Family visitation in ICU

bfjworr · Feb 15, 2005

I agree with earle58...

Our own icu also makes exceptions for patients who are dying.... I have been in that same situation with my father....and the hospital did not make exceptions for my family...... :crying2: we also make an effort for those who can be made DNR to have those patients moved to the floor where visitation is much more lenient.... However, obtaining a DNR can be difficult at times.... and then there is the census to contend with.... even when we downgrade our patients...we find many times there are no beds available to move them too.... :uhoh3:

pamaza · Feb 15, 2005

You were very fortunate to have had shared a beautiful , dignified death with your mom, I assume that because you are a nurse, you know it can be a challenge with families, and was very helpfu in your mother's care. She was very fortunate.

Peolple who are untrained, or who have been guided only by what uncle joe or the media has stated is appropriate care are much less fortunate. I equate it to being much like dealing with an adolescent child. They are afraid and looking for guidence and answers,while at the same time trying to show they are in control of the situation. And as we have all seen, some are able to do this with respect,others are not, but in most situations it is love and fear that are driving these families.

I still maintain that we need to alow the families in at the bedside. I always set strong guidelines as to behavior expected, I address fears and concerns. I also let them know that I have another sick patient or may have to assist another nurse with a patient, and want to be able to provide the best care possible to the other pt as they want for their loved one. I have dealt with the Jerry Springer families, the drunken families, the victims and the perpitrators, and I can wholehaertedly say, although I don't always LIKE the families, I will always try to allow them to be with thier loved ones. My number one rule, I need to be able to allow this pt to rest, and provide the care neccesary, if I am able to do that, the family may stay.

I am fortunate I am not on the other side at this time, I have been and wish I had been given they opportunity to be with my son.

:nurse:

KimberRN1 · Feb 15, 2005

family visitation in icu
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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 :) :) :)

i work for a hospital with apprx .9 specialized icu's....i work in the micu...it's busy....we have a high acuity...and i don't think families should be allowed to stay in the icu 24/7........some of the icu's in my hospital have changed their policy to open visitation....mine hasn't been "made" to do it yet and i really don't see how it can be done......what we do is have the limited visitation....then at the nurse's discretion...we can let family members stay...we always let family stay when someone is dying....by doing this...you can keep the springer rejects out...and let others who don't cause a problem stay......we are very busy and have too much going on to have an extra person in the room.....we have vents...crrt...iabp....heating or cooling blankets ....tons of drips....tons of lines....sometimes the iv poles look like christmas trees....we do bedside procedures.....you all know what it's like....i hate when i have to climb over people to hang a drip or fix the pump...get to the vent...plus....these are really sick people... it's not really in the best interest to let family stay in the room for their own safety...who knows what they can pick up....you know the families that come in during visitation who are constantly running out of the room...."i think daddy is trying to tell me something"....."i think mommy wants moved up in the bed"...."i think her arm hurts"...."this thing on the monitor looks different than yesterday".....can you imagine them in the room all day... i'd pull my hair out....my favorites are the "internet searchers"...the ones who write down all the drips then look them up and call back to tell you all the side effects and maybe it's cauising such and such to happen...they also like to look up the diagnosis and of course the internet always gives the worse case senario....these are the types of freaks you don't want in the room all day...

leslie :-D · Feb 15, 2005

You were very fortunate to have had shared a beautiful , dignified death with your mom, I assume that because you are a nurse, you know it can be a challenge with families, and was very helpfu in your mother's care. She was very fortunate.
Peolple who are untrained, or who have been guided only by what uncle joe or the media has stated is appropriate care are much less fortunate. I equate it to being much like dealing with an adolescent child. They are afraid and looking for guidence and answers,while at the same time trying to show they are in control of the situation. And as we have all seen, some are able to do this with respect,others are not, but in most situations it is love and fear that are driving these families.
I still maintain that we need to alow the families in at the bedside. I always set strong guidelines as to behavior expected, I address fears and concerns. I also let them know that I have another sick patient or may have to assist another nurse with a patient, and want to be able to provide the best care possible to the other pt as they want for their loved one. I have dealt with the Jerry Springer families, the drunken families, the victims and the perpitrators, and I can wholehaertedly say, although I don't always LIKE the families, I will always try to allow them to be with thier loved ones. My number one rule, I need to be able to allow this pt to rest, and provide the care neccesary, if I am able to do that, the family may stay.
I am fortunate I am not on the other side at this time, I have been and wish I had been given they opportunity to be with my son.

