open visitation in icu??

RN34TX · Nov 18, 2005

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.......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 totally disagree. It's the families that need to be reminded that it's not about them, just as much, if not more so, than the nurses need to be reminded.

If families truely cared a lot more for my patient's well-being than I do, and that their decisions and visitations are truely based on what's best for the patient, then why am I still hanging blood transfusions and keeping 100 year old people with cancer ravaged bodies alive on vents and pressors every day?

Because life and death decisions are based on a family members own skeletons in their closet, guilt, basically self absorbed and selfish reasons that end up having little to do with what the patient would actually want. It scares me how many nurses here actually assume that someone's adult child will always do what the patient would want and would have no other motives.

I can't count the number of patients that I've tried to wean that suddenly need to be put back on the vent because family drama erupts in the room.

So much for anxiety relief.

Also, if someone's husband or son gets a closed head injury, it's not a license to act up at the hospital under the label of "stressed out."

People need to take responsibility for their own behavior, regardless of what tragedy has recently stricken them.

People also need to start respecting the nurse of their loved one, start acting more like a truely concerned family member and less of a watch dog here to supervise and catch "bad nurses" who don't deliver pain meds or empty urinals fast enough for them.

dorimar, BSN, RN · Nov 18, 2005

Kudos to PJMOMMY. Your dedication is honorable. When safety is involved, it IS all about the nurse. Patient advocacy should not mean potential harm to the nurse. Don't mis-understand me. I don't think abuse should be tolerated, (verbal or physical). I agree that your unit should be locked PJ, & I have always respected people who can work in those environments. I am not one of them.

Noryn · Nov 18, 2005

The great open visitation debate! In my experience nurses hate this so much and the fact that there is a lot of literature that supports open visitation doesnt help either. Back when I worked in the critical care unit I never saw an article that said open visitation did harm to the patient.

Open visitation doesnt mean you take all of your patients out in a large room and let everyone visit or stay 24 hours a day. It usually means allowing 1 close family member to enter a critical care environment when it will not be detrimental to the patient.

As much as we like to thing we can be everything to our patients (I mean we use therapeutic communication, touch, etc) we need to realize our limitations. Husbands/wives and other family members at times are our strongest support systems. Patients who are going through an acute serious illness need their loved ones more than 4 hours a day or 10 minutes every hour. We cant fill that void especially if we have 1 or 2 more patients. And lets be serious there are a lot of nurses out there who arent the most compassionate people to fill that role.

It comes down to this. In my honest opinion a well thought out open visitation unit is a much more therapeutic environment than one with limited visiting hours. As always the nurse and doctor should have all of the input on this, not some quality assurance person in administration who handles complaints. It needs to be stressed that only close family members (not some cousins's stepbrother) are the only ones allowed to use this and patient's condition/ family member behavior (noticed I said member just 1 usually) play an important role.

The reasons these fail are poor planning by management and management not supporting decisions made by the nurses. I can think of horrid situations with family members but 95 percent of the families are supportive and appreciative.

My biggest concern reading these posts is that it seems as if some people think this means an "open door" to the unit at all times or think open visitation means 20 family members coming and going as they please. There are patients this wouldnt be beneficial.

I would be curious to read some links/articles anyone could post that conclude open visitation is detrimental to the health of patients. If you guys have any please post--it has been years since I have researched this matter.

**canoehead, BSN, RN** · Nov 19, 2005

One person is different- and not what I thought was meant by open visitation. I, personally, would be OK with that.

fergus51 · Nov 20, 2005

One person is different- and not what I thought was meant by open visitation. I, personally, would be OK with that.

Exactly, but unfortunately most nurse managers I know would not call that open visitation either.

Ruby Vee, BSN · Nov 20, 2005

i, too have worked in both locked units and units with open visitation, and i far prefer the locked units. open visitation may work well in some communities, but in the inner city hospital where i'm working now, not so much. we've had rival gang members and abusive spouses try to "finish the job" that brought the patient to the hospital in the first place, a "loving spouse" who wanted to "put her out of her misery" with a bullet, and patients in wards or semi-private rooms to whom open visitation meant that 30 or 40 of their "closest friends and family" members should be allowed to hang out at all hours despite the needs of their roommate(s). i've seen out of control family members assault the patient, other family members, the visitors of other patients and the staff. i've had my wallet stolen, also my stethescope, my jacket and my winter coat (on a truly miserable day). visitors have also stolen from patients and from other visitors who have left purses, jackets, etc. unattended. one family member went through my purse "looking for a bible." i only found out because, when i returned from helping clean up another patient, the family member commented "oh, you're reading a nevada barr novel." at my blank look, she said, "that is your purse, isn't it?"

if you are in a smaller community serving mostly self-supporting folks with polite and supportive families, open visitation may work for you. more power to you. if, however, your patient population and their visitors are indigent, disenfranchised, larcenous or just plain a$$hole$, a locked unit protects your patient, other patients, and the staff.

it really burns me to have nurses who haven't experienced what i'm describing, either because they're practicing in safe, suburban communities or because they haven't left their office to check out the units in years judge those of us in the trenches. if your experience isn't like mine, good for you. if you're a manager in a place like mine, come on out of the office and help me to deal with the plethora of visitors who are out of control. but either way, don't judge until you've walked a mile or more in my shoes!

