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.
The past few weeks, we have tried to identify how visitation effects our patients outcomes and staff moral/work satisfaction.
It has been hard to seperate the two.
However, on of the most difficult obstacles to this study is the deviation by some staff members from the visitation policies in each portion of the study....
When I was 6 years old, one of my uncles got into a serious motorcycle accident. He was in the ICU for about three weeks, never regained conciousness. At the time, NO kids under 13 were allowed to visit. We only saw this uncle a few times a year... and I don't remember him now.
I understand that at the time, it was thought that kids seeing very ill relatives would be traumatic-- but as the kid it was happening to, I thought that the nurses were big meanies who cared more about rules than they did about kids' feelings. Expecting a kid to sit quietly for hours in a waiting room (and getting yelled at by a surly receptionist for walking around) to me was more cruelty on top of not letting me see my uncle.
As I got older I began to understand the problems nurses have trying to deliver care while visitors are present... but my 6-year-old self got the message "You're only a kid, you don't matter."
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
the past few weeks, we have tried to identify how visitation effects our patients outcomes and staff moral/work satisfaction.
it has been hard to seperate the two.
however, on of the most difficult obstacles to this study is the deviation by some staff members from the visitation policies in each portion of the study....
any suggestions?
are you (or is anyone?) supporting the nursing staff as they are forced to deal with the onslaught of visitors? or are you leaving them to deal with it on their own? if a nurse is swamped and the family is getting in the way of patient care, is there a nurse manager, social worker, patient representative, chaplain or someone to take the family away from the bedside and/or provide them some support and allow the bedside nurse to take care of the patient? who ends up dealing with disruptive family members? the nurse who is also trying to care for two critically ill patients?
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[color=#4b0082]and if you're having visitors at the bedside more often, have you thought through what that means in terms of accomodations? have you provided chairs for the visitors to sit in, or are they co-opting the nurse's chair, leaving her to stand for 12 hours? (i could do that 25 years ago -- would have difficulty with it now.) is there someplace for the visitor to hang their coats? set their purses and packages? or are they covering every available flat surface, leaving no place for the nurse to set a dinner tray, a medication administration record or a med to be crushed, mixed or drawn up? is there adequate space for the nurse to get around the visitors to the bedside nurse server, the sink, the bedpan hopper?
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[color=#4b0082]as long as the visitors create more work and worse working conditions for the bedside nurse, they're going to resist more visitors. i know this comes as a tremendous surprise to nurse managers. aacn has spoken and increasing visitation is the way to go. so why won't those lazy nurses get on board with the program??? perhaps they're overworked, overwhelmed and overstimulated!
When I was 6 years old, one of my uncles got into a serious motorcycle accident. He was in the ICU for about three weeks, never regained conciousness. At the time, NO kids under 13 were allowed to visit. We only saw this uncle a few times a year... and I don't remember him now.
I understand that at the time, it was thought that kids seeing very ill relatives would be traumatic-- but as the kid it was happening to, I thought that the nurses were big meanies who cared more about rules than they did about kids' feelings. Expecting a kid to sit quietly for hours in a waiting room (and getting yelled at by a surly receptionist for walking around) to me was more cruelty on top of not letting me see my uncle.
As I got older I began to understand the problems nurses have trying to deliver care while visitors are present... but my 6-year-old self got the message "You're only a kid, you don't matter."
I have to respond to that. I read stories like that fairly often, and as cold as it sounds, I'm tired of pro- "no unlimited visiting time" people acting as if the rest of us never experienced grief and heartbreak and don't know what it's like.
I'd say that someone is quite lucky to not have experienced loss of a loved one because most of us have.
I'm tired of the old "it's all about the patient" and "the family needs to be supported and not ignored when crisis strikes" rhetoric.
The reality is that a nurse needs to be focused on the patient and their immediate medical needs BEFORE any of this other fancy "family dynamics" stuff.
2 ICU patients is plenty for one person to handle. All of the crying, screaming, family drama can and has caused nurses to miss the big stuff, and no, we can't do it all, taking care of the patient and all of the family drama.
I understand how your perspective was at the age of 6, but if it were me in the ICU, I would want my nurses vigilantly focusing on me getting out of there alive, not worrying about whether or not they hurt my 6 year old nephew's feelings.
When someone gets critically ill, it quickly becomes all about the individual family member and how it affects them personally, and the attention quickly moves away from the patients themselves, both by the nurse and the family.
It wasn't a case of "Uncle Rudy needs to rest so he can get better"... Rudy was not going to be leaving the hospital alive, they knew that after the first week. After three weeks, the hospital told my aunt that they were shutting off his life support... I don't understand in that case why visitors were even a problem since the situation couldn't possibly have been made worse by people being in his room.
Someone who is brain-dead and on life support is WAY different than someone who has a chance at recovery. It would have been understandable to be kept out of the room if Rudy was getting better.
Excellent posts Ruby and RN34TX...agree 110% and would love to work with both of you from your postings here. :)
Only wish our managers would LISTEN to our concerns, and that all nurses would stick together on this instead of caving to appease obnoxious familywho are increasingly making our workload even more stressed to the point of dangerous for patients..