hi pamaza,

my first question would be is how come you weren't able to be w/your son? i'm assuming he was in icu and you couldn't see him at all?

as for your comment about allowing families to stay provided the pt. can get some rest and provide the necessary care, i still don't believe the pt. is getting the rest they need with family members at their side 24/7. the icu is such a busy place atc, and the lights aren't dimmed at noc, i would find it next to impossible for a patient to get rest...what about these jerry springer families, how do we know that the pt. even likes some of the family members?

perhaps because you couldn't be with your son is the reason why you're for open visitations.....that would be understandable.

speaking as a hospice nurse, i just want my patients to rest. and families will stand vigil around the pt.....and trust me when i say the pt is glad when i've sent family members home.. more often than not, the pt. purposely waits for the family to leave, they thank me and then they die typically within a half hour. i've seen this dozens of times. so whether we know it or not, it would seem that often families can be more of a hindrance as they cause the patient anxiety, which is so contradictive of the rest we all advocate for.

now if the pt in the icu requested to see someone, then yes, go get that person. but i just can't assume that all these people that visit are necessarily close to the patient.

with my mom, i saw people coming in that were neighbors, people from work....i told the nurse i didn't want that as my mother would never want to be seen like that. so the nurse told these people mom needed to rest. thank God for these nurses. they were awesome; and they listened to my input. and there was a meeting with 2 doctors, mom's dh, myself and one of the nurses to give report. one of the doctors was pressuring my stepdad to wait and see. my stepdad was too distraught to even speak and it had been decided the noc before that i was to make any and all decisions- so when i put my foot down to this bullying doctor, he retorted that i wasn't even poa. and i said that stepdad gave me permission to make all decisions and i wanted everything stopped today. the doctor turned to my stepdad and said is that what you want? and he said yes. and then i told the doctor how dare he bully and intimidate a man that was clearly vulnerable. :angryfire

meeting over and the nurse told me i made the right decision. and if mom died 55 minutes after being taken off the ventilator and all lines stopped, it just goes to show you how close to death she was.

sorry for getting side-tracked- she died on 12/19 and sometimes the grief gets worse rather than better.

but as it stands, it looks like that open visitation is going to be the policy in many hospitals. and i don't think they're looking at the big picture.

leslie

mattsmom81 · Feb 15, 2005

Leslie I had a similar event with my own Mom...huge dose of chemo for lung ca with liver mets, something ruptured internally, she 'blew up' also. We elected NOT to intubate her, and made her comfort care only at that point, so we avoided the whole ICU scene and went directly to a hospice approach, MS drip etc. It was a peaceful death for her and my family as well. I had one younger sister who resented my decision because of her own emotional dependance on Mom (selfishly wanting to prolong her suffering) but fortunately the rest of us outvoted her and were able to let Mom go peacefully.

Peaceful dignified deaths are the best deaths....and as an ICU nurse I so often do NOT see these, although I try hard to facilitate it when I can get family and docs to cooperate. (which is often the hardest part..they are holding out for a miracle, afraid to make a decision, etc)

And to the rest on this thread..I DO believe in family presence when death is approaching, but when they are full codes not all family can handle this. The better approach for futile full codes is to facilitate DNR and patient transfer OUT of the ICU if at all posible...best all around for everyone involved IMO.

