help me figure out how to say...

Antikigirl, ASN, RN · Dec 29, 2006

Our hospitals ER has a rule of only one person at a time back to visit a patient...basically due to space, it is a small ER! Our hospital still has visiting hours *whew* and goes to 2030 and it is announced in English and Spanish. If we have patient families that are being very cooperative...like leaving the room when we ask for questions (Hipaa), or a peri care, and move out of the nurses way so they can get to items, and are quiet and respectful a nurse can override that time and allow them to stay longer.

Thank goodness most patient families I have run into have been cooperative and I let them stay longer or even arrange for a cot. But there are times when that visiting hours call is so very needed and helpful to get our jobs done, or even just check on the patient and converse with them without others in the room, or them hurrying up to talk to you so they can come back in.

If I need to have people leave the room...I simply state "The patient and I are going to need some privacy for this treatment, please feel free to wait in our waiting room around the corner, and I will come notify you when we are done." I never say "sorry but" or "I hate to bother you all"...because that lessens my authority as the patients nurse and the need for the patient nurse relationship to be strong at this time...Just to the facts, smile,...oh and over estimate your time if they ask how long...that way you aren't going to make them angry waiting!

Good luck...takes practice, and beleive me...I use to hate this part and really procrastinated doing it..then I finally figured out that my comfort level didn't matter...my patients health does!

Trauma Columnist · Dec 29, 2006

I worked in a level one trauma center for 10 years and the commonality for our trauma pts was that the injury was sudden and suddenly plunged the pt and family into a very stressful situation. Some suggestions:

1. "I promise that I will take very good care of your son/daughter/wife/husband (and use their names) - you go rest now."

2. "Jane needs her rest in order to recover from this injury." You can help her by letting her sleep." (This can sometimes be a hint to go home and rest for the visitors. However, if the pt is critically injured, I would encourage one or two family members to stay at the bedside if at all possible."

3. "We want to care for your son/daughter, etc in the most efficient way possible in order to have a speedy recovery. They need even more rest now that they are injured."

4. Sometimes giving the family members something to do: feeding the patient, helping them reposition, start home training if that is a goal. This way, the visitors too will know that everyone, including them needs to rest.

5. Along these same lines, explain that the caregivers in the home need their rest NOW because they will be overwhelmed and stressed out when they make the transition from hospital to home.

6. If there is a chance that the pt might die, then by all means allow family members to stay the night - perhaps rotating one in the room, the rest in the waiting room.

7. I always use the ENA guidelines to guide my practice. The ENA fully supports family presence.

Good luck - your patients are lucky to have such a compassionate nurse.

all4schwa · Dec 29, 2006

trauma--very good suggestions!! i'll keep these points in mind, thanks everyone!

RNfromMN, BSN, RN · Dec 29, 2006

:yeahthat:

dream'n, BSN, RN · Dec 29, 2006

I really feel that unless a patient is in a private room, visiting hours must be strictly observed. I'll never forget, just having given birth and being put in a new room with a roommate that had the whole, darn state visiting. I was in pain, heavily bleeding, in a skimpy hospital gown, and it made me feel totally violated. The nurses would come in to discuss the lady partsl bleeding, breast feeding, and to do their exams. The whole time, total strangers could hear every word of it. I really and truly felt violated, and 10 years later it still makes me wince. So, for the sake of roommates, keep the visitors to the schedule and don't let too many people in at once if possible.

GingerSue · Dec 30, 2006

Is this kinda the same thing? I struggle with asking family members to leave when it's time for assessments...or getting their loved on on the commode...or changing them...What do you seasoned nurses say to family when this comes up?

I would be straight-forward and explain that I must turn the patient every two hours, and that means also maybe changing any soiled linen - and I found that the family members respected this - not a problem and I think that they appreciated (they even asked me to be the regular private duty nurse for the patient)

DidiRN · Dec 30, 2006

I don't work stepdown anymore (I did for many years), but do ICU. I've used this scenario several times with families, and it usually works, perhaps it might be helpful in some of your cases with hovering families who won't let their loved one rest well. I will tell them that if they go to the doc with the flu, what is one of the big things that the doc tells them? That they must get lots of rest in order to get better. Then I state that in their loved one's case, they need even more rest than someone with the flu, because they are extremely ill, and that rest helps them to heal, fight the infection even better (if that happens to be the case), and hopefully get them on the road to recovery much sooner. I also state that because we are in the rooms alot they are already probably somewhat sleep deprived since we interrupt their sleep for procedures, assessments or whatever around the clock, and getting proper rest whenever they can is even more important. I don't say this to try and get them to stay out of the room for my own convenience, nor to make them feel guilty for bugging the patient too much; I just want them to understand that constantly waking the patient is not good for them, and that they could actually help their loved one by letting them rest as much as possible. I usually try to say this also to the husband/wife or significant other, and alot of the times they will pass this along to the rest of the visitors. It usually works for me, and makes some families feel like they are participating in their care of their very ill loved one, just by allowing them to rest as much as they can.

