What Part Of Low Lights Minimal Stimulation Do You Not Understand!!!!

[sarahbellum]

I spent more time yesterday educating numerous family members than giving pt care, I left work with a massive headache and was hoorifice from talking in a forced low tone and I need to vent....

I work in a unit newly designated as a "Neuro ICU" My hospital has always been liberal about visiting hours in the ICU and part of me understands the customer service aspect but,

When Grandpa has a head injury, making him perform like a trained monkey for every neighbor and family member that walks in is not going to help healing. After numerous attempts to explain this to two completely different families this week, I finally told the family last night that "Would you have him walk for four hours only five days after he broke his hip?" "Then why are you stimulating him for hours on end, his brain needs to heal, just like the rest of his body!" They spent the rest of their time yelling "Calm down Dad or we'll get in trouble again by that nurse!"---this is my other pet peeve HE HAS A BRAIN INJURY HE IS NOT DEAF

This was not the most tactful thing I have ever said to a family, and they were complaining to nightshift when I left about how its THEIR father and they should be able to see him. I do not understand why I'm supposed to let this behavior go on. Administration acts like we just don't want to deal with the family when we ask for a locked door-- phone at the door unit. We are getting a new unit and moving in June and from what I saw--IT DOESN'T EVEN HAVE DOORS!!

The new unit will be our surgical ICU and the neuro pts are staying in the old unit where the family acts like its their living room. I've had to ask people to stop eating Jack in the Box in rooms with pts with C-diff (gross--why don't you just lick their butthole?) I really believe that these lax rules are contributing to rebleeds and infection rates.

I think I am going to talk to our stroke coordinator. I know she knows this goes on, but I do not think she knows what a problem it is. Of course I need to clear it with my manager first, but I can't see why liberal visiting hours in a neuro ICU are appropriate at all.

Any advice on how to handle these families?

[leslie :-D]

that's just crazy.

it sounds like a sign with clear rules, stating these pts need a quiet environment in order to recover.

then again, who knows?

families are often worse than the pts.

make sure you document all the 'education' you give these visitors, over and over again.

but no matter what, continue in advocating for what is best for the pts.

best of everything.

leslie

[TazziRN, RN]

My brother was in ICU with a bleed. Visiting was only ten minutes every two hours, but because my parents were quiet the nurses were sweet about letting them in more often. I would save my visits for the evenings so my parents could use the days to the max. Then I got called in by my NM, who had been talked to by the ICU manager. A family friend, who I got in by saying he was my uncle, ruined it for all of us. He took advantage of the nurses letting my parents in and snuck in on his own, and would stand there yelling in his already-loud voice for Chris to "wake up! Squeeze my hand!" I was furious when I found out, not only because he ruined it for my parents, but because he was not doing my brother any good. Some people just don't get it.

[RN1982]

I hate it to no end when family members scream into the patient's ear and tell them to wake up or squeeze their hand. They are not deaf. They are sedated for a reason, they NEED rest. It does the patient no good when families do that. I also get irritated when family members lean on the patient, especially a patient that has had abdominal surgery. People have no common sense.

[nrsang97, BSN, RN]

Kati,

What about some of the neuro surgeons who scream at the pts too? We have one that can be heard on the opposite side of the unit from which he is on.

I have never understood while I am doing my q1h neuro check and family is present, they have to think they need to tell the pt what to do while we are trying to assess. I just don't get it. I usually tell them that the pt needs to focus on what the nurse is asking at the moment, and this will be it and not to continuously ask them to show 2 fingers, squeeze hands either.

These patients need rest. They need quiet. Some people just don't get it. No matter how nice you are or how you surgar coat it.

[RN1982]

Kati,

What about some of the neuro surgeons who scream at the pts too? We have one that can be heard on the opposite side of the unit from which he is on.

I have never understood while I am doing my q1h neuro check and family is present, they have to think they need to tell the pt what to do while we are trying to assess. I just don't get it. I usually tell them that the pt needs to focus on what the nurse is asking at the moment, and this will be it and not to continuously ask them to show 2 fingers, squeeze hands either.

These patients need rest. They need quiet. Some people just don't get it. No matter how nice you are or how you surgar coat it.

Yeah I totally understand. After explaining it a few times, I get frustrated and ask them whether or not they'd like their relative to heal? If so, I tell them to knock it off. I've said stuff to patients' families that normally would get me in trouble.. things like "I explained the visiting policy twice already and how many more times do i need to explain it before you actually understand it."...sorry I try to be nice and caring but I'm only thinking about my patient.

