I currently work in a critical care unit that has instituted a policy of open visiting hours. Aside from a two hour time period in the morning (0630-0830) and the evening (1830-2030), up to three visitors are permitted to be in the patient's room at all times thoughout the day. I am told that this a growing trend in the critical care environment across the country, but I have found it to be a source of stress and frustration. Any thoughts?

As long as the visitors are behaving themselves and allowing you to get your care done, then it's not a problem.

If the visitors are interfering with your ability to give appropriate care, then notify your supervisor, so that more stingent visiting hours can be set up for that patient.

The last time one of my family members was in ICU, I always asked the nurse if it was a problem for me to be in the room. If they needed to do something and my presence was going to interfere, I left and gave them the needed time or asked what would be a good time to return.

Hi, I must agree with HipaB4hands regarding having a more accessible critical care unit.

When I had worked In the special (intensive) care unit at MSKCC we allowed the visitors easier access to their loved ones, with the understanding that, if things got "hairy" we might ask them to step out for a wee bit. We also included the family in the nursing care -- if the family wanted to participate, that is.

That being said, sometimes you would come across a family member or an entire family that needed to feel like they were in control r/t their loved one being so critically ill. I have had experiences where the father would change the settings on the vent or increase/decrease the drip rates of certain meds. Then we would get the whole house involved in a family conference (social services, Fellows, Primary Nurses taking care of that particular little boy). Also, it might help a bit more if more awareness was given to the differences in culture that we as health care professionals see in many of our patients and their families.

All in all I give a "thumbs up" to having the unit, the patient and the nursing and medical staff more accessible prn. {but not during rounds, smile}

good luck!

Thread moved to MICU and SICU forum...with poll added.

Thank you for your responses. Allow me to add some additional information. When this concept was proposed, we were told that this was being formatted using "research based" criteria. I have yet to see the research on which this practice was based. In pooling my fellow staff members, I find that having family members present is more a hinderance that an an asset to the provision of quality nursing care. Allow me to expound on this if I may. I work in a Neurosurgical Critical Care Unit. The majority of the patients who are admitted to the unit have experienced a significant neurological assault and are minimally responsive. Many are kept in a minimal state of responsiveness using various pharmacologic treatment modalities. A large number have multiple hemodyamic monitoring (arterial lines, swan ganz, ICP, etc). These patients require frequent neurologic assessment, physiologic monitoring and and of course basic nursing care. Add to this the numbers of ancillary testing (CT scans, angiography, echocardigrams, MRI, etc). The rehabilitation process also figures into the mix...PT, OT, Speech. Often one feels like traffic controller. I am not underestimating the therapeutic value of having a familiar voice or loving touch; nor do I wish to suggest that visitors do not serve a valuable addition to the healing process. For the most part, visitors do have a sense of when it is time to leave the room. However, there is often a quite negative situation that occurs. Sometimes the family members become very angry that they cannot stay in the room all the time. There have been times when the visitors have caused a major scene including yelling and foul language. I have had several family members in the intensive care setting. There are times when leaving the room is appropriate...during a bath, cleaning up incontinence, painful procedures. Additionally, those family members who are compliant with our policies see and hear those who choose not to be. I have noted the results of these things in our Press Ganey scores.

i am all for 'flexible' visiting hours but i think definitive parameters have to be implemented.

i don't think it benefits the patient having the family around 24/7.

on the contrary, it often creates additional stress to the patient, as well as the staff.

although i don't work in icu, i am a hospice nurse and am accustomed to having family around 24/7. i cannot tell you how many times i've observed my pt to start getting anxious. after i tactfully booted the family out, the pt would thank me and often times, pass away.

leslie

I have mixed feelings about "open units." I have worked in several different institutions and interestly enough it works in some areas and not in others. I've tried to figure out why. In my experience, the smaller community hospitals that I have worked in have been successful with open units. In the larger university hospitals the "open unit" system hasn't worked (again in my experience). I have to think that there are many reasons for this.....most often the patients are sicker, the patient may have come from out of town (so family is away from home), the environment is more choatic in the larger institutions. Sometimes when units are open family members never leave. They become sleep deprived and irritable. I have actually seem some family members become aggressive towards staff.

I understand the desire to want to stay with a critically ill family member but some people just can't handle it.

I think there should be open visits, with limitations.

I think that 'consideration to the pt.'s rest time' should be expressed to all visitors.

Perhaps (maybe around shift change) there should be a 'no visits between this and that'.

And i think there should be a rule that family needs to step out when the pt. is getting a linen change, bath, or other procedures.

I again would like to thank those who have responded to my question and to all those who have voiced their opinion in the poll. This is by no means an easy situation to find compromise. A case in point. One of our current patients has been in our unit for five days. Post-operatively she was confused and continually climbing out of bed. A family member offered stay with loved one in lieu of a sitter; which at the time was appropriate. Since that time, we have become obliged to provide her a wheelchair and escort to transport her to the restroom, since she unable to walk. As a token of our gratitude for staying with the patient the hospital provided for her the evening meal. Since that time we have become responsible for providing her a daily menu that meets her special dietary needs and she is served her meal in a recliner chair. Our patient continues to get out of bed and roam down the hallway trailing her monitor wires behind her while her family member watches television and naps. What is wrong with this picture?

I currently work in a critical care unit that has instituted a policy of open visiting hours. Aside from a two hour time period in the morning (0630-0830) and the evening (1830-2030), up to three visitors are permitted to be in the patient's room at all times thoughout the day. I am told that this a growing trend in the critical care environment across the country, but I have found it to be a source of stress and frustration. Any thoughts?

I don't think it's a good idea. Patients are much sicker in ICU and should not have to be bothered with people milling around or having company they really don't want. The incidence of codes is higher in ICU and for that reason alone there should not be open visting hours.

Not a good idea.

~faith,

Timothy.

I've been doing this gig for about 12 yrs now...and my vote is definitely no. I understand that the family is concerned about their family member. I do all I can to keep them update. But, if the patient is critically ill, then he needs intensive care...which does not mean the family is at the bedside 24/7 keeping the pt from resting and/or interfering with the nurse's care of that pt.

Don't beat me up, but I voted yes. Only because if it was my loved one I would want to be there. Of course I would stay out of the way, leave when appropriate, and treat the nurse with the upmost respect. I would like to see policies that were not written in stone. I think 3 visitors is way too many in the unit. A visitor can step out to allow another some time. If behavior is inappropriate or causing stress for the patient or nurse then the nurse should have the authority to enforce a "time-out" away from the unit. I believe there are many disruptive visitors, and there behavior should have consenquences. However, if it is my spouse, please let me be present and if you need me to move, leave, go grab you some dinner.....just let me know.