open visitation in the icu?

Dalzac, LPN, LVN, RN · Mar 29, 2007

It is a nightmare. my ICU had open visitation. The families just won't let the pt. sleep. they want cots.. (noway, the room just isn't big enough) The stupid c/o get bigger. They want you to take care of them almost as much as the patients. And they want you in there all the time, even when you try to explain you have another patient. Now if the patient was really bad yes they can stay. The drunk visitors roll in every night just about bar closing time. Most of the time they are beligerant. I always did bathes on the comatose patients and the family would never leave. I really hated it most because the ones that did sleep at night never got any rest at all.

TazziRN, RN · Mar 29, 2007

Ours has it but with guidelines: no visiting at shift change, no one under 12 years old, and not if the nurses are busy with a pt, even if it's another pt. It works very well but we only have a 4-bed ICU.

misscece · Mar 29, 2007

let me clarify that i have no problem extending visiting hours in cases where the patient needs someone to keep an eye on them (dementia, trying to get out of bed) or when pt's are terminal.

i can't stand following a nurse that allows people to stay for as long as they like because then i have to be the bad guy simply by adhering to the visitation policy - which is posted on the door outside of the unit as well as in a handout we give. fellow nurses - please note that when you bend rules based on your own personal reasons (and not obvious ones like the ones i listed above) - you are setting up your co-workers.

Purdue_Nurse · Mar 29, 2007

I used to work in an ICU with open visitation and I think it is a horrible idea. :nono: In some cases it worked out alright but there were always the families that constantly hovered over the patient and agitated them. There were several occasions when I had to ask family members to leave for awhile so the patient could rest. No matter how much we tried to explain how important rest is for these patients they just didn't get how it wasn't a good thing to be in grandpa's face talking to him and touching him 24/7. They also didn't understand why 10 loud family members and a screaming child weren't allowed to cram into the room all at once. Also, as a previous poster mentioned, the families usually expected us to take care of them as much as the patient. The hospital policy was that only food for the patients could be called down and ordered from the cafeteria; families had to go down and get something for themselves if they wanted it. Some threw a fit about this. Also, while running around like crazy dealing with a different patient who was crashing they would come up and ask, "Can we have 3 cups of coffee with sugar and cream please?" On my list of priorities right now your coffee is about number 99! :angryfire

Sorry, just venting here!

lsyorke, RN · Mar 29, 2007

As a family member(and nurse) who recently had hubby in ICU a few times..no way to open visitation. Families need the downtime and will NOT take it unless forced. Not good for the patient, not good for the families.

Bluehair · Mar 29, 2007

let me clarify that i have no problem extending visiting hours in cases where the patient needs someone to keep an eye on them (dementia, trying to get out of bed) or when pt's are terminal.
i can't stand following a nurse that allows people to stay for as long as they like because then i have to be the bad guy simply by adhering to the visitation policy - which is posted on the door outside of the unit as well as in a handout we give. fellow nurses - please note that when you bend rules based on your own personal reasons (and not obvious ones like the ones i listed above) - you are setting up your co-workers.

I live in a small community, and we have an 8 bed ICU. Our vs hours have been open, and we are chaniging the policy to restrict them slightly. No visitors from 9 p.m. until 8 a.m., and none from 6:30 pm to 7:30 p.m. (shift changes at 6:30). No more than 2 at a time, no one under 12. We have pretty heavy Hispanic population. No generalities meant here, but in our local population we have noticed that the very large families do better (and the patient) all do better when we can allow them all to come in for just a minute or two. There are some pretty well recognized issues amongst the locals regarding the family's duty to visit their mother/father/grandparents, etc. in the hospital. They are very good about observing our restrictions, but we do need to enforce them consistently. If one person lets the whole clan in it becomes a nightmare for everyone else to enforce the rules. We had to have the Medical Director address the whole topic in a staff meeting at one point. Since then it's a lot more consistent and works for us here just fine. We do encourage family participation in patient care, which either makes them thrilled or they leave. (Basic stuff - would you like to help her brush her teeth?) **Our patients are often lower acuity than in many hospitals.

We do offer guest trays for families here, but we don't make a big deal out of it. Many of our patients don't eat well at home so it's nice to be able to offer a hot meal to their spouse/family. Generally we don't have family who are real demanding, though, so it sounds like a different scenario than some of you have.

Also, we have the caveat 'at the nurse's discretion'. So if someone shows up all coke'd up or drunk, they are politely asked to leave. Or we call security if they won't or are disruptive.

TraumaICURN · Mar 29, 2007

I work in a 23 bed TICU. We have closed visitation. I have also worked in an ICU with open visitation. To me, closed visitation is much better. In my experience, the family seems to be more demanding than the patient sometimes. Of course, if a patient's condition is deteriorating, then we consider allowing family to visit as they please.

Sue Damonas, BSN · Mar 29, 2007

10 years ago my father was in the ICU with pulmonary edema.He stabilized and I went in for the next visiting hour and he was the best I have ever seen him.We were having a wonderful time talking and his nurse came in and made me leave because the hour was up. When I came back later on he started to deteriorate and died later that night. How I wish that nurse would have let me stay a little longer when he was feeling so well. I don't mean all day but just a little longer. It still bothers me to this day.

llg, PhD, RN · Mar 29, 2007

I worked for many years in Neonatal ICU, where open visitation has been the norm for many years. Many NICU's even allow small children to visit. Yes, it is stressful to have the families around so much, but NICU nurses learn how to deal with it. It's just part of the job routine for any nurse in pediatrics. We teach families how to be good visitors and enforce rules that prevent them from being too disruptive or harmful to the patients.

I never understood why an adult ICU shouldn't be able to do the same thing.

misscece · Mar 29, 2007

i am sorry that happened to you. i also worked nicu for many years but i believe that parents are much more apt to let babies sleep. also, babies don't feel the need to "entertain" or interact with their company.

i'm not sure what your dad's situation was - i have no problem letting people stay if the person is doing really badly given they are respectful of the patient's need to rest and of me needing to do my job (i believe most icu nurses are the same).

brissie · Mar 29, 2007

I blame it on the whole service orientation theme that has been pushed in healthcare over the last 20 years or so. We are not running Holiday Inns and yes i'm afraid that the doctors and nurses do know what is best for the patient, that is our job. As a nurse I'm not going to turn up at your work and start telling you how to do your job so don't tell me how to do mine. People are not clients, they are patients. The hospital environment is not service oriented, it should be oriented towards what is best for our patients and this is not always, in fact I have found hardly ever, what is considered best by a patients relatives, and sometimes by the patients themselves. I have found that the best relatives and visitors are the ones that want the best for their loved one not what is best for themselves.