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.
It has been a continuous struggle for ICU nurses in the Dallas Fort Worth area of Texas (and other areas if one believes this BB) to maintain the AACN's optimal 2:1 ratio. I frequently encounter 3:1 as both staff AND agency, and have had problems getting the nurses to stand together to fight this, sadly. Someof our local hospitals and critical care managers have made it 'policy' that ICU nurses cannot refuse admissions...and nurses have gotten suckered into working dangerously like this. IMHO the care delivered is very poor in this situation, but because other nurses have accepted the liability, it becomes difficult for one nurse to say 'NO'. The higher ratio makes the push for open visiting even more intolerable and proves we will get what we accept, and if nurses won't stand together and say 'no more' this will continue..
You need to come work at my hospital in southeast TX and get out of DFW.
If admitting dept calls for a bed and say we have 1, 2, 3, 4, how many number of open beds BUT every nurse already has 2 patients each, we tell them that we are full and have no open beds. If they say "yes you do have open beds" then we say you need to send another nurse over here, then the beds will open up. That is a strict policy, 2 ICU patients per nurse, period.
I worked Med/Surg in Dallas where the policy was if there was a clean room, a patient could go there, regardless of staffing and that is way wrong.
I sometimes took 7 and even 8 patients without a CNA/PCT or unit clerk to help me out and it was unsafe and often stayed well past my shift to get things done. ICU not allowed to refuse admissions?
Just because you have a clean room doesn't mean that a patient should be placed there. I certainly wouldn't want to be an ICU nurse's 3rd patient or a Med/Surg nurse's 7th or 8th patient. I don't even think that they should have more than 5.
Maybe you are right and we do need to unionize, look at California.
Unfortunately, once you've taken those extra pts, a precedent is set. A couple of times, they've asked our nurses to take a second pt with a fresh heart -- maybe one that was a few hours out of the OR but still intubated. Even if it was a do-able situation, we've encouraged one another to say "NO WAY! I CANNOT DO THAT!". The problem as we see it is that once we've taken that second pt, then the next time they'll say "well we've done this before and it worked out well so you WILL take the pt".
I am a former burn patient and was in ICU. The restrictions were way to restrictive. I believe it was 1 visitor every 4 hours.
My parents went to the powers that be and told them I was a people person and they were killing me. The hospital relented as long as my vital signs were good.
I believe I got better much faster.
*A funny story is that the Greek Orthodox Bishop of Atlanta came to see me in ICU. He was elderly and supported by 2 other priests. Now if you have ever seen a Greek Orthodox Bishop...they have a presence! They wear long black robes, carry a staff, and have a huge medallion of Christ around their neck. Plus a giant hat. I heard the nurses looked at him amazed.
That is a strict policy, 2 ICU patients per nurse, period.
Just because you have a clean room doesn't mean that a patient should be placed there. I certainly wouldn't want to be an ICU nurse's 3rd patient .
I just wish the ICU that I work in had the policy of no more than 2 patients. On Thursday and Friday I had 5 ICU patients as did the other nurse. We had an aide until 1500. It was absolutely horrible. I went home both nights and crashed. It is dangerous and uncalled for. Hospitals need to start looking at whether it would be cheaper to require more nurses or to pay a malpractice suit. I have tommorrow off, so I will be job hunting.
Specializes in Obstetrics, perioperative, Infection Con.
Sorry for the strong language, but has any of you ever had a family member in ICU? It is an incredible hard thing to deal with. My father died in ICU in The Netherlands last May, the hardest thing I have ever had to deal with. The unit was locked, but we where welcome at any time just by calling in (even when he was considered stable).
I know the family can be a pain in the behind in the ICU, ever thought some of them are because they are beyond coping? Being a nurse I could hardly handle it, but with the help and compassion (ever heard of compassion?) of the nursing staff we managed to keep things together and make the correct decission.
Sorry but this thread has me just fuming!!!! :angryfire :angryfire :angryfire
Sorry for the strong language, but has any of you ever had a family member in ICU? It is an incredible hard thing to deal with. My father died in ICU in The Netherlands last May, the hardest thing I have ever had to deal with. The unit was locked, but we where welcome at any time just by calling in (even when he was considered stable).
I know the family can be a pain in the behind in the ICU, ever thought some of them are because they are beyond coping? Being a nurse I could hardly handle it, but with the help and compassion (ever heard of compassion?) of the nursing staff we managed to keep things together and make the correct decission.
