Family visitation in ICU

NoCrumping · Feb 22, 2005

I work in a neonatal ICU so it's a little different obviously... But, we have open visiting hours for parents (except for shift change) and then strictly enforced rules for others (4 hours a day, siblings only on weekends). It can be great for the right people. Those families get to know the nurses, come to understand our work and can be very helpful. Unfortunately there are crazies out there. I have found the key to open visiting working isn't about open or restricted hours, it's about how the families are controlled when they are on the unit and how the manager backs up her nurses. Unruly, rude, troublesome families need to be stopped in their tracks. People will only misbehave as much as we allow them to and nurses can only stop this if they are supported by their supervisors. That's why I blame supervisors more than the families.

It also comes down to this: Administration thinks that , if a person has a choice in which hospital they receive care in, and that same person had dear old aunt Hilda, cousin Herb, Granny/Gramps in the ICU, and they let them see those people as they wished, they figure they will chose to go to that hospital when needed, as they will have a good memory of their experience. Its plain old PR, if you ask me. I just cant figure out why they dont use safe staffing for this same reason.... I guess they figure, they have the patient in the bed allready, who cares what they think, when the nurse assigned to them is to busy with her other patients to give them the care each and every one of them deserves and needs? Keep em' comin..........

HMMMMMMM..................:uhoh21:

RN34TX · 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

Family is important, but no, not "just" as important. We've all been taught in nursing school the importance of family involvement in patient care. I don't think that anyone here means to dismiss the family and friends that visit, it's the disruptive behavior that interfere's with nursing care that (I thought anyway) that most of us on this thread are referring to.

I've tried to regulate visiting on a case by case basis as you previously suggested. Sometimes it works, often it didn't for me. Why?

Do you think that the "disruptive" family in the waiting room did not notice the "nice" family not being asked to leave and walking in and out of ICU more frequently than they were allowed to? I've actually hid family members behind corners and curtains who came in from a long way to see their family member so that the others would not notice.

Like I've stated earlier, I've seen some serious orders get started late or missed altogether because of family members following the nurse around whether they are at the patient's bedside and then keep following them to the nurse's station asking questions and making demands to the point where they couldn't even open up the chart to look at new orders because they are so busy changing mother's pillow case that got a small red stain from liquid Tylenol on it and other numerous and frivolous requests.

Quote: "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"

That's your opinion and here's mine:

Any nurse who thinks that spending time entertaining family requests and concerns is equally as important as keeping up on medication schedules and order changes should not be at the bedside.

It's not an issue of compassion, it's being realistic about how much one person can do in 8 or 12 hours and prioritizing what is most important to do within that time. Prioritizing means that you first take care of the patient's immediate safety, physical, and medical needs. Nothing should be competing with a nurse's time so that those things get neglected but it happens and family members can,and often do contribute to this.

BittyBabyGrower, MSN, RN · Feb 22, 2005

We just revised our visitation in the past year. All the ICU's did...our hospital wanted to promote family centered care and had open visitation except at change of shift..well, that was chaos thru the whole house! We banded together and complained big time. They also saw a jump in security calling for the Jerry Springer families :uhoh3: The adult ICU's went to one SO at the bedside, no timeframe, the rest have to come during visiting hours and they have 15 minutes in the hour. We went to parents without limitations (we ask them to leave at shift changes, during procedures and admits) and grandparents can come alone between 1030a and 830p. The parents are also allowed 2 extra visitors a day in the visiting hours and when their two ID visitor badges are gone then that is it until 1030 the next AM. Choose wisely weedhopper. And we do give grief to the nurses who are afraid to make people follow the rules...even if it isn't our patient we tell the visitors the rules. We are also going to start making the parents sign the visitation sheets to show that they read them.

When my mom was in ICU, the nurses were wonderful and they were willing to let us stay, but I knew that they had stuff to do and didn't need us underfoot. They made a huge exception for my dad who was COPD with O2...they were wonderful to him and didn't make him leave, they worked around him, provided him with tanks of O2 so he could stay there and not use his portable and made sure he had something to drink. They made the last few days my dad had with my mom wonderful.

PJMommy · Feb 23, 2005

That's your opinion and here's mine:
Any nurse who thinks that spending time entertaining family requests and concerns is equally as important as keeping up on medication schedules and order changes should not be at the bedside.
It's not an issue of compassion, it's being realistic about how much one person can do in 8 or 12 hours and prioritizing what is most important to do within that time. Prioritizing means that you first take care of the patient's immediate safety, physical, and medical needs. Nothing should be competing with a nurse's time so that those things get neglected but it happens and family members can,and often do contribute to this.

