ICU Visiting Hours

MQ Edna · Jul 7, 2002

Sharkadelic, I did work in a unit that had "flexible visitation". We closed for two hours 6:30-8:30 both morning and nights to allow report (confidentiality) and assessment time. We actually found that once families and loved ones knew that they weren't going to be restricted, they were actually quite reasonable and gracious. They understood when you had to shut down the unit for a crisis or code (although we did allow some to stay during a loved one's code-also a good thing though a separate thread idea). Naturally there are a few jerks, but for the most part these people would be jerks no matter what. We tried to limit visitors to 2-3 at a time to prevent overloading the patient, and we did limit children under 14. Naturally if there was a special circumstance such as a parent or grandparent, or a pending death, we worked diligently to ensure that the family had the access they needed. My feeling is that open or flexible visitation CAN and DOES work! I'm trying to get it arranged at my current facility, but still some resistance. Good luck! :kiss

DelGR · Jul 7, 2002

SharkadelicRN, go to the aacn.org (American Association of Critical Care Nurses). They published several articles at different times related to ICU visiting hours in their journals over the years.

We have open visiting hours with limits as to how many visitors can be in the room at one time, rarely children, but we do let some in within reason.

pacernurse · Jul 7, 2002

I wish our unit had had a positive experience when we had open visiting hours but in our case it didn't work out at all. We have a 24 bed ICU and the visitors were out of control. If you asked them to leave, they usually refused. We would find them in the staff kitchen helping themselves to the patients' (and staff's sometimes) food. If there was no one at the nurse's station some people would come and read their family member's chart. They would walk behind the desk and make long distance phone calls on our phones. When we would ask them to leave because of a code or shift report, they would either ignore us or hang out outside the coding patient's room to watch. How fair is that to the coding patient? We tried everything to fix the situation, we tried contracts, posted guidelines, sitting and talking to the family. Nothing worked. It got to the point that the patients weren't getting any rest and would actually ask us to "please throw them out." Our fresh MI patients particularly would be exhausted by the middle of the afternoon and would often sleep for hours after the visitors left. The patients are critically ill and I know the families want to stay but in the long run it doesn't do either one of them any good. The patient needs to rest and the family needs a break away from the bedside. After we reinstituted some type of visiting hours, some of the families said that they were glad because now they don't "feel guilty" if they aren't at the bedside all the time. If the patient is very critical or is dying, that is different and the family comes and goes as they need to. I think some type of restriction is needed. Our unit went to a four hour block of time in the morning, a couple of hours in the late afternoon, and then two hours at night. Visitors were not alowed in at shift changes nor during the night. It doesn't seem to be as bad as it was with the open visiting.

If you are looking for research on open visiting hours, try the AACN website, http://www.aacn.org, they have done quite a bit on the subject, and check out CINAHL too.

fedupnurse · Jul 7, 2002

As Pacernurse stated, the visitors in the Northeast tend to be a bit hostile and intense. I walked in to work the other day to hear a family complaining that it took the nurse 45 minutes to speak to them. A. he had 3 patients and their family member was the least critical (isn't that always the way???) B. It was late afternoon and this poor slob hadn't even had a nibble to eat or peed all day. And the managers suck right up to these people!!! Makes my blood boil!

We tried open visiting and it was a disaster. We now have several blocks of time with signs everywhere about no cell phone and 2 at a bedside at a time and no kids under 12, etc. but it is like the visitors to my unit become blind and deaf when they step off the elevator on my floor! I walk into rooms with 10 visitors and say "sorry folks, 2 at a time." And they respond "yeah, we know." That's when my nice voice turns to an irritated one and I say well we have this rule so that if your father goes into cardiac arrest we don't have to trample over tons of people to treat him. Time does count you know!!. Some leave but most stay.

There has been a totally full moon over the place this past week! Holdays bring out the obnoxious in people.

OrthoNutter · Jul 9, 2002

We didn't have open visitation in the ICU where I used to work...it was flexible but at the nurses' discretion. They couldn't get in the door without being buzzed in because it was electronically locked. Most visitors were pretty understanding if we had to ask them to leave for whatever reason. But then, this was a small ICU too....only 7 beds. No such thing as 3pts per nurse...it was one on one, unless they were ready to shoot up to the ward.

