Dealing with ICU visitors - page 2
I need to know if others out there have the same difficulties with patients family members/visitors in the ICU. In my facility visiting hours are more strict than they are on the floors.... Read More
May 18, '09Occupation: I work in a medical ICU of my local hospital. Specialty: Critical Care ; From: US ; Joined: Jul '07; Posts: 143; Likes: 87My daughter works in an acute care long time setting where families are there all the time. She is generally a calm, nice person, but one day recently she had it with one particular family. Because they had two daughters who were CNA's (we've all met these kind) they felt they could dictate their mothers care to my daughter. My daughter put up with this for awhile then stated, "If you actually think you can do better, take your Mom home.) She regretted this immediatly fearing for her job, but the family actually came out and appoligized and said they were glad she put them in their place!
May 18, '09Specialty: ICU/Critical Care ; Joined: Feb '08; Posts: 4,914; Likes: 7,697too bad we can't say stuff like that.
May 19, '09Occupation: Neuro Surgical ICU Specialty: Cardiac ICU, Neuro ICU, Burns ; From: US ; Joined: May '04; Posts: 2; Likes: 3Dealing with patient families in the Intensive care units can be your most challenging and frustrating skill. Its important to remember that your patient's family IS your PATIENT TOO! It makes your job more difficult and tiring yes, but that is why we only have two patients. If you do your best to educate, comfort and get to know your families believe me, they will be your best asset and helpers. HOWEVER, if you ignore them, they can be your worst nightmare!
Take the time to introduce yourself, sit down with them and answer their questions. Orient them to the unit and the patients plan of care.. Once you have established a trusting relationship with them they will do anything you ask.
There are times that you need peace and quiet in the pt's room so you can concentrate and not make errors; and that is just what you tell the family," Listen guys, I need to concentrate here so I can do the best for your family. Can you go for a walk or go to the waiting room for ....time?" Believe me, Eleven years of ICU nursing has taught me, the better your family trusts you the easier your job will be!
GOOD LUCK! and lots of love from FLORIDA!!
May 19, '09Joined: May '06; Posts: 1,288; Likes: 940We have open visiting hours, so there's no restriction on the number of visitors or the time of day they arrive/leave. I haven't had any major issues. Sometimes I've had patients whose entire extended family show up and although they're not awake, their HR, RR, BP increases from all the stimuli from noise. I usually point this out to the family members and ask them to be quiet or to visit in our waiting room. They usually can't argue with the fact that there are really sick people in the ICU and they need an environment that promotes rest and healing, not noise.
May 20, '09Occupation: ED/trauma Specialty: 13 year(s) of experience in ED/trauma ; From: US ; Joined: Mar '08; Posts: 192; Likes: 351In my opinion, I think it should be individually based, and depend on how the pt is reacting to it. I think that there are times when the family needs to go!n However I also feel that part of our job includes caring for the walking wounded (AKA-the family). I would also like to add that if the patient was one of my 3 kids I would like to try to see if you could get me to leave the room! However I would never get in the way of care, although I may ask questions/offer opinions.
May 20, '09Specialty: ICU/Critical Care ; Joined: Feb '08; Posts: 4,914; Likes: 7,697Had the best family the other day. Patient was admitted two hours prior to my shift from OR. I gave the wife and daughter the phone numbers to the unit and our voicemail system. She said absolutely no visitors after she leaves, the patient needs rest and that I shouldn't have to deal with them and should just be focused on taking care of her husband. I thought wow, would be nice if most families understood that.
May 20, '09Joined: Jun '02; Posts: 14,165; Likes: 59,217i've worked in facilities with open visitation, and i've worked in facilities with locked icus. i've worked in places where management backs the bedside nurse, and i've worked in places where the family rules and management basically gives them whatever they think they want. i've worked in large, inner city teaching hospitals and i've worked in smaller community hospitals. i prefer locked icus -- especially in large, inner city teaching hospitals but open visitation can work. it can work if management supports the bedside nurse, if whatever rules that do exist are uniformly enforced and if families tend to be calm, supportive and respectful of the healthcare staff. unfortunately, that combination is exceedingly rare. what we have where i work right now is a large, inner city hospital used by members of several rival gangs (with all the drama you might expect), no visiting hours, rules enforced at the whim of the nurse at the bedside at this particular moment, and management that bends over backward to suck up to anyone who claims to be family. it's a disasterous combination, and i could tell stories . . . .