[nrsang97, BSN, RN]

Also we have had family physically shake patients. I have not seen it , but I have known it to happen.

I had one person whose friend was visiting. Friend of pt was drunk, and pt would have no idea he was there. (pt was being terminally weaned later that shift.) He kept yelling at him to talk to him no matter how many times I told him that the pt could hear him but was in no way able to respond. He wouldn't listen to me until I threatened to throw him out.

We had another situation in the same room, differnt pt when his friend came to visit. He was saying to the pt "Come on man don't you hear me", and then proceeded to smack him in the face with his visitor pass. He was quickly asked to leave.

People have no common sense anymore. I just don't get why they would think this was appropriate.

I have had one pt family member call another and tell them the pt worke up. To my suprise when the pt daughter calls and asks if her mom woke up, I told her no and asked who told her that. I had to tell her that her Aunt was nuts. This woman had a GCS of 3. Not gonna wake up.

[RN1982]

Also we have had family physically shake patients. I have not seen it , but I have known it to happen.

I had one person whose friend was visiting. Friend of pt was drunk, and pt would have no idea he was there. (pt was being terminally weaned later that shift.) He kept yelling at him to talk to him no matter how many times I told him that the pt could hear him but was in no way able to respond. He wouldn't listen to me until I threatened to throw him out.

We had another situation in the same room, differnt pt when his friend came to visit. He was saying to the pt "Come on man don't you hear me", and then proceeded to smack him in the face with his visitor pass. He was quickly asked to leave.

People have no common sense anymore. I just don't get why they would think this was appropriate.

I have had one pt family member call another and tell them the pt worke up. To my suprise when the pt daughter calls and asks if her mom woke up, I told her no and asked who told her that. I had to tell her that her Aunt was nuts. This woman had a GCS of 3. Not gonna wake up.

Good grief. People are crazy. We have a patient who has a diffuse global anoxic injury and GCS of 3. No pain response, pupils fixed and dilated. Family friend asks whether or not I believe in miracles, which through me off guard. He said a miracle is gonna happen, she's gonna wake up. Ok. sure.

[aeauooo]

My pet peeve: televisions.

Do you want to see a confused/agitated patient get more confused & agitated?

Turn on the TV.

[nrsang97, BSN, RN]

Good grief. People are crazy. We have a patient who has a diffuse global anoxic injury and GCS of 3. No pain response, pupils fixed and dilated. Family friend asks whether or not I believe in miracles, which through me off guard. He said a miracle is gonna happen, she's gonna wake up. Ok. sure.

Had the same thing happen with a GOL pt. Family friend at bedside. Family accepted GOL and pt was to be donor. We were going to be swanning her and bronching her later that night. Family friend says "Well is she responding." My response was that she wasn't and she wasn't getting any better and she wouldn't. (I didn't want to say her family was having her organs donated) She said "Say there is a miracle. What would you look for to see that she is responding?" I was so taken aback that my aide had to repeat the question to me. I answered her the best I could.

She was medivaced from another local hospital and she was brain dead upon arrival. No cough, no gag, no corneals. Brain dead is brain dead.

This pt had such hydrocephalus that she herniated. Her ICP was so high that when I was assisting with EVD placement the doc asked me to move so the CSF wouldn't hit me. I think her ICP was about 40 or 50 at that time.

[RN1982]

Yeah, I told the family member that I always try to look into the scientific aspects of such situation. I know that the patient will never wake up. I flat out told the aunt that such a severe neurological event, the patient will more than likely never be the same. Explained that she is not taking any spontaneous breaths, not responding to pain, no gag, no cough, all of which are not good signs. She has some flow to the brain, very minimal but not enough to consider her brain dead. I feel really bad for the family and I realize they need time to accept the situation but I get frustrated when five family friends corner me start barraging me with questions about her neuro status.

[imenid37]

I think the OP was just trying to do her job and advocate for the pt. It is ridiculous how disprespectful some families can be of the staff. Many think the "know better" than the nursing and medical staff, but would be the first to throw accusations at the staff when something goes wrong. I get so sick of dealing with rude and demanding people who believe rules are for everyone but them. I hope if they complain the manager will stand up for the nurse. It really burns me up when hospital admin tries to pacify people who behave like this.