Personally re: ICU visiting in general, I have always found it easier to have established visiting times and rules, with the option to bend them a bit; than to have open visiting and THEN try to place some limits. Its just a huge battle to do this, timeconsuming and energy sapping IMO.

pamaza · Feb 15, 2005

hi pamaza,
my first question would be is how come you weren't able to be w/your son? i'm assuming he was in icu and you couldn't see him at all?...
with my mom, i saw people coming in that were neighbors, people from work....i told the nurse i didn't want that as my mother would never want to be seen like that. so the nurse told these people mom needed to rest. thank God for these nurses. they were awesome; and they listened to my input. and there was a meeting with 2 doctors, mom's dh, myself and one of the nurses to give report. one of the doctors was pressuring my stepdad to wait and see. my stepdad was too distraught to even speak and it had been decided the noc before that i was to make any and all decisions- so when i put my foot down to this bullying doctor, he retorted that i wasn't even poa. and i said that stepdad gave me permission to make all decisions and i wanted everything stopped today. the doctor turned to my stepdad and said is that what you want? and he said yes. and then i told the doctor how dare he bully and intimidate a man that was clearly vulnerable. :angryfire
meeting over and the nurse told me i made the right decision. and if mom died 55 minutes after being taken off the ventilator and all lines stopped, it just goes to show you how close to death she was.
sorry for getting side-tracked- she died on 12/19 and sometimes the grief gets worse rather than better.
but as it stands, it looks like that open visitation is going to be the policy in many hospitals. and i don't think they're looking at the big picture.
leslie

Leslie,

Hi my name is Paula (thought I should introduce myself).

They let me see my son, I was 22y/o at the time, he was 4 1/2 weeks old, I had tried to get a doctor to understand he was 'sick' for 3 days, stayed up all night holding him so he could breath, then they admitted him for bilat pneumonia.They transferred him across town to a Ped ICU. I was allowed to see my son 10 every 2 hours. While you sit in the waiting room, alone and scared, other people tell you their horror stories of illness and injury. This just increased my worry and concern. I just wanted to make sure my baby was alright.I would go in for my prescious 10 min, coud touch his foot, not understanding the monitors ,or really what the nurses were telling me. wanting desperately just to hold him and have them tell me he was alright, and not think of all the stories and saddness I was hearing in the waiting room. At the time I was married to a a very unkind man, and I was also limited on the time I was allowed to go to the hospital. I could take the bus after he left for work, but had to have dinner on the table at 5pm.( I was looked down upon because of this). Little did they know my heart broke everyday I left, and those breif 10 min visitations flew by so fast.

My son lived and is now 19 y/o living in Tucson. He's 6'2" tall, and growing into a fine young man. I became a nurse about 4 years later.

I aslo live in Alaska where many people,including myself, do not have family close by. Friends are family.

Also many vented patients aren't able to say who they want or don't want in there visiting. I have held the hand of many aa alone person when they we're dieing, so they wouldn't die alone. I have said prayers with the lone daughter/son or spouse at the time of death of a loved one. I can't count the hugs. Other than hospise, I believe the ICU's have the highest death rate, many times the families DON"T have time to make ammends, say I love yous ,accept the possible/probable death of thier loved one. I am comfortable with the death process, I feel it an honor to assist in a time that can be tragic for all involved, to help a person have a peaceful dignified death. It's very hard to do when you have IV pumps and vents, and multiple other technological wonders about. I have coded people with their families present,some that made it and some that haven't.

People want to know we've done all we can to help their loved one. In the waiting room all you can do is talk, cry, worryand pray, you see no evidence that they tried,or not.

I am sorry, I digressed.

I am glad your nurse was responsive to your requests, she should have been. I would have been.

As far as the bullying lady, maybe she knew no other way to make sure WE did our best.

I am very sorry for the loss of your mother. I lost my father 14 yaers ago, I still think of him fondly and often.

I guess this will be an long ongoing debate

Sincerly, Paula

leslie :-D · Feb 15, 2005

Leslie I had a similar event with my own Mom...huge dose of chemo for lung ca with liver mets, something ruptured internally, she 'blew up' also. We elected NOT to intubate her, and made her comfort care only at that point, so we avoided the whole ICU scene and went directly to a hospice approach, MS drip etc. It was a peaceful death for her and my family as well. I had one younger sister who resented my decision because of her own emotional dependance on Mom (selfishly wanting to prolong her suffering) but fortunately the rest of us outvoted her and were able to let Mom go peacefully.

