Family zone in PICU pt rooms

AmyRN303, BSN, RN · Apr 9, 2014

As a parent, I slept in a recliner at my son's bedside in PICU. The nurses at first encouraged me to sleep in the family rooms they have set aside for such cases, but I didn't sleep well at all. I think once they realized I would be out of their way and low maintenance even though I was bedside, they didn't suggest it anymore. I can't speak from the nursing perspective, but as a parent, I was thankful for the opportunity to be there. Of course, having seen some family members/friends expecting to room in on a cardiac med floor, I think that may be the exception rather than the rule.

Pediatric Critical Care Columnist · Apr 9, 2014

We're also undergoing a redevelopment of our PICU and our PCICU. Our hospital has gone so far overboard with the concept of family-centred care that it has become family-directed care, so I guarantee there will be sleeping space in each room. One of our physicians told me one day that I COULD NOT tell family members to leave the bedside at night so they could get some sleep. Actually, I think how he put it was that I couldn't tell anyone that they couldn't "visit" a family member in the PICU. I feel that having a parent sleeping at the bedside is a bad idea, partly due to the effects of sleep deprivation and partly due to the way it hinders the provision of nursing care for the patient. It's unrealistic to demand that the room of a critically ill patient be as dark as possible and all noise be eliminated so a parent can sleep... but it happens. I'm very sorry but it's impossible to properly assess a patient, give a med, change a diaper/dressing or document one's findings silently and in the dark.

I've been a PICU parent myself. My son was a PICU patient for 7 weeks. It never entered my head to sleep at the bedside. There were very few nights that I felt I simply could not leave because of how sick he was, and on those nights I stayed late, but always left eventually to get some real sleep in a real bed.

21strawberry · Apr 9, 2014

The PICU I'm from had sleep surfaces in every room. There are certainly pros and cons, but I don't think the family members should be kept away. Were there some who did more harm than good while at the bedside? Sure. But there were also patients who, if well enough, would melt down without a parent there. If I were a PICU parent, I'm sure I would want to spend the night if I had the option.

umcRN, BSN, RN · Apr 13, 2014

At my hospital all three ICU's (picu/cicu/nicu) have parent sleep areas. In the picu/cicu (where the rooms are bigger for bigger patients) they have their whole own area in the back of the room complete with their own tv (a little much IMO). They have a pull out sofa, bathroom (because lets be serious, most of the kids are not using the bathroom, there is no shower though), cabinets for storage etc and they do move in. They are made well aware though on admission that the child is the sole focus of care and if the lights need to be on all night long because the child is unstable then the lights will be on all night long. I have never heard a parent of a very sick patient complain that the lights were on or that we were too loud. Often on the night of surgery we will suggest to parents that they go home and get some sleep (especially if it's a newborn) and for all newborns we really encourage moms to go get some sleep in a bed but sometimes it just doesn't happen and the parents refuse to leave. Except for the rare crazy parents (and they are few and far between) we rarely have issues with parents being at the bedside 24/7. I don't have children but I couldn't imagine having a child in an ICU and being forced to leave to sleep, I wouldn't want to leave their bedside for anything. The only thing we do not allow in our unit is food so parents must leave and eat in the waiting room (where we also have a shower and laundry area).

eaus · Apr 13, 2014

The unit in which I work invites the parents to stay the night at the bedside on a built in sofa/sleeper. In my opinion this is a nice service especially for families who live a distance. Many parents report having more stress when they are away from the bedside. The rooms have a toilet and there are male/female showers on the unit. The rooms are tight at times but I have learned to be quite a contortionist. Parents are encouraged to give as much care as possible. There are occasional family disturbances but no more than there were when rooming in was not offered. A light is necessary in order to assess the patient. This should be made clear to the family. All in all I think this is a good service to offer.

