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.
We have four - thirty minute visiting hours each day. Almost all of the families respect our schedule.... and there are times when we need to have the families in the rooms to help keep a patient calm.
Some famlies don't understand our visiting schedule.
Not many of our rooms are very large.... we have very very sick patients who often times have prisma, nitric, vent, keane bed, all the iv poles, random machines for cooling/warming, traction at the end of the bed.... so on and so forth.... sometimes there is hardly any room for more than a few people, and when these families don't respect TWO visitors at a time and try to crowd 10 people in the room for visiting hours, it makes it difficult to get to the patient.... I'm not sure if more or longer visiting would cure this problem.....
Visitation time is always a difficult topic, because different ICUs take care of different patients with different needs......
We try to be a good judge of when to bend the rules.... but in general, all of our familes tend to agree that they want us focused on their family member, not them.
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?
:)
-No visiting during shift change...7-8am and 7-8pm
-No more than 2 visitors in the room
-No food in the room
-No children under 13 without an adult
-No sleeping in the rooms
-No cell phones
We are going to start being a little stricter because night shift is getting walked all over. These are the biggest rules we have that are going to be inforced. Not enough in my opinion but it is a start.
In 2003 we allowed visitation every two hours for 30 minutes around the clock...there were many problems and this past year (2004) we switched to 11 am to 4 pm and 8 pm to 10 pm...and that seemed to be working well but AACN is recommending open visitation and our administration is rethinking the visitation policy again...that is why we are doing the trial...in an attempt to see what works best....
Many hospitals define open visitation differently... I haven't seen many places that actually offer 24/7 visitation to families.... and so many nurses are critical of open visitation - it will be interesting to see the results of the study...
-No visiting during shift change...7-8am and 7-8pm
-No more than 2 visitors in the room
-No food in the room
-No children under 13 without an adult
-No sleeping in the rooms
-No cell phones
We are going to start being a little stricter because night shift is getting walked all over. These are the biggest rules we have that are going to be inforced. Not enough in my opinion but it is a start.
......but AACN is recommending open visitation and our administration is rethinking the visitation policy again...that is why we are doing the trial...in an attempt to see what works best....
I keep hearing this also...that AACN is recommending open visitation. Can anyone direct me to a link with this recommendation? I can't seem to find it on the AACN website and would like to read these recommendations myself... In particular, I'm curious as to how they define "open visitation".
This is what I have found so far....from AACN and AMA
American Association of Critical-Care Nurses
1.Family visitation and partnership in the critical care unit. (NGC-1147)
oFamily visitation and partnership in the critical care unit. Aliso Viejo (CA): American Association of Critical-Care Nurses (AACN); 1997. 46 p. [33 references]
For more information, please refer to the American Association of Critical-Care Nurses Web site.
Health Care Leader Urges Hospitals to Ease Visiting Restrictions in ICUs
(Announced August 13, 2004)
"In a commentary published in this week's Journal of the American Medical Association, Donald Berwick, MD, CEO of the Institute for Healthcare Improvement (IHI), encourages hospitals to ease restrictions on visiting hours in intensive care units to give patients more control over who can visit them and when. He says open visitation policies give patients a support system and more familiar environment, enable family members to provide feedback to nurses and physicians, and strengthen trust between hospital staff and families. Berwick urged hospitals to open their ICUs for a few months to assess the impact of open visitation, with an eye toward implementing an unrestricted ICU visitation policy. Nancy Foster, senior associate director for health policy at the American Hospital Association, said that many nurses and doctors have been less restrictive on visitation policies when doing so seemed appropriate. She said information from the IHI's work would "provide valuable information to inform both formal hospital policies and the judgments made by nurses and doctors across the country."
Thanks! I'll look up these sources. However, if I'm reading this correctly, the last article you quote is really from a commentary in JAMA, right? So a doctor/administrator who has probably never spent more than 30 minutes in the middle of the night in an urban trauma hospital in the heart of the "ghetto".
As a side note, we had a PATIENT go absolutely wild the other night at about 3 AM. Maybe this is sexist...but I was so thankful we had a couple of big, healthy male nurses working that night because I don't think us ladies could have physically handled this guy long enough for the Haldol to kick in.
This is what I have found so far....from AACN and AMA
American Association of Critical-Care Nurses
1.Family visitation and partnership in the critical care unit. (NGC-1147)
oFamily visitation and partnership in the critical care unit. Aliso Viejo (CA): American Association of Critical-Care Nurses (AACN); 1997. 46 p. [33 references]
For more information, please refer to the American Association of Critical-Care Nurses Web site.
Health Care Leader Urges Hospitals to Ease Visiting Restrictions in ICUs
(Announced August 13, 2004)
"In a commentary published in this week's Journal of the American Medical Association, Donald Berwick, MD, CEO of the Institute for Healthcare Improvement (IHI), encourages hospitals to ease restrictions on visiting hours in intensive care units to give patients more control over who can visit them and when. He says open visitation policies give patients a support system and more familiar environment, enable family members to provide feedback to nurses and physicians, and strengthen trust between hospital staff and families. Berwick urged hospitals to open their ICUs for a few months to assess the impact of open visitation, with an eye toward implementing an unrestricted ICU visitation policy. Nancy Foster, senior associate director for health policy at the American Hospital Association, said that many nurses and doctors have been less restrictive on visitation policies when doing so seemed appropriate. She said information from the IHI's work would "provide valuable information to inform both formal hospital policies and the judgments made by nurses and doctors across the country."
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.
When I am juggling 3 critically ill patients who have critical needs, I do not have time to handle abusive, demanding, in-your-face family members underfoot all the time. Period. Tact has little to do with it and I hope you're not implying that if nurses don't like open visiting they have less tact. Please.
