Family visitation in ICU

  1. family visitation in icu

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    hi...i just found this site yesterday....it looks like a great way to get to know people and find out current opinions about nursing issues....

    i am currently working in a busy community hospital in a 12 bed icu....

    we have visitation issues....our unit use to allow family in to see patients indiscriminately....then limited visitation fro 11 - 4 am and 8 - 10 pm. family members are getting use to these hours but we still have many problems.....

    would like to get other opinions.....

    do you think their is a relationship between family presence in the icu and positive outcomes fro confused and ventilated patients?

    do you think the length of stay is decreased because of family presence?

    are the incidents of injury reduced by family presence?

    how often do you use restraints? do you find you need restraints less when family are allowed more visitation?

    do you have open visitation?


    ths is a hot topic in our unit....many nurses think visitors interfere with patient care....others think they are helpful....but i believe each situation should be looked at individually - not all situations can be treated the same way.

    thanks for your opinions
  2. Visit bfjworr profile page

    About bfjworr

    Joined: Jan '05; Posts: 66; Likes: 7
    Staff Nurse / Preceptor

    171 Comments

  3. by   RN34TX
    Ideally, all situations/visitors should be treated individually because yes, some visitors are helpful and supportive and can reduce the need for restraints as well as keep the patient safer in general. Many others, however, can interfere with care and can run the spectrum of anywhere between just being needy and calling on you constantly to flat out disruptive to the patient and the unit in general.

    I once allowed a family member who drove a long ways to see her relative stay with her all day and not just the 15 minute intervals per policy. I gave her a chair away from the vent and she sat quietly in a corner all day and the patient was awake enough to appreciate it as well.
    The problem was that I literally had to hide her and keep her in there because a very disruptive family of 8-10 people sat in the waiting room waiting for their next visiting time. I had to make sure that they did not see this woman coming in and out of ICU at her leisure.
    The problem family never failed to provide 15 minutes of torture to their mother as well as the staff every time they showed up for visits so there was no way I was going to allow them to stay any longer than I had to.

    I wish that I could have simply told them that she was allowed to stay because she did not cause problems and interefere with care like they did, but how do you tell an already irrate family something like that?
    You can't make exceptions for one while making others follow the rules even though I did do that for 3 days for this particular visitor and I've made exceptions for others as well but I've always had to keep it under the table so that everyone does not start trying to get into ICU at their leisure.
  4. by   Elenaster
    RN34TX - you touch on a very important point regarding having everyone follow the same rules. Some family members are fantastic and their presence is very beneficial to the patient, while others are rejects from "The Jerry Springer Show" that you don't want within 20 feet of you or your patient. And you better believe that if you let one bend the rules with your discretion, all the others will hear about it and then the complaining will begin.

    In my 11 bed Neurosurgical ICU, we have closed visiting with the following hours:

    9:30-10:30 am
    2:00-3:30 pm
    5:00-6:00pm
    8:00-9:30pm

    Honestly, I feel like it's more than enough with the majority of our patients. Because I work in neuro, many family members stand about helplessly, expecting you to sit and look at them the entire time. Many neuro patients go weeks and weeks with very little change, and I've found the families often start to obsess about things that are irrelevant because they don't want to deal with the magnitude of the brain injury.

    Having scheduled visiting, I always try to cluster care in such a manner to maximize the family's time with their loved one. We also have an open unit, so we try to get procedures out of the way outside of visiting time, which helps protect all the patient's privacy.
  5. by   bellehill
    Our neuro ICU just implemented open visiting hours except during shift changes. It is a wonderful concept but I think there needs to be more control and rules for the visitors. What ends up happening is visitors sitting at the nurses station while the nurse is working with "mom", they come and go ALL night long with no regard for the other patients or nurses. Management doesn't back up the nurses because we don't want any unsatisfactory customer service scores.

    When family members come from long distances or truely help the patient I have no problem with them being in the room. If I have to trip over their chair everytime I want to see the pt I have a problem. About 60-70% of the time it isn't a problem, it is the other % that ruin it.

    Does anyone else have open visiting hours and what rules do you enforce?
  6. by   mattsmom81
    Quote from Elenaster
    RN34TX - you touch on a very important point regarding having everyone follow the same rules. Some family members are fantastic and their presence is very beneficial to the patient, while others are rejects from "The Jerry Springer Show" that you don't want within 20 feet of you or your patient.
    ITA...and love the analogy to Jerry Springer show ...some I swear had to be recent guest of his....

    It is sooo 'PC' now to support open visiting...with little emphasis on potential negative impacts on nursing care, privacy, and patient response. When we individualize/open up visiting time, we set a precedent other visitors demand.When we must limit disruptive families and they complain, we nurses are frequently reprimanded.