Now I've moved to a capital city and the hospitals are much larger....seems that with the increase in size of the units have come with a decrease in the mentality of the visitors. I started off in ICU when I moved to this hospital but I couldn't stand it....moved to ortho a month after I got there and I'm reasonably content with my decision. At least I can put my bouncer's hat on there and start tossing people out at the close of visiting hours without seeming like an inconsiderate &$!#@. lol

Tephra · Jul 9, 2002

Good topic.. we're only officially closed 6a-9a and 6p-8p... open visiting otherwise. Two visitors at a time, no one under 12 without approval, come back in 15 minutes if door is closed. We don't let you interact (read: wake up!) sleeping/sedated patients between 10p and 5a-6a. And the nurse decides whether the patient can tolerate being awakened at other times too.

We STILL get abusers. "Oh, no, I won't wake her!" but they lean over 2" from the patient's face.. good gracious! I've gotten to restricting folks to the foot of the bed and pulling curtains/doors. I work night, I KNOW how hard it is for the patients to get their sleep/wake cycles aligned.

Biggest problem? Staff inconsistency. Example: day shift nurse lets family pull up chairs and chat, night nurse is NurseRatched for saying no. Family present at time for shift report? NurseRatched again has to enforce confidentiality. One nurse feels she is Family Advocate by bending rules, other ends feeling like BadGuy. The key is getting everyone to hold to guidelines -- a difficult issue.

fedupnurse · Jul 9, 2002

After having worked in a very small low acuity community ICU and the high acuity regional referral center ICU, I agree that the level of nastiness increases in the higher acuity hospitals. It doesn't help that the suits are running the place like a freakin hotel...

ceecel.dee, MSN, RN · Jul 9, 2002

Our small ICU lets nurses use their discression. It works pretty well here where almost everyone knows almost everyone else and most are typically civil in behavior, and willing to trust the nurse who says,"I think we just need to let him have total rest right now". There is a written policy about this and our DON is really pretty good about supporting our decision about how much visiting is too much visiting.

nrw350 · Jul 9, 2002

Have you all ever had a patient that requested no visitors? After reading this thread I think that I would want to be left alone for the most part if I was critically ill. Thanks for you all's input.

Nick

Nurse Ratched, RN · Jul 9, 2002

I don't know about ICU; it seems like the patients there are too critical to allow anyone who casually knows the patient to come calling or gawking at any hour. And unfortunately that seems to be the norm. (semi-related aside: I personally HATE those columns in newspapers that list who has been admitted to the hospital. Just an invitation for the nuts to come out. )

I'd rather have a strict policy that can be relaxed in certain cases than a free-for-all that leaves visitors with a sense of entitlement like mentioned in the previous posts.

Zee_RN, BSN, RN · Jul 9, 2002

Open visiting hours doesn't work at my place either (yes, I'm in the Northeast too). It always amazes to me how selfish visitors are!!! So many of them seem to put their needs before the patient's! There's the poor patient struggling on bi-pap with the family asking a million questions and the patient wants desparately to respond...meanwhile, pulse ox is 84%. Still, six family members hounding patient. Many, many instances of similar nature. Our doors are NOT locked ... visitors are requested to come in via the waiting room where there's a phone to notify us of their arrival. I cannot tell you how many people come through the doors marked AUTHORIZED PERSONNEL ONLY...they are push-paddle doors and I have seen many people pry these doors open with their fingertips to get in (don't you think if you had to pry a door open like with your fingertips, it might give you an indication that you shouldn't enter?!).

We have restricted visiting hours and I wouldn't have it any other way. Still, we have a problem with staff consistency. When I ask a family member to leave (always politely...my trade line is "It's time for good-bye kisses!"), it frustrates me to no end when I'm told by the visitor "Well, I was allowed to stay for 3 hours yesterday!" So I seem like Nurse Nasty.

When I introduce visitors to the unit, I give them our pamphlet and explain visiting hours. I also tell them that they may see some family members appearing to come and go at will ... and that this is usually a BAD sign!! If family members have unlimited access, it is usually because of a terminal wean or imminent demise of patient.