Originally posted by Linda B. RN
1. What type of visiting policy do you have in the unit that you work?
2. Have you ever worked in a unit that has an open visitation policy, an if so, how well did it work?
3. Were rest patterns disrupted?
4. Was confidentiality compromised?
5. Do you prefer a closed or open ICU? [/B]
We have an open visiting policy where I work, and I HATE it! In fact, in my next job, I'm looking for one where there isn't an open visiting policy!
The theory is that having family around promotes patient comfort and a sense of well-being, and I suppose that in some cases, that may be true. The problem is, in many cases it is NOT true. Rest patterns are disturbed by family members who feel that their visit is more important than the patient's rest -- because "they can sleep all night." As all nurses know, that's not the case. I've seen patients literally exhaust themselves trying to interact with family members who didn't have the sense to leave them alone and let them sleep.
Confidentiality is compromised as well. I've seen family members hovering around the nursing stations, trying to overhear conversations between health care team members -- both about their own loved ones and about the patient next door. (I've been sitting with his wife every day for a week, and we're really good friends now. I'm sure she'd want me to know.") If you ask a family member to step outside for a procedure, whatever, they often lurk in the hallway where they can overhear all sorts of confidential stuff even if they're trying not to. It's amazing what kind of information exchange goes on in the waiting room! While my father was in ICU, I heard all sorts of confidential information about him from the family members of the patient next door who were gossiping with each other and with visitors about other patients about "that nutcase in room 8." (Dad was hypoxic, very confused, and very loud about it.) Seems the doctors were standing right outside the other patient's door, talking about Dad. I'm sure that goes on in my ICU as well. In fact, I've had other patients' visitors trying to confirm stuff they'd heard about my patient! I've seen visitors ambling down the hall, looking into every room to see if they spot anyone they know, and some of them even ask "Why is that guy wearing that mask?"
Management seems to love the open visiting policy, most staff nurses hate it. It doubles, even triples our work load. As we care for the patient, we're also forced to chat with the family, explain procedures several different times (once for the patient and once for each member of his or her extended family), and listen to stories about great-aunt Esther's gall bladder problems. Anxious families come boiling out of patient rooms, shrieking for the nurse because "Dad needs something!" (Usually nothing.) To be fair, this seems to be the behavior they learn from watching television shows, where any change in the patient's condition heralds the hero's bellowing for help. Anxious family members follow you into other patient rooms. I've been assaulted by family members, and once tackled by a prison guard who was trying to protect me from a visitor's home-made machete. (A very LONG story!) More than once, I've had to deal with calling the police because an agitated family member was bringing a gun to the hospital to enforce his wishes. (It's always a him!) One wanted to kill himself, some wanted to kill the family member and one wanted to kill the doctor. (He did, but not on my time.) My husband, who had just drawn blood on a Hep C + patient stuck himself with the needle when the patient's husband grabbed him to demand the reason for the blood draw.
In short, I hate the open visiting policy.
Ruby Vee, who thinks that the best patient is an intubated, sedated orphan with no friends. (Mostly joking!)