Well said.

bfjworr · Mar 3, 2005

Well said.

The past few weeks, we have tried to identify how visitation effects our patients outcomes and staff moral/work satisfaction.

It has been hard to seperate the two.

However, on of the most difficult obstacles to this study is the deviation by some staff members from the visitation policies in each portion of the study....

Any suggestions?

:rolleyes:

MedicalZebra · Mar 3, 2005

When I was 6 years old, one of my uncles got into a serious motorcycle accident. He was in the ICU for about three weeks, never regained conciousness. At the time, NO kids under 13 were allowed to visit. We only saw this uncle a few times a year... and I don't remember him now.

I understand that at the time, it was thought that kids seeing very ill relatives would be traumatic-- but as the kid it was happening to, I thought that the nurses were big meanies who cared more about rules than they did about kids' feelings. Expecting a kid to sit quietly for hours in a waiting room (and getting yelled at by a surly receptionist for walking around) to me was more cruelty on top of not letting me see my uncle.

As I got older I began to understand the problems nurses have trying to deliver care while visitors are present... but my 6-year-old self got the message "You're only a kid, you don't matter."

Ruby Vee, BSN · Mar 6, 2005

the past few weeks, we have tried to identify how visitation effects our patients outcomes and staff moral/work satisfaction.
it has been hard to seperate the two.
however, on of the most difficult obstacles to this study is the deviation by some staff members from the visitation policies in each portion of the study....
any suggestions?

are you (or is anyone?) supporting the nursing staff as they are forced to deal with the onslaught of visitors? or are you leaving them to deal with it on their own? if a nurse is swamped and the family is getting in the way of patient care, is there a nurse manager, social worker, patient representative, chaplain or someone to take the family away from the bedside and/or provide them some support and allow the bedside nurse to take care of the patient? who ends up dealing with disruptive family members? the nurse who is also trying to care for two critically ill patients?

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[color=#4b0082]and if you're having visitors at the bedside more often, have you thought through what that means in terms of accomodations? have you provided chairs for the visitors to sit in, or are they co-opting the nurse's chair, leaving her to stand for 12 hours? (i could do that 25 years ago -- would have difficulty with it now.) is there someplace for the visitor to hang their coats? set their purses and packages? or are they covering every available flat surface, leaving no place for the nurse to set a dinner tray, a medication administration record or a med to be crushed, mixed or drawn up? is there adequate space for the nurse to get around the visitors to the bedside nurse server, the sink, the bedpan hopper?

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[color=#4b0082]as long as the visitors create more work and worse working conditions for the bedside nurse, they're going to resist more visitors. i know this comes as a tremendous surprise to nurse managers. aacn has spoken and increasing visitation is the way to go. so why won't those lazy nurses get on board with the program??? perhaps they're overworked, overwhelmed and overstimulated!

RN34TX · Mar 7, 2005

When I was 6 years old, one of my uncles got into a serious motorcycle accident. He was in the ICU for about three weeks, never regained conciousness. At the time, NO kids under 13 were allowed to visit. We only saw this uncle a few times a year... and I don't remember him now.
I understand that at the time, it was thought that kids seeing very ill relatives would be traumatic-- but as the kid it was happening to, I thought that the nurses were big meanies who cared more about rules than they did about kids' feelings. Expecting a kid to sit quietly for hours in a waiting room (and getting yelled at by a surly receptionist for walking around) to me was more cruelty on top of not letting me see my uncle.
As I got older I began to understand the problems nurses have trying to deliver care while visitors are present... but my 6-year-old self got the message "You're only a kid, you don't matter."

I have to respond to that. I read stories like that fairly often, and as cold as it sounds, I'm tired of pro- "no unlimited visiting time" people acting as if the rest of us never experienced grief and heartbreak and don't know what it's like.

I'd say that someone is quite lucky to not have experienced loss of a loved one because most of us have.

I'm tired of the old "it's all about the patient" and "the family needs to be supported and not ignored when crisis strikes" rhetoric.

The reality is that a nurse needs to be focused on the patient and their immediate medical needs BEFORE any of this other fancy "family dynamics" stuff.

2 ICU patients is plenty for one person to handle. All of the crying, screaming, family drama can and has caused nurses to miss the big stuff, and no, we can't do it all, taking care of the patient and all of the family drama.

