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 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? }
I'll tell you what about those that aren't...I bend the rules for them. I am there to care for the PATIENT. That is why I am a nurse. If the family needs help, I put in for a social worker referral. About 1/1000th of a percent of the time family is helpful, calming the patient, and actually bathing them. The rest of the time they are a distraction from the patient. I had a patient's husband once hand me a pillow as I was turning his wife. His daughter said condescendingly "Don't do that, that's HER job". At night we do not have secretaries, HUCs, or even aides a lot of the time. And I work in a 53 bed trauma/mixed ICU. Often I can see a visitor is in the room by the monitor; it freaks out the patient, especially heads. And MOST of my patients are vented, sedated, and unstable.
[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.]
The crisis is a HEALTH crisis, that is why you have a critical care nurse there to care for the patient. You need to trust the nurse to do his/her job (as you obviously do not by the below statement about your mother not feeling safe. What would your father do if she went into v-tach?) This is not about you assauging your feelings of love for your son, but letting us save his life.
I will say things are different on the floor, I have been a med/surg nurse and let families spend the night in the patient's room. There is more room, less time to hand the patient their water pitcher, and they are STABLE.
[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.]
We all work in different environments. There are ICUs in a couple hospitals across town where, if I worked, I wouldn't be as opposed to open visitation -- nice neighborhoods, non-trauma facilities, wood floors, 5-star hotel accomodation-type rooms. And then there is my unit...meth, homeless, drug-seekers, every Darwin-award wanna-be, circa 1970s decor, rooms the size of a postage stamp... you get the picture.
All I'm saying is that there is no right or wrong answer to open visitation and I resent that someone writes a paper or a commentary where everything is black and white. Spend a night in our ER where you go through a metal detector to enter and talk to the receptionist through bullet-proof glass. Hang out in my ICU at 3 AM when a group of bangers is standing at the door in big bulky coats asking if they can come in and see their "cousin" -- and feel immensely thankful that the doors are LOCKED. I could go on and on re: this topic. I just want to see a "study" or the "research" or the "commentary" after these black-and-white authors hang out in the ghetto, trauma hospitals for a while. And, for the love of Pete, respect that I'm a professional healthcare provider and can make reasonable decisions about visitation for MY patient.
American Association of Critical Care Nurses (AACN) had a position paper on just this subject, as it seems to be a problem all accross the US. I have long been a proponent of open visiting, and am often at odds with my fellow co-workers. We must realize that it's not about us, it's about them. The patient and family, because family is so important to patients, no matter what their relationships are like. I have found very few people who absolutely should not visit for long periods, and most of the time, asking my patients their preferences has helped control some of the visiting.
IMHO the position paper of the AACN is a slap in the face to critical care nurses working in less than optimal conditions all across America, and does not take into account all the variables we deal with.
There are too many variables for this association to make such a blatant statement and I am appalled they would do so. What is BEST for an INDIVIDUAL patient is when a critical care nurse is allowed to make an informed decision about such matters IMO, and to have some control over his/her area of practice. I am writing to my organization as I speak to voice my dissatisfaction.
Hospitals will use this 'position' to further justify their customer service agendas, unfortunately, and intrusive family members to justify their presence even when that presence is deleterious to our patients.
Quote"The crisis is a HEALTH crisis, that is why you have a critical care nurse there to care for the patient. You need to trust the nurse to do his/her job (as you obviously do not by the below statement about your mother not feeling safe. What would your father do if she went into v-tach?) This is not about you assauging your feelings of love for your son, but letting us save his life."
I feel it is both, I have had codes, I have families present. One in particular was a tricyclic OD. On and Off for 5 hours. She made it thru, but had she not, her family knew that we had done everything we could to keep this 32 y/o alive. Instead They were able to tell her we had. Also those codes where you are coding because the family has no clue, They torture thier loved one because they can't stand to see mom go. I have had a couple where the family requested we stop, they realized it wasn't 2 shocks and they were stable AS SEEN ON TV. I ask the families to step out at appropriate times, and I have hed to have drunken pissed off families removed.
I do think most nurses have the common sense to know what is best for thier patients. I don't know you, but have dealt with those who don't want visitors because they don't deal well with families, death(explaining it) ordon't want their practices under scrutiny. I beleive if you educate the families well, set up the behavioral boundries well, it can work. Granted I have never had a gang banger come after me, my opinion probably wouldn't be the same, But with my experience, inner city and outlying community, and IHS, I stand by current position.
