Small children visiting patients in the critical care setting... thoughts??

[TigerGalLE]

I'm wondering what other nurses and even nurses who are parents think about this topic. I haven't been to this forum in a while. But this has really been on my mind and need some opinions.

I work in the ICU. We don't have too strict of rules in my opinion. One rule we have is that no children under the age of 12 can visit. We have this rule in place to not only protect the children but also to protect our possibly immunocompromised patient population. Family members get soo upset about this rule. They don't understand why their 2 year old can't visit grandma on the ventilator who has cdiff and lines and tubes in every hole. We have made exceptions. If a patient is dying and they want to come say good bye or whatever we let the children in. But if we expect the patient to recover we generally do not let the children come in. I have a 1 year old. I've tried to put myself in their shoes. I don't think I would let my child see his grandparents in that shape, nor would I want him exposed to MRSA/VRE/ESBL/CDIFF and I wouldn't want him to bring germs into the unit.

What are your thoughts? Children yes or no? I had a family member really yell at me yesterday, tell me I was a heartless person that needed prayer. I felt like my intentions were good... were they?

[Ellekat2]

Perhaps hospitals should use family visiting by children as a teaching moment. Have a child-level sink where the child's hands can be washed and dried, a child-sized mask that can be used if needed. An assessment of the child's level of wellness-is the child coughing, running a temperature? And instructions to wash hands or use hand gel when the visitors come out of the room,. A short explanation of what to expect (grandma is having trouble breathing; there is a tube helping her breathe) might help a child understand the importance of not messing with any equipment.

It's great that nurses are concerned about the child's health. I have seen too many times (and stopped a few) where the child is obviously ill and has no business being with great-grandma who is ill with UTI, but expected to recover. Why give ggma another illness to add to her problems when handwashing and a mask will minimize the risk? I try to slow them down (running down the hall, around the slowly moving patients with walkers) and keep them out of rooms they don't belong in. I lower grandpa's bed and lock it out (after the parent has left the bored eight-year-old alone with grandpa) after finding him as high as the bed will go. I tell the children in front of the parents to not play with the second bed in the room (and lock it out so they can't.) They are already on it, with their shoes and socks off, despite the sign that states the bed is for a second patient who is coming from surgery in an hour.

If hospitals want family-friendly care, they have an obligation to protect that patient and any other patient by providing guidelines on appropriate behavior while visiting. This doesn't mean NO visiting, this means appropriate visiting-short visits, no playing with equipment, respecting the needs of other patients and of the time that staff has available, using basic hygiene and higher levels of hygiene, such as a mask or even a gown, when appropriate. And definitely, not leaving young children in the care of the patient while the parents run errands, pick up take-out, or go out for a cigarette.

[Ruby Vee, BSN]

Now I'm not an evil person. All of these situations sound reasonable for letting children in to see loved ones. And I myself have let children in to see loved ones. But most of the people who get upset are the ones who bring the 3 year old in to see their 2nd cousin who has pneumonia and is on the vent that they haven't seen in 5 years themselves. So in those situations I say no.

And yesterday I told the family no because grandma would be moving out the next morning and we had some really infectious patients in the unit. They got extremely upset. Said they were going to report me and said I needed to be prayed for. I wasn't mean about it at all.. i just said "no" and told them our rules. Then when I gave report I found out the night nurse had let the 4 year old in to see grandma the night before anyway. That made me even more upset. Why does she need to see grandma everyday? It just wasn't worth the risk in my opinion. Our hospital is trying to move towards more family centered care. Like letting families in during codes and procedures. So who know what is going to happen in the near future.

And I snuck a therapy dog into the ICU once too... shhh don't tell anyone that either :)

I don't think you're an evil person -- you must be a wonderful person if you understood the necessity of seeing one's dog! And that dog probably behaved better than most of the children who visit! Anyone who attempts to bludgeon you or manipulate you with the idea of prayer is probably not really as religious as they'd like to pretend. That's just wrong.

Our unit has a policy of no visitors under 16. Exceptions are made in exceptional cases -- Dad is dying and wants to see his 4 year old one last time or the ten year old whose mother has been in ICU for the past year . . . . But it's very clear that this is an exception and everyone's expectations are managed ahead of time . . . our manager, social worker and customer service representatives get involved.

