How would you have handled this?

[WTTsMom]

I am a student RN at Arkansas State University. Last week while doing a clinical in the ICU I approached a situation that I'd like your input on. The doctor came in to see a patient and decided that it was time to turn off the vent and there was little hope that this man would survive. He called the spouse and she agreed that it was time and it was planned for the following day. As news circulated throughout the family, everyone (even from out of state) came to the hospital to see him. His primary nurse was very short with the family, explaining that they were to follow the hospitals visiting hours (which are not long at all) because she was not able to care for the patient with all the distractions. The family was crying and upset, saying that this was their last chance to see him. The family told her that they were going to issue a complaint. She told them to do whatever they felt they needed to do.

I felt so bad for them. Of course, I don't work in the ICU but I think that special circumstances should have been made for the family. What could have been done to make this a better situation?

I plan to work in the ICU so this is a touchy subject for me.

Thanks,

Cynthia

[time4meRN]

That's too bad. Most ICU nurses are very kind when it comes to caring for these pt's. As for me, most of the time it is a good experience. In ICU it seems we spend so much time putting tubes in every oraface there is , starting every gtt known to man etc.. etc.. many time all in the name of keeping a dying person alive for the family that isn't willing to let go of their loved one. When a family decides that it's the pt's time to go and are willing to let a loved one dye with dignity, I'm all for that. What care did the nurse need to do. The care at that point, should be emotional and symptomatic. The pt's doesn't need swan readings, bath etc. If I am in the unit and a nurse is being inappropriate with care, i would confront her. I have no problem with that, but I've been in critical care many many years, if I didn't feel comfortable I would call the nursing sup and let her/him take care of it. (the other nurse doesn't need to know you called). As nuses we are pt/family advocates. Sometimes it's not easy but needs to be done.

[snowfreeze, BSN, RN]

One ICU I worked in made terminal weaning patients 1:1 when at all possible. You need to do a lot of teaching and give a lot of support to family. Bedside vigilance to keep the patient comfortable and/or have the patient appear comfortable to family is necessary. Family was also allowed to be at bedside within reason and at the discretion of the nurse.

One patient who was alert but terminal and on a ventilator at the time wanted 5 close family members at her side during her last few hours. That family followed her wishes and had a small and very awesome last party for her. A bottle of champagne was consumed and some snacks were provided by family as they all remembered years of her happy life. This family was quiet and respecful of the ICU environment but still made her last few hours very comfortable. Everyone stepped out for the extubation, once she was comfortable after meds they returned. She slowly faded away as they chatted about her life. I don't remember this lasting long, maybe an hour or so from extubation.

[Medic/Nurse, BSN, RN]

Situations like this one DEMAND that compassion be allowed to trump the silly little RULE BOOK. The nurses argument that patient care is compromised by the family being present is silly.

This patient is dying.

Actively dying.

It is the LAST Chance for the family to be fully present with their loved one.

The hours (and minutes) are getting small.

There is ONLY 1 RIGHT answer to a patients family that requests an exception to the "rules" in a situation like this one:

RN to the family: "Whatever you need I am here for you."

The family will remember this forever. If I had been "their" nurse, I'd have followed their desires - providing that it did not compromise other patients. (And I'll bet they did not)

Bless you WTTsMom - sounds like you are getting your head and heart in the right place. It takes both - and you are on your way to being a good nurse.

FYI-I have "delayed" helicopter transports (and critically needed intubation) to allow the family the time to say "Goodbye". Sometimes, I may not not always know what is right - but, I always know what is KIND. I'll choose that when conflicted.

Practice SAFE!

.

[Artemis2]

Flex your visiting hours and allow extra visitation while keeping control of the situation for the good of everyone in the ICU. Wife or parents or children at the bedside as much as they want as long as it is not a crowd. Stress to the family that for the wellbeing of the other patients in the ICU visiting will have some limitations (no more than 2 other than the wife, etc) but that you will do everything you can to accomodate them. Most people are agreeable, understand your position and are willing to work with you as long as you are willing to work with them.

Balance order with compassion and most of all communicate. A lot of customer service issues can be dealt with by compassionate, empathetic and clear communication.

[CarVsTree]

I am a major stickler when it comes to visiting hours because I believe patients get more rest and we nurses are better able to coordinate care when there are no distractions from family.

That being said... when someone is dying, I throw the hours out of the window. Curtains can be pulled and doors closed, and honestly, whatever it is that I have to do is nowhere near as important as the family being able to say goodbye.

Absolutely! I don't understand the 2 at the bedside when the patient is dying. Give the family their privacy and allow them to spend their last moments with their loved ones. Limiting this is barbaric.

[CHATSDALE]

a vent can be cared for in a private room and it would have freed an icu bed for someone who coulld be helped

man must have been someone special if so many in family came to see him..

[WHudson]

I think the nurse should have let the family spend more time with the patient. When I did my rotation in ICU there was a patient who had been taken off the vent that morning and the nurse allowed the family to spend time with the patient. I think the family need time to say good bye to the patient to help deal with the grieving process.