hi...i just found this site yesterday....it looks like a great way to get to know people and find out current opinions about nursing issues....
i am currently working in a busy community hospital in a 12 bed icu....
we have visitation issues....our unit use to allow family in to see patients indiscriminately....then limited visitation fro 11 - 4 am and 8 - 10 pm. family members are getting use to these hours but we still have many problems.....
would like to get other opinions.....
do you think their is a relationship between family presence in the icu and positive outcomes fro confused and ventilated patients?
do you think the length of stay is decreased because of family presence?
are the incidents of injury reduced by family presence?
how often do you use restraints? do you find you need restraints less when family are allowed more visitation?
do you have open visitation?
ths is a hot topic in our unit....many nurses think visitors interfere with patient care....others think they are helpful....but i believe each situation should be looked at individually - not all situations can be treated the same way.
daddy starts breathing faster and sets off the high rate alarm. co workers sigh and glare at the nurse.
DADDY WHATS WRONG? WHATS WRONG DADDY!!!NURSE SOMETHINGS WRONG! HE CAN"T BREATHE! HE'S NOT BREATHING!!! I KNEW I SHOULDN'T HAVE SAT IN THE WAITING ROOM WHEN DAD NEEDS ME HERE!! HE NEEDS ME! ONLY I KNOW HIM! HE'S GOT TERRIBLE ANXIETY AND ONLY I CAN CALM HIM DOWN!!! DADDY YOU'VE GOT TO CALM DOWN!! OMIGOD HE'S NOT GETTING ENOUGH OXYGEN!!!!
by the time visiting time [15 minutes] is over, daddy is bucking the vent and setting off alarms constantly.
and thats all i have to say on the matter of "open visitation"
Great story!!
That is all too familiar of a scenario repeated over and over in my own and every other nurse or RT I've ever worked with who deals with vent patients on a daily basis.
I don't know about the rest of you, but I'm getting a little tired on this thread of those who are for open visitation 24/7 acting like stories like this are the tiny minority and the vast majority of family members are helpful and therapeutic and how it's "not about us it's all about the patient."
Yeah, that's real therapeutic family dynamics and support for the patient.
When the family member walks in, it's all about them, not the patient, make no mistake about it.
Example: How many times do family members end up fighting over issues that have nothing to do with the patient themselves or their medical needs while standing over the bed? Oh yes, those of you who are for open visitation are going to say "hardly ever".
Who do we nurses end up busting our humps attempting to please and serve once the family walks in? The patient? Think again.
That is all too familiar of a scenario repeated over and over in my own and every other nurse or RT I've ever worked with who deals with vent patients on a daily basis.
I don't know about the rest of you, but I'm getting a little tired on this thread of those who are for open visitation 24/7 acting like stories like this are the tiny minority and the vast majority of family members are helpful and therapeutic and how it's "not about us it's all about the patient."
Yeah, that's real therapeutic family dynamics and support for the patient.
When the family member walks in, it's all about them, not the patient, make no mistake about it.
Evidence: How many times do family members end up fighting over issues that have nothing to do with the patient themselves or their medical needs while standing over the bed? Oh yes, those of you who are for open visitation are going to say "hardly ever".
Who do we nurses end up busting our humps attempting to please and serve once the family walks in? The patient? Think again.
It does seem like we need some sort of compromise....some institutions have so little visitation...when my father was in an ICU in Oklahoma City... we were only allowed to see him three different times a day....for half an hour...if we weren't there at that time... it was our tough luck.... and of course doctors were never around during visiting times....
24/7 is way to open according to the majority of posters....
our facility will have a 4 week trial of open visitation except for the hours between 7 am and 9 am.... and 7 pm and 9 pm...this will give famiiles access to times when the doctors are rounding....
We have predicted that some doctors will change their patterns of rounds to those times when visitors are not present....
It is sure going to turn the unit upside down for a month to say the least...
