open visitation in the icu?

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just want to get some feedback from those of you who work in icu's regarding visitation. does your hospital allow open visitation or do you have set visiting hours? if you have set visiting hours, are they adhered to? and most of all - what are your opinions regarding this issue?

i currently work in an 11 bed sicu and management is considering open visitation. our visiting hours are currently 11am-1pm, 3-4pm and 7:30-8:30pm. i really think i might quit if they make it an open icu. i work in a very wealthy are where it is hard enough to deal with the clientele (let alone their family members) who are used to having everything the way they want just because they are loaded. i'm busy enough tending to my critical patients without having to worry about family member's being thirsty or "too cold". what has this world come to?????

It has been about 6-7 years since I worked in the unit but the last time I really researched this, the studies supported open visitation and it actually improved pt outcomes. There were a few nurses that were strongly against this and became frustrated because they couldnt find any studies backing closed visitation.

I honestly feel like open visitation is a great idea but 9 times out of 10 it is just implemented wrong. I dont think open visitation was ever meant as a blind policy allowing the unit to be open 24 hours a day rather it was designed to allow close loved ones to be at their family members side when they are needed the most. As good as we nurses are, we are limited at some of the comfort we can provide especially emotional comfort.

It just has to be used with common sense which most administration and managers dont have. No, 3-4 people shouldnt be visiting at 3am, it should be a very controlled environment for the security of the patient and staff with the ultimate decision in the hands of the nurse taking care of the patient.

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Every reason against it is a reason that M/S nurses have to put up with. How about closed visitation for the ENTIRE hospital!! It'd probably end the nursing shortage, hehe!

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Specializes in ICU/ER/TRANSPORT.

I could just see the nightmare for our rinky dink 12 bed icu if we went open door. Sure all the reserch shows good things about it. I've read the papers the AACN put out about this issue. And I believe it worked fine, that is if your a gigantic teaching type hospital, they have security at the door to help regulate visitors and they'll remove them it they start getting in the way. But in my situation, where our hospital has 2 old arthritic security guards, this would'nt fly.. There are 3-4 rns in our icu q shift. Thats 3-4 pts per nurse, no cna's or tech's. Now all you unit nurses can imagine how busy it gets, so I guess with open door I'd have to service the visitor as well, ie..coffie, crakers,candy, pillows, blankets, new remote for tv, then it'll progress to-"I don't feel good will you take my temp or b/p, or please check my blood sugar...And then there are times I will not have the time or patience to explain every little trival thing I do, from taking apical pulse to setting the trim on monitors, And lord knows how many chest tubes will be sgtepped on, and invasive lines will be pulled out by the visitor, and whos fault will it be? Yep, yours the rn. Because you are responsible for everything.. Open door in the unit, hell why not let them in the or to. Like the previous post said "we are not a holliday inn". Heck I reckon I'd leave the unit if that happened.

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we have the visiting hours posted on the door of our unit - no security in front of the door but the visitors do have to ring a buzzer in order to be let in. unfortunately, this is the same door that everyone else swipes to get into so family members will just follow people in even though they are well aware of what the hours are. i would LOVE, LOVE, LOVE a security guard.

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Specializes in NICU/Neonatal transport.

I think nurses need to stop viewing families as adversaries and more as partners.

Family centered care isn't just for children.

I agree with llg, NICUs make it work, usually, though there are still nurses who do not treat the parents as welcome or partners.

Attitude makes a huge difference.

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if my unit had help - we have no techs, the charge nurse takes a full assignment and we often go without a secretary - i might have more time to work out a "partnership" with difficult families. however, when i'm running nonstop trying to keep my patients (often tripled) alive, i don't take well to someone running out of a room to tell me their family member "just moved" or that they need something that they are capable of getting themselves (i'm talking about the family member). a pt who is sick enough to be in the icu needs to have time to rest - this means that family members should not be in their faces trying to get them to talk when they are intubated, should not be holding multiple phone conversations in the pt's rooms on the phone and should not expect me to tend to them. also, there is a certain level of dignity that should be afforded to pt's - if i were that sick, the last thing i would want is for my family to be bringing in extended family or their friends just to see me while in that shape. the "attitude" being expressed are not towards those who help the situation - it is more about those who make our jobs more difficult. sadly, this is the majority more often than not.

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We started open visitation in our ICUs (except CVICU and CardioPulmonary Transplant ICU) and it was a disaster.

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Specializes in Nurse Scientist-Research.

Back to the way NICU's have done open visitation through the years;

First off; Parents are NOT likely to let their baby sleep until they have been educated over and over and over about how sleep is so essential to the baby's growth and development. But true enough babies do not feel the need to entertain the visitors.

Look up some NICU visitation policies and you will find some good guidelines:

Briefly;

Two people are designated as the main contacts (generally mom and dad) and no one goes back to the bedside without them. No more than 2 people at the bedside at any given time. No sleeping at the bedside. Children ages 3-12 are only allowed to visit if they are siblings (I guess you could modify this for adult ICU), and no one under 12 allowed in during RSV season. No food or drinks except water in the patient care areas. No one with symptoms of contagious illness or fever.

All parents are given a copy of the guidelines and have to sign a copy of it saying they have read and will comply.

Yes, it's very stressful every evening between 7:30pm to about 9:30pm as every parent tends to visit at that time and there never seem to be enough chairs for everyone.

It sounds like many of the issues with open visitation could be addressed with well defined guidelines for visiting tailored to each unit. But they MUST be consistently applied. We have issues when this is not done in our unit.

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Specializes in Everything but L&D and OR.

We have been trying the "open visiting hours" here in our 10 bed ICU. It does work most of the time, but of course you are going to have those that try to abuse the rules. we used to have families step out during change of shift due to HIPPA, but now our bosses are saying even this is not necessary. I am not sure how this is going to work. It almost seems like they are getting rid of every reason to have the visitors step out, even for just a little while. When you have those certain family members that actually do more harm thatn good so to speak, you are never going to be able to get them out of the room so you can take care of the patient and the patient can get some real rest. Some people just don't get it, and this is where open visitation can be a pain. Don't get me wrong, I think the idea is great, but unfortunately there are still going to be issues with it.

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Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

I am totally fine with family members being in the room as long as they are having a positive effect on the patient's status. However, if they are agitating the patient, interfering with care, or if there are too many of them in the room, then I have to be the bad guy and boot people out. And sometimes, no matter how "therapeutic" you are when doing it, some people will get mad at you.

I had a wife of a patient grab my arm and yell at me for booting 6 family members out of the room when the patient's heart rate/bp skyrocketed, and he went into resp. distress. She was actually yelling at me that the family members had driven 40 miles to see the patient. They were talking loudly, crying out loud, and picking over him. She actually blamed me for his status. I think restricted visiting can be a good thing when needed.

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We have open visitation in our ICU also, and for the most part we don't like it. We have had several families who play "pass the baton" all night from the waiting room, going in the patient's room for 15-30 minutes and then returning to the waiting room and sending someone else in. There is constant traffic up and down the hall and constant conversation as they are walking around. Not to mention all the requests for pillows and blankets and ice water, etc. It drives us crazy and the patients don't sleep.

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We have open visitation in our ICU and it can be a nightmare, depending on the family. I think there is a lot to be said for teaching people to be good visitors, AND for having enforced guide lines. Without them, it is chaotic.

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