Open visitation policy - page 2

I am ADN/RN enrolled in the RN-to-BSN practicum at the University of South Alabama in Mobile Alabama. For my current assignment, I have been instructed to collaborate on-line with a nursing... Read More

  1. by   nightnurse06
    I work in a cardiac surgical unit with three half hour visits a day. BUT.....the visitors start showing up at 7am, and it does not stop all day. There has been some banter regarding making it an "open" unit, but what is the difference? The administration does NOT back the nurses up in any issue regarding visitors, ( The visitor is ALWYAS right), so we do not even bother to try to enforce the visiting hours. There is a spike in narcotic use during family visits, and not matter how many times you tell them not to wake the patient, they go in the room, touch them, talk to them, and once awake, ask them if they are in pain....repeatedly.
    They proceed to speak LOUDLY in the room, despite repeated requests not to do so. They use their cell phones in the hallway in front of neighboring rooms, while staring in at other patients. ..and my personal pet peeve....the STALKER visitor.....you know the one......they follow you into another room....peeking around the curtain ....trying to catch your eye.....or walk into a room where you are doing CPR to tell you "mom wants to get into bed".
    I for one am sick of it. I LOVE patient care. I actually enjoy dealing with families when they are given LIMITED access to me....The doctors get to walk away...they get to do their job without people staring at them...stalking them......telling them what to do...and stealing their chairs......
    I can give families all the info they need in a half hour...the rest of the day should be devoted to patient care.
  2. by   NAURN
    Our visiting hours are 10-11am, 1-2pm, 5-6pm, and 830-10pm.

    We have not tried the open visitation, but I can tell you that it would not work well for us. We are a fairly small ICU (8 beds) that are all in a horseshoe shape close together. So there would definitely be privacy issues. They did try it years ago before I started working there and they said it was a nightmare. You would be in one room with the curtain pulled cleaning poop and the next room's family member would peek her head in the room wanting to know where the nurse was. Total HIPPA violation there. People do not realize what we do between visitations and how busy we are.

    The problem with open visitation (IMO) is that instead of taking care of the pt, you end up taking care of the family. I don't like that. When pts are critical, they need #1 rest. It is not a sicial gathering for everyone and their uncles to show up to chit chat. (we are a small town where everyone knows everyone typically). And if I am managing 5 drips trying to keep a pt alive, I don't have the patience or the extra attention to give to a family member that wants a cup of ice, or wants to know why the pt's arms are swollen. Let me stablize the pt FIRST, then ask your questions. Families do not understand.

    We do not have visitation during shift change so that works well when giving bedside report.