Sorry but this thread has me just fuming!!!! :angryfire :angryfire :angryfire
Marijke
Marijke,
Sorry about your father. I have never had a family member in the ICU, I often try to imagine what it would be like so that I can be more compassionate for their families. I don't have a problem with visitors in the ICU...I have a problem with the lack of respect that these visitors show to the nurses and the lack of support from management when we have problem visitors. Because you are a nurse I am sure you recognized the importance of letting the nurses work with your father and having the time and space to support and help him the best they could; many visitors don't have this knowledge.
It is unfair to the patient when nursing care is compromised by visitors, which happens more often than not. I don't think anyone on this thread is against visitors, we just are against open visitation without guidelines that are enforced. It is our job to be an advocate for the patient and sometimes that does mean we are against the family. Please don't be offended.
I agree Bellehill. Marijke, I have been a family member in the ICU as well with my father. Fortunately he recovered. I am very sorry you lost your father. I certainly don't want visitors to be kept from their loved ones as long as they don't interfere with care. I do think there need to be reasonable restrictions though. Too many people at the bedside and we can't function if there is an emergency. Visitors there at report time and we can't maintain confidentiality. Visitors who actively interfere with nursing care and we can't provide safe care to our other patients. These are real concerns.
It is unfair to the patient when nursing care is compromised by visitors, which happens more often than not.
This is just NOT my experience.
I don't know what area you are in, but this is NOT the case where I am. MOST of the visitors that come into the ICU are so freaked out by everything that they are afraid about where to stand, what to breathe around, and what to say or do, let alone touching things or possibly compromising the care of their loved one. When I move around a patient's bed, more often than not, visitors literally jump out of the way, almost always. I have to reassure them that they are okay where they are and that I will move around them if I need to expalining that that's what I'm used to doing as the surroundings around a patient in the ICU is usually like climbing a jungle gym anyway. Their response is usually, we just don't want to be in your way! :)
It is our job to be an advocate for the patient and sometimes that does mean we are against the family.
Using "we" connotates that all nurses feel this way. I do not. Not even sometimes.
Marijke, I have had family in the ICU and at no time did I feel entitled to 24-7 visiting, nor did I disrespect the nurses and their need to have uninterrupted time to care for my loved one . I NEVER insisted on prioritizing their energies on ME, as I understood that I was NOT the priority.
Today's visitors/ family members increasingly feel entitled to the nurses' time. I doubt if you are a critical care nurse; as it seems you do not understand the expectations, and what is involved with being an effective critical care nurse. Somehow I think if you DID understand, you would NOT be 'fuming'.
When did critical care nurses' focus get forced to visitors and away from our patient care? I don't know if I care to work critical care again because of the unreasonable expectations on my energy. With the ratios and continous flow of visitors (I am supposed to welcome acquaintances now even...who camp out and feel entitled to make demands on my time time)ICU nursing is just not worth it to me anymore. The stress and the liability has just plain worn this old nurse out.
My experience has just been the opposite. The visitors where I'm at don't seem to want to move to allow us to get to our patients. I can probably count on one hand in all the years I've done this that families actually did what they do at your facility. Even with proper explanation as to why they need to stay back, saying it in a courteous and respectful and compassionate manner, alot of the times it falls on deaf ears even with repeated reminders.
This is just NOT my experience.
I don't know what area you are in, but this is NOT the case where I am. MOST of the visitors that come into the ICU are so freaked out by everything that they are afraid about where to stand, what to breathe around, and what to say or do, let alone touching things or possibly compromising the care of their loved one. When I move around a patient's bed, more often than not, visitors literally jump out of the way, almost always. I have to reassure them that they are okay where they are and that I will move around them if I need to expalining that that's what I'm used to doing as the surroundings around a patient in the ICU is usually like climbing a jungle gym anyway. Their response is usually, we just don't want to be in your way! :)
Using "we" connotates that all nurses feel this way. I do not. Not even sometimes.
First, I work in a busy (who isn't...) 30-bed med-surg-neuro ICU in a large metro area in the middle of scary neighborhood. We are open to visitors 20 hours a day - we close for an hour at a time during change of shift (07-08, 14-15, 19-20, and 23-00) which is quite often not at all well received by acquaintances/friends/sort-of family, but usually received okay by immediate family (except some who will never be happy - we all know who they are). We do make exceptions - comfort care/out-of-town visitors/pt just got there or got stabilized - but make it a point to inform people that it is an exception and that this will not be accepted in other circumstances.