I too have had to intervene, many many times sadly, on behalf of a coworker's crashing patients because they were allowing family to monopolize their time and attention. I've had to call codes for them while they're dealing with obnoxious, entitled family. This should NOT happen and I blame managers and administrators first and foremost.
I would like to expand on RN34TX's excellent comments and add:
Any ICU nurse who doesn't prioritize their care on their patient doesn't deserve to be in ICU; they need to work elsewhere IMO. The ICU patient deserves to be #1 priority at all times: that is why they are in ICU afterall.
It wasn't a case of "Uncle Rudy needs to rest so he can get better"... Rudy was not going to be leaving the hospital alive, they knew that after the first week. After three weeks, the hospital told my aunt that they were shutting off his life support... I don't understand in that case why visitors were even a problem since the situation couldn't possibly have been made worse by people being in his room.
Someone who is brain-dead and on life support is WAY different than someone who has a chance at recovery. It would have been understandable to be kept out of the room if Rudy was getting better.
That's understandable in your particular situation where your loved one wasn't going to get any better. People do need closure and I don't think that anyone is debating that. But I'm also not sure of exactly what your family was expecting at that time.
What I mean is, even in a "brain-dead" patient, DNR, what have you, you still can't have the ICU turning into a zoo where the family wants to come in 8 at at a time to say their goodbyes.
To refuse you because of your age alone was probably not appropriate by today's standards, not sure how old you are, but I was 6 in the 1970's and it it was perfectly acceptable to refuse kids in ICU then and it was considered to be more damaging to have someone that age witness ICU patients and events. Tough call sometimes.
Excellent posts Ruby and RN34TX...agree 110% and would love to work with both of you from your postings here. :)
Only wish our managers would LISTEN to our concerns, and that all nurses would stick together on this instead of caving to appease obnoxious familywho are increasingly making our workload even more stressed to the point of dangerous for patients..
I too have had to intervene, many many times sadly, on behalf of a coworker's crashing patients because they were allowing family to monopolize their time and attention. I've had to call codes for them while they're dealing with obnoxious, entitled family. This should NOT happen and I blame managers and administrators first and foremost.
I would like to expand on RN34TX's excellent comments and add:
Any ICU nurse who doesn't prioritize their care on their patient doesn't deserve to be in ICU; they need to work elsewhere IMO. The ICU patient deserves to be #1 priority at all times: that is why they are in ICU afterall.
JMHO.
Thanks Mattsmom!!
But keep in mind that I think that we have a bond due our both being permanently damaged from the evil doings of the big "K" hospitals in DFW.
Most of my bad experiences are taken from my employment there where visitors were just plain out of control and basically ran the place.
No ICU is going to be completely drama free and that's just the nature of the work, but at least where I work now visitors do have to follow rules and instructions and that includes leaving when asked to leave by the NURSE, no questions, no threats to call administration.
We do not just threaten to call security if things get out of hand, we actually do it and people do get escorted out. Very rare if that has to happen but we make it very clear in the beginning of what is expected of people when they visit.
Oh yes and don't forget about our MN connection as well in addition to the big "K" thing in DFW.
Yes I've noticed we have some similarities in our backgrounds RN34TX! I believe our experiences do make us who we are as people and as nurses; whether we've seen unfair practices or not, whether we or a friend has been grossly wronged by the healthcare system or if we've only seen fair practices, if we've worked in union environments then go to a nonunion/employment at will areas... it all figures in doesn't it.
I have been a critical care nurse for 25 years. I am definitely against open visitation in a critical care unit. I am in the process of leaving the unit environment because of this. 1. visitors gawk at other patients while strolling through the unit to visit their family. 2. they interfere with patient care. 3. patients do not receive the care they deserve because family is in their scrutinizing all that you do, so we stay out. 4. the presence of visitors in the unit creates havoc. example-- one visitor became hostile because a nurse said her mothers rhythm was tacky... I am so disappointed in this new concept. My young manager says its a generational "THING" she believes in visitors at all times.
I have been a critical care nurse for 25 years. I am definitely against open visitation in a critical care unit. I am in the process of leaving the unit environment because of this. 1. visitors gawk at other patients while strolling through the unit to visit their family. 2. they interfere with patient care. 3. patients do not receive the care they deserve because family is in their scrutinizing all that you do, so we stay out. 4. the presence of visitors in the unit creates havoc. example-- one visitor became hostile because a nurse said her mothers rhythm was tacky... I am so disappointed in this new concept. My young manager says its a generational "THING" she believes in visitors at all times.
It is NOT a generational thing, it's a "I'm a manager now" thing.
I've been a nurse since my mid-20's and I'm 34 now, still probably younger than most ICU managers.
I didn't appreciate being scrutinized and abused by family members when I was a new nurse either, the only difference was during my first couple of years I busted my hump trying to please them in every way possible. I genuinely thought that how pleased family was with you was a reflection of how good of a nurse you are.
A few hundred never-to-be-satisfied families later, I learned my lesson.
bfjworr
66 Posts
The past few weeks, we have tried to identify how visitation effects our patients outcomes and staff moral/work satisfaction.
It has been hard to seperate the two.
However, on of the most difficult obstacles to this study is the deviation by some staff members from the visitation policies in each portion of the study....
Any suggestions?