[midlandrn]

We too have open visiting in a 15 bed general ICU. We do close at shift change and discourage visiting after 10pm. We have had these hours for about 8years and they can definitely be challenging. People just don't understand when you are pumping on someone's chest that perhaps that is not a real good time to ask for a pillow. As much as I was used to (and most times would prefer) a tighter control on visiting, I think the patients really do need the comfort of that familiar person. For the most part also, visitors are very cooperative and have no problem stepping out for procedures, etc.
Don't get me wrong though, a couple of days of "visiting only at the top of the even hour for 10 minutes and close at 6pm until 10am"......would be kind of nice.
Make sure if they insist on staying, you put them to work. The rooms are small and there's no space for standing around watching us work. show them where the linen is and the tv controller and the ice machine, etc. It will get better.

[jellybeanmead]

Hi all!! Check this out. We have just celebrated our one year anniversary in our new unit. Our unit has 20 beds and in each room, there is a room connected to it for the family members to stay. The room has 2 chairs that pull out into a bed, a flat screen tv, sink, wardrobe closet, mirror, table, and a phone. We also have 24 hour visitation hours. 4 visitors can be at the bedside at a time during the day and 2 people can stay overnight. I must say, having the family members practically live in the unit was a bit challenging. Especially when the pt is coding and the family is coming out of the room wondering what all the comotion is about. However, with the family at the bedside, they are able to see and appreciate everything we do. Also during CPR, they normally want you to stop the code once they see you beating on your family member's chest. Now that can go the other way because sometimes they start to compare nurses etc. But even with the visitation, it caa be a lot of traffic. It is still in progress. Oh, we also have a family coordinator at the front of the unit to orient the family members and brief them of the rules. If we have any problems, we call the family coordinator. (Yes, we have had problems). Long story short, it has its ups and downs.

[newohiorn]

I work in neuro ICU and we have open visiting hours 20 hours a day with the exceptions being 2 hours at a.m. shift change and 2 hours at p.m. shift change. The rule is supposed to be no more than 2 visitors at the bedside but I often see a few more, although I personally haven't seen it abused much (i.e. 10 visitors). Our visitors do not have to check in or anything like that...they can just walk right in. We do strictly enforce the 4 hours that they may not come in. We discourage sleeping in the room like one is camping out and I haven't seen that much either but I haven't taken care of any of the young trauma patients yet as I have only been in neuro ICU for 3 months. I came from a med-surg floor and I thought the open visiting hours would be a disaster in ICU but I really can't say I've had any problem with it. Frankly, I'm surprised how little people are at the bedside--not in a bad way just that I thought families would be there the entire 20 hours and most are not.

You might be surprised that if your visiting hours are more open family members might not be so overwhelming and pushy as they are in the very short visiting hours. I think it gets pretty boring and depressing to sit at the bedside of an unresponsive, vented patient and most family members eventually get the picture that they need to go home and get some rest. Many of them can't mentally deal with being at the bedside constantly and I find that many make brief visits to the patient and then go back to the waiting room even during times they are allowed to be in the room.

[CarVsTree]

I'm still new to Trauma-Neuro ICU but we've had open visitation.

Families can visit 9:30a to 6:30p then 8:30p to 06:30a. If they are in any way interfering with the patient's care (for example over-stimulating a neuro) we can tell them to leave.

Just yesterday, I had mom & dad over-stimulating my SAH, Frontal Hemorrhagic Cont, DAI. I told them that he needs rest and quite, showed them his elevated HR and BP of 190's over 90's and told him that is a direct result of them talking to him. Dad wanted me to give him something for the BP. I told him he needs absolute quiet. They're welcome to stay but they may not speak - even to each other. Assured Dad that I will continue to monitor his VS and if the quiet doesn't settle him I can medicate him.

Parents were very compliant at that point. But, I know not everyone is. Our hospital has had open visitation for a long time and it definitely is more labor intensive for the nurses, but we absolutely enforce the rules and we'll help each other out with bringing the point home.

BTW, the above pt's SBP went down the the 130's and Dad actually asked me at what blood pressure can we start bugging him again. They just don't get it. Mom said, I just want to be able to read a book to him without his blood pressure/HR going up. I guess they hear what they want to hear.