    Now, we do make exceptions, like a pt that was made DNR and being taken off the vent, we let the pt's family be with them for end of life. Also, if we have super confused pts that do better with a family member at the bedside, we are known to allow that. We are also known to be a little more lenient with hours when we slower, leaving doors open later, etc. And just basically its based on how intense the families are. Some are very easy to deal with, others not so much.
  3. by   dmoney2023
    We just went to open, and it can present a bit of an issue giving the family their time and at the same time not being rude and making sure the patient is taken care of. I like it closed better.
  4. by   MollNick
    Nurses in open units need to ban together and gather as much information as possible in articles, studies done etc. showing how open visitation does not help the patients b/c of constant stimulation along with impeding nursing care. Present this information to upper management, government officials, anyone who has any pull in supporting or changing to closed units.
    I cannot remember all the times I have had patients tell me they just want to be left alone because of their family/friends constantly talking to them etc. to try to help them be more comfortable. We also witness the drama and dynamics playing out amongst the visitors in these patients rooms. Then, to make things worse, the visitors will not leave to allow the pt. to rest or during shift change when asked to leave. It really irritates me when visitors won't leave when it's so easy to see that their loved one is exhausted. I had this DNI patient come in with CHF and was put on Bi-Pap. Her crazy freakin' daughter kept taking the mask off so she could understand what her mother was saying and then cuss the Respiritory Therapist for educating and instructing her to leave the mask alone......unbelievable!!
  5. by   ljeanmarielouise
    I worked in a major medical center with open visitation between 8 am to 8 pm. We allowed 1 family memeber to stay with the patient during those hours with the guideline they would step out as needed during procedures or hemodynamic instability. We loved it as did the patients and families. Most families were very accomodating if we had to limit their time occassionally. It was especially nice when patients were disoriented or restless.
  6. by   nightnurse06
    For years I have thought that giving visitors a handbook to hospital etiquette might be helpful in curbing rude and disruptive behavior...it might include some of the following...feel free to add your own....this really is not a bad idea.
    1. Respect the hospital's visiting hours.
    2.Don't sit on the bed. Use the chair provided, if the is not chair stand. Do not take a chair from the nurses station. Chances are if you are in an ICU, you should be staying that long.
    3. In the ICU , IF there is a toilet in the room, DO NOT use it. This is for patient use only. It is also not to be used as a chair.
    4.Don't take the whole gang with you when you go visiting. The patient may benefit more from a few hours of restful sleep than from all the boisterous conversations.
    5. If there are religious icons on the walls, LEAVE THEM WHERE THEY ARE. You are a guest in the facility, and are not to remove anything from the walls. If you or your loved ones are offended by the object you should choose a different hospital in the future.
    6. Do NOT stalk your family members nurse. Nurses are busy, and must divide their time between their patients. Chances are you will see the nurse soon enough. Above all , NEVER EVER follow the nurse into another patients room, or peek around a closed curtain.
    7. IF you are provided with a phone number to call for updated and requested NOT to give it out...DON't give it out to everyone in the family. Your loved one's nurse does not have the time to talk to five separate family member. YOU call and update those who need to know.
    8. If you are in the unit during shift change do not attempt to eavesdrop. Go in the room and visit.
    9. When requested to leave the room so the nurse may care for the patient , go to the visitors lounge. Please do not stand in front of the next patient's room and stare in.
    10. As much as you would like to share you medical stories, please don't. Allow the nurse to concentrate on your family member. There are times when keeping critically ill patient stable is a challenge, and that challenge is made ever harder by constant chit chat and talking in the room.
    11. Please be respectful of our facility. It may not be your home, but help us keep it clean. Our housekeeping staff works hard. Throw paper towels in the trash, not on the floor NEAR the trash. when using the rest room please wipe the seat if you have soiled it, and eat in provided areas. NOt in lounges, or patients room. We work hard to keep it clean and do NOT want bugs.
    12. Above all, PLEASE turn off your cell phone, keep your children in the lobby, talk softly, and observe the 2 visitors at a time rule.

    I am sure more can be added...any ideas?
  7. by   blackandyellow
    1. We are open 24 hours a day for visitation.
    2. I like our policy and I dislike our policy at the same time. For patients that are close to death I believe that the family should be allowed to stay. However I have had patients who's families have stayed the whole time they were there and it makes it difficult to navigate around the room and some families actually disrupt their family members care.
    3. For some patients yes. I have seen some family members playing video games or having the tv on loud and the patient did not get much sleep or family members that keep starring at the monitor and every time a patients respiration dropped a few points waking them up to make sure they remember to breath.
    4. My biggest pet peeve is when visitors come through the unit and stare into every patients room until they get to their family members room. We have had to speak to several families about that. I think during report it can be difficult. Although we try to speak as quiet as we can there will be family members that will go to the desks to ask a question. There have been times during a code or a patient is hostile that I wish family was not allowed in the unit.
    5. I like the idea of certain times to visit while working with the family. I understand that many family members work off shifts and when a patient is dying their family should be allowed in the unit whenever they please. I would prefer if family was not around at change of shift or when codes occur but that cant be predicted.
  8. by   MollNick
    I really like the ideas from Nurse06. For administration insisting on open units, this is something exact, to the point, understandable even for what I would term "uneducated" visitors which should be put into some sort of law like the 5 patient rights and HIPPA.
  9. by   PMFB-RN
    Regardless of what the visitation policy is it MUST be at the discretion of the bedside nurse assigned to that patient. The charge nurse, supervisor and unit manager must back up the decisions made by the bedside nurse in regard to visitors.
    I have worked in both and currently work in a closed unit. I very much prefer a closed unit but an open one can work well _IF_ the bedside nurse is given absolute discretion and supported in his/her decisions.
    I once walked in to find my patent's wife pouring Pepsi into my intubated patient's mouth. This was the final straw after several questionable behaviors from her and I believed she was a danger to my patient so I banned her from the room unless a staff member was in there at the same time. The night nursing supervisor had a fit and refused to back me. I had to threaten to walk away from that job at the end of my shift. The unit manager did back me up the next AM and strong wording was placed in our visitor policy that all visitor policy was at the discretion of the bedside RN.
    The same discrssion is needed in my current closed unit with very limited visiting hours. At the descretion of the bedside RN those hours can be extended on a case by case basis.
    I admit that such desretion can be confusing for families with one nurse allowing one thing and the next nurse not. We explain to our families that thois may well happen and that vast majoriety understand when some simple explanations are given.
  10. by   ICUenthusiast
    We have an open visitation policy, but we request that family/friends leave for shift change unless the nurses for that patient are ok with it. Of course, this is not considered for a dying patient.

