open visitation in icu??

pickledpepperRN · Nov 16, 2005

I'm glad we worked to get visiting 22 of the 24 hours.

It is the registered nurses who have authority to restrict visitation. We also have a visitors lounge where families often support each other.

My heart cannot allow me to kick out a parent, spouse, or close relative or partner.

Once a young woman coded. I brought the mother to the bedside and put her daughters one free hand in hers. The doctor hadn't wanted here ther but rose to the occasion admirably. She said to him, "I was with my daughter when she was born. Thank you doctor for letting me be with her when she went to heaven."

My beloved uncle died this year with the family he vowed to keep together together.

They were Okies traveling during the depression. He never started a grade and finished in the same school so he vowed his kids would not have to leave friends like that. He lived in the same house from the adoption of my oldest cousin until the wedding of my youngest.

He mother was an LPN at that hospital. His sister led the volunteers for years. I was a candy striper there.

We are so glad he was at the home town hospital because I don't know the visitation policy at the city VA where he got fine outpatient care so he lived nearly 90 years.

We did a song about him. Here are part of the words:

"HE HAD MORE FRIENDS THAN YOU COULD COUNT,

HE FED THE POOR WHEN THEY WERE DOWN AND OUT

HE'D LAUGH AND JOKE AND LIFT THEIR SPIRITS TOO

HE LOVED HIS BABIES THAT NO ONE COULD DOUBT

HE RAISED HIS BOYS TO BE EAGLE SCOUTS

AND THE GIRLS GREW UP TO LOVELY LADIES TOO

ONE SUMMER, 1953, 10 OF US COUSINS IN HIS OLD CHEVY,

FORT WORTH TEXAS HERE WE GO

IT SURE WAS HOT AND US KIDS STARTED WHINING

BUT BEFORE LONG HE HAD US LAUGHING AND SMILING

HE SANG "RINGS ON HER FINGERS, BELLS ON HER TOES

EVERYTHING SEEMED LIKE THE BESTEST BIG DEAL

AS HE CRUISED ALONG BEHIND THE WHEEL (IN THAT OLD AUTOMOBILE)

AND HE TOLD US STORIES TILL

HIS NOSE STARTED TO GROW

WE SAID UNCLE ***** YOU'RE FOOLING TO US

HE'D SAY NO THAT'S JUST EXACTLY THE WAY IT WAS

I JUST STRETCH THE TRUTH A LITTLE, BUT THEN EVERYONE DOES

NOW ALL THE STORIES I'VE TOLD ARE TRUE

AND I HAD TO LEAVE OUT GUITE A FEW

BUT I HOPE THEY MADE YOU LAUGH AND SMILE A TIME OR TO

LIVING LIFE THE WAY HE LIVED, GIVING LOVE WAS HIS SPECIAL GIFT

NOW HE'S PASSED IT ON

HE'S PASSED IT ON TO YOU

I must add my families thanks to the ER nurse who told the truth and made sure family was called. The amazing ICU nurses. The special ICU RN who helped the doctor make him a DNR when my uncle wrote, "If I'm gonna die the take this out of my throat so I can talk!"

The staff who moved him to a 'comfort care room' (wish we had one of these).

I cannot thank enough the young nurse who offered us water and tissue with tears in her eyes.

fergus51 · Nov 16, 2005

I think open visitation is fine IF management supports nurses when they need to place restrictions on difficult families. Otherwise it is a nightmare. Most families can do ok in the hospital, but let's be honest here, some can't. They go crazy and they take away from patient care. That is not acceptable.

gizelda196 · Nov 16, 2005

WHOAAAAAAAAA. Settle down there. I have been on both sides of locked and unlocked units. I have to say that now we are locked and have gained a little control over or unit. I have post about this some where else so I wont get into it.

