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.
Marijke, I have had family in the ICU and at no time did I feel entitled to 24-7 visiting, nor did I disrespect the nurses and their need to have uninterrupted time to care for my loved one . I NEVER insisted on prioritizing their energies on ME, as I understood that I was NOT the priority.
Today's visitors/ family members increasingly feel entitled to the nurses' time. I doubt if you are a critical care nurse; as it seems you do not understand the expectations, and what is involved with being an effective critical care nurse. Somehow I think if you DID understand, you would NOT be 'fuming'.
When did critical care nurses' focus get forced to visitors and away from our patient care? I don't know if I care to work critical care again because of the unreasonable expectations on my energy. With the ratios and continous flow of visitors (I am supposed to welcome acquaintances now even...who camp out and feel entitled to make demands on my time time)ICU nursing is just not worth it to me anymore. The stress and the liability has just plain worn this old nurse out.
My experience has just been the opposite. The visitors where I'm at don't seem to want to move to allow us to get to our patients. I can probably count on one hand in all the years I've done this that families actually did what they do at your facility. Even with proper explanation as to why they need to stay back, saying it in a courteous and respectful and compassionate manner, alot of the times it falls on deaf ears even with repeated reminders.
This is just NOT my experience.
I don't know what area you are in, but this is NOT the case where I am. MOST of the visitors that come into the ICU are so freaked out by everything that they are afraid about where to stand, what to breathe around, and what to say or do, let alone touching things or possibly compromising the care of their loved one. When I move around a patient's bed, more often than not, visitors literally jump out of the way, almost always. I have to reassure them that they are okay where they are and that I will move around them if I need to expalining that that's what I'm used to doing as the surroundings around a patient in the ICU is usually like climbing a jungle gym anyway. Their response is usually, we just don't want to be in your way! :)
Using "we" connotates that all nurses feel this way. I do not. Not even sometimes.
First, I work in a busy (who isn't...) 30-bed med-surg-neuro ICU in a large metro area in the middle of scary neighborhood. We are open to visitors 20 hours a day - we close for an hour at a time during change of shift (07-08, 14-15, 19-20, and 23-00) which is quite often not at all well received by acquaintances/friends/sort-of family, but usually received okay by immediate family (except some who will never be happy - we all know who they are). We do make exceptions - comfort care/out-of-town visitors/pt just got there or got stabilized - but make it a point to inform people that it is an exception and that this will not be accepted in other circumstances.
In my experience, there are plenty of people out there who ruin it for the whole population. I am very glad that we close when we do, and I am very comfortable asking families to leave when I am doing cares/assessing the family - and always go and get them when I am done if I have told them I would. In a perfect world, open visitation is a wonderful thing. But in REALITY, I do believe that if we are not able to stand up and give pts their privacy, do the care we need to without interruption, and play these situtaions by ear (as far as pt needs, family needs, and how appropriate families are acting), patient care is compromised.
Just a few specific tidbits that came to mind... all three ICUs in my hospital had tried totally open visitations with no restrictions. Mine was the first to institute any restrictions, and the other two have followed suit as they found it to be too chaotic especially around change of shift time.
After reading the article about pt satisfaction scores, I wonder how HIPAA fits in... this article says that people were dissatisfied with the information they got. But I have to be careful that I don't even tell the wrong person that the patient is even a patient in my hospital to protect my license and the patient's confidentiality. Interesting story recently - a patient was terminally ill and had a very dysfunctional family. Had a specific list of family members who could see him/have info. He died about midnight with all of those family members at bedside. Between 04-07 (and probably more on day shift, I don't know) we received at least 5 calls from "family" who were not on the list inquiring how his night went. When told they needed to talk to his immediate family, we repeatedly heard, "but I am family, how was his night?" These people would say they were dissatisfied with info - but at pt's request.
Okay, so a few other problems I have with some (not all family members) - I have more than just a few times had family members turn off my patient's vent and monitor alarms "because that's what you did when you were in here and told us not to worry because he/she was coughing." And that is keeping your family member safe???? How will that stand up in court when you sue my hospital for allowing your family member to die and I don't have proof that my "negligence" had more to do with you touching things you shouldn't have?