I understand how your perspective was at the age of 6, but if it were me in the ICU, I would want my nurses vigilantly focusing on me getting out of there alive, not worrying about whether or not they hurt my 6 year old nephew's feelings.

When someone gets critically ill, it quickly becomes all about the individual family member and how it affects them personally, and the attention quickly moves away from the patients themselves, both by the nurse and the family.

MedicalZebra · Mar 7, 2005

It wasn't a case of "Uncle Rudy needs to rest so he can get better"... Rudy was not going to be leaving the hospital alive, they knew that after the first week. After three weeks, the hospital told my aunt that they were shutting off his life support... I don't understand in that case why visitors were even a problem since the situation couldn't possibly have been made worse by people being in his room.

Someone who is brain-dead and on life support is WAY different than someone who has a chance at recovery. It would have been understandable to be kept out of the room if Rudy was getting better.

mattsmom81 · Mar 7, 2005

Excellent posts Ruby and RN34TX...agree 110% and would love to work with both of you from your postings here. :)

Only wish our managers would LISTEN to our concerns, and that all nurses would stick together on this instead of caving to appease obnoxious familywho are increasingly making our workload even more stressed to the point of dangerous for patients..

I too have had to intervene, many many times sadly, on behalf of a coworker's crashing patients because they were allowing family to monopolize their time and attention. I've had to call codes for them while they're dealing with obnoxious, entitled family. This should NOT happen and I blame managers and administrators first and foremost.

I would like to expand on RN34TX's excellent comments and add:

Any ICU nurse who doesn't prioritize their care on their patient doesn't deserve to be in ICU; they need to work elsewhere IMO. The ICU patient deserves to be #1 priority at all times: that is why they are in ICU afterall.

JMHO.

RN34TX · Mar 8, 2005

It wasn't a case of "Uncle Rudy needs to rest so he can get better"... Rudy was not going to be leaving the hospital alive, they knew that after the first week. After three weeks, the hospital told my aunt that they were shutting off his life support... I don't understand in that case why visitors were even a problem since the situation couldn't possibly have been made worse by people being in his room.
Someone who is brain-dead and on life support is WAY different than someone who has a chance at recovery. It would have been understandable to be kept out of the room if Rudy was getting better.

That's understandable in your particular situation where your loved one wasn't going to get any better. People do need closure and I don't think that anyone is debating that. But I'm also not sure of exactly what your family was expecting at that time.

What I mean is, even in a "brain-dead" patient, DNR, what have you, you still can't have the ICU turning into a zoo where the family wants to come in 8 at at a time to say their goodbyes.

To refuse you because of your age alone was probably not appropriate by today's standards, not sure how old you are, but I was 6 in the 1970's and it it was perfectly acceptable to refuse kids in ICU then and it was considered to be more damaging to have someone that age witness ICU patients and events. Tough call sometimes.

RN34TX · Mar 8, 2005

Excellent posts Ruby and RN34TX...agree 110% and would love to work with both of you from your postings here. :)
Only wish our managers would LISTEN to our concerns, and that all nurses would stick together on this instead of caving to appease obnoxious familywho are increasingly making our workload even more stressed to the point of dangerous for patients..
I too have had to intervene, many many times sadly, on behalf of a coworker's crashing patients because they were allowing family to monopolize their time and attention. I've had to call codes for them while they're dealing with obnoxious, entitled family. This should NOT happen and I blame managers and administrators first and foremost.
I would like to expand on RN34TX's excellent comments and add:
Any ICU nurse who doesn't prioritize their care on their patient doesn't deserve to be in ICU; they need to work elsewhere IMO. The ICU patient deserves to be #1 priority at all times: that is why they are in ICU afterall.
JMHO.

Thanks Mattsmom!!

But keep in mind that I think that we have a bond due our both being permanently damaged from the evil doings of the big "K" hospitals in DFW.

Most of my bad experiences are taken from my employment there where visitors were just plain out of control and basically ran the place.

No ICU is going to be completely drama free and that's just the nature of the work, but at least where I work now visitors do have to follow rules and instructions and that includes leaving when asked to leave by the NURSE, no questions, no threats to call administration.

We do not just threaten to call security if things get out of hand, we actually do it and people do get escorted out. Very rare if that has to happen but we make it very clear in the beginning of what is expected of people when they visit.

Oh yes and don't forget about our MN connection as well in addition to the big "K" thing in DFW.