i have a hard time asking people to leave...if it's totally not necessary that they be there, i don't beat around the bush. but we do get a lot of trauma patients, broken up and mangled. this often means young people with parents, aunts, brothers, cousins. and what about when they come from out of town and dont arrive till night time? also, we get alot of the icu step down syndrome. mostly they are still very sick and the family thinks they should be in the icu. they have all night visiting privledges with private rooms over there, and it really it one of the most beautiful units. ours is in the oldest, smallest part of the hospital, no privates. i reassure that i'm going to take very good care, i check and chart on my pts hourly, yada yada yada...i some of them just can't tear them selves away. we do tell them they can hang out in the waiting room and check on their loved one periodically, and i understand why the rules are in place. i still feel awkward and cold asking them to leave!! i'm wondering if anyone can offer some of their 'lines' used in these situations.
p.s. when i came back from lunch last night the waiting room looked like a homeless shelter with everyone sacked out with bath blankets, fully dressed and crammed together. sheesh, i'm gonna have to start using the back elevators.

CHATSDALE · Dec 30, 2006

i have never been asked for an 'excuse slip' but i know that the pressure of too many visitors can be a stress for the immediate family who are trying to deal with the most horrible times of their lives and having friends, neighbors and outlying family crushing in most with good intentions but needs to be limited all the same

i have seen the worst of families, would make your hair curl, they had a private room but they spilled out into the hall, several times security had to be called to break up or prevent physical altercations...

sometimes you can ask a member of the family to decide who waits in waiting room and who should go home and get rest to take on a shift next day to get the updates and then call the rest of the family because hospital personnel can't call everyone

one family can't take up the whole waiting room, present families with the facts and they will usually respond with understanding

Home Health Columnist / Guide · Dec 30, 2006

Sounds like you and all staff need to review the policy to be sure it is meeting the needs of patients and staff. Because of the different needs/capabilities in your facility versus ICU open policy, all of the organization needs to work on this. Exceptions will need to be made, consistently by all staff. I agree with runners ideas, but would avoid the "this is not a social ...." comment. Maybe this is an opportunity for you to step up. Talk with your NM about forming a team (you lead) to review (so you have authority and support for your initiative), address and educate on organizational visitation policy and making it work for everyone. Do your research, educate, plan, discuss etc. Maybe a new and improved policy is needed. Maybe ask for a patient or visitor to participate. Maybe signs, pamphlets, a guide for exceptions etc. Who knows...maybe this can be a PI for the hospital, satisfy a JCAHO, clinical ladder, skills building, raise booster activity for you and team buiding/de-stressing/improving patient care for everyone. Good Luck!

Great advice!

prmenrs, RN · Dec 30, 2006

It helps to have visiting policy written to give to visitors, and it helps to have ICU warn them that "it'll be different out there!!".

This is in addition to reviewing and updating as needed.

Good luck!

Sisukas · Dec 30, 2006

when we transfer patients to icu, we give the family a quick run down on the icu visiting policy, show them to the waiting room, and remind them that the rn needs a minimum of an hour to "get to know" their patient before family can come in. usually it's the csn for the floor who does this. when patients come down to m/s from icu or stepdown, the rn brings the patient down, introduces the family to the accepting nurse, then gives report. the icu rn also reminds the family of the new area's visiting policy, especially if the patient is going to a semi-private room. we try to empasize that the transfer is an indication of an improvement and the family can relax a little.

the point is, there's teamwork between the two units. it took a long time to get there, and was helped by the fact that most of our icu nurses started in m/s or telemetry. can you meet with the icu manager and start this process?

Miss Ludie · Dec 30, 2006

I think also you have to respect the roommates privacy --What a JOKE in a semiprivate.

Just say because your mama has a roommate, you need to have only a lady in the room at nite who can visit a while and then rest in the lobby.

Daytime, you can say, Excuse me we have to do a ________on your Mama, I'll be right out to let one of you return. Thank you for understanding.

Or I'm sorry we have had a "complaint" about the people moving around in there, let's just have one at a time. Then glaze your eyes over as if it was the most natural thing in the world. Course make sure security isn't going to throw them out of the lobby.