Negotiating visiting hours

TulsaTime · Jan 14, 2008

Having worked in several units now with open visiting I thought I'd seen it all until last night. We actually had a family member asking for a cot for the waiting room & a pillow. She was upset there was no place to sleep in the waiting room!

Before I could stop myself I said that's because it is a waiting room for an intensive care unit not a sleep room or a hotel room & it is not a place for people to sleep LOL. I then directed her to information about hotels if she wanted a place to sleep.

Then it got better. She called back about an hour later complaining it was too bright & she could not find how to turn the lights out & how was she supposed to sleep in the waiting room with all the lights on. thankfully someone else answered that call!

We recently went to open visiting hours in our icu's. I don't mind it except---it is suppossed to be two at a time, for 15 minutes an hour max, and no one during shift changes. There are no overnight stays allowed. They have to be in the waiting room.
That does not mean 10-12 people are welcome. When I remind you of this for the 15th time don't say "I didn't know." I can not take care of your family member if I can not have a clear unobstructed path on a least one side of the bed. What if your family member codes? There are 12 chairs, empty food wrappers, laptops, pillows, blankets, an abundance of spectators, ugh! I have been threatened 2-3 times where security had to become involved because family xyz has been here all week and the other nurses didn't enforce the no overnight stays in the room rule. Then I get accused of "not liking their family." When I ask you to step out it means NOW. Not in 30 min when you feel like it. You will not ignore me because I am female either. It never seems to fail the little COPD lady on BIPAP who is always anxious, has the family who could use a xanax salt lick themselves. They want to hang on her bed, in her face, take off the BIPAP because she needs a drink, to brush her teeth, whatever. Seriously, it takes ten times longer to do anything, and the patients are worse off.
P.S. if you have chest pain, a headache, asthma NO WE WILL NOT GIVE YOU ANY MEDICINE!!! you have to go to ER:smackingf
Sorry I am not happy with the new rules as you can tell. Off my soap box:innerconf

JohnW · Jan 15, 2008

Here in Boston, this stuff if huge news. The following article was on the front page of our major newspaper (The Boston Globe). Personally, I think it's crazy. Of course, the running joke is that the hosptials are preparing for the time there are no nurses and the families have to take care of the patient themselves :)

Brigham to widen access to ICUs

Family presence seen as aid to care in cardiac cases

Globe Staff / January 2, 2008

When Brigham and Women's Hospital in Boston opens its new cardiovascular wing in May, all 136 rooms - even those for intensive-care patients - will include a family sleeping area.

Among the amenities:a pull-out bed with bed linens and a flat-screen television.

The rooms will be as big as 350 square feet - about double the size of the hospital's current rooms - andpatients will be ableto designate a relative or friend to stay with them each night, basically living alongside them in the room.

Doctors and nurses will encourage family members to help provide basic care, such as bathing and changing bandages, and allow designated individuals to remain in the room for most procedures, including removal of chest tubes, insertion of intravenous lines, and even resuscitations.

"Pediatric hospitals have embraced this for years; the family is not thought of as a visitor," said James Conway of the Institute for Healthcare Improvement, a nonprofit research organization in Cambridge that has pushed the opening of adult ICUs to families.

Brigham officials say this is the only cardiovascular center in Boston designed to include a family member in the patient's room.

The Brigham is one of a growing number of US hospitals experimenting with open access or nearly open access for families of adult ICU patients - an idea that has met with opposition from staff at every institution that has tried it, at least initially.

Many Brigham nurses also were uncomfortable with the concept at first- and some still are -though the hospital already has a relatively liberal visiting policy in the ICUs; exceptions are often made to the official visiting hours of 1 to 9 p.m.

They worried that families with their own demands and questions would distract nurses from caring for patients. Nurses also were concerned about having to clean up after them - or having totend to fainting or upset family members during graphic or emergency procedures.

"People die in the ICU if you miss something," said nurse Karen St. Martin, who works in the eighth-floor cardiac ICU. "It has to be a controlled environment."

But after St. Martin and other nurses helped develop ground rules spelling out nurses' roles and establishing boundaries for family members, most staffers are now happier about relatives being a near-constant presence.

Some, likeMeteriver "Thelma" Kincaid, already spend day and night at the hospital.The 65-year-old Bostonian has been living nearly full-time in the cramped family waiting room on the Brigham's eighth floor since October. Her daughter, Lauren, 23, who is suffering from heart failure, has had four operations since June, the most recent on Oct. 2, to try to repair a leaky artery.

