A truly bad idea.
Fortunately, the only place I saw it tried, the CV docs did all their cases across town for 6 months - 2 open hearts every weekday to zero - x 180 days.
And then management 'saw the light'.
This is part of what I wrote to the President of the Amer Assoc of Crit Care Nurses:
Howdy from Texas and Congratulations on becoming
President. I was present at NTI when you accepted the
reins. I politely listened to your views on open
visitation and would like to offer a different
I know that the national AACN is advocating open
Here's the thing: I am first, very first, prime
directive first, a patient advocate. As a very close
second, I'm a family advocate.
In the ICU that I have work in, the open
visitation experiment (or should I say fad) was tried
and ultimately abandoned. So I have some experience
from both sides of this practice. Now mind you, I work
nights, so my opinions are colored by a non-9-5,
non-academic, in the trenches mentality that often
times gets lost from drawing board to actual design.
There are two major drawbacks to open visitation.
1. Sick people need to rest, ESPECIALLY AT NIGHT.
I remember many years ago a young mentor telling me
when I was a still younger nursing student that there
are two types of people you should never wake up:
babies and sick people. That left an impression on me
a few years later as an eager new night nurse trying
to prove to the world that I was capable and ready.
As a result, I came to realize that taking hours away
from a patient's much needed sleep cycle in order to
prove that I could assess every nook and cranny was
wrong. It was not the ultimate in patient advocacy, it
was erroneous - a wrong dose error - not enough sleep.
And so, I have become a sleep advocate.
Often times, I consider my best shifts to be composed
of benign monitoring of sleeping patients (well, as
benign as cyclical NIBP/12-Leads/Lab draw/neb
tx/alarms/etc. can be). I design my care around
sleeping periods and I strenuously defend those
periods - from noise and light pollution, from
unorganized multi-disciplinary care (I work hard to
ensure that most care is done at the same time in
order to avoid frequent interruptions of sleep), and
from eager, if detrimental, disruptions. Doctors
expect it of me to ask if our improving patient really
still needs hourly blood pressure readings, or if q2
or even q4 would suffice. Resp TX is in the habit of
calling me in advance after 9pm to find out if and
when their therapies can coincide with mine.
No matter how you dismiss a critically ill patient's
need for sleep: it is important. In more situations
than not, it is the best care.
The thing about open visitation is that families feel
obligated to have somebody there all the times. This
has two extremely negative effects on sleep. First,
there is always somebody fidgeting and fussing in the
room. Second, even if a patient CAN sleep through such
doting, there is an expectation from families (and
unfortunately some nurses) that critically ill
patients need constant critical modalities performed.
Sometimes, the best medicine is being left alone. If I
spend four hours away from the beside of a sleeping
patient that I am nevertheless continually monitoring,
I am being a sleeping patient's best advocate. A
family member at a sleeper's bedside creates the
expectation (in both them and the nurse) that critical
care is comprised of frequent interactions. Sometimes,
this could not be further from the truth. It's easy to
say that more education is a key to resolving this
issue. My experience is that it is virtually
impossible to distinguish benign neglect from simple
neglect in the eyes of well meaning family members
that are deeply involved with the first phases of
grief (anger and denial).
2. Families need sleep, too.
I am also a family advocate. I have seen all too often
frail spouses morally obligated to spend night and day
at the bedside to prove their loyalty. Like their
critically ill soulmates, these clients of mine are
also being deprived of necessary recharge. Even if
they feel compelled to stay at the hospital, closed
visitation gives these dear ones access to the plush
couches in the waiting room to sleep. And this
exhausted spouse that WE are creating in our misguided
attempts to be compassionate: this is going to be our
patient's primary caregiver in the days to come. We
are setting them up to fail from simple exhaustion.
Closed visitation gives a much-needed structure for
sleep. Abandoning that structure is the opposite of
patient and family advocacy.
I simply cannot fathom how exhausted patients and
exhausted family members improve outcomes.
At the point end of life comes into play, I have never
seen family members deprived of access. Every closed
visitation policy that I have read or worked under
includes the provision: at the discretion of nursing
staff. It is simply inaccurate to portray denial of
access at end of life as a true component of a
comprehensive closed visitation policy. . .
In truth, you are dismissive of my point of view. To
bring that point home, let me tender that, at some
point during this letter, you have already dismissed
my opinion as neanderthal to modern nursing. You are
so sure that I am out of step with the times, that my
rationale and compassionate viewpoint on this issue
has fallen on deaf ears.
I cannot believe that I am in the extreme minority with
my beliefs. What I do believe is that AACN wishes my
beliefs to become an extreme minority.
Let me finally add that this letter is not written in
an agitated or angry tone. The tone you pick up on is
frustration. Frustation because I also believe that I,
too, am being a patient and family advocate.