Dealing with ICU visitors

[leesespieces]

I need to know if others out there have the same difficulties with patients family members/visitors in the ICU.

In my facility visiting hours are more strict than they are on the floors. Visiting is supposed to be from 12-8 and we close the unit to all visitors during change of shift (for HIPPA reasons). There are only supposed to be 2 visitors at a time and no children under 12 allowed. We even give pamphlets on the ICU to the family at the time of admission to the ICU that outlines all of the above in addtion to things to expect when your loved on is in the ICU.

However, more often than not 3-4 or more people will show up and go into a patients room at a time. (Part of this is the fault of security and/or visitor control). When they are reminded of the rules or when the overhead announcement is made when visiting is over for the night or during shift change, visitors simply ignore us. In a few instances they refuse to leave. And once recently we've had to call security and the police dept.!!

I am not heartless and I do understand and am willing to make exceptions when I know the pt's spouse or child works until late and wants to come by after hours for a little while or if the pt is actively dying etc. But many times these are patients who are completely stable whose families give us the hardest time. Also, there are times there are 4 visitors in this rm with the patient, a vent, monitors, mult IV poles, IABP etc and they are crowded around the patient and when I come in to do my job to care for THIER family member they don't even back off so I have to do acrobatics to hang a new drip or check a BP! And they act like its such a nuisance to let me do what I need to do when I ask them to please move. We explain to them that ICU pts need more rest than they think with all the tests, procedures, etc they go through. But it doesn't stop them from yelling into their loved one's face (who is vented and on a propofol gtt) "WAKE UP MOM!!!! I KNOW YOU CAN HEAR ME!!! WAKE UP AND LOOK AT ME!!"

They use their cell phones in the room after being told it interferes with the monitors connected to their loved ones. They don't wear the appropriate PPE when going into an iso room. If they do wear it, they leave the room and go in the hallway to talk on their cell phones still wearing the gown and gloves. And the nastiest thing of all is when the use the bathrooms that are shared by 2 rms to dump bedpans and urinals!!!!

Not sure if I've just lost my patience along the way or if anyones meets this much resistance, and often outright rudeness from family members. I love it when they finally do leave saying so intentionally loud "Sorry I have to leave, the nurse is kicking us out" or "they won't let me stay with you."

Just wondering what your visiting restrictions are in your ICU's, if you meet the same resistance, and what you all do in these situations.

[richard1980]

We have a locked unit so I don't have to deal with people coming in when I'm not expecting, etc. If we don't want company we simply say "not right now." They really don't have a choice. There's a lot of talk about "family oriented ICU care." I too understand the need for families to see their loved ones when they're sick and vice versa. But if someone is critical and sedated there's no reason for someone to insist on staying while you try to navigate around them. It usually works well to inform families, like you talked about above, that their loved one is very sick right now and needs to rest. I tell them that short visits are ok, but there's a reason they're in the ICU and not the floor. Good luck to you!

[NotReady4PrimeTime, RN]

Our visiting is essentially a free-for-all. The only time the unit is closed to visitors is if we're doing surgery on the unit. We've even had parents insist on staying at their child's bedside while we were running a code at another bedside. (The flip side of that would be the mom who told me about an experience she had recently; her baby is in an isolation room with a wall of windows looking out on the unit. There was a code at the bed just outside the room and everyone forgot she was in the room and could see it all. It was very distressing to her and I advised that if it ever happened again - her child is one of our chronically criticals - she should just pull the curtains so she could ignore it all. But I digress.) Our unit secretaries don't bother to check with us to see if visitors are okay, and they don't make any attempt to keep an eye on how many people they've let in to see the same patient. We have the 2-at-the-bedside rule but that is generally ignored, especially by certain groups of people who, even when bluntly reminded of the rule, smile and stay right where they are. Our management makes no attempt to correct this behaviour except to send out the occasional weakly worded email about allowing families to stay during codes... Since we're a PICU, it seems that we HAVE to let parents and other family members have free access at all times of the day or night. Once when I had only just started on the unit, I had a teenaged MVC with spinal cord injury patient who wasn't being allowed to rest. She had a stream of family and friends in and out of her room until all hours. Her mother had mentioned that the girl seemed to not to be recovering as she should. I suggested she could benefit from a routine: up at the same time every day, predictable schedules for her treatments, to bed at the same time each night and no visitors after 10 pm other than mom. When I reported this plan in rounds the attending virtually tore me to shreds... "We CANNOT restrict family access to a patient!" So much for patient-focused care.

[cloister]

Our SICU is starting to rehash our visiting policy, which at this time is pretty much 24/7 with exceptions made for change of shift. The day shift deals with it more than those of us on nights, but we sometimes have visitors stay all night, camped in a chair at the bedside. I'm pretty laid back and don't mind most of the time, but there are times when the family needs to leave, either to benefit them or the patient.

