Family visitation in ICU

bluesky, BSN, RN · Apr 23, 2005

Bluesky, it doesn't sound like you are in the minority at all. Well behaved visitors can stay, bad ones can't right? That's probably what we all want. I've never met a nurse who thought no one should be allowed on the unit.
I don't see why the second someone wants to discuss the poorly behaved nutcases, we have to say "I'm not talking about the nice visitors". It seems obvious to me that the problem is the nutcases and I don't feel bad about saying that. The hospital is not a hotel or a tourist attraction and you'd be surprised at how many visitors to our unit have acted as though it was lately. They not only disturb the staff, they disturb the other visitors and patients. We don't have our babies in private rooms.

Would you believe I am more disturbed by a poorly behaved nutcase RN I work with than any visitor!

fergus51 · Apr 24, 2005

Would you believe I am more disturbed by a poorly behaved nutcase RN I work with than any visitor!

I would believe it. I've worked with a few nuts in my time. The solution is the same as the nutcase visitors: GET OUT AND DON'T COME BACK UNTIL YOU CAN BEHAVE LIKE A CIVILIZED PERSON.

I am tired of hearing "Well, they're stressed" as an excuse to crazy behavior. I'm stressed. Every other family member in the unit is stressed. They don't all act like wild animals. And the poor behavior has no relationship to the baby's condition. Some of the craziest people have kids who are really doing well (feeder growers). It's time for people to start taking responsibility for themselves. I would be completely embarrassed if I ever behaved the way some of our visitors do.

carebear64 · May 22, 2005

Just because my patient is vented and sedated doesn't mean he/she isn't entitled to their privacy. I can be in the process of bathing, suctioning or some other awkward task and in walks a family member wanting to observe and comment on everything I am doing. I don't like discussing personal information at the bedside when my patient is unable to participate in the conversation. I don't know if the patient even wants that family member in the room, not to mention having them know all the details about what is going on. Patients have the right to privacy at all times.

Secondly, As a nurse, I should be able to perform my job without supervision and judgement from the visitors. I want to be supportive and help them understand what is happening, but it never ends. I don't think it is in my patients best interest for me to have to stop and explain everything over and over again to visitors. I often feel pressure to give certain information and support that the physicians and pastoral care should be providing.

I absolutely agree with being supportive, sensitive and caring to the entire family, but I think we should be the ones to set the limits. We should have the freedom to be flexible with the visitation policy based on our patients particular needs, and the management should support us 100%!

PCloudy · Dec 8, 2005

Hello to everyone. Just 2 weeks ago, our "in touch" administration mandated open visiting hours. We have tried to be positive but our experience so far has been unbelievably negative. Families are largely inconsiderate and we find ourselves trying to instill some common sense and guidelines for appropriate behavior in the critical care settings. We have had everything from rubbernecking during procedures in other patient's rooms to significant other's climbing in the bed and exploring under the covers when the pt is on contact isolation. I am firmly convinced that our society shows pathetic signs of exponential rise in the numbers of really stupid people. We have small rooms that not only have to accommodate the pt (frequently bariatric in nature), vents, IABP's, CVVHD machines, cooling blankets and any number of other pieces of equip.....but 9-10 (or more) family members that insist on waking the pt from a propofol siesta to agitate them to the point that interventions are necessary. We have found that the family members expect flawless care and attendance by the nurse and doctors but they can't pry themselves away from the side of the bed long enough for the staff to get within arm's reach of the pt. It's only a matter of time before a back injury occurs because these single digit IQ's can't see the need in giving us some room. It's hard enough to drag a limp (or stiff - equally as difficult) body around in bed when there is very little room to begin with. In the last 2 weeks, we have had 3 people give their notice and are moving on to other areas that have reasonable visitation. They are tired of wiping butt only to have 3 people barge through the closed door while the pt is uncovered. Somehow, I doubt that these visitors make the pt more "comfortable." I could go on forever. I, too, have applied for a job closer to home and with appropriate visiting time so that we can get our work done and the pts can have time to rest between the parades of well-meaning family and friends. Our hospitalists and cardiologists (among other groups of MD's) have serious complaints that have been voiced to our administration (in vain). Naturally, the ones making the rules don't have to contend with the fallout.

ptadvocate81 · Dec 12, 2005

Our ICU units debated over the open visitation issue, and ultimately decided against it. It is hard enough to get things done during the visiting hours with having to manipulate yourself around family to get to the patient without them being there all day. I understand how difficult it is for family not to be able to see their loved one when they choose, but most of these pts need minimal stimulation anyhow. Our new hours are: Limit 4 people to the room during visiting hours and 0600-0630, 0800-0900, 1200-1300, 1700-1800, 2000-2100. The committee decided that longer visiting hours would help the families, and centering them around mealtimes would help the nurses out that have pts that are eating and make the family feel more involved in their care. We have had these hours for about a year now and they are working out wonderfully.

Teachchildren123 · Oct 7, 2006

Open visitation 24/7, NO!

