Happy New Year! Hear is a question my boss wants me to research so I came right to the experts. What kind of information or opinions do you have regarding visitors/ family in the ER. Apparantly at my facility this has been an issue from time to time when the ER nurse doesn't allow family members in to visit the ER patient. I think one of the times it was with a critically ill patient. Do you have any references/ articles or just general feedback I would be happy to pass it on. I did try to research it online and emailed the ENA but didn't get any info. Thanks!
Jan 4, '07
Search your nursing journals or get a librarian to do that for you. There has been quite a bit of publication on this topic in the past few years. The concensus is that family ought to be present, but restrict the number. OUr ER allows 1 person, two if the patient is a minor. We flex on this some depending on the situation. We always reserve the right to exclude anyone if they are disruptive.
Jan 4, '07
I am not an ER nurse I am a paramedic. The ER's that we go to mainly both only allow 2 visitors in at a time. They give the family two stickers that will allow them through the doors so that only two can get through at once. No sticker means you do not get in. The doors to get into the ED are locked so that they have no choice, but to talk to the registration people first. Obvioulsy in some situations mroe family may be allowed in, but not to often. Hope this helps
Jan 4, '07
Our policy is 2 at a time, but I have no problem violating that for a) critical care situations/dying pts b)families that are quiet and non-disruptive. I have very strong opinions on family presence during codes - I think they should be allowed as long as there is someone there to talk them through what is happening and catch them if they fall.
My big issue is traumas that come to us completely nasty - bloody, needing NGs and Foleys etc. If the pt is critical but "stable" I prefer if the family stays in the cry room until I get those things done. I hate dropping NGs with family in the room, and I feel that the exposure of private parts should be kept to a minimum. I do feel, however, that the doc needs to step out and talk to the family before they come back. Just a quick explanation of "He was really sick when he came to us, and to protect him we put a tube in his throat to help him breathe; you'll also see a tube coming from his nose/mouth to keep him from vomiting. The trauma surgeon is in with him now and can give you more detailed information about what is going to happen next." I don't feel it is okay for family members to come back and be shocked that their family member is intubated and sedated. It leads to some pretty interesting situations in the trauma room....
A little off topic, but that's our procedure and my personal feelings. We are a 40 bed Level I.
Jan 4, '07
We allow two visitors for pts in rooms, and only one visitor for our hallway pts. Also, visitors of EMS pts stay in the lobby for 15 minutes before they're allowed back, this lets the nurse get report from medics and get the pt settled without interruption. (Of course, exceptions are made if we need info from family/coding pts, etc)
Jan 4, '07
we have rules that unfortunatly, we do not consistently enforce.
the rule is supposed to be that unless the patient is a minor, no family is allowed back until after the doctor sees the patient.
the only other exception is for those who are unresponsive or obviously confused.
why? so the doctor can get the story from the patient. if the patient isn't doing a good job of answering questions, the doc may request the family come back while he is examining the patient. otherwise, the family has a tendency to speak for the patient.
once the doctor has seen the patient, 1-2 people can come back, depending on the size of the room. they can "change out" many times, but only 1-2 should be there at a time. otherwise, we are literaly tripping over family members. however, this rule is often ignored. it is very frustrating.
Jan 4, '07
Our rule is 2 at bedside. If I have a critical patient, I don't care how many are at bedside, as long as the charge RN is with them answering questions and they are not being disruptive and I have everything done that I can do for them. I also don't agree with family members staring at grandma stark naked in the trauma bay while you are doing chest compressions. I think we should consider a patients dignity and take into consideration that they probably would not want their family to see them that way. If the family understands that CPR is is progress before they come into the room then I will try my best to cover the patient with a blanket to maintain that dignity.
I have mostly found that it is almost always the 19-year-old female with the UTI that wants 10 of her friends in the room talking on cell phones and ordering pizza.