As far as codes go, we don't have a full policy as far as I know, but play it on a case-by-case basis. I have had three experiences of families being present - two of which were bad experiences, all three codes which ended in the pt dying. Screaming and yelling and falling down on the floor in hysterics are what I mean by bad experiences. The one good experience happened to be the patient's wife who was well-prepared that this could happen and immediately said that we needed to stop and let her husband go.
Re: pets - we have an infection control policy about pets visiting and as long as they follow the policy, we do allow them - I have had one patient's pet visit her. It helps that we have glass doors and she happened to be in one of our negative airflow rooms so we had two sets of doors that helped us feel like her cat wouldn't get out if we needed to walk in. Her son brought her cat a few times - and it was always fine. Actually, the poor cat was scared of everything and hid in the corner the first time, really didn't disturb anything - but this patient was relatively stable, too.
It's sad to me that the horrible family experiences are the ones that stick out in our minds. I wish I could say that I was always positive about family members - usually it's really not detrimental, but those are the families that follow our guidelines and are not manipulating us or threatening us or getting in our way or walking all over us. But there's always someone who will do all of those things, and tact or compassion do not help. We as nurses are able to combine the "art and science" of nursing that we heard so much about in nursing school in order to provide individualized care; I think "family care" also has to be highly individualized, all visiting policies need breathing room, yet nurses must be empowered to stand up for safety, for what is best for the patient (their number one priority) and then what is best for the family (second priority). Sorry for being long-winded - there's just no simple answer to everything brought up in this thread!
I realize I currently not working in a larger city ICU, I have. I am very much FOR open ICU visitation. I guess I have always told the families, You are allowed to stay and visit as long as it is not distrupting my patient or my ability to care for my patient. I can't say that I haven't come across people who weren't a real pain, but what about those who aren't? If it were my spouse, parent, sibling or child you would have a battle on your hands if you weren't allowing me in. I went thru thet hell when I was niave, and my eldest son was in ICU, 19 years ago. It broke my heart to see him for only a very fast 10 min.
Rememer,to these people and there families, this IS a crisis!, we are but visitors in thier lives.
My mother was vent post op for a few days once, she told me the only time she felt truely safe was the 10min intervals they allowed my father in to see her. Then the nurse would shove the little TV infront of her face. I feel in MOST cases( and I have worked nocs) they family is a benefit.
I realize I currently not working in a larger city ICU, I have. I am very much FOR open ICU visitation. I guess I have always told the families, You are allowed to stay and visit as long as it is not distrupting my patient or my ability to care for my patient. I can't say that I haven't come across people who weren't a real pain, but what about those who aren't? }
I'll tell you what about those that aren't...I bend the rules for them. I am there to care for the PATIENT. That is why I am a nurse. If the family needs help, I put in for a social worker referral. About 1/1000th of a percent of the time family is helpful, calming the patient, and actually bathing them. The rest of the time they are a distraction from the patient. I had a patient's husband once hand me a pillow as I was turning his wife. His daughter said condescendingly "Don't do that, that's HER job". At night we do not have secretaries, HUCs, or even aides a lot of the time. And I work in a 53 bed trauma/mixed ICU. Often I can see a visitor is in the room by the monitor; it freaks out the patient, especially heads. And MOST of my patients are vented, sedated, and unstable.
[if it were my spouse, parent, sibling or child you would have a battle on your hands if you weren't allowing me in. I went thru thet hell when I was niave, and my eldest son was in ICU, 19 years ago. It broke my heart to see him for only a very fast 10 min.
Rememer,to these people and there families, this IS a crisis!, we are but visitors in thier lives.]
The crisis is a HEALTH crisis, that is why you have a critical care nurse there to care for the patient. You need to trust the nurse to do his/her job (as you obviously do not by the below statement about your mother not feeling safe. What would your father do if she went into v-tach?) This is not about you assauging your feelings of love for your son, but letting us save his life.
I will say things are different on the floor, I have been a med/surg nurse and let families spend the night in the patient's room. There is more room, less time to hand the patient their water pitcher, and they are STABLE.
[My mother was vent post op for a few days once, she told me the only time she felt truely safe was the 10min intervals they allowed my father in to see her. Then the nurse would shove the little TV infront of her face.]
We all work in different environments. There are ICUs in a couple hospitals across town where, if I worked, I wouldn't be as opposed to open visitation -- nice neighborhoods, non-trauma facilities, wood floors, 5-star hotel accomodation-type rooms. And then there is my unit...meth, homeless, drug-seekers, every Darwin-award wanna-be, circa 1970s decor, rooms the size of a postage stamp... you get the picture.