1. Pt healing: No way the pt can rest (he is sleep deprived enough as it is by us doing task, t+p, call bells other pts, IV beeping, phones...) Nothing more agravating than visitors trying to wake up pt's on a sedative drip/vented/in DT's while you finally got him relaxed!

I tolerate just the 1 hr on my shift, and that's is often my max! I love people but, a lot of family are very demanding, asking the same ? the dayshift answered and I answered for the last 3 nights... A lot of time visitors are very disturbing to the pt. The pt who had a infarct for ex. need all the rest possible, comforting environment and a lot of encouragement.

2. Pt safety: It is very stressful to be in the ICU. Having strangers lurking in rooms, and walking around at all hours of night is non-sense! Even the churches are not open at night. We have way less staff at night.We have 3 security guards, which one is in ER ATC. How are we going to control the comes and goes? When will someone come in and shoots us all (as one fx member already treatened us last year, that's how we got to have a buzzer for entrance permission 3 months later)??? No kidding! Scarry!

Even in the burbs, weird things happens!

Bad enough the bad things the "Jerry Springer's " of the world do:

Bring cola to your active diabetic/upper GIB with NG to sx, or free water to your flash pulmonary edema/renal/dialysis pt, or just water for the intubated pt: "but mom's thirsty!

People do not understand that we have to have some restrictions and that the reasons are verified and valid. We are not to punished them!

3. Propagation of bugs: "Please, gown up, wear gloves, wash your hands before and after touching pt, don't let the toddler crawl on the floor, oh! no! the babyis licking it's fingers like at the buffet!

4. Request to excuse myself everytime I have to:

Clean up stinky-unavoidable Clotridium Difficil, suction the long oral strigy secretions from Buffalo to Paris, cleaning up emesis and lower GIB at the same time, who want to smell and see all that? Poor pt, who think he wants to share this with other? Make him feel ashamed and without his identity one more time, after all, Administration calls him "The Customer"!

Excusez-moi, I have to let you wait for 30 mins in the waiting room, I must do my Swan readings (among other things), listen to the lungs, do the I and O and call Dr. Nephrologist and Dr. Cardiologist with the results of the 5 labs I was supposed to draw 2 hours ago, just before my 3rd pt coded!

Or just everytime I have to check UO, change my 100.000 drips, place p.ox on again, since the room is crowded with even 1 + person.

5. Rules: Good to give them out right away. If only they would be respected! Got to T+P, assess at least Q2hrs, clean ups, baths, IV insertions... Would you want to stay for CPR too! Now that you got your loved one so excited! Great show at 4 AM for the esophageal varices pt, unfortunately morbidely obese.

NO HOSPITALS ARE NOT A ZOO, A MUSEUM, OR AN ATTRACTION!

I might seem harsh, but I do have a lot of compassion and love my patients. I do not object to flexibility, of course you can stay when the pt is dying, or you can come 5 mins every hr if critical. Or all the CPR time, if it helps you.

However, I was very happy when I could stay with my love one, I did I+O, put chart togheter, bath, feed, walked, iced... and told the nurse to let me know when she needed me out of the room... I was still labeled ""his wife is a ICU RN". Nonetheless, they cheated on his VS, offered pain med once in 8 days, kept the call light/urinal unreacheable after the scan. That's pretty bad when you got one broken arm and pelvis fx, can't walk, last round down the hall, double door would not hear yelling for help!

The thing is everywhere, there is good and bad. Moderation taste better. And I DO NOT WANT OPEN VISITING HOURS![EVIL][/EVIL]

Teachchildren123 · Oct 7, 2006

I appreciate grits #142, RubyVee#143, KimberRN1#119, NMnurse posts. Sorry Pamaza for sad experience. Carebear64, #155, sweat post. Thank you all!

gradcare, LPN · Oct 10, 2006

For mine, open slather visiting very bad for all however we have 24/7 visiting however it is made very clear to visitors that they WILL leave for round, handover and procedures. I also have my rules that I tell them 1) If I am on the move and do not ask you to move stay put. 2) I will talk to who when I have time....the care of you loved one comes first. 3) wash hands first and last 4) If you look tired I will suggest you go get some sleep. If you do not take this suggestion then you loved on may be getting a 4 hr spongebath. Seems to work o.k. Just need to make sure that everyone in the unit plays by the rules.

Tanvi Tusti · Oct 10, 2006

Im wholly in agreement with 24/7 visiting. The busy 10 bed ICU I was in charge of has open visiting, with some limitation and works great. I think its a good thing for patients and relatives alike and apart from the occasional blip we never had a problem.

Our 24 hour policy applied to direct family members only, ie:spouse and parents. There were timed visits for all other relatives. The named nurse spends a few minutes with them explaining the visiting policy and are never met with anything but positives.

Relatives are asked to leave the bedside during any nursing or medical procedure (adminstration of meds or general obs. not included in that) and of course should any emergency arise they would be guided out of the unit and into the visitors room.

If relatives felt the need to stay the night there is a special room allocated for them to sleep and they can pop in and out throughout the night to be with their loved one.