I have horror stories about youngsters visiting in the ICU, but very few stories about well-behaved children visiting. There was the young (teenaged) mother who dropped off her two children with Grandma, who was in the CCU actively infarcting, and went off to a party. "Grandma always watches my kids when I go out," she said. She didn't seem to have a clue that Grandma had other priorities. Then there was the child whom no one was supervising who had obviously heard the adults talking about "unplugging Grandpa". She crawled behind the bed and unplugged every piece of equipment in the room. Thank God for alarms and battery back-up! There was the child who was standing on the nurse's (rolling) chair and fell, striking her head on the sink and necessitating a trip to the ER. That wasn't MY visitor, thank you! She was visiting my patient's roommate and I had already told both her parents and the patient's nurse that she was going to get hurt, and had plucked her off the chair and set her on the floor twice (which upset the parents because who was I to touch their child?)

[CP2013]

I guess I'm not really sure why it matters that much if their are other infectious patients on the unit? Are these children visiting and getting in bed with all the patients on the unit?

I agree that my job would be easier and for strict infection control purposes it would be better if nobody ever visited, but then again it's not all about me or unjustified infection control precautions (like saying family can't visit because another patient in another part of the hospital might be infectious).

Because the hospital is the one not getting reimbursed for hospital acquired infections. So if they come in and touch everything in the hallways and it is transferred to another patient, the hospital loses money, thus not being able to afford to keep the nurses on the unit, etc etc. It's a slippery slope I think. What if there is a patient with TB and little Johnny decides he wants to visit.....well now we have TB all over the unit....And yes, I have seen it.

I had a family member in ICU, only negative pressure rooms in the hospital were in ICU, and patient had active TB infection. Some idiot family member decided to sneak a kid in, and neither the "adult" or the child wore any sort of gown or mask or anything to visit. (This hospital had rules that only 1 family member could visit and they had to be fit tested before they could visit, so they would wear an N95 while in contact with patient, looong time ago)

Well family member decided she wasn't going to wear a mask, and wasnt going to make the child wear one either. Then she said the hospital caused her son to get TB. I never did hear what happened to him. My family member was transferred to a critical care hospital, but now I am thinking about that little kid with TB.

I kind of love it when Risk Management talks loudly outside of patient rooms. Keeps my day interesting to learn new things.

[evolvingrn, BSN, RN]

I don't work in an icu, but i LOVE kids visiting ! I encourage it. Its a mood booster.

[luv_o_so_much]

Hi TG,

I read your post and began to read all the responses..... so very touching! I want to answer your question about your intentions: Only you know if your intentions were good or not.

From what you stated in your post I believe your intentions were good. I am not a nurse (yet) I work in an ICU in a supportive role and I am the one that answers our door and usually the one sent to ask the family to limit the visitors or provide information regarding visitors ..... UGH .... I am so very lucky that over the last 10 years I have not had someone react the way they did with you! It would indeed break my heart a little. What I do is explain the policy and give details about why we limit the visitors and give parameters on kids and the age. Germs, equipment, and - yes I go there - I ask the parent ... and words used vary greatly depending upon the individual & circumstances ... will your child be ok if they see grandma or grandpa this way? That usually zoinks the parent back into thinking about the child's mental well being too. It means I have given them all the information to decided.

Now my ICU has made exceptions of course. A mom that had cancer and really should have been with hospice had 3 young kids. The nurse let them back and after the visit the doctor asked her if she wanted to be intubated or provided care where she could spend time with her children. That was so tough to be a part of! I hugged her while she cried and made her choice. Three days later she was intubated ... 4 days after that she died. Another time a lady was intubated, extubated, intubated, extubated and she was not getting that again..... we did not think she would make it and allowed her lap dog to sit on her lab for almost 24hrs. That doggie did not make a peep. She died shortly after. THANK GOODNESS no powers that be were there that day!

I will put this out there too: My unit is uniform and communicates to the ENTIRE staff during morning huddle where we need to be aware of visitors - easy on rules or strict. This helps because then we don't have one shift letting all the cousins back with there 3 kids that they can't control while the patient next door is barely hanging on so the nurse can focus. We also let everyone in the family know who the spokes person is and redirect them. Its not being a mean nurse, its prioritizing on a case by case scenario. We can't always be right, we will def have times when we are wrong, but as a nurse you know in your gut who should be let back and when. If your facility is strict and your charge or manager is around have them explain it to the family.

