Dealing with ICU visitors

I agree with setting limits and initiating an active dialogue with family and friends. They want to see the loved one, we want to care for them so why not let the pt decide more?

I'd suggest raising the issue at a staff meeting to see what the consensus is and find some direction from management. Rather than everybody does their own thing about the visitors and then other co-workers get frustrated by it. Hammer out a policy so every knows and make sure the manager gives direction. That way there may be better co-operation amongst individuals.

We have a locked unit, 2 visitors at a time policy, but every now and then it needs to be discussed at staff meetings to "gently remind" everyone to stick to it!

In theory we have visitation every other hour for the first half hour from 6am to 10pm limited to two visitors at a time.

Of course, this never happens. Our rooms are generally full of people. When I get admissions, I try to make it clear when I cover visitation that it is in the patients best interest that we keep visitors to two at a time and I'll try to send family members home as often as I can at night. Our fold out couches are not comfortable and they have a tendency to wake up every time a pump goes off or every time a vent alarms or every time I walk in to move a pillow or check the foley. Technically, we aren't supposed to let people stay over night, but we generally let one person stay over night.

Of course, if a patient is actively dying, I really don't care how many family members come in and out (as long as I can still give meds!) and I'm more lenient in the few hours after an admission so wives and husbands and kids and Mom's and Dad's can come in and see that their person is okay (or get a full update on what isn't okay).

Sometimes it works!

I must say I am dismayed by the tone of most of the emails in this discussion thread. I'm afraid that most of you are appear as though you have absolutely no idea or compassion for what the families of critically ill patients are going through. Now as you are working in ICU I dont think that is a fair representation of what you are really like. While I agree some visitors can get in your face and in your way when you are trying to care of patients. And some get get quite inappropriate with the yelling for the patient to wake up. And some get even get violent BUT they are in the minority. As my references are in my work computer I will post them here when I'm at work next week. However the most important need for relatives is to be close to their loved one and its largely irrelevant what age they are because whether they are 4 or 40 or 60 they may have a parent who wants to be with them. Relatives are stressed, they dont understand whats going on, they are sleep deprived and they are unable to process information properly. So they will seem to be asking questions after question but thats because cognitively they are not process information.

As a number of members have said, get them on side, explain whats going on, explain the rules and they will usually play by the rules

I bet we work in the same ICU and just haven't crossed paths...

I have worked in several hospitals and none of them had locked ICUs. We had a phone in the waiting room that dialed directly to the nurse's station and visitors could ask if they could visit. This works only if the person is literate. It was and still is amazing to me that you can post a large 3x4 sign on the doors of the unit to call before entering and how many people are suddenly illiterate and blind .

Have any of you noticed that usually when you get one PITA family-it spreads?! We had about a months worth of really "challenging" families. Seems like it comes in spurts.
Ms. X (patient) who had done everything to absolutely kill herself (without actually suiciding) with ETOH, drugs, etc. was dying of a complication of her lifestyle. Talk about problems! Her family said that we were just letting her lay there and die, (uh, excuse me folks...we weren't the one that came in with + everything on the drug screen, + other miscellaneous lifestyle diseases, and a liver shot to hell) complained about every little thing, went to the patient advocate over every other thing, threatened to sue us all etc...Anyway this bunch got many of the other patient's visitors in an uproar and it made life for all of us very difficult for a while.

We utilize security if we need to. Really and truly, all the nurses I work with follow policy pretty well. We also will bend rules where appropriate. A lot of the time, a simple explanation for the reasons behind why we ask them to call is enough. Guess we will always have a few that will make our lives "interesting" Sigh.

2 til 8pm, visiting, that is it. 2 visitors at a time, and next of kin only. Any other visitors are allowed if the nOK gives permission, again, this is restricted.

This is a given and is not questioned in my dept.
Relatives are told of this rule and why we have this rule.

There are of course exceptions to this as already stated.

It works well, it has done for years. We have never had to call security, we have never had an issue..may be somethig to do with the polite English, but we all know what we are doing and we all do it.

To be fair, it gives them "permission" to not be there exhausting themselves 24 hours a day.
Also, we get quite close to our families, and build up a trusting relationship, they see their relative is bieng cared for with respect and with dignity, then very often feel comfortable leaving thier loved one in our care. We are quite proud of this reputation.
Having spent time talking with families, we can kinda work out with them what level of visiting they feel comfortable with.
We are a small unit (13 beds) and as long as they are kept well informed and we communicate effectively with them, they dont usually make an issue of visiting.
When we have a child in, the parents stay, no questions asked....but then we transfer them ASAP to a specialist centre.

We have oopen visits, with certain "rules", that are never followed. Supposed to be open from 0830 to 1800, but we ALWAYS have familys rolling in at all hours, while were are trying to give/get report, and trying to hoard the docs while they are trying to take care of the patients. However, that doesnt usually bother me as much as those that, never fail, call everyday at 0700, right in the middle of shift change, and insisnt on talking to the nurse from the night shift, the day shift, and any docs that may be there. And, kid you not, want us to take the phone into the (comatose, vented) patients room so that they can "talk" to them...iwant to scream sometimes!! dont usually mind having family there, as long as my room isnt crowded, i can get to what i need to do,and you arent agitating my patient that is already in 4 point leather restraints (yes, i am dealing with this now..meth OD plus a little of everything else)..And do not,and i repeat DO NOT come track me down in the other patients room down the hall to ask me if i took your loved ones temp last hour or if i will take it NOW..i am about to code this other patient. Your afebrile daughter can wait one darn minute...oh yeah, and not to mention said mother UNLOCKED her daughters LOCKED restraints, cause she wanted to move around in bed...WHAT??? yeah...and with all that kicking and fighting she almost knocked ALL of us nurses and a few security guards out! (yes, the previous nurse was an idiot for leaving the key in the room and letting mom know where it was..that is being handled) Seriously people...seriously (yes, i work in MICU, but lately it seems like the catch all unit for all the psych/OD patients.....)

We have family that insist upon calling at change of shift. I don't even come to the phone; I just ask the secretary to ask them to call back in an hour or two. If they don't get any information at 0700, they'll stop calling at 0700.