Our problem is that even though our ED doors are locked, people will stand in front of them and wait for someone to come out and then run back demanding to see their loved one. This is a huge problem with our domestic dispute cases. Irrate husband that just beat his wife, stands in front of the doors and as soon as someone leaves, he runs back. I also have a huge problem with patients in the ED who are their to be seen for some BS complaint and they run out and smoke every 5 minutes, or to use their cell phone or what ever, because this allows our doors to be open without good reason and gives tons of people the chance to get through the doors.
Maybe I just had a bad day today, but I think that if you leave your exam room for any reason other than to potty or go for testing, you should have to be re-triaged.
Feb 25, '07
At my facility we have a one visitor policy unless the patient is a minor than they are allowed both parents. Our policy is more for the fact that we have outgrown our facility. Most folks understand but you still get the occassional jerk who would rather stand there and argue for ten minutes instead of allowing you to care for their loved one.
Feb 25, '07
There is a time for visitors, and there is a time when visitors should not be allowed. We used to have a 2 visitor per patient rule, but somehow this rule has become obsolete in our ED. Management seems to believe that if the patients have visitors, then they will not be watching the clock and will not realize how long they have been in the ED. I disagree....that's what they'll be talking about. I believe that we should limit our visitors to no more than 2 at a time......the rooms are small, making it difficult to complete tasks at hand. I understand that people want to be with their family members during times of illness, but we have to try and limit visitors, not only for our sake, but for our patients as well. Too many visitors at one time keep me from providing the care my patient deserves. On the other hand, it is good to have visitors at the bedside, because we can't always be right there watching the patient and the visitors can help us kind of keep and eye on our patient, and let us know if their condition is worsening before we are able to make it back to check on him/her.
Feb 26, '07
we allow one visitor to come back with the patient. Exceptions to this are made with critical patients, patients that are being transfered upstairs to their room and incoherent patients. Personally, the ER rooms are too small for the fifteen family members that so many people bring. I understand that with some it is culteral, but we need room to get to the patient.
Feb 27, '07
We try to keep it to one, except children, we'll let both parents in then. Serious stuff and codes we keep the family out! But we try to have one staff member talk to one family member who can relay to the rest of the family what is happening. (Otherwise you tell the same story 15 times to 15 different people)
Feb 27, '07
I don't know what it is at the hospital I am doing clinicals at, but either there isn't one or it isn't enforced. A few weeks ago we counted 8 people in one tiny room not counting the pt. It was actually getting noticeably warm in there from the bodies.
This lady was clearly loved, but come on folks! Turns out her pacemaker was tweaked recently and the durn thing fired several times and the whole world thought she was going to die. I guess they wanted to watch her die, too. (She didn't and was just fine.)
Feb 27, '07
The ED where I work has the 2 visitors for a minor, 1 per adult rule.
I feel that there should be no visitors until the Dr. sees the pt. (adults
that are able to communicate).
The young people who are accompanied by their parent(s), Are NOT going to be honest about certain things. Sexual, drug usage etc.in front of their parent. That also goes for spouses/ significant others. Or family members, & friends. There are certain things that people will not admit to in front of
Women now think that pelvics are spectator sport, and invite the gang.
A lot of it is plain nosiness from the family/friend.
In some cases they can be helpful.Tho usually the one that insists
on going in with the pt, is the one who knows the least about the pt.
I don't believe in "trading out" (not including certain situations).
VISITING, should be done when the pt is admitted. NOT the ED.
It seems ED's have become a place for social gatherings, and family reunions.
So-called visitors to a room, want to stand in the hall & watch.
Or walk around talking on their cell phones.
10 people for a kid with a cold.Visitors taking up seats that should be for the pt's standing.
ED is supposed to stand for EMERGENCY, NOT "EVERYBODY" DEPT.
But since I'm a lowly RN,and others like me, without input into policy making.
You can only seek employment elsewhere if it gets that bad where you work.
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