How would you have handled this?

SuesquatchRN, BSN, RN · Nov 5, 2007

I see both sides.

It's really difficult to work with the whole tribe surrounding the patient. Further, it isn't in the exhausted patient's best interest to be overwhelmed with a bazillion relatives for hours and hours.

There's no reason that every family member needs to intrude into the ICU on a deathwatch. Stop in, pay your respects, and then leave and let the wife/so keep the vigil.

jmgrn65, RN · Nov 5, 2007

We always made special circumstances for situations like this. We would let the family in and keep door closed if possible.

TrudyRN · Nov 5, 2007

I wonder why the patient is still in ICU (well, ok, he's still on the vent) but why is there all that much to do for him? He should be kept clean and dry and as comfortable as possible but there should be a decrease in vital signs being taken and in I&O monitoring and in pressors and other meds.

Also, the hospital needs to do some orientation for the family. They should be informed that the person is in ICU and is still receiving very frequent care from the nurses, therefore their access to him will be limited. They should be instructed that it is not possible for all of them to be in the room for hours on end and that only a brief visit is expected of them. People really don't know how to behave, I guess, in times like this.

I have no easy answers. It depends on each facility, I guess. I can't blame the nurse too much but can't blame the family, either.

jojotoo, RN · Nov 5, 2007

I'm usually pretty much "by the book" on visitors and visiting hours. But you've got to be able to be fexible in situations like this. As long as the patient is medicated for his comfort, this would be the time to start skipping some of the routine procedures (full bed bath, etc.) and allow the family - and patient to say goodbye and have some closure.

dansamy · Nov 5, 2007

I would have allowed the wife to remain at the bedside and then also allowed 2 other family members in at a time to say their good byes. Not long per group. 15 minutes or so. When they were all done, I'd have allowed the wife to remain at the bedside and begged (management) to have a cot allowed for her to stay the night.

SICU Queen · Nov 5, 2007

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.

leslie :-D · Nov 5, 2007

i am for immediate family keeping a bedside vigil, if that is what they want.

but ultimately, my concern is for the pt, and their well-being.

i have an advantage, where i get to know my pts and their feelings and their eol wishes.

not everyone wants the 'kin folk' there, trust me.

if they come in and set up camp, no...i will not allow that.

if they come in and are respectful to and of their immediate environment, i am much more flexible.

but again, i always keep in mind, what my pt wanted, and w/whom.

leslie

l.a.m.b, ADN, RN · Nov 5, 2007

i am a student and i also work at a hospital. i feel that even though nurses are very busy and they have things to do, consideration to the pt and family is due. family needs to say goodbye for their closure and to heal, even if it was to be expected. books say that hearing is the last thing to go for the dying pt, and to hear their loved ones whisper their love for that person is priceless. also, nurses have been trained to be therapeutic and to provide holistic care. why not let the family take time to say goodbye? why put a time on that? let the person dying be surrounded by their loved ones. move equipment out, let people in and close the door. the nursing supervisor often leaves that to the nurses discretion. as long as family members do not disturb other pt's/families i see nothing wrong with this. have nurses become so task oriented that compassion is set aside? no, not all nurses thank goodness!

llg, PhD, RN · Nov 5, 2007

A lot would also depend on the physical facility ... the number of family members ... and their behavior. For example, 50 people being loud and disturbing the other patients and families can not be allowed. But 2 or 3 extra visitors at the bedside at a time can usually be accommodated without causing any harm. Each case needs to be assessed individually.

WTTsMom · Nov 5, 2007

Thank you all for replying. I think I would have found a way also to make special circumstances. Our ICU is fairly small but he was in a small room with a door and even if the whole family couldn't have stayed with him, I also believe his wife should have. I know that when my grandfather was in the ICU a year ago, my grandmother was allowed to stay with him 24/7, but that was in St. Louis, a much bigger city. It was the only thing that gave them both peace.

I guess I'll learn my own ways of handling situations when I graduate but I do love having this board to run things by.

Thanks again,

Cynthia

TazziRN, RN · Nov 5, 2007

Having been in the family's shoes, I am forever grateful to the ICU staff who threw the rules out the window when my brother herniated. We all knew he'd herniated but it was several hours before we got the official word from the doc because he was in surgery on another case. The staff allowed my family to come and go as we pleased, since we did not interfere with the care of other pts in the unit.

Having been the nurse working when a pt was dying in the ER, I say that nurse had no reason to restrict the family. I allowed families to come in and stay, explaining that I would be moving around them and that I may have to ask them to step out for a few minutes occasionally. I have never had a problem.