Ruby Vee, BSN · Apr 14, 2014

I don't think there's much you can do to prevent families from sleeping in rooms -- it seems to be the wave of the future, and whether or not you think it's a good idea, it's the latest. (For the record, I agree with the concerns about sleep deprivation and the family member who may be too muddled to retain any teaching done or to make good decisions.) If you have any input into the physical layout or design of the rooms, opt for minimal furniture. You don't need a sleeper sofa AND three chairs for visitors. Three visitors can sit on the danged sofa (only one person will be sleeping at the bedside overnight) and additional visitors can take turns standing. Or bring in a folding chair temporarily. We've got far too much furniture in our patient rooms, and you have to move it to get the patient to the bathroom, to get behind the bed to the wall suction and oxygen, to get to the closet. It took a very large patient room and made it too small to navigate!

jrt4 · Apr 18, 2014

When I hear nurses talk about visitor restriction it makes me want to pull my hair out...especially in pediatrics!!! There are times when you have to escort the parents from the room when you are doing an invasive procedure (lines, drains, etc) but during routine care they should be encouraged to stay!!! They are the advocate for their child! Patient safety is inhibited when you do not allow the parent at the bedside not when they are at the bedside. That way of thinking should be left in the 20th century...

Ruby Vee, BSN · Apr 18, 2014

When I hear nurses talk about visitor restriction it makes me want to pull my hair out...especially in pediatrics!!! There are times when you have to escort the parents from the room when you are doing an invasive procedure (lines, drains, etc) but during routine care they should be encouraged to stay!!! They are the advocate for their child! Patient safety is inhibited when you do not allow the parent at the bedside not when they are at the bedside. That way of thinking should be left in the 20th century...

I've never worked peds and I've never been a parent. But I have been at the bedside for nearly 37 years, and I've noticed that not all visitors are good advocates for the patient -- and some of them are too self-involved to be ANY sort of advocate. Some are, in fact, detrimental to the patient. It is for those visitors you have restrictions in place. I cannot imagine that people become any more selfless, intelligent or even common sensical just because the patient is a child.

jrt4 · Apr 25, 2014

I've never worked peds and I've never been a parent. But I have been at the bedside for nearly 37 years, and I've noticed that not all visitors are good advocates for the patient -- and some of them are too self-involved to be ANY sort of advocate. Some are, in fact, detrimental to the patient. It is for those visitors you have restrictions in place. I cannot imagine that people become any more selfless, intelligent or even common sensical just because the patient is a child.

Ruby it is very different for pediatrics. Our patients can not advocate for themselves (most of them). That is the difference. The parents are over involved because they are the only advocate for their child. It is only appropriate to restrict visitation in pediatrics if there is a security risk or if there is a sterile/invasive procedure. Otherwise the parents should be at the bedside. Visitor restrictions can be placed on visitors who are not the primary care givers. I guess that is the other point...the parents are not always the primary care giver...its often grandparents or siblings.

ncglazergirl · Apr 28, 2014

I used to work in a PICU that strictly forbid overnight sleeping at the bedside. Then I went to work in a PICU that encouraged families to stay at the bedside. It drove me really crazy at first. I had a hard time being under 'watchful eyes' at first. The fact of the matters is that if your hospital has endorsed this, then you have to figure out how to make it work. If I had very sick patients, I would ask the parent to push their chair/cot against the wall so that I would have full access all around the bed. I explained that their presence was important and needed, but not at the expense of their child's welfare. In other words, if there was an emergency, I needed to be able to have quick access instead of having to move a bed out of the way. This made sense to most parents. I also didn't try and worry about the parents need to sleep that much. If they wanted sleep, they could go else where. If they wanted me to take good care of their child, they would let me do what I needed to do. That being said, I did try to be considerate, but the truth was that their child was my first priority, not them. With families it will never be super easy, and the more families you have at the bedside, the more your unit will figure out what works best at your hospital. Good Luck!

soxley · Apr 28, 2014

My son was in the PICU off and on for months during cancer treatments and almost exclusively for the month prior to his death. It was never a question of if I would be welcome in the room. Thankfully this wasn't an issue with the hospital my son was at. Im still a student so I don't have the real life experience, however, I can't imagine how this is actually an issue. This situation can be so scary for kids and parents alike. I couldn't imagine my child spending nights there alone without me. A 16 year old patient might have a different perspective but for my son who was diagnosed at 7 years old, it sounds ludicrous to keep parents away.