In my experience, there are plenty of people out there who ruin it for the whole population. I am very glad that we close when we do, and I am very comfortable asking families to leave when I am doing cares/assessing the family - and always go and get them when I am done if I have told them I would. In a perfect world, open visitation is a wonderful thing. But in REALITY, I do believe that if we are not able to stand up and give pts their privacy, do the care we need to without interruption, and play these situtaions by ear (as far as pt needs, family needs, and how appropriate families are acting), patient care is compromised.
Just a few specific tidbits that came to mind... all three ICUs in my hospital had tried totally open visitations with no restrictions. Mine was the first to institute any restrictions, and the other two have followed suit as they found it to be too chaotic especially around change of shift time.
After reading the article about pt satisfaction scores, I wonder how HIPAA fits in... this article says that people were dissatisfied with the information they got. But I have to be careful that I don't even tell the wrong person that the patient is even a patient in my hospital to protect my license and the patient's confidentiality. Interesting story recently - a patient was terminally ill and had a very dysfunctional family. Had a specific list of family members who could see him/have info. He died about midnight with all of those family members at bedside. Between 04-07 (and probably more on day shift, I don't know) we received at least 5 calls from "family" who were not on the list inquiring how his night went. When told they needed to talk to his immediate family, we repeatedly heard, "but I am family, how was his night?" These people would say they were dissatisfied with info - but at pt's request.
Okay, so a few other problems I have with some (not all family members) - I have more than just a few times had family members turn off my patient's vent and monitor alarms "because that's what you did when you were in here and told us not to worry because he/she was coughing." And that is keeping your family member safe???? How will that stand up in court when you sue my hospital for allowing your family member to die and I don't have proof that my "negligence" had more to do with you touching things you shouldn't have?
As far as codes go, we don't have a full policy as far as I know, but play it on a case-by-case basis. I have had three experiences of families being present - two of which were bad experiences, all three codes which ended in the pt dying. Screaming and yelling and falling down on the floor in hysterics are what I mean by bad experiences. The one good experience happened to be the patient's wife who was well-prepared that this could happen and immediately said that we needed to stop and let her husband go.
Re: pets - we have an infection control policy about pets visiting and as long as they follow the policy, we do allow them - I have had one patient's pet visit her. It helps that we have glass doors and she happened to be in one of our negative airflow rooms so we had two sets of doors that helped us feel like her cat wouldn't get out if we needed to walk in. Her son brought her cat a few times - and it was always fine. Actually, the poor cat was scared of everything and hid in the corner the first time, really didn't disturb anything - but this patient was relatively stable, too.
It's sad to me that the horrible family experiences are the ones that stick out in our minds. I wish I could say that I was always positive about family members - usually it's really not detrimental, but those are the families that follow our guidelines and are not manipulating us or threatening us or getting in our way or walking all over us. But there's always someone who will do all of those things, and tact or compassion do not help. We as nurses are able to combine the "art and science" of nursing that we heard so much about in nursing school in order to provide individualized care; I think "family care" also has to be highly individualized, all visiting policies need breathing room, yet nurses must be empowered to stand up for safety, for what is best for the patient (their number one priority) and then what is best for the family (second priority). Sorry for being long-winded - there's just no simple answer to everything brought up in this thread!
I realize I currently not working in a larger city ICU, I have. I am very much FOR open ICU visitation. I guess I have always told the families, You are allowed to stay and visit as long as it is not distrupting my patient or my ability to care for my patient. I can't say that I haven't come across people who weren't a real pain, but what about those who aren't? If it were my spouse, parent, sibling or child you would have a battle on your hands if you weren't allowing me in. I went thru thet hell when I was niave, and my eldest son was in ICU, 19 years ago. It broke my heart to see him for only a very fast 10 min.
Rememer,to these people and there families, this IS a crisis!, we are but visitors in thier lives.
My mother was vent post op for a few days once, she told me the only time she felt truely safe was the 10min intervals they allowed my father in to see her. Then the nurse would shove the little TV infront of her face. I feel in MOST cases( and I have worked nocs) they family is a benefit.
RN34TX
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