open visitation in the icu?

llg, PhD, RN · Mar 30, 2007

We have open visitation in our ICU and it can be a nightmare, depending on the family. I think there is a lot to be said for teaching people to be good visitors, AND for having enforced guide lines. Without them, it is chaotic.

I agree about the need to definite guidelines that are enforced consistently. "Open visitation" does not have to mean "chaos."

Another point to consider: If families are allowed to see more of the patient's life and care, they may be more able to recognize when it is time to discontinue or set limits on the amount of care provided. That's been my experience in the NICU. When all families see is their baby all cleaned up and resting quietly, they have more trouble "letting go" and recognizing that further treatment is doing more harm than good. Families who visit a lot and see the low quality of life that their babies have on a routine day-by-day basis and see for themselves that treatments aren't working are often more in sync with the staff's perception of when it is time to back off and perhaps stop treatment.

RNperdiem, RN · Mar 30, 2007

As long as family members don't shake my patient and shout "Mama! It's me Mary Kay! Mama!". The patient being the formerly agitated one I worked hard to settle down, then families and visitation are fine with me.

BittyBabyGrower, MSN, RN · Mar 30, 2007

I'm in a NICU also and we have open visitation, but the visitors have to be with a parent, 3 at the bedside at one time (one being the parent). We have visitation hours from 11a-3p 4p-7p 730p-10p. Only parents may visit 24 hours. We found that allowing most families unlimited visitors ended the fights with families at the front desk. But, we also have them read over the rules, sign the little paper that says yup I read this and agree with it and will abide by it, and if they are disruptive or the baby can't handle a lot of stim, then we boot out all others and restrict it to parents only. No, preemies don't have to entertain their visitors, but the parents and visitors will all be telling baby to wake up, you're being lazy, want to play pass the baby, etc. We just put our foot down, and usually, most of them are okay with it. You have to have limitations.

misscece · Mar 31, 2007

i don't know - i've done both nicu and adult icu and i still say that adult visitors are a lot harder to deal with. for me, parents were mostly just afraid - imagine how petrifying it is to see your little baby with wires and lines everywhere - or to see them crying with an ett in and not making a sound. i found that education was the key with them in that once they understood that i knew what i was talking about, they tended to "trust" their baby more with me and that they tended to follow my suggestions more readily. in adult icu's you can't even get family members to honor living wills let alone listen to anyone outside of the family. sick babies scare the hell out of people and i think people are more likely to let them be when they start to trend downwards. with adults it's more like "hang in there! you can do it!!" everyone's convinced that despite the fact that grandpa is 96 and on a breathing machine in kidney failure, the fact he's a WWII vet means he's tough as nails to this day. my nicu also had written guidelines that had to be signed. this would be a good thing for adults icu's i agree - but when people act like they don't see the big ass writing (literally) on the walls stating visiting hours (or act like you just made up the hours despite it being in print) i don't know what good it would do.