Hang in there, you may not be able to stop it, but make sure you have strong language for visitors about the rules and the nurses authority to enforce them. They harm/interfere with patient they're out.

Good luck!

[valkyria]

While I understand both sides, I still here my parents talk about how difficult it was to "live iin the waiting room waiting for our 30 minutes with you,' I also see it from the patients side, even while I was in a coma, I wanted to hear something soothing and hauntingly familiar like my mother's voice-even though when I woke up, I did not know that was who she was. I also see it now, from the nurses side, there are things that we do not want the family to see, and it is hard enough for us and the patient to see. There are times that the 24 hour lights and beeps and alarms of the ICU are all the stimulation either of us can handle. The bottom line needs to be the safety of the patient. The patient is there to be closely monitored in a CLOSED and CONTROLLED enviornment. The setting is not perfect but it is that way for a basic reason. Now, compromise could be the answer. Though most administrations are a feast or famine situation. Perhaps, making the hours a little longer, an hour instead of 30 minutes? But the nurses must have autonomy in our domain. We must have control in our realm. We should be able to call security and close the doors, not because we are calus or unfeeling. We each have cried our share of tears for our patients. But enough has to be enough! Or do we have to wait until we have an "adverse event" or God forbid a "Sentinel event" before someone with authority listens to our cries?

[kaiagrace]

I work in the ICU, also with neuro patients, and I think open visitation can be a henderance to the nurses, doctors and patients. Currently we are closed from 6-7:30 am and pm for shift change and first assessment. other than that people are free to come and go as they please. can be a big hassle when the unit is full (14).

[ELKMNin06]

HA!

It is true. It does exist. No visiting hours in the Neuro-surg ICU! Supposedly....the only time families are not allowed are between 7-8 am/pm....they normally don't even abide by that. The doors are supposed to be locked, however, anytime someone..dr..family..etc. goes in and out..well people come right in............no one calls...we don't have security anymore (wasnt in our budget). Famlies spend the night-bug the living daylights out of you when you are trying to get things done...dear god the monitor beeped!!! we practice family centered care you know! HA!

Even during shift change we struggle to maintain HIPPA-we all try to enforce the rules but we allll know how families seem to think the rules are there for everyone else but not them. Amazing.

Are you ready for the best part?!?!?!

At our staff meeting a few weeks ago we find out that children are not going to be restricted in the ICU any more either! Bring on the babies! Or so they state it...It is up to the RNs discretion. Hm.

[ELKMNin06]

Originally Posted by CarVsTree

I'm still new to Trauma-Neuro ICU but we've had open visitation.

Families can visit 9:30a to 6:30p then 8:30p to 06:30a. If they are in any way interfering with the patient's care (for example over-stimulating a neuro) we can tell them to leave.

Just yesterday, I had mom & dad over-stimulating my SAH, Frontal Hemorrhagic Cont, DAI. I told them that he needs rest and quite, showed them his elevated HR and BP of 190's over 90's and told him that is a direct result of them talking to him. Dad wanted me to give him something for the BP. I told him he needs absolute quiet. They're welcome to stay but they may not speak - even to each other. Assured Dad that I will continue to monitor his VS and if the quiet doesn't settle him I can medicate him.

Parents were very compliant at that point. But, I know not everyone is. Our hospital has had open visitation for a long time and it definitely is more labor intensive for the nurses, but we absolutely enforce the rules and we'll help each other out with bringing the point home.

BTW, the above pt's SBP went down the the 130's and Dad actually asked me at what blood pressure can we start bugging him again. They just don't get it. Mom said, I just want to be able to read a book to him without his blood pressure/HR going up. I guess they hear what they want to hear.

Hang in there, you may not be able to stop it, but make sure you have strong language for visitors about the rules and the nurses authority to enforce them. They harm/interfere with patient they're out.

Good luck!

Also love those family members that just insist on piling the blankets on a febrile pt with a temp of 39 C..on a cooling blanket for that matter! Doesn't matter how many times you tell them......think about all the other things i could be accomplishing in that time!