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.
Our critical care unit initiated an open visiting policy at the first of the year. In my view, it has negatively impacted our ability to deliver care.
It is interesting to note that the referenced/linked article extolling open visiting policies was not written by a bedside critical care nurse, nor was it clinical research; Indeed, it was not written by a nurse at all. The author is associated with Press-Ganey, the well known patient satisfaction survey folks. It seems that they found that restricted visiting in ICUs was a source of patient dissatisfaction among 30-40% of the respondents. Health leaders in their infinate wisdom disregarded the inference that a clear majority of their respondents had absolutely no problem with the policies as they were. Presumably, these status quo folks had valid reasons for answering as they did, but no matter.
Our open visiting policy was instituted corporate-wide, top-down under the "patient focused care" banner. But clearly, if the Press-Ganey percentages apply to our system/facility, we aren't focusing on all the patients and families, or even the majority---- only the complainers. Sadly, consideration to the ramifications of open visitation will only occur when they are reflected in declining facility loyalty numbers.
What are those ramifications? All one need do is read this thread for starters: Increased environmental noise, decreased confidentialty, decreased REM sleep, decreased security, decreased infection control, increased equipment tampering, increased staff interruptions/distractions, decreased employee satisfaction etc. etc. In it's zeal to pacify patient A's disappointment that their 5 year grandaughter could not visit previously Management neglected to consider that patient B might not appreciate a 5 year old's squeeling at the top of their lungs, or their uninvited appearance while attempting to use the bedside commode.
One might argue that these negative byproducts are in no way inevitable...... The "If only the nurses would announce and enforce the rules consistantly everyone would be happy" mindset. Were it that easy. I noticed with some amusement that many hospitals are now relaxing their no cell phone policies; according to the article I read, the health leader's explanation (paraphrased)was that the rules were so blatantly ignored by the public, surely there would have been more patient deaths/incidents if they posed a significant threat. Plus trying to enforce the rules just made the public mad. So let's just make them happy.
Frankly I believe the all or nothing approach is fatally flawed. I believe that experienced professional nurses are capable of implementing flexible visiting policies which truly reflect the wishes of the individual patients/families, yet are fluid as circumstances change, and do not disrupt the unit as a whole nor infringe on the rights of the silent/currently satisfied majority. That is, given appropriate support I believe we are capable of using good judgement in these and other matters. Of course that would mean giving up some control and placing more decisions at the bedside. Think that will happen soon?
Do you have any references regarding visitation open or closed to share with us?
Do any of you have policies for pet visitation in your ICU's? Our hospital does...and we have actually had a few pets visit our patients....it is amazing how little trouble they are compared to family members.... :)
Do any of you have policies for pet visitation in your ICU's? Our hospital does...and we have actually had a few pets visit our patients....it is amazing how little trouble they are compared to family members.... :)
We have a pet therapy program, but they are specially trained animals, not the patient's own (is that what you are referring to?) but not in ICU, just in Med-Surg and peds ... I personally would be really uncomfortable with pets in the ICU ...
I've often wondered how a visitation contract would work - is anyone doing this? We've done this with a couple of pts and have pretty good results. We just talk to the primary decision-maker - whether that is the pt or the next of kin and:
1- Designate one person we communicate new info to and ask everyone else to contact that person. That way we give the updates once and can avoid the same questions 50 times - and have a pat answer for anyone calling asking for an update.
2- The decision-maker makes a list of exactly who may visit and anyone else is not allowed on the unit. It takes the blame off of the nurses because we can say "I'm sorry, but pt X's wife has asked that we limit visitors." The nurse isn't the "bad nurse" for refusing entry.
3- Any concerns we have about a visitor or visiting frequency are addressed with the decision-maker -- with the explanation as to why we are concerned.
Of course, this all falls apart when the entire family unit is dysfunctional. However, I've seen it work really well when we've had some long-termers. It helps with HIPAA issues also because they've stated exactly who may visit -- and we are only giving info to the one person.
I note that it's funny how often the "wrong people" have tried to gain access or get info when we've used this contract. Phone call: "Uh, yeah...I'm such and such's sister. Can you tell me how he's doing?" When we tell "sister" that she needs to call wife, we get a response like "Right...uh, what's her name and number?". Happens a LOT with highly-publicized cases.