    I'm glad other ICU nurses here notice this.
  7. by   RN34TX
    Open visiting is PC but interestingly enough, almost exclusively supported only by those who do not have to be exposed to abusive and disruptive families.
    Same goes for the ever so popular PC "families should be present during a code."
    Jerry Springer drama and lawsuits waiting to happen, that's all that is.
  8. by   PJMommy
    Quote from RN34TX
    Open visiting is PC but interestingly enough, almost exclusively supported only by those who do not have to be exposed to abusive and disruptive families.
    Same goes for the ever so popular PC "families should be present during a code."
    Jerry Springer drama and lawsuits waiting to happen, that's all that is.
    I agree. I also find it interesting that this is so often supported by the daytime administration folks who are much less concerned than I am (at 2 AM) about some gang banger coming to finish the job.
  9. by   mattsmom81
    Quote from PJMommy
    I agree. I also find it interesting that this is so often supported by the daytime administration folks who are much less concerned than I am (at 2 AM) about some gang banger coming to finish the job.
    Wow you said it PJ Mommy! Everytime I read a nurse supporting open visiting I wonder where they work and what position they hold. while I do get some lovely cooperative and helpful visitors (some I would love to let stay with confused granny cuz it is helpful), I increasingly encounter hostility, threats and violet outbursts. Today's general public cannot seem to handle crisis without acting out...and I am not staffed to deal with this AND patient care.
  10. by   bfjworr
    Although our unit has closed visitation hours....our unit is easily accessible....There are no locks on the double doors and there is no one preventing them from walking through the double doors to the unit itself. Each patient door can be locked and this is encouraged by our manager. There is a red phone visitors are suppose to pick up and use to find out if it is convenient to visit. Many do not use the red phone.... We limit visitors to two at a time... but many do not pay attention... Some nurses do not enforce the rule and then all the other staff nurses receive aggravation from the families when they follow the guidelines. Another problem is families try to wake up sedated patients while they are on the ventilator or loosen or remove restraints while they are visiting and forget to replace them when they leave. Patient confidentiality is compromised when family members approach the nurses station.....we have glass doors on our rooms so all our patients are easily seen by the nurses....and unfortunately sometimes visitors....Do you have some of these same problems....
  11. by   Elenaster
    Quote from bfjworr
    Although our unit has closed visitation hours....our unit is easily accessible....There are no locks on the double doors and there is no one preventing them from walking through the double doors to the unit itself. Each patient door can be locked and this is encouraged by our manager. There is a red phone visitors are suppose to pick up and use to find out if it is convenient to visit. Many do not use the red phone.... We limit visitors to two at a time... but many do not pay attention... Some nurses do not enforce the rule and then all the other staff nurses receive aggravation from the families when they follow the guidelines. Another problem is families try to wake up sedated patients while they are on the ventilator or loosen or remove restraints while they are visiting and forget to replace them when they leave. Patient confidentiality is compromised when family members approach the nurses station.....we have glass doors on our rooms so all our patients are easily seen by the nurses....and unfortunately sometimes visitors....Do you have some of these same problems....
    Aside from the red telephones and glass doors b/t your patients, I would think we worked at the same hospital based on what you just described.

    Nothing irks me more than when you FINALLY get some buck-wild patient settled down and asleep for the family to come and wake him up, in spite of the fact you've explained to them to leave him alone.

    Just a few weeks ago, we had this really wacko patient that even the most kindhearted and patient nurses could no longer deal with. We got the chief resident to come and talk to his even more wacko wife, where he explained to her ICU psychosis, lack of rest, etc. ad nauseum. After the resident left, she proceeded to bark at him in this awful, loud, gravelly voice that he needed to "CALM DOWN!!!!" Oh yeah, that helps...........
  12. by   PJMommy
    Ah...I still remember a 8 hour "slow code" pt who came as a post-op trauma. I didn't sit or pee for those 8 hours and never once left the room. Desperately trying to maintain a pressure with every pressor I could lay hands on, infusing blood as fast as the pt was losing it, running fluids wide open -- docs standing in the room giving non-stop verbal orders. I look up at one point...must have been about 4 AM...and see a man standing in the door, watching. I knew he wasn't my pt's family so I barked at him about what he wanted. His response, "just watching". Uh, no you are NOT just watching...move your a** out of here. Turns out he was family for another pt on the unit -- and he later had the audacity to tell the charge nurse that I was rude. Yeah, because when I'm dying a slow, hard fought early death in the ICU - I really want total strangers as an audience.

    So, yes bfjworr, we have the same problems. My personal favorite is the family who, despite extensive explanation and teaching, cannot grasp that I really meant it when I explained about no stimulation for the brain injured, sedated, chemically-paralyzed pt. No...shaking him and yelling "John, can you hear me?" doesn't qualify as "no stimulation".
  13. by   bfjworr
    Under what conditions do you feel open visitation is appropriate..and therapeutic?
  14. by   11:11
    You will regret it.

    I think all ICU's should have a large bold sign that says "We Reserve the Right to Refuse Anyone" right on the front of the locked entrance.

    I work in the ICU of a large teaching and research facility. Its an open unit. Its been a terrible experience for me. Other nurses might not care or know better. Our NM does not support us either regarding pt visiters or enforcing unit rules. The bottom line is customer based service, not RN's which is why they constantly hire.

    The last unit I worked on was locked. We had a great dedicated pool of charge RN's who espoused leadership and supported their staff. If visiters refused to leave security was called pronto. Ive actully seen them use their powers of arrest.

    Look, I understand what its like to have a family member in the ICU. Ive been there. Ive also been an ICU pt. So I like to think I am sympathetic. I personaly would not leave my wifes side.

    Unfortunately not all people are equiped to deal with the stress of a medical crisis. And they arent always "jerry springer specials" either (I resent that). Many times they are well educated, informed, articulate, and empowered individuals who crack under years of dealing with comorbidities, dysfunctional families, and unresloved issues (one or all).

    Another issue is my right to privacy while I practice. I dont think mangement has taken that into consideration nor will they until nurses step up to the plate and stand up for themselves.

    I think units with high acuity pts from trauma, transplant, to medical should all be locked. Then let the unit decide if a visiter is accpetable to stay at the bedside or not. If not explain why and kick them the hell out, call social services, chaplain service and somehow help them.

    Personally Ive just about had it with ICU-

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