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?

[Esme12, ASN, BSN, RN]

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

True and I worked at a hospital that allowed pets to visit...just not in the ICU, OB/LD, surgery, and the nursery.

[Ruby Vee, BSN]

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?

Yes, they were poorly behaved ADULTS who failed to adequately supervise the CHILDREN they brought in to visit. If the children hadn't been there, they would not have needed the supervision. Since the nursing staff doesn't have time to supervise child visitors and since so many adults who bring them don't bother, the problem is simplified if there are no children visiting.

Besides, kids are little germ factories -- not something that our ICU patients need.

[MunoRN, RN]

Personally I find few things as enjoyable as a vented patient with no family, but I don't try and rationalize that as what's best for my patients, it's what's best for me. I notice that we've mentioned infection prevention as a concern, although I think this is more based on a hope that it is a reason for limiting visitors rather than it actually being a valid reason, a large number of the studies referred to below involved visitation that was open to children:

"Evidence-based practice has shown that open visitation in the intensive care setting positively impacts patient outcomes. However, many intensive care units continue to strictly limit visitation hours. One concern for nurses is that open visitation will expose their vulnerable patients to an increased risk of infection. This fear is unfounded in professional literature as well as in the experience of a busy intensive care unit in San Antonio, Texas. Keeping our patients safe from hospital-acquired infections requires vigilant attention to infection prevention procedures. Meanwhile, what may actually be bugging our patients is a health care culture that is based on tradition and is blind to the many benefits provided by a more liberal visitation policy rooted in patient-centered care."-http://www.ncbi.nlm.nih.gov/pubmed/21160294

[TigerGalLE, BSN, RN]

Not talking about children here.... BUT the only reason I think visitation should be limited is so patients can REST. Some families really don’t know when to stop hovering and sit down already. A patient in ICU is in no mood to entertain.

Now I know some family members do sit down and let their loved ones rest. I think it just needs to be evaluated case by case. But if you don’t have rules.... or you do have rules... families get upset when it is left up to the discretion of the nurse... then they demand a new nurse. You can’t win sometimes.

[FranEMTnurse, CNA, LPN, EMT-I]

I was stuck in the ICU 6 years ago with nobody to see. I missed my family so much. I didn't have a TV to watch. It was unbearably hot, and I was miserable. I even overheard a loud nurse pronounce a child (accident victim) dead. It was an absolute nightmare.

[GM2RN]

I go with the if I was in this position what would I want. I would want my kids to be able to visit me ( or any close relative, and I have a huge close family) if I were in the ICU. My mom already has asked her PCP if he would write an order her grandchildren to visit if she was ever in the ICU ( my grandfather was in the ICU for a few weeks, before going home on hospice) and he will, seeing that the rules state no children under 12.

Orders like this that go against hospital policy and are not medically necessary would not be considered valid at one of the hospitals where I work.

[amyjrn3246]

I work in a Peds ICU, and during flu/RSV season we have a "no children under 12" policy too, we will make exceptions for the obvious situations, but we also have Child Life Specialists that help prepare the younger child for what they will see and how to express their feelings, maybe adult ICU's need this kind of person to assist the bedside RN with the special circumstances. During summer season, we still have the child go through a brief interview to make sure the child is not sick, have fever etc, and they wear a sticky tag stating that they are not sick. If the pt is on enhanced isolation, for cdiff/vre, etc, no children are allowed, in fact only parents can visit for the ICU stay. No visiting children under 18 can stay overnight. We ALWAYS have families try to bend/break the rules, holding them accountable and even going to the extreme of using behavior contracts becomes necessary at times.

[MunoRN, RN]

Orders like this that go against hospital policy and are not medically necessary would not be considered valid at one of the hospitals where I work.

Patients have better medical outcomes with open visitation, so I wouldn't say it's medically unnecessary.