PS if anyone ever told me I needed to be prayed for I may call our chaplin to stop by. Sometimes they just need to be angry at someone and our chaplins are skilled counselors with a wealth of spiritual knowledge they can use to speak with the individual.

[Student Mom to Three]

I work outpatient, so no experience in this area...but I have a slightly related story that I, at least, find a bit comical.

The year is 1980 and my youngest brother is born. The local hospital had just implemented a policy that siblings may visit mom/baby in the maternity ward. I am 11 years old and so excited. Get to the hospital and before I could go in the room had to do a "surgeon scrub" complete with the little brush and cleaning under my nails. Had to gown up (this is for a regular room...not NICU or anything). Finally passed inspection with the nurse who decided that although I had started out filthy I was now clean enough to set eyes on my mom and baby brother.

I get into the room and see my mother cradling the precious little baby in her left arm.....and puffing away on a Benson and Hedges with the right. Those were the days.....

[MunoRN, RN]

Because the hospital is the one not getting reimbursed for hospital acquired infections. So if they come in and touch everything in the hallways and it is transferred to another patient, the hospital loses money, thus not being able to afford to keep the nurses on the unit, etc etc. It's a slippery slope I think. What if there is a patient with TB and little Johnny decides he wants to visit.....well now we have TB all over the unit....And yes, I have seen it.

I had a family member in ICU, only negative pressure rooms in the hospital were in ICU, and patient had active TB infection. Some idiot family member decided to sneak a kid in, and neither the "adult" or the child wore any sort of gown or mask or anything to visit. (This hospital had rules that only 1 family member could visit and they had to be fit tested before they could visit, so they would wear an N95 while in contact with patient, looong time ago)

Well family member decided she wasn't going to wear a mask, and wasnt going to make the child wear one either. Then she said the hospital caused her son to get TB. I never did hear what happened to him. My family member was transferred to a critical care hospital, but now I am thinking about that little kid with TB.

I kind of love it when Risk Management talks loudly outside of patient rooms. Keeps my day interesting to learn new things.

My point was that despite numerous studies on the topic, open visitation policies that are not age restricted have not been shown to produce any increase in hospital aquired infections. The TB story you related had nothing to do with the age of the child. Failure to follow infection control guidelines presents the same risks to others regardless of age. You seem to be implying that TB was potentially spread due the age of the child, not the failure to follow precautions.

[umcRN, BSN, RN]

I haven't read this entire post so excuse me if I'm repeating something. I work peds so sometimes it can be a little different, sometimes kids NEED to see their siblings to feel better, both the ones in the hospital and the ones out. We have a limit, no one under two except in VERY special circumstances. This is difficult for families that have twins and one is sick and for those families that have many small children but that is our rule. Typically a child life specialist will be able to meet with the siblings (and it's siblings ONLY) and prepare them for what they will see with a doll and age appropriate terminology. Children are also screened by our front desk staff, temps are taken and parents will out some paperwork about any recent illness or contact with someone sick, then they are allowed in. Parents are aware that they are in charge of their child and they may be asked to take their child out at any time if the child is being disruptive. Most times we don't have any issues and the older toddler/school aged kids really appreciate being able to have contact with their siblings. I took care of one little boy who was about 2 and a half and the way he would light up when his 8 year old sister came in the room absolutely brought tears to my eyes every time. His sister was able to look past the giant CVVH catheters coming out of his neck and the ETT in his nose and just play with her brother and it helped them both immensely.

[Laurie52]

I don't think you're an evil person -- you must be a wonderful person if you understood the necessity of seeing one's dog! And that dog probably behaved better than most of the children who visit! Anyone who attempts to bludgeon you or manipulate you with the idea of prayer is probably not really as religious as they'd like to pretend. That's just wrong.

Our unit has a policy of no visitors under 16. Exceptions are made in exceptional cases -- Dad is dying and wants to see his 4 year old one last time or the ten year old whose mother has been in ICU for the past year . . . . But it's very clear that this is an exception and everyone's expectations are managed ahead of time . . . our manager, social worker and customer service representatives get involved.

