Open Visiting Hours in ICU...Yes or No?

[goldenbobcat]

I currently work in a critical care unit that has instituted a policy of open visiting hours. Aside from a two hour time period in the morning (0630-0830) and the evening (1830-2030), up to three visitors are permitted to be in the patient's room at all times thoughout the day. I am told that this a growing trend in the critical care environment across the country, but I have found it to be a source of stress and frustration. Any thoughts?

[JeanettePNP, MSN, RN, NP]

I again would like to thank those who have responded to my question and to all those who have voiced their opinion in the poll. This is by no means an easy situation to find compromise. A case in point. One of our current patients has been in our unit for five days. Post-operatively she was confused and continually climbing out of bed. A family member offered stay with loved one in lieu of a sitter; which at the time was appropriate. Since that time, we have become obliged to provide her a wheelchair and escort to transport her to the restroom, since she unable to walk. As a token of our gratitude for staying with the patient the hospital provided for her the evening meal. Since that time we have become responsible for providing her a daily menu that meets her special dietary needs and she is served her meal in a recliner chair. Our patient continues to get out of bed and roam down the hallway trailing her monitor wires behind her while her family member watches television and naps. What is wrong with this picture?

Am I getting this right? The patient's sitter is confined to a wheelchair and needs care of her own? You definitely don't need 2 for the price of 1 in the ICU!

[ZASHAGALKA, RN]

I personally like having my families around. I work in a Trauma/surgical ICU and we have open hours. I see the family as part of my team. I find that if you educate them and give them some small task to do as early in the process as possible then they feel like they are a part of things. I also like having an extra set of eyes in the room. I have had some families that are hard to deal with but that is only about 5%. Most of the other "bad" behavior has to do with the fact that they are experiencing the worst time in their lives and feel helpless. It also doesn't help when everytime they turn around the media is showing another story of malpractice (they never show the good stuff it seems, even though that is the majority). I find that communication and approaching the family as part of the team and not an enemy, goes along way.

When I was working on medical, I appreciated having an extra set of 'eyes' in the room.

But point of fact, in critical care, the things I'm looking at are very rarely seen by 'lay' eyes, and the things they CAN see are normally either irrationally irrelevant, or readily recognized by me anyway because I'm always 'right there'. (even if I'm in my other pt's room, our ICU has shaded windows between rooms that can be opened and allow me to see into my other room without giving that same view to the bedside. Of course, families mean no view into one room while working in the next - because THEY would be able to see in.)

The things that set off the 'eyes' of those lay people are much more often than not, trivia. Yes, I do, in fact, hear the alarm, but thanks for pointing it out to me.

I can see how babysitting family members is great 'customer service', but it's at the expense of pt advocacy. Because, while I'm playing host, I'm not spending my time picking up on the subtle changes that can avert major problems if picked up upon. And really, THAT is why a pt is in critical care.

Closed visitation didn't just happen. There were powerful reasons behind it. There were pt advocacy reasons behind it. I maintain that I'm not worried about open visitation because, once implemented, the various units will come to see why it was a bad idea in the first place. You don't just change things for change sake. It's important to evaluate WHY something is the way it is. And once evaluated, closed visitation remains a good idea.

Maybe it's not great 'customer service', but my priorities skew towards pt adovcacy. And it is good pt advocacy.

~faith,

Timothy.

[elizadream]

We are not allowed to restrict visitors at any time from being in the rooms in our ICU, except maybe for cleaning up stool and even then sometimes they refuse to leave. Most refuse to even use the intercom and they get mad if you say something. Most visitors are anxious and slow you down, but I know they have a need to be there so that's ok. , don't you? My mother has pain! She needs something right now for pain! (or nausea, or wants to be repositioned yet again). Sometimes I think the pt agrees they have whatever need it is, just to make the visitor happy.

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The only time I realllllly hate it, is when they are there around 1730-1930, because that's end of shift then report time...

IT's against HIPPA Laws to allow visitors milling around when you're giving report! We stopped that Flat when we reported it to our Manager.

[sweetommabear]

I work in a very busy CVICU, our patients are extremly critical, probably the most critical in the state. This is a very explosive subject, I do not believe that families should have the right to come and go as they please. Our Vice President of Nursing and my nurse manager all believe in open visiting policy, and believe me she makes no bones about it. I feel that we as beside nurses should have some say in the matter. I cannot tell you how many times I come into work and find out dayshift has told the family they can spend the night in the room. :angryfire I don't know what the answer is but we have to find a way to work together on this subject. I do not have an issue with family being @ the bedside of someone who is actively dying, or someone I am going to withdraw support on. I have had experiences where families have pit one nurse against another. We have enough stress in our job all ready without any additional stress.

[RN34TX]

This is a very explosive subject, I do not believe that families should have the right to come and go as they please. Our Vice President of Nursing and my nurse manager all believe in open visiting policy, and believe me she makes no bones about it.

So your vice president and NM all believe firmly in open visitation?

Interesting pattern.

The biggest advocates for open visitation that I've run across so frequently seem to be those who never have to actually deal with the casualties of it.