    But because of our unit's layout, we're technically a locked unit and all visitors are preceded by a phone call to the patient's nurse asking if it's ok for them to visit. As much as I don't mind a patient's family member around (mainly because I have learned to say "I understand you have questions, but I need to finish ______. I will be happy to talk to you about this in a bit."), there are times when it's been useful.

    Unstable critical moments are not usually bad with family around.. They stand to the back and watch if present, and ask questions later. But our unit is also very good at announcing everything they do to help alleviate anxiety of the family and allow their coworkers to be sure what's going on as well.

    The only time I have really asked for a family to stay out in the waiting room is when the pt's family members were a doctor and his wife was a nurse... honestly. A few weeks later, a coworker let a different family stay during an unstable critical moment, another doctor/nurse combo, and the doctor was starting to step into boundaries of diagnosing and asking why we weren't treating x with y etc when what was happening was outside of his specialty completely.....
  11. by   nightnurse06
    I agree with what you say. I think I can say without hesitation that nurses do NOT want to keep people from DYING family members. What we DO want is for people to behave with MANNERS and COMMON SENSE.
    Immagine if you will any one of our visitors going to work and having a stranger stalking them and staring at them continually as they did their job.......you mechanic does not allow you into the bays...you surgeon does not allow you to watch him oporate, and your attorney does not allow you to stare him down as he prepares you case.....why do people think it is okay to treat a nurse in a different way?
    We want to help...just give us the space and the RESPECT.
  12. by   lvICU
    My last job was in a facility that had visitation guidelines (not policy) and it was a constant struggle. There were some nurses who were so "by the book" and others that were very lenient. Personally, I think the patient has the right to have a family member at their bedside at all times if that is their wish. Being a patient in the ICU is a scary situation for the patient and family and I think this is often forgotten. Can you imagine being told that your husband of 35 years might die but you can only come see him every for a few hours a day? That would not sit well with me.

    I do agree that there must be a level of respect and general rules to follow when visiting patients in the ICU. I generally found that if I told the family that I would let them in to see their family member as often as possible but that they may be asked to leave for bathing and procedures, it worked rather well. It was the cases where some staff immediately told family what they couldn't do is when these power struggles seem to occur.
  13. by   RhondaIndyRN
    I don't know how long you will be following this post, so I'll give you my 2 cents. I work on a 30 bed ICU with an essentially open visitation policy except from 7-9 (am and pm) when we are giving report and performing our first assessment. If family is insistant on staying, I encourage them to remain in the patient's room to avoid any Hipa issues. I did have a situation in which the family refused to leave, even on the physician's recommendation, during and intubation and a bronch. It was very uncomfortable situation for everyone.

    Rhonda

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