I think some family members need for the nurse to be the heavy - They feel guilty leaving their loved one, but they really need to get away. I don't mind if they claim that I'm kicking them out. Hey, it achieves the same end, and assuges their guilt. I have teenaged sons, so I got used to being the Wicked Witch a long time ago. Blame me! Go away!

I don't have a real problem setting limits with families. Most of them seem to understand why they need to tone it down after I talk with them. Some, of course, never do get it, but they're the exception, not the rule. As I mentioned before, however, day shift has a more difficult row to hoe.

I will add that I once worked in a unit where a 10 minute/hr policy was strictly enforced. Frankly, we spent more time fighting with family members and enforcing the stupid policy than we did explaining what was going on. I hated the "us against them" mentality it fostered and I wouldn't want to go back to it.

[labcat01, BSN, RN]

Our unit is closed for change of shift and that's about it. I find that most of our families are pretty cooperative with a little sympathy and education. For example, most of my families know what kind of sedation their loved ones are getting and why. My personal philosophy is that we have to educate families and make them partners in their loved ones care. If I do that, then I get families that are MUCH more cooperative and better able to handle the changes and decisions that come.

A patient in the ICU may be "stable" but to their family members, it is still a catastrophe because they aren't used to this like we are. As someone that recently had a parent in the ICU, I know how much I appreciated being with my father every minute that I could. I would never deny anyone else the same courtesy provided that it did not interfere with patient care. Sadly, I know I am in the minority on my unit

Although we do get the occasional problem families....sigh!

[NotReady4PrimeTime, RN]

My own son was in PICU for seven weeks, and I can certainly understand parents' wishes to be with their child. What I don't get is the next-door neighbour's sister's babysitter coming to see the kid... that they've never laid eyes on before. I also don't get the need for the entire community to come to the hospital and camp out for days in our waiting room for a kid who will recover and never look back. Oh yes, that happens.

Labcat01, I hope your dad is on the mend and that your experience has brought you closer.

[leesespieces]

I definitely understand parents wanting to be with a child in the hospital. I think parents should be there. And I agree, I don't see the need for the whole community to show up. Thats the problem we had I referred to in my OP. For this one pt we had at least 40 people in the waiting room day in and day out with quite a few small children running around, it was completely inappropriate.

I also agree that educating the family can go a long way to putting the family at ease and ensuring some cooperation.

And certainly there are families that just don't get it no matter how many ways you explain something, unfortunately.

janfrn: I hope your son is doing better after his stay in the PICU

Labcat01: I also hope your father is doing well

[NotReady4PrimeTime, RN]

I definitely understand parents wanting to be with a child in the hospital. I think parents should be there. And I agree, I don't see the need for the whole community to show up. Thats the problem we had I referred to in my OP. For this one pt we had at least 40 people in the waiting room day in and day out with quite a few small children running around, it was completely inappropriate.

Maybe we work in the same hospital!

janfrn: I hope your son is doing better after his stay in the PICU

He's going to be 26 in less than a month. After he was discharged on June 26, 1989 (LOS 160 days) he has spent only 4 more nights in hospital, each separate admissions for same-day surgeries. (3 liver biopsies and a tendon release.) I graduated from nursing school 5 years almost to the day after we brought him home. He has his challenges but he's happy and healthy; the rest isn't important.

.

[dorie43rn]

We have the best visiting hours. 9am-930 12-1230 5-530 and 8-830.

I have been told that hospitals that have open visiting, and it works, are the ones that have management on the nurses side. Most hospitals cater to the pts family. One hospital I read about has an open door policy, but the nurse tells the family the rules, and if they don't follow, they are asked to leave and they have no one to complain to because mgt backs the nurse.

I for one am very lenient with my families unless they are disruptive, bossy, demanding or just plain mean, then out the door they go. I always remember I am the PATIENT advocate, not the families.

[RN1982]

I find the problem to be lack of consistency among the nurses. Some will let the family stay at bedside because the family is being quiet but that is against our policy. I make it a point when we get new admissions to the ICU to let family know that they cannot stay at bedside because the rooms are too small which they are and that they are welcome to stay in the waiting room overnight and come back periodically to see the patient under the discretion of the nurse. Some of my co-workers let the family do whatever, sleep at the bedside in folding chairs which is frustrating because we do have to do our job and part of it is NOT weeding through the family members.

[dorie43rn]

I do agree with you to a point. I refuse to kick out a wife whos hubby of 60 years will probably die that night and that is the last time she will see him. Who cares about visiting hours at that point? If it bothers other families, I just shut the curtain. I will not however let family members stay for non emergent reasons.

[RN1982]

There are exceptions to the rule. I wouldn't kick out a family member if the patient was dying. But I would have them leave if the patient was otherwise stable.