Great stories above..ones we can all relate to if we've been doing this awhile I'm sure. But...the talking heads on the AACN board have spoken...the damage is done... the politically correct powers that be will soon have 24-7 open visiting the standard. Regardless of what experienced bedside critical care nurses have to say about it.
I would love to see ICU nurses stick together on this issue, but like other nurses, they tend to cave as a group. It takes less energy, after all, to just let everyone else have their own way.
I have watched patients deteriorate to coding with nurses frantically trying to appease family members to the point they didn't NOTICE their patient's vital signs status.
I've also had nurses allow their 6 family members to stand outside MY patients room gawking at MY patient half the night and keeping them awake...and I've been the bad guy when I objected. (My patient was claustrphobic and couldn't tolerate a closed door)
So...part of the problem is WE can't agree on what the priority is.
well i work in a hospital my self and i feel different then you do about this topic. this topics hits a lot closer to home for myself simply because we had a recent situation with a family member of my own. my aunt was admitted in to the icu unit here in florida and we were very very restricted to see her. it later became a huge problem where the charge nurse was involved and other upper management from the hospital. all i can say is that yes every situation is different, but in our case our aunt was dieing and we did want to be there with her in her last moments of life. it was very difficult being told we could not; because we would be in the way. but you know what unless you are personally in there shoes you'll never know what it is like sitting in the waiting room while your loved one is dieing in the other room and you can not do anything for them. it's terrible. and i believe that being in a situation like that, one should not be restricted to see your loved one. my advice to your unit is that perhaps the problem could be in how you deliver the message to the family members that have there loved ones in the icu unit as well as the level of proffessionalism, and the sicerity of how you deliver the message. for me and my family our experience was a horrible one. it was more difficult to swallow for my self because i work in the field and i was not use to my hospitals treating people in the nature that we were. so it really saddened me. all nurses have to remember that yes there is a job to be perfomed but ultimately we are all there for the patient and the family, and to many times i have personally seen nurse get to wrapped up with the fact that it is a job and that we lose sight of what we stand for. and how family's wheater they realize or not do look to us for comfort and some type of healing during such a difficult time. it's allready hard enough to lose some one you love. what sounds better . im sorry but you can not come to visit unless it is visiting hours. or sir or mam i understand that you would like to spend some time with your family at this moment, but we have incorporated a visting schedule so that we can provide the best care for yours and all patients that are in this unit. i understand your frustration, im sorry that your family member is even in here with us i understand your fears of not knowing. but let see me what i can do for you, if nothing let me get you at least an update on there condition. i believe the second response is way better then coming across cold or unproffessional you know. because you may have been in the field for a long time but for evey family that walks thru those icu unit doors it is many times there first time and i believe we lose sight of that and that's when all the complications come in. for me and my family we will always remember what we went thru at the hospital where my aunt was at. she later died but lucky enough for us she died at home because ultimately she wanted her family by her side no matter what. for me i feel that we have been permanantly marked by this facility. now when we look back we remember her but along side of that we have been given the grief from the hospital that will never be forgotten. i truly believe that the best medicine for an ill patient is there loved ones by there side and we should honor that and respect that. thanks for your time. jay jay
hi...i just found this site yesterday....it looks like a great way to get to know people and find out current opinions about nursing issues....
i am currently working in a busy community hospital in a 12 bed icu....
we have visitation issues....our unit use to allow family in to see patients indiscriminately....then limited visitation fro 11 - 4 am and 8 - 10 pm. family members are getting use to these hours but we still have many problems.....
would like to get other opinions.....
do you think their is a relationship between family presence in the icu and positive outcomes fro confused and ventilated patients?
do you think the length of stay is decreased because of family presence?
are the incidents of injury reduced by family presence?
how often do you use restraints? do you find you need restraints less when family are allowed more visitation?
do you have open visitation?
ths is a hot topic in our unit....many nurses think visitors interfere with patient care....others think they are helpful....but i believe each situation should be looked at individually - not all situations can be treated the same way.
