Visitors during Procedures

CEN35 · Jul 29, 2001

we try to ask all visitors to leave, for foley insertions, ng insertions, intubations, codes, iv's, central lines, fem sticks, abg's whatever? yes some get mad and irrate......and then write the ceo to complain. what do i say? does the or allow family members to watch surgeries? not!

debbyed · Jul 30, 2001

For routine procedures like Foley's and NGT's I will ask the family if they would mind stepping outside for a minute. If a family member requests to stay and the patient agrees I show the family member where to stand. I always try to position them so they can talk to the patient and hold their hand.

A visit to the Emergency Room for a seriously ill or injured patient, the elderly and the young sometimes causes as much emotional trauma as the injury/illness itself. All patients have a right to as much comfort as we can give them.

In the event of a Code situation you must go on gut feelings. Always have someone with the family member who can explain everything that is happening and to make sure the family member knows they must not physically interfer.

We must always remember that this may be the last time a loved one can say "I Love You" or in some cases "I'm sorry" and still believe the patient is alive and heard them. I'm sure each of us has been seperated from a loved one after an arguement. You always think you can say something later, but what happens if the worse happens. We must think of the families as well as the patients.

From personal experience I was present when my father died. After the third time he Coded and was revived(technically) I told the doctor to stop. I knew they had done all they could and I was grateful. I never had a moments thought of "what it" and I was able to pass that on to the rest of the family.

Just because doing something differently may make us unconfortable do not forget to take into account the wishes of others; both patient and family.

ComicRN · Jul 30, 2001

Every instance is different, so we must take it on its own merits.

I am a nurse, but I am also the mother of a 22 year old son who has been hospitalized numerous times and has had 18 surgeries. I have only been a nurse for 9 years. So, for the first 13 years of my son's life, I was "just a mom."

I respected what the nurses and doctors had to do. In fact, it was while watching those incredible pediatric nurses that I decided to go back to school and become a nurse (not pediatrics though.....too close to home!!!) However, I never left my son's side during a procedure. I made sure that I was not in the way, but I made sure that he could hear my voice. Sometimes, I was HIS voice. He was too young to speak up for himself, so someone had to do it. To many of those nurses, and doctors, he was "just another patient", the "colostomy in room 14". To ME, he was my first-born, my little red-haired wonder.

Granted, he never needed to be coded, there were never any life-threatening emergencies. I'm not sure what I would have done in those situations. But, I was always given the choice of staying or leaving during a procedure....and I always stayed.

I even fought for, and won, the right to be with him when anesthesia was induced. It was a hard won battle and I was the first parent in the hospital to ever have done that. But, when that particular surgery was over, and the surgeon came to us, he said that it was the first time he could remember that a child did not come out of anesthesia crying. He awoke very calmly. After that I was welcomed into the pre-anesthesia room without any problems. It is now offered to parents routinely in that hospital.

My son is now 22 and had surgery as recently as 1 year ago. Obviously, he is old enough to speak up for himself now, and I respect his privacy and his ability to make decisions. But, if he wants me there, I'll be there.

As a nurse, I feel confident enough in my practice that I do not mind having family members in the room when I do a procedure. BUT, it is ALWAYS up to the patient. I would never go against the wishes of the patient, no matter what the daughter, or wife, or whatever, wanted!

Thanks for letting me ramble!

Zee_RN, BSN, RN · Jul 30, 2001

I am in agreement with parents being present with children. You would have to drag me kicking and screaming away from my child's side too. I think it is a different case, however, for adults in an ICU. And many people THINK they are standing "out of the way" and are not being intrusive but they are. I have had to crawl over visitors in the room who wouldn't budge for me to fix an IV or hang an antibiotic.

The family that was present during the code were also a bit ... reactionary, for lack of a better word. When the patient wanted his mouth suctioned (oral secretions building up while intubated), the family went NUTS in the room...HELP HELP HELP!!! He needs HELP right NOW!!!!! Six family members come screaming out to the station. I suctioned his mouth and they said, "Well! What would have happened if we had not BEEN HERE!!!!" My reply: "He would have drooled." Things like this went on and on and on...and it gets tough when you're already overstretched. Wish we had the time for all the education and hand-holding but it's just not there any more. (My burn-out is showing, please excuse me.)

Jenny P · Jul 31, 2001

When I had an anaphyllactic reaction years ago, my husband was my lifeline and he was chased out of the ED room when I needed him most. Yes, I was an experienced ICU nurse and knew what was going on, but I still needed to hear his voice. I even knew some of the nurses who were working there that night, but I really needed him to be with me at that time.

Now that he has M.S. and has had several emergency admits in the past 3 years, he insists on my being with him through it all. He says he can't remember what he's being told, and I am there for him.

So far I have never had a patient or family insist on being present during procedures or codes, but I would let the patient decide this if at all possible and only if another nurse could be with the family during the procedure or code. To watch a loved one being intubated in real life without a medical person telling what is going on to the family sounds like cruel and inhumane family care-- no wonder that family was reactionary.

**canoehead, BSN, RN** · Aug 2, 2001

Some things I have observed- the patient of course comes first, and their wishes should be respected if at all possible.

BUT sometimes family is in the way because they just don't know where to go, and there isn't enough room for the code team let alone a visitor. If an emergency occurs the bed is surrounded trying to save a life, the family can't see, and struggle to respond to a loved one's distress, they get in the way.

It's hard to have honest communication, make suggestions when a family member is listening to every word. If someone screws up, or misses something they may get snapped at anyway, and that affects the family listening- wondering if something has gone wrong.