Even without thewashing-machine-sized cardiac assist device next to Lauren's bed, there would be little space for Kincaid to sleep in her daughter's ICUroom. So each night between 11 and midnight, when most visitors have left the family room, she rolls out a fold-up cot, makes the bed amid the half-full coffee cups and soda cans, and closes the door so she can sleep. Lately, another female visitor she has gotten to know has slept in a cot next to her. But sometimes Kincaid shuts her eyes inches from a complete stranger

The nurses know Kincaid and allow her generous visiting time with her daughter, but she said "the privacy [of in-room accommodations] would be nice."

Dr. Donald Berwick, president of the influential Institute for Healthcare Improvement, several years ago challenged hospitals to open ICUs to families, to improve the quality of care and the hospital experience for both patients and families. He and other supporters pointed to a few hospitals where patients went home sooner and medical errors dropped after family members were let in to ICUs, partly because they noticed problems like missed medication.

But the idea remains controversial among hospital workers around the country. Internet message boards devoted to healthcare are filled with debate about the subject. On an institute online discussion group, one ICU nurse said open access was a success at her Midwestern hospital, and to keep out family "may cause more pain and suffering to the patient." But another nurse complained, "It is total mayhem," and still another wrote,"You end up spending more time tending to the family members than caring for the patient."

At Geisinger Health System in Danville, Pa., the hospital's initial attempt to open its ICUs 24 hours a day failed. The hospital limited visitors to two at a time and required themto leave during procedures.

"It didn't work when we trialed it," said Angelo Venditti, operations manager and a nurseat Geisinger. "Nurses were afraid to ask families to leave. So they didn't give families a good reason to step out. Families didn't understand and got into debates about why they had to step out."

The hospital rethought its plan. It trained nurses in communication skills, let doctors and nurses decide when families could stay for procedures, and set up a system of lights to signal when relatives could return to the room. Now, open access is working well, Venditti said.

Brigham staff and executives acknowledge that having family members around more often will be an adjustmentfor all concerned. Loved ones may find they don't get much sleep in an ICU room, given that nurses check patient's vital signs constantly, and some may decide not to stay. In other cases, patients may not desire that much togetherness with their families.

The nurses committee that drafted guidelines for the hospital's new Shapiro Cardiovascular Center sought to strike a balance. The group recommended developing a family handbook that explains the hospital's expectations for relatives staying overnight in a patient room, including that nurses will not make their beds and may ask them to leave for certain procedures. The hospital will train nurses how to communicate with families, and also promised nurses help from social workers and other staff.

Family members, along with the patient, will be briefed on each day's treatment plan, but families won't be present when nurses exchange information about patients during shift changes, a rapid, highly technical conversation.

Now, several nurses said, they feel more comfortable that the change will work.

"Things are shifting," said Matthew Quin, nurse manager of the Brigham's eighth-floor cardiac units. "Families are becoming part of the care team. They're healers too."

RN1980 · Jan 15, 2008

man thats crazy, so i guess they'll want me to split my pay stub with the patients family next.....sometimes people expect to damn much.

RNperdiem, RN · Jan 15, 2008

Ok, families staying in the room all night would be too much for me except in rare instances.

What I would recommend is in-hospital motels for families of critically ill patients. My hospital converted an old nursing dorm into a $12/night motel for families. The rates are reasonable, but space is limited.

The above listed plan puts a heavy burden of enforcement on the nurses.

Sounds good on paper, but these new fads always sound good on paper.

I'm still a fan of generous visitation with some limits in place.

optimus_prime · Jan 16, 2008

sighhhh.... what a worldwide problem.... i used to call the security guard to overcome this situation when things got out of hand.... but the annoying thing is... when the visitors start scolding the security guard.. they will turn around and says... "THE NURSES CALLED ME TO ASK Y'ALL TO LEAVE"... i feel like want to stuff my shoe in his mouth!!!

squirlkeeperCCRN · Jan 16, 2008

I just found this site a few days ago, and was thinking of posting this very topic after caring for a patient with the family from he**. We have open visiting in our unit and when we put a 12 bed addition onto it, built in beds for families to spend the night. Most families given the facts of stimulation on their loved one's health in certain situations is enough to promote proper behavior on their part. There are those families (you all know the ones I am talking about) that see this as an opportunity to get attention. They literally "take over" the waiting room, hang out at the desk (multiple family members asking for an update), all walk around being dramatic on their cell phones, sleeping on the floor next to the patient (there is only one bed in the room), and consume 50% of my time. God forbid you spend anytime taking care of your other patient, they will hunt you down for some piddly request (more than once I've had family members enter my other patients room looking for me). The ultimate annoyance is when multiple family members call on the phone or come to the desk during report for their hourly update....not appropriate! I do and always have been an advocate for families to be involved in the process of healing, I truely think it is important, BUT shouldn't there be some limits? What can be done? The family I recently dealt with's mother was elderly, in poor health, and in constant attendance, not taking her meds, didn't want to hear any bad news...fired one nurse who was honest with her because she didn't want to hear what she said. She became aggresive toward anyone giving her any bad news...problem is there was no good news. Would we have been serving her correctly to lie? We called family to come and get her and she flat out refused and became irrate with the nurses for going against her wishes...she nearly passed out twice from hyperventilation, but would not leave or go to the ER. Meanwhile she was threatening the whole time to sue the hospital over various issues (none of which had any validity). How do you juggle taking care of critical patients and ongoing issues like this? It's really beginning to wear on me. What can you do if that is your hospital's policy? I like the ativan salt lick idea, but like the old saying goes...you can lead a horse....