I am sorry you had a difficult time at this hospital. Please do not judge us based on your one poor experience. No one on this board disagrees that there are exceptions to every rule and sometimes there are not. A patient that is dying is always the excpetion, no questions asked. At least once a week I have family members make my job a lot harder by stressing out the patient or increasing their anxiety level by "helping". All I can do is ask them to leave since visiting hours are never over. It will be curious to see if your opinion changes when you become a nurse. Good luck with the studies!
hi...i just found this site yesterday....it looks like a great way to get to know people and find out current opinions about nursing issues....
i am currently working in a busy community hospital in a 12 bed icu....
we have visitation issues....our unit use to allow family in to see patients indiscriminately....then limited visitation fro 11 - 4 am and 8 - 10 pm. family members are getting use to these hours but we still have many problems.....
would like to get other opinions.....
do you think their is a relationship between family presence in the icu and positive outcomes fro confused and ventilated patients?
do you think the length of stay is decreased because of family presence?
are the incidents of injury reduced by family presence?
how often do you use restraints? do you find you need restraints less when family are allowed more visitation?
do you have open visitation?
ths is a hot topic in our unit....many nurses think visitors interfere with patient care....others think they are helpful....but i believe each situation should be looked at individually - not all situations can be treated the same way.
thanks for your opinions :) :) :)
first i'd like to say that even if situations should be looked at individually, you can't change policy according to the dynamics of each family.
having said that, i think theoretically open visitation sounds like an ideal, esp with the probability of pt responding positively to their family. or it can also make the pt more anxious since they feel comfortable enough to express their fears. so that can go either way.
i don't believe in open visitation as i think the potential of certain family members can take time away from the pt since the nurse is answering all their questions and addressing their concerns.
this past december my mom was in the icu- she had sepsis secondary to an adverse reaction from chemo. the icu nurses were awesome; they knew i was a nurse so i didn't have much to ask. she was on a ventilator, vasopresors and 4 different abx. she was also unresponsive. the only thing i told the nurses is that i felt her pain to be poorly controlled. but other than that, they let me do am care; one of them had me change her central line dsg. and i had little to say. i went back home and a few days later, received a call stating mom had taken a turn for the worse. and i was shocked at what i saw....she had ascites, looking like she was 7 months pregnant and her arms and hands were extremely swelled. her temp was 104; her wbc was under 10. so it was decided to stop all treatments. the nurse started a morphine drip, which worked beautifully; then she disconnected all iv's and extubated her; the nurse had no problem with me being there. the nurse then scooted mom to one side of the bed and i climbed in and held her. i would look at the monitor every now and then while mom just gently snored. 50 minutes after stopping everything, her vitals were all going down on the monitor and 5 minutes later, she took her last breath....very peaceful.
but in the next room there was this woman who was bullying the nurse, tellling her she'd better not do this or she'll have her license. the pt was an older male so i assume it was her dh. and her voice was loud and angry. so even if one could understand that this woman was upset and her anger displaced, the nurse just does not have the time to try and explain everything she's doing and why. so i think there could potentially be many anxious family members and the nurse shouldn't have to deal with the family- she needs to focus on her pt. and these nurses don't stop. and that is why i don't think open visitation benefits the pt or the nurse. i think they should have ltd. visitation policies and if a family member turns out to be helpful or non-intrusive, then the rules can be bent...just my .02.
Our own icu also makes exceptions for patients who are dying.... I have been in that same situation with my father....and the hospital did not make exceptions for my family...... we also make an effort for those who can be made DNR to have those patients moved to the floor where visitation is much more lenient.... However, obtaining a DNR can be difficult at times.... and then there is the census to contend with.... even when we downgrade our patients...we find many times there are no beds available to move them too....
You were very fortunate to have had shared a beautiful , dignified death with your mom, I assume that because you are a nurse, you know it can be a challenge with families, and was very helpfu in your mother's care. She was very fortunate.