hi mm,

when my mom found out that she had aml, she wanted everything done. so they admitted her as an inpt with a chemo drip. she wasn't very comfortable and was c/o abd pain and they gave her morphine, rather than see why she was getting so much pain. finally on the 5th day of continuous chemo she spiked a temp and pain was unrelieved. they brought her for a ct scan and found her entire sm and lg bowel were infected and her wbc was under 10. she lost consciousness, was transferred to the icu and was dx'd w/sepsis; she also had bil pneumonia; and her bp was bottoming out so they started her on dopamine, 4 abx (genta, vanco, flagyl and cipro), as well as lr and tpn. we all knew her prognosis was very poor; and knowing that dying was her greatest fear i had to ensure she didn't awaken (which i didn't think she would). but she was intubated before she had taken a turn for the worse and they had the vent on the lowest settings (but inevitably ended up increasing the settings.

you know mm, i was upset because the didn't have her on a morphine drip but understood that they couldn't risk playing around with her bp. so once it was decided to stop treatments, then the morphine drip was started and i'll tell you, what a wonderful effect it had on my mom; you could just see her whole face relax and when iwas holding her in bed, she just softly snored away. as a hospice nurse, i was very pleased with the effects of the mso4 drip....and thank God, she never knew what hit her. for that I shall always be grateful.

i had thought about going into icu but decided against it. too many doctors that use these heroic life-saving interventions that is hell on the pt and the family. i just couldn't deal with that.

and whenever your mom passed, i am truly sorry.

it's still new for me but there's something about losing your mom and it stays with you. i hope you have found peace with your loss.

leslie

mattsmom81 · Feb 15, 2005

HUGS to you leslie...I agree, there is something about losing our Moms and it stays with us for years. it has been several years past now for me, and it is still emotional. I wish you peace as well, I know it isn't easy.

bfjworr · Feb 21, 2005

HUGS to you leslie...I agree, there is something about losing our Moms and it stays with us for years. it has been several years past now for me, and it is still emotional. I wish you peace as well, I know it isn't easy.

Your are so right.....losing a parent is something that affects us all. For many of us, it helps us to understand our patients and their anticipatory griefing...

My father's death was much more painful than my mother's death. He was alert and so much an active part of our family....my mother had alzheimer's and had not sopoken for more than 5 years... we could not be sure what or who she remembered....

I think we mourned her before she was actually gone.....

It has helped me to form close bonds with some of my patient's families....

I still have days when no bond can be formed with certain families in our unit... no matter how hard I try.... they are either to anxious or too bulligerent....

Marijke · Feb 22, 2005

I have been reading all the postings, since my last one a while ago. Ther are some very good ones, mainly from people who have seen both sides of the story. Yes family members can be a royal pain in the behind, yes there should be a way to restrict visitors who are disruptive. However decissions should be made on a case to case basis. One posting stated family members are not in need of nursing care and should not interfere. However, family members are very much in need of nursing care and compassion. Any nurse who doesn't get this should not be at the patients bedside.

Critical and palliative care is more than just taking care of the ailing patient, family and friends are just as important.

Marijke

NoCrumping · Feb 22, 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"

Beautiful!!!

Ya know what? The whole thing boils down to this: The role of the RN stinks.We are trained from the very beginning to "treat the family as your patient" blah blah blah... I personally think we have enough to do with the ACTUAL patient.We have to be responsible for the WHOLE body, INCLUDING the MIND, and the FAMILY too? In the ICU??? Sounds crazy, doesnt it?? Well, thats what we as RN's signed on to do. Just look at your license. Thats what it means. RN= I take everybody's guff , and I am proud of it, "because I am a nurse, and thats my job".:) Lets just let the family have a bed next to the patient. Better yet, since they are going to be there...... lets make them honorary RN's, LPN's, RTs', whatever particular role THEY feel most comfortable with. A little bitter, disgusted, am I? I guess so. Nurses come with the room rate. When we dont, then we will have a voice in our own working conditions. Until then, I will be envying my friend, who cleans TEETH as a dental hygenist, makes the same pay as me, has better hours, etc etc etc. ( oh, yeah and we are not supposed to be "in it for the money", so pretend you didnt actually see me complain about $$$ shhhhhh.......)

If my daughter wants to be a nurse, I allready told her I will not pay for it. :stone

NoCrumping · Feb 22, 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
"5 ICU patients"....... thats an oxymoron..........:rotfl: :rotfl: :rotfl: :rotfl: :rotfl: :rotfl:
Been there, bought the T-shirt.