I have been in critical care for 11 years now, I still believe that, yes this is a HEALTH crisis for the pt. It is a LIFE crisis for both the pt and their families.
I do think this will be a controversy until a time comes when our jobs are obsolete, in otherwords, ending no time soon.
American Association of Critical Care Nurses (AACN) had a position paper on just this subject, as it seems to be a problem all accross the US. I have long been a proponent of open visiting, and am often at odds with my fellow co-workers. We must realize that it's not about us, it's about them. The patient and family, because family is so important to patients, no matter what their relationships are like. I have found very few people who absolutely should not visit for long periods, and most of the time, asking my patients their preferences has helped control some of the visiting.
It is about the patient and the nurse who has to take care of the patient. The family is an important component but is not the priority. I work in a busy neuro ICU, these patients get complete neuro checks every hour. Once the patient's family members see one check, they "perform" checks every 5 minutes on these patients. It doesn't help me when the patient responds out of habit rather than understanding. We need very tight BP control on our bleeds, any stimulation sends these patients back to the OR...should I let whoever wants in to see them just so I don't offend anyone?
I don't think there is an easy answer but I am also upset at the lack of trust and respect that has been show by the AACN and other posters who think we love to kick families out just to be mean. I am an advocate for the patient, not the family. Work in my job for a shift and see what it is like.
I still stand by my position that it is about them not us. We are outside the bubble... there are a lot of nurses that look at a patient as their patient. Well, the patient belonged to the family member first. AACN is taking the stance because of the extreme restrictive nature of some big city ICUs like 15 min per hour. Read the article Connie Barden (Past president) wrote, that was her address at the NTI a couple of years ago. I have been on the other side of the fence so to speak and the anxiety it caused was awful. Families fight about who gets to spend precious minutes of that 15 with the patient, etc. I also work with neuro patients, and seem to be able to make the point with the families for the need for a quiet environment, etc.
I agree that shift changes shouldn't allow visitors because of HIPPA. I also agree that there should be limited visitation at night because families also need their rest. Most of the bed baths are done on nights in my unit, and this eliminates the need to further restrict visitation on day shift due to bed baths. Of course, visitation can be adjusted to the needs of the patient, like dying, patient request, family arriving from out of state, etc.
A good family wouldn't fight over who has to spend time with their familiy member, they would understand that their loved one needs intensive nursing care, and that their loved one needs as much rest as possible to recover. I like to tell families that whenever they have the flu or whatever, what's one of the first things the doctor says to you? That you needs lots of rest. I will then tell them that their critically ill loved one needs even MORE rest than that. Alot of times this seems to work, but not always.
And even if you are not being intrusive during visitation with a loved one, you should be concerned that the other family may very well be monopolozing time away from your loved one, therefore not able to provide the intensive nursing care that they need. I can't tell you how many times I've had difficulty with families who say "well, that nurse allowed me to sleep at the bedside". That particular nurse usually was so busy or so intimidated by the family that these kinds of things happen, which then cause even further problems. There needs to be some level of control, and it's not for our own convenience, it is for patient safety. IMHO.
Not too long ago I had a family member become upset with her mother doing so poorly, she went completely ballistic with crying and rolling all over the floor. I called for some help (ie pastoral care and the nursing supervisor), but they still wouldn't make them leave. It's bad for "PR". In the meantime, these antics were upsetting the entire unit. If managment doesn't back us up with stuff like that, patient care is compromised. That's my entire point. It is a safety issue. And BTW...this happened at 3am.
And you are correct...if someone is dying or whatever, I have no problems at all letting them in to be there with them, sometimes we can do special circumstances. But whenever someone comes in, I make a point when I mention visiting hours that sometimes we do "bend the rules" for someone else, but that doesn't mean we are playing favorites, usually because someone is dying.
I still stand by my position that it is about them not us. We are outside the bubble... there are a lot of nurses that look at a patient as their patient. Well, the patient belonged to the family member first. AACN is taking the stance because of the extreme restrictive nature of some big city ICUs like 15 min per hour. Read the article Connie Barden (Past president) wrote, that was her address at the NTI a couple of years ago. I have been on the other side of the fence so to speak and the anxiety it caused was awful. Families fight about who gets to spend precious minutes of that 15 with the patient, etc. I also work with neuro patients, and seem to be able to make the point with the families for the need for a quiet environment, etc.
I agree that shift changes shouldn't allow visitors because of HIPPA. I also agree that there should be limited visitation at night because families also need their rest. Most of the bed baths are done on nights in my unit, and this eliminates the need to further restrict visitation on day shift due to bed baths. Of course, visitation can be adjusted to the needs of the patient, like dying, patient request, family arriving from out of state, etc.