Personally I can't explain procedures and keep up with an emergency at the same time. We are a small hospital and barely have enough people on nights to respond to an emergency. Usually the people that understand what's going on are too busy delagating and assesssing. Not that I don't think they have the right to a thorough explanation, just that I don't have the brain cells to do it all at once. We don't have ANYONE extra to stay with family and provide support.

I think as healthcare workers we have some justification to get 5 minutes to process a critical incident before we go out and try to support family. Really.

Discussing the effectiveness of interventions, and the implications of assessment findings can't be done with family there. "OK, he was down for at least 10 min before EMS (or hospital staff) got to him." Or " this pt is 90 years old, and with metastatic CA, the family wants everything done"

My personal least favorite, but a fact- We have rules mostly for the families that won't step out when asked, the more accomodating the family is the less we notice that they have been there all day, and night, because we know that if we really need to ask them to step out they will.

And what about the lady I had just last month who insisted on staying overnight in the ICU right bedside the bed, and was very nasty about any requests for private assessment time. Then the next night we had made arrangements to accomodate all her requests she decided to stay home, but was fighting to have permission for the dog to visit. Seems as long as she couldn't get something that something was exactly what she wanted.

Crankily,

CH

Zee_RN, BSN, RN · Aug 2, 2001

Canoehead, you said in much nicer way what I was thinking...I was gonna reply, and erased it, something to the effect of being too busy with compressions to stop and explain to the family what was going on. The code was on the floor, not in ICU, I didn't have control of the surroundings; I was already knee-deep in alligators. Yes, someone should have stepped in and talked to the family but, quite frankly, I was a little occupied at the time and was not in the position to delegate it.

You are also right on the money with the accommodating family being much less intrusive and therefore, provided more. We are much more willing to bend the rules for the family that understands when to step out than those who get in-your-face at every opportunity.

RNforLongTime · Aug 2, 2001

I agree with those that said a parent should be allowed to stay with their child. Although I am not a parent myself, I know that there would be no way in he!! I would be chased out of a room where something was going on with my child.

Now for things such as a central line insertion, I would ask visitors and family members to leave unless the patient was adamant that a family member stay with them. Central line insertions are sterile procedures and only necessary personnel should be present i.e.--the surgeon and the nurse and of course the patient.

As far as things such as IV's? I have had family members stay in the room but I always ask the patient if that is ok with them. More often than not though a visitor or family member has a phobia with needles and leave the room asap after they hear the word needle mentioned.

Kelly:)

prmenrs, RN · Aug 2, 2001

My [adopted] son is a 17y/o ex-premie who had grade 3/4 IVH's as a result of his prematurity and his birth mother's IV drug use. He has a VP shunt. He has had LOTS of surgeries, mostly minor ENT proceedures, or anesthesia for imaging studies, and, in the last 2 years, about 3 for his shunt.

I have been present for lots of stuff, and I can tell when I need to be there and when I need to NOT be there. I aslo know when I need to be at the head end of the bed, getting him to hold still, calm down, focus on breathing, etc.

I need to be there for both of us!!! For me, so that when a Doc comes in on rounds, I can find out what the plan of care is, what I need to prepare him for, when do I have to get there in the am (I really try not to spend the night, I can't sleep), make sure he gets a good diet, etc. Make sure they don't transfer him out of the IMU because "he's not sick enough". Yeah, but he only needs to herniate his brain once, and he hasn't stopped hurling from the post-op pressure change yet. If he's out on the floor and gets in trouble, no one will know for a while. Basically, be the mother! He wants me there. That doesn't stop him from flirting with the nurses, esp. the blonde ones. (Mom, she's a blondie. I know, honey, I can see her from here.)

I think it's different when it's a pt. with a chronic problem who needs someone there to advocate and knows the whole story. A pt. like my son who's "intellectually challenged", and/or has a complicated medical history. I think we may need them in the room to answer questions.

In the NICU, we have parents hanging all over us all the time. Sometimes, they are VERY high maintanence ALL the time, not even when there's anything happening. We do get used to it. I've had things go great when the parents are there, and go straight for the hopper as well. Once, I had to grab a baby out of the mom's arms, put her back in the incubator and suction the snot out of her ET tube--all while a local cable channel was videotaping me for a documentary about premies!!!! :eek: I could see out the corner of my eye that Mom was crying, so I said, "I'll be with you in a minute, Mom". Afterward, I put my arm around her and "mothered" her, too, explaining what happened, etc. Much to my surprise, that little interaction was on TV, too!

I guess what I'm trying to say is that this is an individual thing, but that the more families are there to see what goes on, IMHO, the more comfortable we get at actually including them in our care and I think that's NOT a horrible thing.

All that having been said, there are exceptions, like they're armed, they're wailing so loud you can't hear what's being ordered, they've recently shot up. Those folks--outta here!

nurs4kids · Aug 2, 2001

I usually leave the decision up to the parent. I have found that the child's reaction to the treatment is relative to how the parent reacts (calm parent='s calmer child, etc). Before I had kids of my own, I often wondered how on earth a parent could leave the room while their child was going through a painful procedure. After going through an IV fiasco with my one year old, I changed my whole attitude. After the second attempt for access, I was crying worse than her. I refused to allow a third attempt until it was determined the IV was definitely going to be used. I would never leave my child, but after going through that, I can see why some parents would choose to leave. Some coworkers always have parents leave. It's just a personal choice.

During codes, we always ask parents to leave the room. We routinely send the parents with the patient to Anesthesia for preop sedation. Occassionally, the surgeons will allow a parent to observe the entire surgery (seen this twice in the past year).