Family visitation in ICU

bfjworr · Jan 20, 2005

Data Supports Open ICU Visitation Policy
By Paul Clark, for HealthLeaders News, January 13, 2005
http://www.healthleaders.com/news/feature62357.html

Thanks for all the great reading material....I will take it to work with me tonight and share it with my co-workers....

nurselily3 · Jan 20, 2005

The hospital I work at is a Teaching Trauma Level 1. We have an open visitation policy also, much to the nurses dissatisfaction. There are rules set but we have 7 separate ICU's .....so, when one patient gets moved from one ICU to another and the first has been abusing the "rules" then the family wants to know why its so in the second ICU. One unit lets family sleep on the floor for goodness sake and wonders why we wont let them in our unit. For the longest time we didn't have locked doors on our units either. Only the ED was locked down. We just have "clerks" who call in when so and so's family would like to visit (is that OK). The nurses have the right to say yes or no, but if its not locked down what is going to keep the Jerry Springer families from coming in?

I recently had a young girl (17) that had been shot by an unknown assailant in a waffle house. Her family was out of control. After repeated times going over the rules about letting people parade in an out. Cause as the rule stipulated...only two at a time, so people trade out....ALL DAY!! The parents thought that this didnt' apply to them, so they stayed while kids and family walked in an out as if it were a side show...stopping to peek at all the other poor souls lying in there. They didn't know half of these people! And the guy who shot her is still walking the streets. Who's to say that he doesn't come in with the group of kids (I don't think he was much older then them)? That would put all the other families, patients, STAFF...everyone in danger. Management didnt' care. Finally I told the parents that I had enough, that if they didn't control the problem...I would with the help of security and not let anyone visit while she was in the ICU. Finally they got the picture. People just don't have any respect for other people!

Ive been on the other side of this picture too. My father spent 43 days in the hosptial after a lung transplant. He coded and died on day 44. I think its shameful to think that people want to see their loved ones pounded on. I had a hard enough time dealing with him laying in a bed dead, covered with a white sheet. Not to mention, as Im sure you all have dealt with, throwing stuff on the floor cause who has the time to find the trash. We try to clean up the rooms, but there are always things left behind like heplocks...tops to emergency drugs...etc. This stuff was all laying under his bed..just as a reminder of what he had been through. Not something that lay people shoud be seeing.

Our units finally got locked down. Half the time the people will wait till someone comes out the door and seak through it. That, or they will sit and pull on the handle like children (which in most cases breaks the door). Where do you draw the line??

I think people should be able to see their family, but within reason. This should be supported by management (who were all mostly bedside nurses at one time, they just quickly forget).

leslie :-D · Jan 20, 2005

this is particularly important in an icu setting and these visitations need to be enforced. it certainly does not benefit the patient nor the nsg staff- too many distractions and interferences.

you were right in putting your foot down.

often times, that's all it takes.

and i'm sorry about your dad.

leslie

bellehill, RN · Jan 20, 2005

Open visitation takes the focus off the patient and onto the families, who aren't in need of nursing care. The other thing to think about is the families who will only leave because they have to, take away that reason and they are at the bedside 24/7. Try to suggest they go home to rest and they refuse. After a couple days these people get nasty and irrational from lack of sleep and hygiene.

fairone · Jan 21, 2005

/start vent

This topic has recently become an issue in our unit and can relate to each and every problem posted in this topic. Management recently decided that we were to abolish our current visiting hours and have an open visitation policy after a family complained that our visiting hours were to strict.

Previously we had no visitors during the morning Dr's round and a 3 hour block in the afternoon 1-4, other than that visitors were allowed around these times, which on the whole worked quite well and family were fairly compliant - of course there is always the exception with the palliative/dying patient, interstate visitors etc. etc. So a few months ago, without any input, discussion or suggestion to the ICU staff, management decided to change our visiting hours to open visitation. As you can imagine managements follow-up as to how the staff or the unit are feeling about this change is impeccable...NOT.

Although when this change did come about, I did go in with an open mind, thinking that maybe it wouldn't make much difference, how naive I was! I must add we do try to mention to visitors and family to detract from visiting during the morning doctors round and shift changes, because of privacy issues, but you can without a doubt ensure that there will be visitors at the door despite. Issues I've found with open visitation ->

* for some it's a social occasion coming into visit with family spending more time talking to staff or visitors, looking at the monitor, looking at other patients, etc. etc. 'what's the blue line for, what's the red one for, what's that drug' need I go on.

* despite that, yes they maybe in bed all day, patients do get tired very quickly and easily, particularly after being seen by numerous doctors, physiotherapists, procedures being done etc.. I don't think visitors understand the scope of actually what patients go through sometimes and then they are expected to sit and entertain visitors for fours hours and they wonder why they are so tired! As far I can tell this can be detrimental to LOS. I found having even this 3 hours in the afternoon, patients actually appreciated the quiet time and had the opportunity to catch up on some very lost sleep...that is until visiting hours began again and there were visitors coming in going 'are you awake...?' despite telling them he was asleep.

I could go on. Believe me. But these are probably the main issues that have seemed to escalate since changing visiting hours. There are always times we appreciate visitors/family being there and I do understand there need to be there and visit..and I don't have an issue with that at all, but as previously mentioned I think there needs to be boundaries set, and often by the time we realize this (usually after problems start occurring..) it's too late.