May 27, '09Occupation: Clinical nurse educator Specialty: 32 year(s) of experience in critical care, med/surg ; From: US ; Joined: Oct '05; Posts: 171; Likes: 76I agree with setting limits and initiating an active dialogue with family and friends. They want to see the loved one, we want to care for them so why not let the pt decide more?
May 28, '09Joined: Jan '02; Posts: 562; Likes: 128I'd suggest raising the issue at a staff meeting to see what the consensus is and find some direction from management. Rather than everybody does their own thing about the visitors and then other co-workers get frustrated by it. Hammer out a policy so every knows and make sure the manager gives direction. That way there may be better co-operation amongst individuals.
We have a locked unit, 2 visitors at a time policy, but every now and then it needs to be discussed at staff meetings to "gently remind" everyone to stick to it!
Jun 1, '09Occupation: ICU Nurse Specialty: ICU, Psych ; Joined: Dec '07; Posts: 70; Likes: 36In theory we have visitation every other hour for the first half hour from 6am to 10pm limited to two visitors at a time.
Of course, this never happens. Our rooms are generally full of people. When I get admissions, I try to make it clear when I cover visitation that it is in the patients best interest that we keep visitors to two at a time and I'll try to send family members home as often as I can at night. Our fold out couches are not comfortable and they have a tendency to wake up every time a pump goes off or every time a vent alarms or every time I walk in to move a pillow or check the foley. Technically, we aren't supposed to let people stay over night, but we generally let one person stay over night.
Of course, if a patient is actively dying, I really don't care how many family members come in and out (as long as I can still give meds!) and I'm more lenient in the few hours after an admission so wives and husbands and kids and Mom's and Dad's can come in and see that their person is okay (or get a full update on what isn't okay).
Sometimes it works!
Jun 7, '09Occupation: Clinical Nurse Consultant Specialty: Critical Care Nursing ; Joined: Nov '08; Posts: 53; Likes: 28I must say I am dismayed by the tone of most of the emails in this discussion thread. I'm afraid that most of you are appear as though you have absolutely no idea or compassion for what the families of critically ill patients are going through. Now as you are working in ICU I dont think that is a fair representation of what you are really like. While I agree some visitors can get in your face and in your way when you are trying to care of patients. And some get get quite inappropriate with the yelling for the patient to wake up. And some get even get violent BUT they are in the minority. As my references are in my work computer I will post them here when I'm at work next week. However the most important need for relatives is to be close to their loved one and its largely irrelevant what age they are because whether they are 4 or 40 or 60 they may have a parent who wants to be with them. Relatives are stressed, they dont understand whats going on, they are sleep deprived and they are unable to process information properly. So they will seem to be asking questions after question but thats because cognitively they are not process information.
As a number of members have said, get them on side, explain whats going on, explain the rules and they will usually play by the rules
Jun 11, '09Occupation: Registered Nurse Specialty: Critical Care, PACU, Plastic Surgery ; From: US ; Joined: Jun '09; Posts: 1I bet we work in the same ICU and just haven't crossed paths...
Jun 12, '09Joined: Feb '04; Posts: 842; Likes: 576I have worked in several hospitals and none of them had locked ICUs. We had a phone in the waiting room that dialed directly to the nurse's station and visitors could ask if they could visit. This works only if the person is literate. It was and still is amazing to me that you can post a large 3x4 sign on the doors of the unit to call before entering and how many people are suddenly illiterate and blind .
Have any of you noticed that usually when you get one PITA family-it spreads?! We had about a months worth of really "challenging" families. Seems like it comes in spurts.
Ms. X (patient) who had done everything to absolutely kill herself (without actually suiciding) with ETOH, drugs, etc. was dying of a complication of her lifestyle. Talk about problems! Her family said that we were just letting her lay there and die, (uh, excuse me folks...we weren't the one that came in with + everything on the drug screen, + other miscellaneous lifestyle diseases, and a liver shot to hell) complained about every little thing, went to the patient advocate over every other thing, threatened to sue us all etc...Anyway this bunch got many of the other patient's visitors in an uproar and it made life for all of us very difficult for a while.
We utilize security if we need to. Really and truly, all the nurses I work with follow policy pretty well. We also will bend rules where appropriate. A lot of the time, a simple explanation for the reasons behind why we ask them to call is enough. Guess we will always have a few that will make our lives "interesting" Sigh.