Thanks! I'll look up these sources. However, if I'm reading this correctly, the last article you quote is really from a commentary in JAMA, right? So a doctor/administrator who has probably never spent more than 30 minutes in the middle of the night in an urban trauma hospital in the heart of the "ghetto".
Love that comment. Another example of the only healthcare people who support "open visitation" are those who wouldn't actually have to deal with it when they are here raising hell and your patient is going crazy fighting the vent. If any bigwigs did witness any of it, what is their famous line?
Wow you said it PJ Mommy! Everytime I read a nurse supporting open visiting I wonder where they work and what position they hold.
When I am juggling 3 critically ill patients who have critical needs, I do not have time to handle abusive, demanding, in-your-face family members underfoot all the time. Period. Tact has little to do with it and I hope you're not implying that if nurses don't like open visiting they have less tact. Please.
First of all, where are you working where you are assigned 3 ICU patients? That's insanely unsafe. Last night I had both of my 2 patients maxed out on their vasopressors with pressures still falling and almost lost one of them. Thankfully my ICU does not support open visitation because I couldn't have imagined having to handle these 2 patients along with the drama of screaming and crying family members trying to direct and supervise me and yes that is exactly what they come in and try to do. Well-meaning or not.
People can say how great it is for the patient all they want. If it were me intubated and about to crash, I would want my nurse focused on me, not consoling and calming down my family and trying to do PR work for the hospital so that they don't get reported or out of fear of lawsuits. My family can wait outside and let the nurses do their work.
I have personally seen nurses get so distracted with pillow-fluffing out of family demands that the big stuff has been missed or late because they can't get the family off their back long enough to even open the chart.
AMEN!!! I can't tell you how many times I've had this happen to me; families who try to put their own demands in front of your other patients. This alone is enough for limited visitation. I agree with you 100%.
People can say how great it is for the patient all they want. If it were me intubated and about to crash, I would want my nurse focused on me, not consoling and calming down my family and trying to do PR work for the hospital so that they don't get reported or out of fear of lawsuits. My family can wait outside and let the nurses do their work.
I have personally seen nurses get so distracted with pillow-fluffing out of family demands that the big stuff has been missed or late because they can't get the family off their back long enough to even open the chart.
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.
I prefer to not have to deal with families on my unit, which is why I work nights. Rarely, we allow one family member (same gender) to stay if it helps calm the patient.
If I worked ICU or ER, I doubt if I'd like an open policy. Interacting with the family just takes more from the patient of the precious little time I have to give. Just MHO.
That said, I just have to tell you that a couple of years ago, my 19-year-old niece was allowed into the ER trauma bay where the staff was desperately trying to resuscitate her 38-year-old mother. The long Code was not successful.
The poor kids lost their grandmother and their mother within 9 months. She got custody of her sister (17) and brother (13), and is raising them now.
She told me that at least she has peace of mind about what happened in that hospital room, and that it comforted her to know how hard the nurses worked to save her mom.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
love that comment. another example of the only healthcare people who support "open visitation" are those who wouldn't actually have to deal with it when they are here raising hell and your patient is going crazy fighting the vent. if any bigwigs did witness any of it, what is their famous line?
"let me get your nurse for you."
lol!
[color=#4b0082]
[color=#4b0082]i think when you have your trial of "open visitation," management folks ought to make a point of being there round the clock to see what really goes on! open visitation isn't such a great thing when you got the violent husband who beat his wife almost to death wanting to visit so he can finish the job! rarely happens at 3pm when the manager is in her office right across the hall from the waiting room! more like 3am when administration is home, tucked into their beds and thinking about what a great thing they've invented with open visitation!
[color=#4b0082]
[color=#4b0082]last night, there were 30 young males wearing gang colors milling around outside the sicu in an uproar -- evidently someone shot someone else's homey, and they were going to make them pay! both the shooter and the shootee were hospitalized -- one in the or and one in the sicu. and all those "friends" out there, claiming to be family. glad neither of them was my patient!
[color=#4b0082]
[color=#4b0082]then there was the family member that shot my friend bob in the ***. (2am).
[color=#4b0082]
[color=#4b0082]and the family member that was going to "fix mother's problems" with a 9mm. (11pm)
[color=#4b0082]
[color=#4b0082]now the prisoner with the home-made machete down his pants, that was in broad daylight. my nurse manager disappeared while the charge nurse and i dealt with that one. (and the four prison guards -- two guarding the patient and two guarding the visitor).
[color=#4b0082]
[color=#4b0082]perhaps if we refer every in-your-face, belligerent family member to nursing management to deal with, either "open visitation" will lose its popularity, or it will be easier for us at the bedside to deal with.
.thumb.jpg.6eeb2c01c27cfd151d706238b7f6d6b7.jpg){kind=small}
TraumaQueen
88 Posts
We have four - thirty minute visiting hours each day. Almost all of the families respect our schedule.... and there are times when we need to have the families in the rooms to help keep a patient calm.
Some famlies don't understand our visiting schedule.
Not many of our rooms are very large.... we have very very sick patients who often times have prisma, nitric, vent, keane bed, all the iv poles, random machines for cooling/warming, traction at the end of the bed.... so on and so forth.... sometimes there is hardly any room for more than a few people, and when these families don't respect TWO visitors at a time and try to crowd 10 people in the room for visiting hours, it makes it difficult to get to the patient.... I'm not sure if more or longer visiting would cure this problem.....
Visitation time is always a difficult topic, because different ICUs take care of different patients with different needs......
We try to be a good judge of when to bend the rules.... but in general, all of our familes tend to agree that they want us focused on their family member, not them.