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.

[GucciRN22]

it's so frustrating when i'm in a pt's room and trying to hang gtts that were just ordered, do my assessment, etc with three family members in the room!! the only time i think that people should be allowed to stay (and that's a spouse) is when there's someone who probably won't make it through the night cause i just couldn't bring myself to kick them out.

this yelling at sedated patients, staying all hours because another rn allowed it, etc is totally obnoxious! we're a "locked" unit, but if the doors happen to open, for someone who works at the hospital, the visitor just walks right in and next thing you know, there's another person at the bedside. then they want an update, etc, etc, etc....gosh, i sound horrible, but it gets so irritating when there are rules (and yes, our hospital technically has visiting hours) that aren't followed!

[dorie43rn]

My daughter works in an acute care long time setting where families are there all the time. She is generally a calm, nice person, but one day recently she had it with one particular family. Because they had two daughters who were CNA's (we've all met these kind) they felt they could dictate their mothers care to my daughter. My daughter put up with this for awhile then stated, "If you actually think you can do better, take your Mom home.) She regretted this immediatly fearing for her job, but the family actually came out and appoligized and said they were glad she put them in their place!

[RN1982]

too bad we can't say stuff like that.

[ksail2000]

Dealing with patient families in the Intensive care units can be your most challenging and frustrating skill. Its important to remember that your patient's family IS your PATIENT TOO! It makes your job more difficult and tiring yes, but that is why we only have two patients. If you do your best to educate, comfort and get to know your families believe me, they will be your best asset and helpers. HOWEVER, if you ignore them, they can be your worst nightmare!

Take the time to introduce yourself, sit down with them and answer their questions. Orient them to the unit and the patients plan of care.. Once you have established a trusting relationship with them they will do anything you ask.

There are times that you need peace and quiet in the pt's room so you can concentrate and not make errors; and that is just what you tell the family," Listen guys, I need to concentrate here so I can do the best for your family. Can you go for a walk or go to the waiting room for ....time?" Believe me, Eleven years of ICU nursing has taught me, the better your family trusts you the easier your job will be!

GOOD LUCK! and lots of love from FLORIDA!!

Karin

[Reno1978, BSN, RN]

We have open visiting hours, so there's no restriction on the number of visitors or the time of day they arrive/leave. I haven't had any major issues. Sometimes I've had patients whose entire extended family show up and although they're not awake, their HR, RR, BP increases from all the stimuli from noise. I usually point this out to the family members and ask them to be quiet or to visit in our waiting room. They usually can't argue with the fact that there are really sick people in the ICU and they need an environment that promotes rest and healing, not noise.

[I_LOVE_TRAUMA, RN]

In my opinion, I think it should be individually based, and depend on how the pt is reacting to it. I think that there are times when the family needs to go!n However I also feel that part of our job includes caring for the walking wounded (AKA-the family). I would also like to add that if the patient was one of my 3 kids I would like to try to see if you could get me to leave the room! However I would never get in the way of care, although I may ask questions/offer opinions.

[RN1982]

Had the best family the other day. Patient was admitted two hours prior to my shift from OR. I gave the wife and daughter the phone numbers to the unit and our voicemail system. She said absolutely no visitors after she leaves, the patient needs rest and that I shouldn't have to deal with them and should just be focused on taking care of her husband. I thought wow, would be nice if most families understood that.

[Ruby Vee, BSN]

i've worked in facilities with open visitation, and i've worked in facilities with locked icus. i've worked in places where management backs the bedside nurse, and i've worked in places where the family rules and management basically gives them whatever they think they want. i've worked in large, inner city teaching hospitals and i've worked in smaller community hospitals. i prefer locked icus -- especially in large, inner city teaching hospitals but open visitation can work. it can work if management supports the bedside nurse, if whatever rules that do exist are uniformly enforced and if families tend to be calm, supportive and respectful of the healthcare staff. unfortunately, that combination is exceedingly rare. what we have where i work right now is a large, inner city hospital used by members of several rival gangs (with all the drama you might expect), no visiting hours, rules enforced at the whim of the nurse at the bedside at this particular moment, and management that bends over backward to suck up to anyone who claims to be family. it's a disasterous combination, and i could tell stories . . . .

[organichombre, ADN, BSN, MSN, LPN, RN]

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?

[pebbles, BSN, RN]

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!

[2bnursenikki82]

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!

[chani]

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