Seriously, thanks for all of the ideas and laughs, I guess it's nice knowing I'm not alone in my feelings.

optimus_prime · Jan 17, 2008

sometimes i realized most of this "pretend to be care" family member (when instead they are the one who seek for attention) love to use medical terms in their conversation.... gimme a break.... there's one time.. my friend overheard one of this lady who being difficult most of the time with doctors and nurses talking on her cellphone to her other family member "HEY! MOM JUST HAD A CODE BLUE ... THANK GOD IT'S ONLY CODE BLUE.... NOT CODE RED...."

yeah yeah...... ur mom will be roasted if she's in a code red....

squirlkeeperCCRN · Jan 17, 2008

Optimus,

LOL! It does make it really interesting when the family calling the shots has no idea what they are talking about...very frustrating to take care of these patients.

Chisca, RN · Jan 18, 2008

I think open visitation is a fad largely driven by the AACN and hospital management. It sounds so good on paper but all it takes is one family from hell to end it.

Ruby Vee, BSN · Jan 18, 2008

yes, the dramatic and difficult families are memorable, but the bulk of family members are thoughtful and considerate.
nurses can loose sight that these visitors are often bearing up under intense stress. i am saddened that so many nurses view visitors as a nuisance and a bother.
maybe some nurses do not know what it is like to be part of a close and loving family, to be really connected in a community.
the saddest patients are the ones who come to sicu and remain without a name for days until someone identifies them.
i believe that an icu does need limits. mine is generous with visiting- not at shift change or after 9pm(with rare exceptions). two at a time works well too.

i'd like to know where you work -- it's been decades since the majority of family members where i work have been "thoughtful and/or considerate"!! so many nurses view family members as a nuisance and a bother because so many family members are a nuisance and a bother! i'm thinking that has more to do with the community itself than with the nurse who may or may not be fortunate enough to be a part of a close and loving family and connected in the community.

Ruby Vee, BSN · Jan 18, 2008

not too many years ago (in another state), we had a patient whose wife had some sort of dementia. the son and his mother didn't get along. he brought mom to the hospital to visit dad, and then disappeared, leaving her there. dad was in a double room, and mom wouldn't leave. some of the nurses got the bright idea to get a recliner and order trays for mom, and just let her live there 24/7. the longer she was there, the more her behavior deteriorated. maybe her psych meds were wearing off, maybe she had icu psychosis -- i'm not sure what.

mom started complaining that the other patient in the room was the wrong color. she made things so difficult for the other patient, i felt sorry for her. we tried to move one of them, but between the transplants, the vre and the mrsa, there was no place to move either of them. so mom decided she'd take care of the problem by moving the other patient herself. the poor lady's shrieks brought the staff running.

we put mom's recliner by the nurse's station and found another icu bed elsewhere in the hospital for the other patient. then mom decided to "help" the nursing staff take care of other patients. she'd wander into other patients' rooms and turn their oxygen up, down or off, dump their urimeters back into their foley bags, and in one case took a patient alledgedly took a patient off the ventilator.

i find it absolutely apalling how my fellow nurses allowed this behavior to continue. no one wanted to say anything because they felt sorry for her. allowing extended visitation is one thing; allowing a visitor to frighten or potentially harm another patient is quite another.

we don't have many rules for visitors, but the ones that we do have ought to be enforced fairly and equitably by everyone. no hanging out at the nurse's station or in the halls outside the patient rooms. no looking at charts or computers. no food or drink in the patient rooms. (just tonight i had a trached patient vomit and aspirate. he's now back on the ventilator, oxygen at 70%. his mother, who swore the snapple was hers had been giving it to the patient, iknowing he was npo. "he was thirsty," she said. "i know what my son needs!") two visitors at a time. you leave when you're asked or you'll be removed by security and not allowed to return. do what the nurses ask of you, don't do what they ask you not to. should be simple.

unfortunately, nothing is that simple.

ReneeYY · Jan 22, 2008

I finally had to ask a patient's daughter if she wanted me to take care of her mother or take care of her...I couldn't do both. She sat down in the corner of the room and quietly hyperventilated...at least she was sitting!