The MICU that I work in is closed between 7am-9am, 3pm-4pm and 7pm-8pm (for shift change.) We allow 3 visitors at a time, children may only visit between 5pm-7pm. One support person may stay overnight from 9pm-7am.
Does a more open visitation policy help or hurt the nursing care that you deliver? Most families are very respectful of my needing to be with their loved one. May times, I will ask them to step out of the room while I do an assessment....and they are fine with that. Once in awhile there is the family that is all up in my face (or my intubated patient's face.)
What are you visitation hours like and how do you feel about them?
Haha..... That's exactly why I said "it can definitely be frustrating at times". People get a little leeway then they start to take advantage of our unit's leniency. Of course, then, we have to crack down and kick people out or worst case call security. But for the most part people are respectful and appreciative.
Our facility has an open visitation policy. We are only closed from 0630-0830 and 1830-2030 for change of shift. Policy states 2 visitors at a time and no children under 12, although that's mostly up to the nurse's discretion. Fortunately, I've never had an issue with family members interfering with patient care. Some can be more trying than others but mostly just worried about their loved one. And we are pro family during code situations.
Our ICU has open visitation except for 0700-0800 and 1900-2000 for shift report. Visitation is restricted to 2 visitors at a time. I feel open visitation can be good and bad depending on the type of family. If the family is quiet and not overly stimulating the patient and gives me room to to do my job then I don't mind them at the bedside. However, many families constantly stimulate the patient and do not let them rest. This drives me crazy! The patient isn't going to get any better if you never let them sleep. These families are usually very demanding, interrupting me when checking and titrating drips or interrupting me when caring for my other patients for things that are little like a tissue or mouth swab. I do not agree that nurse's convienience shouldn't be taken into account as working in the ICU is stressful and we are hanging/pushing some drugs that are very dangerous and require us to closely monitor our patients. We need to be on top of what is going on with the patient. If the family is interrupting me every 2 minutes (for non emergent demands), or is in the way of the IVs/silencing alarms, messing with monitors and alarms, sitting in front of the vent, then I can not effectively take care of the patient and keep them safe. Then I think they are inhibiting the care I can provide, and my obligation is to keep that patient alive, and well. Like I said before, if the family doesn't interrupt me during med pass and isn't in my way, doesn't touch the equipment and lets the patient rest during sleeping hours... then I have no problem with them staying as long as they want.
I work in a 23 bed Medical, Surgical, Cardiac and Post Open Heart ICU. The unit is set up with one central open nursing station and all rooms in a semi circle layout from the station. The doors are all glass and kept open so we can monitor our intensively ill patients all the time even when pulled to the nursing station or charting. Most patients are unconscious on ventilators or at least have serious AMS and are unaware of where they are or what is happening. You can imagine the violation of HIPPA laws and basic patient privacy if at all times we allowed open visitation traffic in the unit. Many patients have tubes and machines in every orifice, they may be hyperthermic and blankets pulled off with cold packs on groin, perhaps they have C Diff or a GI Bleed and are continually being unclothed and bathed/changed. Of course I'm not saying strip your patients naked and expose them to the unit all day but the truth is if you have continual traffic, visitors will see things, smell things, and hear things that violate the privacy of the other patients. Also physicians who come through the unit are typically in a hurry and are looking to get the update, fix the problem and tackle the next patient ASAP. This will mean I will be discussing lab data, patient information, family history, vital sign trends, perhaps a disruptive family process I've seen and all of this will not be in a secluded sound proof box. I'm not saying this would be shouted across the unit, but we've all dealt with the snooping and nosy "guests" in the ICU who are desperate for some drama. Humans are not perfect. There will be some that are nosy and will violate our patients rights and privacy. It is our jobs to create an environment that prevents that as much as possible.
That just touches on the legal/privacy side of things regarding this issue. The real important aspect of this being a problem is with visitors being a detriment to your patients recovery process. Now I'll preface this with saying that in some cases I will break the rules of the unit and allow a non disruptive, polite, mild mannered family member stay at bedside if I feel it calms or helps the patients overall condition. As a whole though I do not. Usually I will note patients displaying higher BP, HR, Resp, Decreased Sp02 from continually talking and being stimulated by guests. If there is family dysfunction going on (and usually there is) people seem to bring that baggage out when their loved one is critically ill. You will see sudden crying fits, emotionally charged confessions, long lost family coming out of the wood works to see their cousin one last time! These things are emotionally taxing and harmful to not only my patient but the patients all around them who are hearing these people cry and carry on. It is my job to know this, perceive this and prevent this. Another commenter suggested this is "playing god" and I completely disagree. I am trained to care for my patient in all aspects including psychosocial and that is all I am doing. I care for my families and guests as well but never when it is a detriment to my ultimate goal of healing their intensively ill patient.
The whole goal of an intensive care unit is to bring people back from the brink of death or long term injury. I think people have forgotten that in the quest of modern research and political correctness. Sometimes it doesn't take much to push a patient over the line to health or death in the ICU. My job is to do everything in my power to push them towards the health side, that is my goal. If I'm seeing that the battle is lost and that their only healing could come from The Holy Spirit then I will get all the family and encourage them to stay at the bedside as much as they want. I'll let them cry on my shoulder, I'll even let them carry on a little too loudly sometimes. A cup of coffee whatever they need, but until that point my job is to keep that patient on the side of life.
My MICU is locked but has open visitation for up to 2 people/no one under 12 24/7. If someone is on the verge of dying there is not a limit to the number of people allowed. We will let someone sit in the room over night but they're not allowed to sleep or use a recliner. The rooms are just too small and since we have some very sick pt's (and therefore regular codes) it's not safe to have someone spread out and in the way.
Have a pt now who's fiancé is at the bedside 24-7...talking on the cellphone ALL NIGHT LONG. Can't figure out why the pt is spiking temps despite normal WBC ct and negative blood cultures....hmmm maybe it has to do with the fact that the other visitors are in the pt's face kissing the patient??? Maybe they're passing germs onto the patient?? BUT since the first night the pt was in our unit and that nursing supervisor allowed the fiancee to stay with the patient...no other one will kick the fiancee out...Fiancee got MAD at me because I was sitting down while calling the Pulmonologist to tell him that the pt's RR was up in the 40's, HR in the 130's and sats dropping & the pt needed to go back on AC mode---in my facility I cannot do this without the Pulm's order :{ Pt had just had a BM and since pt was intubated I cannot turn pt alone so I needed help.
SNJS
22 Posts
Haha..... That's exactly why I said "it can definitely be frustrating at times". People get a little leeway then they start to take advantage of our unit's leniency. Of course, then, we have to crack down and kick people out or worst case call security. But for the most part people are respectful and appreciative.