I have horror stories about youngsters visiting in the ICU, but very few stories about well-behaved children visiting. There was the young (teenaged) mother who dropped off her two children with Grandma, who was in the CCU actively infarcting, and went off to a party. "Grandma always watches my kids when I go out," she said. She didn't seem to have a clue that Grandma had other priorities. Then there was the child whom no one was supervising who had obviously heard the adults talking about "unplugging Grandpa". She crawled behind the bed and unplugged every piece of equipment in the room. Thank God for alarms and battery back-up! There was the child who was standing on the nurse's (rolling) chair and fell, striking her head on the sink and necessitating a trip to the ER. That wasn't MY visitor, thank you! She was visiting my patient's roommate and I had already told both her parents and the patient's nurse that she was going to get hurt, and had plucked her off the chair and set her on the floor twice (which upset the parents because who was I to touch their child?)

Sorry to disagree, but these sound like poorly behaved adults not children. We changed our visiting policy several years ago and took out all the age based restrictions and instead used behaviors. If any family members, adults or children, are disruptive they leave. Much easier to enforce. Allowing children into the ICU was initially met with much resistance, however in the past 7 years that this policy has been in place we have had few if any problems. There is simply no evidence that children are any more disruptive or cause infection control issues to the ICU than adults. It has been my experience that children are able to look past all the tubes and just see the person they love. They also seem to ask much more thoughtful questions than many of the adults who visit. I know I certainly enjoy their visits more than many of their relatives:). Ask yourselves, if you were in that bed, would you want to see you children or grandchildren?

[OCNRN63, RN]

I think it's sad that some believe children don't belong in the hospital at all.

Germs are everywhere. Yes, a hospital tends to have a lot of germs but does it really have more than a public bathroom, chuck e cheese, a playground?

I snuck my children into see my grandmother when she was on a vent. We didn't think she would pull through. My grandfather wouldn't leave her bedside. Seeing my kids one at a time put such a smile on his face and I believe that my grandmother knew they were there. She did manage to pull through.

Hospitals aren't so bad that kids don't belong.

It isn't about kids but decent behavior...something many adults are lacking.

The problem is many parents won't supervise their children. Then it falls on nursing staff to make sure the children don't try to rummage through the biohazards trash, monkey with equipment, run riot through the hallways, harass the roommate, etc.

[n'ville]

I agree there should be some restriction on visitation of small children not only for the patients and nurses, but for the children themselves. But I am old school and I personally think part of the problem with increased infections in hospitals has to do with the lack of restriction. I know hospitals used to be very strict about visitation and I am not sure that was not better than it is today for more reasons than just the spread of infection. Many times there are so many visitors in a patient room that the patient cannot get any rest and the hospital staff cannot do what they need to do. Now on the other hand, I think some hospitals have taken advantage of the presence of families by using the family to assist the patients instead of having hospital staff providing the services. Sorry, I will step off the soap box now.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

I work on a general surg ward. I hate it when all the family traispe in at the one time and expect to sit around the bedside (my rooms all have 3 beds). I suggest that they take their loved one off for a coffee in the cafe if they are well enough or out to the garden. to other people I explain that in a case of emergency that will need to get in NOW not moving 6 chairs and your general detritus before I can get to the pt.

To the families with small kids who are spraweled on the floor.............Yes the clenaer might of only mopped it but 2 surgeons and 3 nurses have walked over the floor and do you want to know where our shoes have been? Also your kids are your responsibility .............take them out if they are acting up.

0230 this morning and I'm trying to reason with my patient demanding IV Dilaudid with. BP of 84/50. I go out in the hall to grab the dynamap and the kids visiting the patient next door (AT TWO-THIRTY IN THE MORNING!!!) are standing beside the machine with 2 fish dinners and a BAG of Krystal's wanting me to heat it up for them!!!! At the risk of sounding non-team-playerish, it wasn't even a room I was assigned to!!! No! My patients are the ones down the hall triggering the bed alarms while I fix a late darn dinner for these kids who should have their ------ at home in bed!!! (Please feel free to substitute the adjectives for the ones you know I am feeling right now!!!!) where the heck is the truant officer these days?????