I've often wondered how a visitation contract would work - is anyone doing this? We've done this with a couple of pts and have pretty good results. We just talk to the primary decision-maker - whether that is the pt or the next of kin and:
1- Designate one person we communicate new info to and ask everyone else to contact that person. That way we give the updates once and can avoid the same questions 50 times - and have a pat answer for anyone calling asking for an update.
2- The decision-maker makes a list of exactly who may visit and anyone else is not allowed on the unit. It takes the blame off of the nurses because we can say "I'm sorry, but pt X's wife has asked that we limit visitors." The nurse isn't the "bad nurse" for refusing entry.
3- Any concerns we have about a visitor or visiting frequency are addressed with the decision-maker -- with the explanation as to why we are concerned.
YES! This sounds exactly like what we do with ALL of our patient's families. The bedside nurse never speaks to family on the phone. The charge nurse does that for us with a usually canned response unless it's the family spokesperson.
For our chronics (usually starting at one week always sooner with transplants), we also have multidisciplinary team meetings once a week to keep everybody updated. These meetings consist of one or two bedside nurses, a NM or assistant NM, one or two or more docs (different specialties), RT, PT, OT, dietary, the social worker, and a chaplin (if wanted) along with as many family who wish to attend (I know I'm forgetting someone).
Everbody has a plan. The plan is meshed into one big plan. The family is made to feel part of the plan and their input is greatly appreciated and integrated into the plan within reason and the understanding that decisions (including ICU operating policies) are deliberate and for the well-being of the patient.
I was SHOCKED when I found out that the hospital my dad had been in didn't have an interdiciplinary team meeting policy. He was there for FOUR months! No wonder I had to be there at 6am for rounds and stay almost 24/7 so I could catch a doc or a dietician or a physical therapist, or a respiratory therapist, or a social worker, or whatever to talk to! I frequently wondered if they even talked with each other?! I sincerely don't think they did. I think the only form of communication between the healthcare providers was through notes in the medical record.
I could go on and on about what I feel is wrong with the ICU staff:family relationship after reading all of these posts. I think I've said twice in this thread that there are those visitors and patients themselves who just have to be dealt with using extremely firm consistent boundaries, security, etc. I DO NOT deny that, and I've had my share (albiet rare).
I think that by management implementing policies like open visitation and reprimanding a nurse when a family complains is the result of a fear of litigation. Thing is, one of the most common reasons patients and families sue is because they feel uninformed of what's going on or that the healthcare team is hiding or keeping something from them.
People do have a right to know.
Instead of having a plan, and not just nurses but all areas of the healthcare team to truely educate the family, the bedside nurse in most places it seems gets the brunt of the visitor's angst and ends up being the scape goat with absolutely no support from management.
Be mad at management, not the families! Management enables visitors to walk all over nurses!
This thread makes it sound as though every visitor is PITA. I could not practice nursing under these conditions.
Also, it breaks my heart and I'm bothered that a student nurse would say this:
"...sorry but I don't consider it a nurses job to help out the family members."
Even though WE know hospital care is nursing care, to the patients and their families, it's doctor care and most people think ALL staff work under the doctor. It's always the doctor that people want to talk to.
I said ealier that it sounds like hospital management caves in to patients/family and they unjustly reprimand nurses when family complains, and they implement junk like open visiting in the ICU because they are afraid of litigation.
They are dysfunctionally trying to please the "customer." Instead of dealing with the real problem of why visitors or patients may act out, they put a bandaid on the larger problem of communication or lack thereof.
Here's what I'm talking about:
"What prompts patients to sue doctors or hospitals?
Four themes emerged from the descriptive review of the 3787 pages of transcript: deserting the patient (32%), devaluing patient and/or family views (29%), delivering information poorly (26%), and failing to understand the patient and/or family perspective (13%).
CONCLUSIONS: In our sample, the decision to litigate was often associated with a perceived lack of caring and/or collaboration in the delivery of health care"
These days people are told and encouraged to "speak up for yourself!" There are books, one book specifically that teaches families to be prepared to literally camp out in their loved ones hospital room around the clock to keep an eye on things, refuse to leave under the veil of being the advocate for their family member, how to be "assertive" and demand information or to speak with the doctor, and how to be suspicious of EVERYTHING (DANG, I wish I could remember the name of this book - I'll look for it).