I'm not sure if there is ever going to be a solution or a perfect answer to this issue...but it would be a start if management listened to the staff that work in the unit, who know the patients, family and place the best.

/end vent :!

RN34TX · Jan 22, 2005

I have a feeling that if this were 30 years ago we wouldn't be even having this discussion. Over time, family members have gained control to the point where they are out of control.

I know nurses who have left the field specifically over this issue and would no longer tolerate being abused by them, I was almost one of them.

Thankfully, I found an ICU with very strict visitation policies and couldn't be happier about it.

I wish I was videotaped every shift to show those families that yes, I still turn and clean your loved one without your watchful eye and I still do everything i'm supposed to do despite the fact that you are not watching over me 24/7.

Families, you may be very surprised, but I do still function as a caring and competent nurse without your constant critiscism and supervision.

bfjworr · Jan 22, 2005

I have a feeling that if this were 30 years ago we wouldn't be even having this discussion. Over time, family members have gained control to the point where they are out of control.
I know nurses who have left the field specifically over this issue and would no longer tolerate being abused by them, I was almost one of them.
Thankfully, I found an ICU with very strict visitation policies and couldn't be happier about it.
I wish I was videotaped every shift to show those families that yes, I still turn and clean your loved one without your watchful eye and I still do everything i'm supposed to do despite the fact that you are not watching over me 24/7.
Families, you may be very surprised, but I do still function as a caring and competent nurse without your constant critiscism and supervision.

Do you think that families have "gained power" because of litigation fears or have past negative experiences and feelings of guilt by the family provided fuel to the "demands" for more presence in the ICU?

begalli · Jan 22, 2005

Open visitation takes the focus off the patient and onto the families, who aren't in need of nursing care.

Over time, family members have gained control to the point where they are out of control.

Two things I would like to comment on.

Family is the patient. I think that while not physically the same, emotionally and mentally, family members are just as vulnerable, if not more vulnerable, as a sick ICU patient. Just like the patient, they have lost all control of their own autonomy when it comes to their loved one.

Believe me, I'm not denying that families can be a pain in the butt but I think sometimes they "act up or out" because that is the only way they do have some control.

Frequently, instead of dealing with this problem directly by getting social services, the chaplain, or helping provide some other form of support (simply talking frankly about it) that can maybe help families deal with this loss and helping them understand what is best for the person lying in the bed, they are allowed to continue to dysfunction.

My intention is not to minimize the problem. I would be very unhappy with open visitation on our busy unit. I've had my share of downright obnoxious family who no matter what you do, nothing is good enough. But it also bothers me when I hear nurses say that family is not my patient or family does not need nursing care.

fergus51 · Jan 23, 2005

I don't believe the family is unimportant, but they are not my first priority and they are not the patient as far as I am concerned. The patient is the one on the ventilator with dopamine and dobutamine maxed out and although I also provide care to their family and their family is also suffering, their family's needs are secondary. When I say the family isn't my patient, it isn't because I don't care about them, it's because the patient is the patient and the family is the family, kwim? Saying the family is the patient is like a man saying "we're pregnant"... It just isn't true. He may be equally affected by his partner's pregnancy just like families are affected by their loved one's illness, but they are not the same thing. Nursing is all about prioritizing and the patient is the number one priority. Fortunately their needs usually coincide with the family's. Sometimes however, the family interferes with the patient's care and that is unacceptable no matter how stressed they are. I do know what it's like to have a loved one in an intensive care unit and be incredibly scared and frustrated, but I never used it as an excuse to act like a nutcase in the unit.

RN34TX · Jan 23, 2005

Fergus51, I'm with you completely on that one. I fully understand that the families are going through a rough time with a loved one in ICU, but it sickens me to frequently hear the "poor coping skills" and "sense of loss of control" labels that are often given to problem familes to be considered valid excuses to pound fists and curse at the nurses station if they don't get everything their way.

It's pretty sad to see someone act like an adolescent or even younger when they are in their 20's, 30's, 40's, etc. when a crisis occurs in their life.

I too had to experience seeing a loved one in restraints on a vent with tubes coming from everywhere long before I was a nurse or knew anything about nursing. I was 23 and considered dealing with that kind of tragedy as a part of being an adult. You handle a crisis like a grown adult.

fergus51 · Jan 23, 2005

RN34TX, I think that's a big problem with our society today. We try to excuse everything. I don't expect families to be angels and behave perfectly, but somethings are unacceptable and I will never make excuses for them. I have actually heard a parent tell a nurse manager "Bite me! F--- off!" and people make excuses for it. Once that's been allowed once, you can bet no nurse will ever get any respect from her. I can't imagine that was tolerated 30 years ago, so I don't see why it should be today. People are no different.

bluesky, BSN, RN · Jan 23, 2005

Well, this is an interesting subject. Personally I am extremely liberal with visitors ( while on our 14 bed SICU visiting hours are 9A.M. to 9P.M., individual nurses can go beyond that if they so choose) because I frankly put myself in their position and would personally want as much time as possible. While I have been burned a couple of times (neurotic visitors who insist on waking up their sleeping loved one so they can get that sleeping pill they asked for a couple of hours ago, for example); overall I do feel that visitors act as good advocates most of the time and do provide positive stimulation (again, most of the time). Have I conducted a double blind study to ascertain whether visitation improves pt outcome, no.