Peolple who are untrained, or who have been guided only by what uncle joe or the media has stated is appropriate care are much less fortunate. I equate it to being much like dealing with an adolescent child. They are afraid and looking for guidence and answers,while at the same time trying to show they are in control of the situation. And as we have all seen, some are able to do this with respect,others are not, but in most situations it is love and fear that are driving these families.
I still maintain that we need to alow the families in at the bedside. I always set strong guidelines as to behavior expected, I address fears and concerns. I also let them know that I have another sick patient or may have to assist another nurse with a patient, and want to be able to provide the best care possible to the other pt as they want for their loved one. I have dealt with the Jerry Springer families, the drunken families, the victims and the perpitrators, and I can wholehaertedly say, although I don't always LIKE the families, I will always try to allow them to be with thier loved ones. My number one rule, I need to be able to allow this pt to rest, and provide the care neccesary, if I am able to do that, the family may stay.
I am fortunate I am not on the other side at this time, I have been and wish I had been given they opportunity to be with my son.
hi...i just found this site yesterday....it looks like a great way to get to know people and find out current opinions about nursing issues....
i am currently working in a busy community hospital in a 12 bed icu....
we have visitation issues....our unit use to allow family in to see patients indiscriminately....then limited visitation fro 11 - 4 am and 8 - 10 pm. family members are getting use to these hours but we still have many problems.....
would like to get other opinions.....
do you think their is a relationship between family presence in the icu and positive outcomes fro confused and ventilated patients?
do you think the length of stay is decreased because of family presence?
are the incidents of injury reduced by family presence?
how often do you use restraints? do you find you need restraints less when family are allowed more visitation?
do you have open visitation?
ths is a hot topic in our unit....many nurses think visitors interfere with patient care....others think they are helpful....but i believe each situation should be looked at individually - not all situations can be treated the same way.
thanks for your opinions :) :) :)
i work for a hospital with apprx .9 specialized icu's....i work in the micu...it's busy....we have a high acuity...and i don't think families should be allowed to stay in the icu 24/7........some of the icu's in my hospital have changed their policy to open visitation....mine hasn't been "made" to do it yet and i really don't see how it can be done......what we do is have the limited visitation....then at the nurse's discretion...we can let family members stay...we always let family stay when someone is dying....by doing this...you can keep the springer rejects out...and let others who don't cause a problem stay......we are very busy and have too much going on to have an extra person in the room.....we have vents...crrt...iabp....heating or cooling blankets ....tons of drips....tons of lines....sometimes the iv poles look like christmas trees....we do bedside procedures.....you all know what it's like....i hate when i have to climb over people to hang a drip or fix the pump...get to the vent...plus....these are really sick people... it's not really in the best interest to let family stay in the room for their own safety...who knows what they can pick up....you know the families that come in during visitation who are constantly running out of the room...."i think daddy is trying to tell me something"....."i think mommy wants moved up in the bed"...."i think her arm hurts"...."this thing on the monitor looks different than yesterday".....can you imagine them in the room all day... i'd pull my hair out....my favorites are the "internet searchers"...the ones who write down all the drips then look them up and call back to tell you all the side effects and maybe it's cauising such and such to happen...they also like to look up the diagnosis and of course the internet always gives the worse case senario....these are the types of freaks you don't want in the room all day...
You were very fortunate to have had shared a beautiful , dignified death with your mom, I assume that because you are a nurse, you know it can be a challenge with families, and was very helpfu in your mother's care. She was very fortunate.
Peolple who are untrained, or who have been guided only by what uncle joe or the media has stated is appropriate care are much less fortunate. I equate it to being much like dealing with an adolescent child. They are afraid and looking for guidence and answers,while at the same time trying to show they are in control of the situation. And as we have all seen, some are able to do this with respect,others are not, but in most situations it is love and fear that are driving these families.