Nurse "please stop waking up your husband, he's been awake for 23 hrs, after his huge MI and cath proceedure I need him to relax and get a bit of rest".
wife "Im just keeping him comfortable" (adjusting the sheets)
nurse to pt. "are you comfortable?" (patient nodds)
wife (grabbs pillow out and fluffs fo 18th time) "he needs me here"
nurse "he needs you well rested and healthy to care for him when he gets home, its past 10pm, you've been up 24hrs yourself... go home and get some sleep, Illl call you if he needs you"
wife (loudly waking the patient again)"no one has told me to leave, you're the only one"
nurse "ma'm, he isn't sleeping with you here and you need to rest too, please say goodnight to him... it's time"
wife (shakes husband who keeps nodding off in exhaustion)"can YOU believe this... SHE is ordering me to leave!"
nurse "ma'm it's time now"
wife "your the only one with a problem"
nurse "yes, the other nurses have been very generous, it's time to leave, I need your husband to rest now, he's trying to sleep "
wife "YOU CAN"T MAKE ME" (screams)
My experience which didn't end there points out that even well meaning, normally well supporting family... one need their rest, two don't understand nursing priorities no matter how simply or kindly you explain them, three lack the ability to reprioritize their needs...because the family really believes they ARE doing what's best for the patient.
These aren't jerry springer people, these are physicaly and emotionally exhausted normal people who will not take care of themselves if allowed to be at the hospital 24/7. They feel they SHOULD always be at the bedside and many will. Out of exhaustion and sheer stress they start acting up like this... meet them on the street a week earlier and I'm sure they're wonderful people.
BUT, visitation needs solid hours. Then each nurse should flex the hours to the patient needs telling the family..."I'm making an exception for this time, the next nurse may not so please don't expect it" and yeah, if they're told no the next time they may act up
IMHO, you can always extent visitation where appropriate. TRY to limit vsitation when it is "open" and see how family and administration will act. IT's NO longer about the patient then.
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.
Schroeder
I believe this nurse/patient ratio would be considered illegal. You cannot possibly give good care in the ICU if you have to divide your attention between 5 patients. I don't blame you for looking for another job. Your license is at stake.
Ah...I still remember a 8 hour "slow code" pt who came as a post-op trauma. I didn't sit or pee for those 8 hours and never once left the room. Desperately trying to maintain a pressure with every pressor I could lay hands on, infusing blood as fast as the pt was losing it, running fluids wide open -- docs standing in the room giving non-stop verbal orders. I look up at one point...must have been about 4 AM...and see a man standing in the door, watching. I knew he wasn't my pt's family so I barked at him about what he wanted. His response, "just watching". Uh, no you are NOT just watching...move your a** out of here. Turns out he was family for another pt on the unit -- and he later had the audacity to tell the charge nurse that I was rude. Yeah, because when I'm dying a slow, hard fought early death in the ICU - I really want total strangers as an audience.
So, yes bfjworr, we have the same problems. My personal favorite is the family who, despite extensive explanation and teaching, cannot grasp that I really meant it when I explained about no stimulation for the brain injured, sedated, chemically-paralyzed pt. No...shaking him and yelling "John, can you hear me?" doesn't qualify as "no stimulation".
Yes I have been there....all hospitals in our area now have open visiting, I also worked neuro then...I've moved on to PACU....I miss the work and patients, but not the visitors going from room to room, craning their necks to see what is on display
scene: an icu nurse has finally FINALLY sedated her pt after many many doses of ativan and morphine and many evil stares from co-workers due to her loud vent alarms. they are quiet. the nurse feels sanity returning.
enter anxiety ridden daughter who hasn't slept or ate or bathed in the same outfit as yesterday who has set up camp in the visiting room and rushes in to save her father from evil nurses who don't know anything about him and who she needs to keep an extra close eye on so her dad doesn't get substandard care like that poor man she saw on oprah.
the pt shakes her dad vigorously despite multiple long speeches on daddy's need for sleep while on ventilator.
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.
enter the respitory therapist, who, with disgust in his voice, proclaims loudly WHOSE PT IS THIS? WHY AREN'T THEY SEDATED? WHAT KIND OF A NURSE LETS A PT GET LIKE THIS WITH NO SEDATION?
what kind of a nurse indeed.
and thats all i have to say on the matter of "open visitation"
Mayflye
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