As for "training" families we continue to have to teach them ONE spokesperson

for the family, TWO visitors at a time, NO calls \ visits between report/shift change, Stay in the room or go out to the waiting area, I just sedated the patient, please do not attempt to arouse him.and so on.I would consider this "training." And despite all of this ,there are those few nurses who do not recognize the need to have these rules followed which set us up for major butting of heads.Well so and so told me what was happening to the patient yesterday(not even a family member let alone the spokesperson) Why cant I stand in the hallway(code going on) HENRY WAKE UP (bronchospastic vented just finally sedated following the famous field trip to ct scan) I agree that this is time consuming and when you are straight out with 2 critical patients and NO staff You do not have time to alleviate family anxiety and take care of all the little crisis going on with the patients. If all staff was on board with the rules Our jobs would be that much more easier .Instead of splitting family with staff we all need to stay on the same page. After all these are the most critical patients in the hospital and the last thing you need is a distraction when you are titrating critical drips or just need a few moments to think things threw. Visitors should be restricted. Period . Having open visits is not conducive to healing ,period. These patients need there time. When they have gotten past that critical point and go to step down that's when the wife's cousins daughters husbands dog walkers housekeeper can come in.Unti then 10 minutes on the hour between 10-12 and 6-8 is fine and immediate family only AND all the staff needs to stay on the same page . Unless they are dieing that's is a whole different story. I have and will continue to stuff as many people in a room as I can during this process Where can I get one of those comfort care rooms? I find at this point in care a locked ICU unit becomes a hindrance to these types of patients and their families.

when my dad was in the hospital sepsis s/p cardiac cath in my hospital I made my entire family go home take care of them selves and let dad rest. He said it was the best thing for him He was ill ,tired ,not feeling good, in pain and just wanted to be left alone . but did not want to hurt any ones feelings by asking them to leave especially my mum.(who he worried about getting \sick from all the stress) As he progressed through the hospital(ICU,medsurg ,TCU ) And gain strength He was able to tolerate us.(no easy task 7 kids 5 spouses and 16 grand kids

ICU is a time for critical intervention in some ones life.Most are suffering life threatening injuries\disease WE have the most stressful job on this planet trying to sustain their lives. Being able to do that under a controlled environment is the safest and most effective way to care for these types of patients.Bringing in "Trained" family during stable periods though out the day reassures the patient and the family and gives us the abilty to remain professional caring and compassionate.

I am truly shocked at what you all are saying about what patients do and would want. I am the first to admit that it is easeir NOT to have to deal with families when you are trying to figure out what is going on with your patient and haven't even gotten a chance to review their chart yet. However, I believe that MOST families DO relieve anxiety in the patient, as they care a hell of alot more for the patient's well being than we do. I believe visiting should be restricted at shift change for confidentially purposes, and so that we have a chance to get our info in order and give care to our patients. I don't know WHAT AlexCCRN meant by "training " family members either. I don't mind families present most of the time. I have no problems answering their questions, as long as they give me a little rope and time to find the answeres. I always think of how it would be if this patient was MY mother or MY husband, and act accordingly. Seirously I truly feel this way. That comment about "Training" family members was nauseating. when your husband or son gets a closed head injury, see how well YOU take to "training". We must not forget that this job is NOT about US. I will add that i am not a new and idealistic nurse either ,but doing this for 20 years now. maybe you should rethink why you are in this field AlecxCCRN

nicunana · Nov 16, 2005

Don't EVEN tell me that if it was your spouse or child that you wouldn't want to be there 24/7. My husband has been hospitalized 6 times in the past 2 years & the first time I was the model visitor who abided by ALL visitation restrictions and tried my darndest to stay out of everyone's way at all times. When I came back the second day, I got an earful about the lack of care, and what I considered to be patient neglect that he was subject to while I was gone. I stopped making excuses about how busy they were and really paid attention to what kind of care he was getting and discovered that It was downright dangerous to leave a loved one alone at all in an obviously understaffed unit. Because I was able to look out for him & do a lot of the comfort measures myself, he fared FAR better than the other patients who weren't related to nurses. I found that someone else's pain is not always a high priority to the assigned nurse. A PRN drug could easily take 45 minutes to an hour between request & administration. IV's routinely ran dry and monitor alarms remained unanswered for shamefully long periods of time. Water pitchers were provided only if requested & then were only refilled one time daily. (Yuck!) Urinals were full to overflowing for a patient on strict I&O and Bumex. At every meal, the wrong diet was sent up (severe diabetic) that included chocolate cake, puddings, sugar and too many carbs to count. When this was pointed out we were told "That's OK--just go ahead & eat it." Blood sugars never got below 300 all the while he was there. I wonder why?

On several occasions, I actually went to the cafeteria to purchase a more suitable substitute that was more in line with what he should have been served.

I welcome a family member or 2 of my patients. I know they can help be my eyes & ears when I am taking care of another patient & I value the comfort they can provide. I totally agree that too many visitors are NOT good for

anybody--not the patient or the staff or the roommate. If visiting restrictions need to be made, I think it needs to be the number of visitors allowed and limited to immediate family/significant other.

pickledpepperRN · Nov 16, 2005

Oh I know it is tiresome explaining the need for a spokesperson, need for protecting other patients privacy, no interruptions during report, and so on.