All I'm saying is that there is no right or wrong answer to open visitation and I resent that someone writes a paper or a commentary where everything is black and white. Spend a night in our ER where you go through a metal detector to enter and talk to the receptionist through bullet-proof glass. Hang out in my ICU at 3 AM when a group of bangers is standing at the door in big bulky coats asking if they can come in and see their "cousin" -- and feel immensely thankful that the doors are LOCKED. I could go on and on re: this topic. I just want to see a "study" or the "research" or the "commentary" after these black-and-white authors hang out in the ghetto, trauma hospitals for a while. And, for the love of Pete, respect that I'm a professional healthcare provider and can make reasonable decisions about visitation for MY patient.
American Association of Critical Care Nurses (AACN) had a position paper on just this subject, as it seems to be a problem all accross the US. I have long been a proponent of open visiting, and am often at odds with my fellow co-workers. We must realize that it's not about us, it's about them. The patient and family, because family is so important to patients, no matter what their relationships are like. I have found very few people who absolutely should not visit for long periods, and most of the time, asking my patients their preferences has helped control some of the visiting.
IMHO the position paper of the AACN is a slap in the face to critical care nurses working in less than optimal conditions all across America, and does not take into account all the variables we deal with.
There are too many variables for this association to make such a blatant statement and I am appalled they would do so. What is BEST for an INDIVIDUAL patient is when a critical care nurse is allowed to make an informed decision about such matters IMO, and to have some control over his/her area of practice. I am writing to my organization as I speak to voice my dissatisfaction.
Hospitals will use this 'position' to further justify their customer service agendas, unfortunately, and intrusive family members to justify their presence even when that presence is deleterious to our patients.
Quote"The crisis is a HEALTH crisis, that is why you have a critical care nurse there to care for the patient. You need to trust the nurse to do his/her job (as you obviously do not by the below statement about your mother not feeling safe. What would your father do if she went into v-tach?) This is not about you assauging your feelings of love for your son, but letting us save his life."
I feel it is both, I have had codes, I have families present. One in particular was a tricyclic OD. On and Off for 5 hours. She made it thru, but had she not, her family knew that we had done everything we could to keep this 32 y/o alive. Instead They were able to tell her we had. Also those codes where you are coding because the family has no clue, They torture thier loved one because they can't stand to see mom go. I have had a couple where the family requested we stop, they realized it wasn't 2 shocks and they were stable AS SEEN ON TV. I ask the families to step out at appropriate times, and I have hed to have drunken pissed off families removed.
I do think most nurses have the common sense to know what is best for thier patients. I don't know you, but have dealt with those who don't want visitors because they don't deal well with families, death(explaining it) ordon't want their practices under scrutiny. I beleive if you educate the families well, set up the behavioral boundries well, it can work. Granted I have never had a gang banger come after me, my opinion probably wouldn't be the same, But with my experience, inner city and outlying community, and IHS, I stand by current position.
I have been in critical care for 11 years now, I still believe that, yes this is a HEALTH crisis for the pt. It is a LIFE crisis for both the pt and their families.
I do think this will be a controversy until a time comes when our jobs are obsolete, in otherwords, ending no time soon.
American Association of Critical Care Nurses (AACN) had a position paper on just this subject, as it seems to be a problem all accross the US. I have long been a proponent of open visiting, and am often at odds with my fellow co-workers. We must realize that it's not about us, it's about them. The patient and family, because family is so important to patients, no matter what their relationships are like. I have found very few people who absolutely should not visit for long periods, and most of the time, asking my patients their preferences has helped control some of the visiting.
It is about the patient and the nurse who has to take care of the patient. The family is an important component but is not the priority. I work in a busy neuro ICU, these patients get complete neuro checks every hour. Once the patient's family members see one check, they "perform" checks every 5 minutes on these patients. It doesn't help me when the patient responds out of habit rather than understanding. We need very tight BP control on our bleeds, any stimulation sends these patients back to the OR...should I let whoever wants in to see them just so I don't offend anyone?
I don't think there is an easy answer but I am also upset at the lack of trust and respect that has been show by the AACN and other posters who think we love to kick families out just to be mean. I am an advocate for the patient, not the family. Work in my job for a shift and see what it is like.