[NotReady4PrimeTime, RN]

I think children should be permitted to visit family members in ICU under certain circumstances, but I really don't think it should be a blanket policy. Children should be permitted to visit their own parents, their adult siblings, grandparents, great-grandparents (if they've actually spent time in their company prior to this admission) and aunts and uncles. Children under about 5 years old should only visit under extenuating circumstances. Visits should be brief - no more than 15 minutes; children should be adequately prepared for what they're going to see, hear, smell and feel and they MUST be supervised by someone who is NOT the nurse at all times. They should not be permitted to crawl on the bed, play with equipment or run around loose. They should not be permitted to bring food onto the unit but they should be encouraged to have something to occupy their attention.

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.

I too work peds ICU and agree that seeing siblings is beneficial on both sides once kids get to a certain age. But then again, if mom and dad aren't going to keep reins on the visiting children, then that must be dealt with. Our unit has no limits. (NO limits.) We've had newborn siblings sleeping at the foot of big brother's bed. Twin siblings playing on the bed. Older sibs rifling through the DVD selection in the cupboard or sitting at the desk colouring. And at times there have been as many as 6 of them at the bedside at a time! Most of them are well-mannered and behave appropriately, but not all.

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.

I wish! Our unit has little notes up all over the place reminding us that we are NOT to offer child life services to siblings. Period. There is no screening other than the phone call onto the unit to see if the family may enter... and that phone is answered by whomever is handy to the desk when it rings.

I work in a Peds ICU, and during flu/RSV season we have a "no children under 12" policy too, we will make exceptions for the obvious situations, but we also have Child Life Specialists that help prepare the younger child for what they will see and how to express their feelings, maybe adult ICU's need this kind of person to assist the bedside RN with the special circumstances.

Again. That's not even a possibility. If we aren't offering child life services to siblings of PICU patients we're definitely not going to offer anything remotely close to those kids visiting adult family members.

During summer season, we still have the child go through a brief interview to make sure the child is not sick, have fever etc, and they wear a sticky tag stating that they are not sick. If the pt is on enhanced isolation, for cdiff/vre, etc, no children are allowed, in fact only parents can visit for the ICU stay.

Nope. We don't do any of that either.

No visiting children under 18 can stay overnight. We ALWAYS have families try to bend/break the rules, holding them accountable and even going to the extreme of using behavior contracts becomes necessary at times.

We've had situations where the whole family has camped at the bedside for days at a time. In one case three of them slept in a single chair. No one is willing to take on the task of dealing with that...

[ICU.RN]

@ MunoRN+1

I recently had a pts wife bring their small child in during day shift. Apparently, the day nurse walked in to the kids arm going straight into the sharps container. The next day, she tried to bring the kid back. The nurse explained our policy, as well as explaining the situation from the day before. They filed a complaint with the nursing director.

A while back, I took care of a critically ill pt whose husband was like p.o.d 2 from a total knee. The adult children left the husband at the hospital,where we needed to help him set up his cpm, give him love nod injections q12 and help him get up to use the pt only toilet. We explained to them that he could stay, but that she was the pt, and if he needed a reasonable amount of assistance, it would be best if 1 of the several children took him home, and another came to the unit to be with mom. He didn't get his love box injection, and ended up trying to go to the pts potty, but peed all over the floor instead. Case by case agreed!!

[hopetsanchez]

I completely agree that children should not be allowed into the hospital. I love kids as much as the next person but there are some places they don't belong and the hospital is one of them especially the ICU. I've seen parents bring babies in and let them crawl around on the floor OMG I could have died! Of course I did my best to correct the situation. I've seen the school age kids going around barefoot, kids eating in rooms that are contact precautions, etc. Really do we want to expose our kids to whatever is in the hospital?

[GM2RN]

Patients have better medical outcomes with open visitation, so I wouldn't say it's medically unnecessary.

Doctors will ocassionally write an "order" for a private room, for instance. But if the patient doesn't require isolation for infection purposes or some other reason considered by the hospital as medically necessary, it's not considered a valid order an doesn't have to be carried out. So one could argue that a patient would have a better outcome if they have a private room, or any number of other things, but you have to draw the line somewhere. Open visitation just isn't in the same medical "necessity" category as something like isolation from infection is.