For many families this is a time of extreme crisis.

Most family members do leave for an hour during report.

I always make sure to let a close family member, say a spouse, know I am relaxing the rule by letting them stay. Visiting is twenty two of twenty four hours except to protect the patient. If a visitor interrupts report I let them know that they must stay out during report because it is SO IMPORTANT that the RN know the plan of care.

The rare truly untrustworthy visitor does get a different rule for a valid reason. Examples are touching alarms or equipment, posing a danger (one was taking syringes from a sharps container), arguing and so on.

Often I go with the visitor who wants to see the patient who shouldn't be awakened. I have the time to explain bronchospasm to the visitor.

Of course we have worked very hard and long to ensure adequate staffing. Patients and their loved ones should not have to suffer because there is insufficient staff. We give report to a competent RN when taking a patient off the unit for a test or eating a meal. Patients requiring 1:1 nursing care are not assigned with another patient.

We are kind to each other as well as our patients. This includes housekeeping, clerks, RT, PT, chaplain, and physician. It is our unit culture of respect and kindness. As was said, this work is difficult physically, intellectually, and emotionally in the best circumstances. We need to work toward the best possible conditions for our patients, our colleagues, and ourselves.

Visitation and all aspects of patient care need to be based on the assessment of the registered nurse responsible for that patients nursing care.

dorimar, BSN, RN · Nov 16, 2005

In response to Gizelda's post: If you will note,I said family members, not neighbors or dog walkers, and i specifically mentioned mother, son, husband. I am not saying it is ok not to follow the rules of the unit, and I don't think it is ever ok to congregate outside a room due to confidentially of the other patients. Our unit allows only 2 IMMEDIATE family members in the room, and never for the 1&1/2 hour of shift change and shift beginnings. Yes there are problems sometimes with stressed families who will not comply. However, I 've seen many a nurse cause these problems or make them much worse by being defensive with families. It is not their intent to make your job harder by asking questions. I find that if your are courteous, helpfull, and good at your job, they feel secure and don't feel the need to hang around as much, and if they do stay, they stay out of your way when you need them too. I take offense at the "training" comment, as they are not dogs to do you your bidding, but stressed family members who care very much for the patient. We are there for the patient and them, not vice versa. And despite what you say, I would feel much better knowing that my family was there to hold my hand and stay up on what was going on with my care, and I know most patients feel the same as well. There is a nurse on my unit whom i like a lot as a person. She says her favorite patient is tubed, sedated, and orphaned. I truly believe that people who feel this way should choose another line of work.

**canoehead, BSN, RN** · Nov 16, 2005

My mother was recently in the hospital to have a tumor removed from her heart. The ICU visitation was 10 minutes every hour, and truly seemed appropriate to me. Dad was terrified, but got to see her and also to have a break from the bedside knowing he could soon go back. Mom just wasn't up to visitors, but my sister and I got to take a look for ourselves and know what was going on, and then let her rest. The nurse was able to spend time with us during the 10 minutes and answer all the questions regarding the "dryer vent" (ET tube) and that darned "piece of kelp" (atrial myxoma) that had caused the whole thing.

God bless the nurses, especially Karen in the CICU. Anything that would make their job easier will benefit the patients when so much is going wrong so fast. I always wondered about open visitation in the ICU as a nurse, but had never experienced it as a family member. Now I know that, for my family, the 10 minute rule was fine. But in this case we trusted the nurse, she only had one patient, and never was more than 10 feet away from the bedside. If we knew she was going to be taking care of two critical patients it would have been a whole different story. I would be constantly fearful that Mom might change a bit for the worse, or that the other patient would get sicker and be a priority.

Someone said earlier that it was not about the nurses' needs. But it's not about the families' needs either, it's about the patients'. When is the last time you felt like a lump of crud and wanted anyone to come visit- even close family? Just a hello to know they were there and checking in will usually do it, except for maybe one special person in your life. I think 24-7 open visitation is insane.

pricklypear · Nov 16, 2005

I think the problem is making a sweeping "open" or "restricted" rule. I mean, we all know that for some patients, having family in the room often and for long periods is beneficial. For others, it is detrimental. The hard part is trying to explain why Mr. Brown needs to be left alone, not stimulated and annoyed - while Johnnny can have his mom at his bedside all the time. Lots of families simply do not understand the difference. I know if it were me - on the vent, looking like death warmed over, snot bubbling out of my nose, boob hanging out of my untied gown - I wouldn't want my whole family standing around my bed patting me for hours at a time. Just leave me alone, let me drift in and out (mostly out!) and come in occaisionally to let me know you love me. If it were my kids, I would probably want to to sit in the corner all the time just to reassure myself that they were being cared for. But I also know that when things are critical, it's really hard to focus on the task at hand with worried faces all around, perfectly legitimate but untimely questions intruding on my thought processes, and purses all over the floor. I want the nurses caring for my family to be able do their jobs uninterrupted and undistracted. It's just such a fine line. It can't be a concrete one way or the other.

