Family visitation in ICU

heart queen · Feb 7, 2005

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. :eek:

Morguein · Feb 7, 2005

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.

ntflyer60 · Feb 7, 2005

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

icyounurse, BSN, RN · Feb 9, 2005

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" :rolleyes:

RN34TX · Feb 9, 2005

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.

bfjworr · Feb 11, 2005

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.
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...

mattsmom81 · Feb 11, 2005

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.

starjade · Feb 13, 2005

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

family visitation in icu
--------------------------------------------------------------------------------
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 :) :) :)

bellehill, RN · Feb 14, 2005

starjade,

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!

leslie :-D · Feb 14, 2005

family visitation in icu
--------------------------------------------------------------------------------
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.

leslie

RN34TX · Feb 15, 2005

Great post Earle58, my sentiments exactly.

icyounurse, BSN, RN · Feb 15, 2005

beautifully put earle58.