I still stand by my position that it is about them not us. We are outside the bubble... there are a lot of nurses that look at a patient as their patient. Well, the patient belonged to the family member first. AACN is taking the stance because of the extreme restrictive nature of some big city ICUs like 15 min per hour. Read the article Connie Barden (Past president) wrote, that was her address at the NTI a couple of years ago. I have been on the other side of the fence so to speak and the anxiety it caused was awful. Families fight about who gets to spend precious minutes of that 15 with the patient, etc. I also work with neuro patients, and seem to be able to make the point with the families for the need for a quiet environment, etc.
I agree that shift changes shouldn't allow visitors because of HIPPA. I also agree that there should be limited visitation at night because families also need their rest. Most of the bed baths are done on nights in my unit, and this eliminates the need to further restrict visitation on day shift due to bed baths. Of course, visitation can be adjusted to the needs of the patient, like dying, patient request, family arriving from out of state, etc.
A good family wouldn't fight over who has to spend time with their familiy member, they would understand that their loved one needs intensive nursing care, and that their loved one needs as much rest as possible to recover. I like to tell families that whenever they have the flu or whatever, what's one of the first things the doctor says to you? That you needs lots of rest. I will then tell them that their critically ill loved one needs even MORE rest than that. Alot of times this seems to work, but not always.
And even if you are not being intrusive during visitation with a loved one, you should be concerned that the other family may very well be monopolozing time away from your loved one, therefore not able to provide the intensive nursing care that they need. I can't tell you how many times I've had difficulty with families who say "well, that nurse allowed me to sleep at the bedside". That particular nurse usually was so busy or so intimidated by the family that these kinds of things happen, which then cause even further problems. There needs to be some level of control, and it's not for our own convenience, it is for patient safety. IMHO.
Not too long ago I had a family member become upset with her mother doing so poorly, she went completely ballistic with crying and rolling all over the floor. I called for some help (ie pastoral care and the nursing supervisor), but they still wouldn't make them leave. It's bad for "PR". In the meantime, these antics were upsetting the entire unit. If managment doesn't back us up with stuff like that, patient care is compromised. That's my entire point. It is a safety issue. And BTW...this happened at 3am.
And you are correct...if someone is dying or whatever, I have no problems at all letting them in to be there with them, sometimes we can do special circumstances. But whenever someone comes in, I make a point when I mention visiting hours that sometimes we do "bend the rules" for someone else, but that doesn't mean we are playing favorites, usually because someone is dying.
I still stand by my position that it is about them not us. We are outside the bubble... there are a lot of nurses that look at a patient as their patient. Well, the patient belonged to the family member first. AACN is taking the stance because of the extreme restrictive nature of some big city ICUs like 15 min per hour. Read the article Connie Barden (Past president) wrote, that was her address at the NTI a couple of years ago. I have been on the other side of the fence so to speak and the anxiety it caused was awful. Families fight about who gets to spend precious minutes of that 15 with the patient, etc. I also work with neuro patients, and seem to be able to make the point with the families for the need for a quiet environment, etc.
I agree that shift changes shouldn't allow visitors because of HIPPA. I also agree that there should be limited visitation at night because families also need their rest. Most of the bed baths are done on nights in my unit, and this eliminates the need to further restrict visitation on day shift due to bed baths. Of course, visitation can be adjusted to the needs of the patient, like dying, patient request, family arriving from out of state, etc.
mattsmom81
4,516 Posts
Marijke, I have had family in the ICU and at no time did I feel entitled to 24-7 visiting, nor did I disrespect the nurses and their need to have uninterrupted time to care for my loved one . I NEVER insisted on prioritizing their energies on ME, as I understood that I was NOT the priority.
Today's visitors/ family members increasingly feel entitled to the nurses' time. I doubt if you are a critical care nurse; as it seems you do not understand the expectations, and what is involved with being an effective critical care nurse. Somehow I think if you DID understand, you would NOT be 'fuming'.
When did critical care nurses' focus get forced to visitors and away from our patient care? I don't know if I care to work critical care again because of the unreasonable expectations on my energy. With the ratios and continous flow of visitors (I am supposed to welcome acquaintances now even...who camp out and feel entitled to make demands on my time time)ICU nursing is just not worth it to me anymore. The stress and the liability has just plain worn this old nurse out.