With books like these, the attitude of "take control of your own health" (which is not a bad thing when applied properly) and the lack of concern that people feel the doctors give them, people will be aggressive and lawsuits will happen no matter what. Caving in to them does no one any favors, all the way around.
Customer satisfaction = less lawsuits. Bottom line.
So is what seems to be the perception of customer satisfaction by management (reprimanding nurses/open visitation) what the "customer" really wants? Or is it just an easy way out?
For our chronics (usually starting at one week always sooner with transplants), we also have multidisciplinary team meetings once a week to keep everybody updated. These meetings consist of one or two bedside nurses, a NM or assistant NM, one or two or more docs (different specialties), RT, PT, OT, dietary, the social worker, and a chaplin (if wanted) along with as many family who wish to attend (I know I'm forgetting someone).
I love this idea. My mind is already whirling on how it could be implemented in our unit. The first, big question that comes to my mind is how do you coordinate the doc's schedules. I foresee that the primary concern with our docs would be "I am in surgery all day" or "I don't have the time to stop for 20 minutes and visit with every chronic patient's family" in the unit". I'm thinking they'd almost need a block of time set aside. Then how to coordinate all the different services? Pulmonary might have a block of time available at a time completely different than surgery or renal or oncology??
That's a great question! I'm not involved with the scheduling part of these meetings, but you know what, I will find out for you. I don't return to work until Friday, but I will ask my nurse manager how all the schedules do get coordinated. There is one day of the week when our surgeons are not in the OR unless it's for an emergency. They have a day of conferences, etc. I find that these meetings are frequently on that day.
Well, this is an interesting subject. Personally I am extremely liberal with visitors ( while on our 14 bed SICU visiting hours are 9A.M. to 9P.M., individual nurses can go beyond that if they so choose) because I frankly put myself in their position and would personally want as much time as possible. While I have been burned a couple of times (neurotic visitors who insist on waking up their sleeping loved one so they can get that sleeping pill they asked for a couple of hours ago, for example); overall I do feel that visitors act as good advocates most of the time and do provide positive stimulation (again, most of the time). Have I conducted a double blind study to ascertain whether visitation improves pt outcome, no.
I'd put money on it, that statement comes from a new nurse. A few years and abusive families later, you will change your mind. I've been in that position and it's insulting that people assume that I've never been there and that's why I'm so insensitive to family needs.
Yes, there are great supportive family members out there, both to their loved one and the goals of the medical staff, but there are way too many out there that need control because they are out of control.
Wow you said it PJ Mommy! Everytime I read a nurse supporting open visiting I wonder where they work and what position they hold.
Well I work as a BSN in the region's biggest teaching hospital right smack in the middle of the ghetto. We get heart transplants, VADs, IABPs, bad heads (we are the level I trauma center for the area) and all other trauma. I think that except for the most neurotic cases which are few and far between, families can be managed with a little tact. Just my 2.
I guess what I'm trying to say is that I'd rather deal with the occasional jerk so that all the other nice families CAN visit than the opposite, which would be nice families not getting good access on account of a few bad seeds.
I'd like to know where you work too. I've worked around the country and have yet to find one hospital where problematic families are "far few and between."
How about when your patient is on a pressure controlled ventilator, on a nimbex drip, with morphine and ativan drips...and the family persistently tries to wake the patient...
Most families seem to understand once I have explained the situation, "If you were intubated like this, would you want to be awake?". HOWEVER, some family members either don't get it or don't care.
Another problem is families try to wake up sedated patients while they are on the ventilator or loosen or remove restraints while they are visiting and forget to replace them when they leave.
Our unit is hiring a customer service liasion to sit in the waiting room and talk with the families; act a go-between for families and nursing staff. I think it is a wonderful idea and I am sure it will help the day shift nurses since this is when the liasion will be working. What about night shift? Has anyone else heard of this type of position?
bfjworr
66 Posts
Do you have any references regarding visitation open or closed to share with us?