But patients DO get tired. It IS hard for the majority of them to say "you know what? I'm really wiped out, would you guys quit pestering me and go home? I don't want anymore pudding, stop putting blankets on me" They actually feel like they have an obligation to their visitors, like they were the host or hostess. I'd rather err on the side of keeping visitors down to a minimum for the few days in ICU than allow someone to become too taxed with trying to entertain a demanding family.

ZASHAGALKA, RN · Nov 16, 2005

Visitation and all aspects of patient care need to be based on the assessment of the registered nurse responsible for that patients nursing care.

Exactly.

But this is thwarted by visitation policies that are EITHER too restrictive OR too liberal.

~faith,

Timothy.

pickledpepperRN · Nov 16, 2005

Exactly.
But this is thwarted by visitation policies that are EITHER too restrictive OR too liberal.
~faith,
Timothy.

Agree completely!

We have a wonderful retired nursing assistant who volunteers in the visitors waiting room from 7:00 pm to 11:pm three evenings a week.

Our patients families have a much easier time of it when she has been there. She was great when she worked evenings with us too.

What a blessing she is!

PJMommy · Nov 18, 2005

I've said before and I'll say again...you cannot globally say that open visitation is good or bad. Yes, I want to be with my family when they are in the hospital. And yes, I have plenty of warm and fuzzy stories about wonderful families I've worked with.

But...

Work where I work and see the not-so-wonderful visitors. I've seen the city police come in and handcuff, taser, and take down our unruly visitors. I've had the police escort out the belligerent, so-drunk-he-can't-stand "loving" husband. I've seen the gang bangers pounding on our doors to be let in after yet another one of them is mowed down by gunfire and manages to live long enough to get to us -- and who knows which are his family and which ones are coming to finish the job. I've had families scream and physically fight with one another OVER the bed of a head-injured patient. I've had things thrown at me and my fellow nurses. I've seen furniture overturned and chairs picked up and thrown. Heck...someone even attempted to rob our security guard.

I'm sure the hospital on the opposite side of town has good luck with open visitation. We don't. We never will. I will quit my job out of fear for my own safety should they ever open my unit. Come work with me for a few weeks when the moon is full and the dog days of summer hit -- you might not be so keen on open visitation. Please think about hospitals like mine when you preach for open visitation.

pickledpepperRN · Nov 18, 2005

I've said before and I'll say again...you cannot globally say that open visitation is good or bad. Yes, I want to be with my family when they are in the hospital. And yes, I have plenty of warm and fuzzy stories about wonderful families I've worked with.
But...
Work where I work and see the not-so-wonderful visitors. I've seen the city police come in and handcuff, taser, and take down our unruly visitors. I've had the police escort out the belligerent, so-drunk-he-can't-stand "loving" husband. I've seen the gang bangers pounding on our doors to be let in after yet another one of them is mowed down by gunfire and manages to live long enough to get to us -- and who knows which are his family and which ones are coming to finish the job. I've had families scream and physically fight with one another OVER the bed of a head-injured patient. I've had things thrown at me and my fellow nurses. I've seen furniture overturned and chairs picked up and thrown. Heck...someone even attempted to rob our security guard.
I'm sure the hospital on the opposite side of town has good luck with open visitation. We don't. We never will. I will quit my job out of fear for my own safety should they ever open my unit. Come work with me for a few weeks when the moon is full and the dog days of summer hit -- you might not be so keen on open visitation. Please think about hospitals like mine when you preach for open visitation.

Safety must come first. You are completely correct!

I've worked at two county hospitals in Los Angeles.

It needs to be the decision of the registered nurse. I let the mother of a gang member stay with him. Made the uncle have a security escort for a five minute visit. I could make an error but am glad that Mom got to be with her son before he died. Not exactly a warm and fuzzy story. The gang banger uncle was the brother of Moms ex husband. Still that was her kid.

As ZASHAGALKA and pricklypear said it cannot be one way for all units or all visitors.