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.
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.
I'd put money on it, that statement comes from a new nurse. A few years and abusive families later, you will change your mind. I've been in that position and it's insulting that people assume that I've never been there and that's why I'm so insensitive to family needs.
Yes, there are great supportive family members out there, both to their loved one and the goals of the medical staff, but there are way too many out there that need control because they are out of control.
Wow you said it PJ Mommy! Everytime I read a nurse supporting open visiting I wonder where they work and what position they hold.
Well I work as a BSN in the region's biggest teaching hospital right smack in the middle of the ghetto. We get heart transplants, VADs, IABPs, bad heads (we are the level I trauma center for the area) and all other trauma. I think that except for the most neurotic cases which are few and far between, families can be managed with a little tact. Just my 2.
I guess what I'm trying to say is that I'd rather deal with the occasional jerk so that all the other nice families CAN visit than the opposite, which would be nice families not getting good access on account of a few bad seeds.
I'd like to know where you work too. I've worked around the country and have yet to find one hospital where problematic families are "far few and between."
How about when your patient is on a pressure controlled ventilator, on a nimbex drip, with morphine and ativan drips...and the family persistently tries to wake the patient...
Most families seem to understand once I have explained the situation, "If you were intubated like this, would you want to be awake?". HOWEVER, some family members either don't get it or don't care.
Another problem is families try to wake up sedated patients while they are on the ventilator or loosen or remove restraints while they are visiting and forget to replace them when they leave.
Our unit is hiring a customer service liasion to sit in the waiting room and talk with the families; act a go-between for families and nursing staff. I think it is a wonderful idea and I am sure it will help the day shift nurses since this is when the liasion will be working. What about night shift? Has anyone else heard of this type of position?
Our unit is hiring a customer service liasion to sit in the waiting room and talk with the families; act a go-between for families and nursing staff. I think it is a wonderful idea and I am sure it will help the day shift nurses since this is when the liasion will be working. What about night shift? Has anyone else heard of this type of position?
We have the same type of position....however it is primarily seen in the ER. There is a representative available at night too. I believe it is a successful effort to manage families that are in distress and becoming unruly...Before that the only answer was to call the supervisor and security.... That is what we have to do in the ICU. The only patient liason there is the nurse. She is the go between between the family and the phyisician...if a problem occurs we still call the supervisor and sometimes security to our ICU.
We have the same type of position....however it is primarily seen in the ER. There is a representative available at night too. I believe it is a successful effort to manage families that are in distress and becoming unruly...Before that the only answer was to call the supervisor and security.... That is what we have to do in the ICU. The only patient liason there is the nurse. She is the go between between the family and the phyisician...if a problem occurs we still call the supervisor and sometimes security to our ICU.
What would you consider to be the best time schedule for visitation.....?
Does your facility allow the families in room during a code?
Our physicians don't....once I had a daughter come back to the room unexpectedly while we were coding her mother.....It was not pretty...and luckily the nursing supervisor was there...she took her to the family room until the code finished......
We have the same type of position....however it is primarily seen in the ER. There is a representative available at night too. I believe it is a successful effort to manage families that are in distress and becoming unruly...Before that the only answer was to call the supervisor and security.... That is what we have to do in the ICU. The only patient liason there is the nurse. She is the go between between the family and the phyisician...if a problem occurs we still call the supervisor and sometimes security to our ICU.
Our O.R. has a nurse who acts as a liason (the position is rotated), it's a fantastic asset. She pokes her head in all the different rooms to see how things are going and then walks down to the family room periodically and updates families on how things are going. It is the surgeon's job to talk to the family after surgery and let them know how things went in detail, especially in cases where a diagnosis is being made. Unfortunately, there is no liason after surgery is done, and the surgeons are often lax about talking to family in a timely manner, so the PACU is often inundated with calls from family members wanting details which only the surgeon can provide.
What would you consider to be the best time schedule for visitation.....?
Does your facility allow the families in room during a code?
Our physicians don't....once I had a daughter come back to the room unexpectedly while we were coding her mother.....It was not pretty...and luckily the nursing supervisor was there...she took her to the family room until the code finished......
Honestly, I don't know the answer to that. I think it is great that family members are being allowed to spend more time with their loved ones while they are in ICU, I don't think it has to be 24/7. Maybe open between 10A-10P or something along those lines. That gives the nursing staff time to work and the patient time to rest. I definitely don't think families need to sleep in the pt's room. Right now we call family members between 6A-7A to update them on how their loved one did during the night and what the plan is for the next shift. We call one person only.
I ask family to leave at the first sign of trouble, would never allow someone to stay during a code however I don't think it is a policy.
I am very hopeful for this liasion position to help stabilize things between nurses and the family. Unfortunately I think we pick up the slack when doctors don't talk to the family...we get the majority of the anger that is really for the doctor. There are certain things nursing can't discuss (test results) and the docs need to step up and help us out too.
I think one of the chief problems is that their is no "ONE" definition of OPEN visitation.... Just the uttering of the phrase can bring nurses to attention...most say they do not want it....but they might actually have a form of open visitation with restrictions.... So what is "CLOSED" visitation?
I like the idea of calling family members in the morning with an update. I think I will implement that in my stanard of care. Thanks for the suggestion.
Linda
Right now we call family members between 6A-7A to update them on how their loved one did during the night and what the plan is for the next shift. We call one person only.
I like the idea of calling family members in the morning with an update. I think I will implement that in my stanard of care. Thanks for the suggestion.
Linda
Friendly advice: Never call anything your standard of care; miss it and you've violated what you say is a standard of care. Plaintiff attorneys love when that happens.
Friendly advice: Never call anything your standard of care; miss it and you've violated what you say is a standard of care. Plaintiff attorneys love when that happens.
We are going to have a 4 week trial of open visitation....
Would love to hear some guidelines from other places...
What kind of restrictions do you recommend....
How are your guidelines received by your families?
RN34TX
1,383 Posts
I'd put money on it, that statement comes from a new nurse. A few years and abusive families later, you will change your mind. I've been in that position and it's insulting that people assume that I've never been there and that's why I'm so insensitive to family needs.
Yes, there are great supportive family members out there, both to their loved one and the goals of the medical staff, but there are way too many out there that need control because they are out of control.