I still maintain that we need to alow the families in at the bedside. I always set strong guidelines as to behavior expected, I address fears and concerns. I also let them know that I have another sick patient or may have to assist another nurse with a patient, and want to be able to provide the best care possible to the other pt as they want for their loved one. I have dealt with the Jerry Springer families, the drunken families, the victims and the perpitrators, and I can wholehaertedly say, although I don't always LIKE the families, I will always try to allow them to be with thier loved ones. My number one rule, I need to be able to allow this pt to rest, and provide the care neccesary, if I am able to do that, the family may stay.
I am fortunate I am not on the other side at this time, I have been and wish I had been given they opportunity to be with my son.
hi pamaza,
my first question would be is how come you weren't able to be w/your son? i'm assuming he was in icu and you couldn't see him at all?
as for your comment about allowing families to stay provided the pt. can get some rest and provide the necessary care, i still don't believe the pt. is getting the rest they need with family members at their side 24/7. the icu is such a busy place atc, and the lights aren't dimmed at noc, i would find it next to impossible for a patient to get rest...what about these jerry springer families, how do we know that the pt. even likes some of the family members?
perhaps because you couldn't be with your son is the reason why you're for open visitations.....that would be understandable.
speaking as a hospice nurse, i just want my patients to rest. and families will stand vigil around the pt.....and trust me when i say the pt is glad when i've sent family members home.. more often than not, the pt. purposely waits for the family to leave, they thank me and then they die typically within a half hour. i've seen this dozens of times. so whether we know it or not, it would seem that often families can be more of a hindrance as they cause the patient anxiety, which is so contradictive of the rest we all advocate for.
now if the pt in the icu requested to see someone, then yes, go get that person. but i just can't assume that all these people that visit are necessarily close to the patient.
with my mom, i saw people coming in that were neighbors, people from work....i told the nurse i didn't want that as my mother would never want to be seen like that. so the nurse told these people mom needed to rest. thank God for these nurses. they were awesome; and they listened to my input. and there was a meeting with 2 doctors, mom's dh, myself and one of the nurses to give report. one of the doctors was pressuring my stepdad to wait and see. my stepdad was too distraught to even speak and it had been decided the noc before that i was to make any and all decisions- so when i put my foot down to this bullying doctor, he retorted that i wasn't even poa. and i said that stepdad gave me permission to make all decisions and i wanted everything stopped today. the doctor turned to my stepdad and said is that what you want? and he said yes. and then i told the doctor how dare he bully and intimidate a man that was clearly vulnerable. :angryfire
meeting over and the nurse told me i made the right decision. and if mom died 55 minutes after being taken off the ventilator and all lines stopped, it just goes to show you how close to death she was.
sorry for getting side-tracked- she died on 12/19 and sometimes the grief gets worse rather than better.
but as it stands, it looks like that open visitation is going to be the policy in many hospitals. and i don't think they're looking at the big picture.
we also make an effort for those who can be made DNR to have those patients moved to the floor where visitation is much more lenient.... However, obtaining a DNR can be difficult at times.... and then there is the census to contend with.... even when we downgrade our patients...we find many times there are no beds available to move them too.... 
RN34TX
1,383 Posts
Great story!!
That is all too familiar of a scenario repeated over and over in my own and every other nurse or RT I've ever worked with who deals with vent patients on a daily basis.
I don't know about the rest of you, but I'm getting a little tired on this thread of those who are for open visitation 24/7 acting like stories like this are the tiny minority and the vast majority of family members are helpful and therapeutic and how it's "not about us it's all about the patient."
Yeah, that's real therapeutic family dynamics and support for the patient.
When the family member walks in, it's all about them, not the patient, make no mistake about it.
Example: How many times do family members end up fighting over issues that have nothing to do with the patient themselves or their medical needs while standing over the bed? Oh yes, those of you who are for open visitation are going to say "hardly ever".
Who do we nurses end up busting our humps attempting to please and serve once the family walks in? The patient? Think again.