I worked with this policy in place for over 10 years and it was never a problem for anyone, staff or other.

PollyPutTheKettleOn · Nov 23, 2006

I have worked in an ICU where families were permitted to go to CT and MRI with us! It was crazy and stressful. Open visiting hours is a mistake - especially the families that are on a powertrip and catch onto the fact that Management does not support the RNs. I have had families INSIST that I put a pts NGT on suction, rather than aspirate four-hourly. No rationale behind it, they just wanted it that way. Some relatives would insist on looking at blood results - then demand to know why a CRF pts K+ was not topped-up (because the print outs state normal levels), and insist that I call the Dr to get an order for K+!

If I was lying in ICU and my friends, neighbours, the kids my friends were babysitting, my nephews school friends and the travelling circus came into see me lying unconsciuos, naked under a sheet, possibly having a bowel movement or passing wind, I would be MORTIFIED!

Illness/injury is such a private thing, especially when a pt is not able to speak for themselves - how many of us have had random visitors ask "How is she doing?" - um, unless you are next of kin, none of your business.

I always ask - if the pt was at home sleeping, would the visitor go into their bedroom and watch them sleep?

People who do not have much to do with hospitals do not know how to behave, so they need us to show them. We can't show them if we can't set boundries.

Polly (looking to leave ICU because she is burnt out and cranky)

kessadawn, BSN, RN · Nov 23, 2006

our picu has a pretty lenient policy, i think. four visitors max during day from 0700-2100. from 2100-2300 2 visitors at the bedside, and after 2300 only one parent can stay throught the night. and our doors are only locked during the night, so even thought there's a phone for visitors to call on before coming in, most just come right in during the day. i think it's way too lenient. most families are very compliant with this, but the ones who aren't are absolute nightmares.

we once had a teen pt who was the victim of mva, basically an unpronounced brain death while parents got 2nd and 3rd opinions. hey, that's fine, parents need time to be ready to let go, and any support we can give can't hurt. the parents were fine with the policy, the teens that came to say their goodbyes were polite and respectful of policy,family and staff. the adult relatives of the pt were bringing people back in droves, ignoring repeated reminders of the visitation policy, sneaking in at any chance, and very loud and beligerant when gently reminded that they needed to go. it unfortunately came down to security having to speak with the family, and then it just got worse. family members accusing us of "being mean" to this pt's parents, having security "threaten" them. the worst part of all this is that the parents never seemed to have time alone with the child to say things they may have wanted to say one last time, to come to grips with having to let go. those selfish family members took that away from them and didn't even care. :crying2:

ZASHAGALKA, RN · Nov 23, 2006

http://etd-submit.etsu.edu/etd/theses/available/etd-0405104-170949/unrestricted/BoswellS040704f.pdf

From the research for a Master's Thesis: Suzanne Boswell, E. TN State Univ. May 2004:

She examined the beliefs of nurses both before the implementation of a more liberal visitation policy, and 6 months after.

Key Findings:

There was a 33% increase over that time period of nurses believing that their salary was no longer satisfactory to the work they were doing.

An 18% decrease in nurses relating that they were 'proud' to talk to others about their jobs.

A 21% decreases in nurses agreeing with the following statement: If I the decision to make all over again, I would still go into nursing.

19% increase in nurses stating that they disagreed that they had autonomy to make important decisions and that management would back them up.

100% - every nurse in the survey - agreed after 6 months that there was a gap between administration of the hospital and the daily problems of nursing service. Admittedly, the number was high BEFORE implementation of liberal visitation (92.8%), but afterwards: it was a universal and unanimous complaint.

22% increase in nurses that believed they could do their jobs better if they didn't have so much work to do.

20% decrease in nurses stating that they had sufficient time to do their jobs.

23% increase in nurses that believed the following: I believe that allowing families to visit at more frequent intervals can cause more physical problems for my patients.

Amazing results.

For any nurse managers or administrators reading this: recap just ONE item on this list - a move to more liberal visitation caused a 33% increase in dissatisfaction about PAY. Why would that be? More important - what does that say about retention?

"Implementation of a more liberal visitation policy is perceived as an infringement on nursing autonomy if the decision to implement the policy was made prior to consulting all members of frontline nursing staff. Plans to implement the policy continue despite many objections from the frontline. Unfortunately, this creates increased distrust of nursing administration by nurses providing direct patient care."

"Beliefs of critical care nurses related to more liberal visitation policies, perceptions of overwork, and difficulty in dealing with difficult patients has the potential to cause nurses to exhibit negative behaviors without understanding the negative impact on families (Hupcey, 1998). Ryan (2002) asserts that with more liberal visitation policies, nurses will feel more constraint, become less service oriented, and a decrease in patient and family satisfaction will be measured. Alternatively, administrators strive to implement the liberalization of visitation policies because of the belief that it improves visitor satisfaction while concurrently shortening hospital lengths of stay (Roland et al., 2001; Ryan)."

~faith,

Timothy.