such a case as the patient being a donor. keeping the numbers down to two, no more, and not expecting to keep the nurse involved in an 8 hour lecture of "icu 101" would be helpful too.:trc::heartbeat
Nov 21, '08I Do Agree 5 Extra Folks In The Room Is Too Much..... It's Very Hard To Do Your Job With The Extra Distraction Of Family. It Would Be Wonderful If They Could Realize Our Jobs Are Not Easy And Manuevering Around Them Just Makes It Even Harder!
A Little Cooperation From The Visitors Would Be Welsome!
The Only Time I Allow That Many People In The Room Is When I Am Certain The Patient Is Going To Die And Die Soon. I Don't Want Their Last Memories To Be That "the Mean Nurse Did Not Let Me Be With My Family Member"....
Our Unit Has Scheduled Visiting Times And Limits On Number Of People At One Time. We Usually Follow Our Own Rules And Veer When The Primary Nurse (not The Charge Nurse) Decides To! Our Charge Nurse And Manager Is Supportive Of The Idea That The Nurse Caring For The Patient Has The Final Say!
Dec 21, '08Quote from scarymaryactually thought of wearing one myself.Perhaps what you need is this
I don't think the family realizes how they exhaust the pt. as well
as themselves. And no I can't brush her hair now because I need to
hang some fluids and a pressor to keep her alive!
Jan 2, '09Although I may not have as much experience as many of the nurses on this site...I do have experience as a mother of a PICU pt and close friend of an ICU pt...As a nurse myself I agree having 5 family members in the room is extremely tough and potentially dangerous..I truly agree with the 2 family members at a time and if things are heading south open the flood gates...No family members should ever be restricted to 30 min time slots a few times a day...It strikes me that maybe the family members seeing you so busy and stressed with this pt may have helped them realize the gravity of the situation for the their loved one...You did a good thing, they were lucky to have you as their nurse!
Jan 11, '09In my unit we are trying to change visiting hours to our own unique policy since we are a neuro ICU and stimulation can cause so many problems. However it would be open except from 07-0830, and 19-2030, the hours would be 10a-10p. 2 family members at a time. NO overnight sleeping at the bedside. Exceptions will be made to the overnight at the bedside for dying, critical patients, and family acting to help keep the pt calm, or minor pt.
I do not believe that there needs to be 24 hour visitation in a ICU. Patients need their rest, not to feel like they should be entertaining family. However there are the family who has shaken our vented and nonresponsive pt as well. Family about to duke it out at bedside. Family isn't rational when they get no sleep. We had a pt mom recently write our manager a letter telling her how awful we were to her. Guess what she wrote a second letter telling our manager she wasn't in her right frame of mind due to anxiety and stress when she wrote the letter. She apologized for everything she had written. This family told the day nurses that when they hit the call light we were to respond "STAT". She went crazy on me at the desk that night over the charge nurse stating that it was nice that someone gave her a chair to relax in. Good lord I was her punching bag that day because of her lack of sleep.
In our GOL cases, the GOL cooridnators encourage family to come and say goodbye after the pt has been declared brain dead, and then the family usually goes home. I have never had a GOL pt that has had a visitor at all or even stay overnight. However not to say that I wouldn't allow it if that happened.
Your charge should have helped you and not told you not to look stressed in front of the family.
Jul 28, '12Quote from heartnurseinvai have to agree with you in every sense of the word. i don't sugar coat and i don't play the pc game. you tend to get that way when people are shooting at you when you are simply trying to do your job. my marines didn't have time for me to tell them lies about their condition, and i knew if they wanted a chance to get right with whoever they needed to get right with, they needed to know what was going on right then. it's a habit i have kept through out my career and my patients seemed to appreciate it as much as the marines did. in the units, we always would ask the families to nominate a single person to be the spokesman for the group, that would be the person we would update, and they in turn would keep the family abreast of what was going on. and there was always a 2 person limit period. no exceptions and no one could over rule it. if a crisis came up then they made short visits, 2 at a time. or, if we needed the room, visiting would be halted until we finished. this was a critical care unit in a hospital not a hotel. people have to understand and respect that, if they can't do that, it's too bad.i feel your pain planeflyer...i would definitely bring your concern up in your next staff meeting. that is absolutely ridiculous and should not have be allowed. it is one thing if your patient was stable. or, if the family had come to some agreement on code status or heroic measures...that was not the case, and as far as i am concerned, they prevented you from doing your job proficiently.
i am sorry...i am one of those nurses who do not sugar coat anything. i tell the family exactly how i see it. giving a family false hopes is never a good thing. i do think it is necessary for the family to see how unstable their loved one is and how much care i am delivering to the patient. however, not if it is preventing me from doing my job.
i work in a cvicu and we have limited visiting hours.. 4x/day, 30 mins in length. if the patient is unstable or if we are in a middle of a procedure--during the visiting time--they family does not come back and can not make the visiting time up.
i remember when i was a new nurse and felt that my charge nurse made all the decisions, including the care of my patient. i soon developed a backbone and questioned anyone who wanted to tell me how to do my job.
there would have been nothing wrong if you decided to ask your family to leave or to limit the numbers.
you have the final say...it is your license.