RN34TX · Nov 21, 2005

But even in Ruby's description of the "safe suburban or small community" hospital, there are still problems.

The pro-open visitation people here love to paint a picture of the well-meaning supportive family member who is there for companioship to pass the time, emotional support, and comfort.

That's all fine until they transition from supportive family member to self-appointed nursing supervisor.

You can talk all you want about how we're taught to explain each procedure and med before doing it, but that's not realistic for the multiple things that often need to be handled quickly in the ICU.

Having to explain what every number means on the monitors, what every bag of med and fluid is for, every line in the patient, why the vent is going off, etc. etc. is very distracting and can compromise patient care no matter how much of a multi-task super nurse you are.

Then after you've given a basic ICU course to the husband, in walks the son or daughter who in turn, asks the same questions and you start all over again.

Yes, at the hospital up in perfect world, there is an endless amount of time for patient and family teaching and emotional support. You can let the family members vent and voice their fears and concerns with an attentive ear all night long with no visiting restrictions, and you'd still never fall behind in your duties. But most of us don't work at that hospital.

I've noticed a big pattern in my own work settings that the same nurses who give me a long list of things that they weren't able to get done on their shift that I'll need to pick up on my shift, are the same ones who spend a great deal of time entertaining family members.

Well of course you weren't able to get everything done when you end up with 6 patients (visitors) instead of 2.

But regardless if a family member needs support because they're having a hard time dealing with their loved one being so sick or injured, labs still need to be drawn on time, meds need to stay on schedule, dressings and lines need to get changed out, and new orders need to get initiated in a timely manner.

HillaryC, RN, CRNA · Nov 27, 2005

You can talk all you want about how we're taught to explain each procedure and med before doing it, but that's not realistic for the multiple things that often need to be handled quickly in the ICU.
Having to explain what every number means on the monitors, what every bag of med and fluid is for, every line in the patient, why the vent is going off, etc. etc. is very distracting and can compromise patient care no matter how much of a multi-task super nurse you are.
Then after you've given a basic ICU course to the husband, in walks the son or daughter who in turn, asks the same questions and you start all over again.

This is exactly the kind of stuff that makes me insane, especially on a busy day :) As a relatively new nurse, I find dealing with family members to be one of the hardest skills to master. It only adds to the tension when the visitor feels the need to play "nursing supervisor", as someone mentioned earlier. I recently had a difficult visitor annoyed that I didn't move fast enough to get her brother-in-law a straw. The same visitor later asked me "can I have a cup of water", in a tone that made it very clear she believed serving her was part of my job description.

I had a visitor ("his baby mama", as she described herself) go off on me because her GSW baby daddy didn't get police protection outside his room. We had another pt. at the time who was either under arrest or a protected witness who had police guarding him, and no matter how many times I tried to explain our policy to her, she just didn't get it. However, when I got security to come talk to her about making him non-published, she didn't want to do that, because that would mean they had to restrict their list of allowed visitors. Clearly they weren't too concerned.

I don't know where I'm going with this; guess I just had to vent :) Sometimes I really envy the permanent night staff :)

RN34TX · Nov 27, 2005

This is exactly the kind of stuff that makes me insane, especially on a busy day :) As a relatively new nurse, I find dealing with family members to be one of the hardest skills to master. It only adds to the tension when the visitor feels the need to play "nursing supervisor", as someone mentioned earlier. I recently had a difficult visitor annoyed that I didn't move fast enough to get her brother-in-law a straw. The same visitor later asked me "can I have a cup of water", in a tone that made it very clear she believed serving her was part of my job description.
I had a visitor ("his baby mama", as she described herself) go off on me because her GSW baby daddy didn't get police protection outside his room. We had another pt. at the time who was either under arrest or a protected witness who had police guarding him, and no matter how many times I tried to explain our policy to her, she just didn't get it. However, when I got security to come talk to her about making him non-published, she didn't want to do that, because that would mean they had to restrict their list of allowed visitors. Clearly they weren't too concerned.
I don't know where I'm going with this; guess I just had to vent :) Sometimes I really envy the permanent night staff :)

Of course she didn't want that, once it was made clear to her that being non-published might inconvenience her, or possibly restrict the parade of visitors that she expects should be able to come trampling through the ICU at all hours at their leisure, suddenly she isn't so worried about the patient's safety anymore.

Examples like that make me even more annoyed at the previous poster's comment about how a family member will always be looking at the patient's best interest more than the nurses would and this justifies the open visitation theory.

I'm sure that comments will come flying in about how this is the rare exception and not the rule when it comes to visitors and how the vast majority are supportive and therapeautic. Yeah right.

We're professionals and shouldn't have to tolerate being ordered around by anyone's "baby mama."

pickledpepperRN · Nov 27, 2005

I work permanent nights. We've had death threats by a family member, non stop phone calls by another, gang members, and patients in custody.

I continue to believe the decision regarding visitors must be made based on the assessment made by the registered nurse responsible for the patient. Getting report is the first step in making that assessment. When in doubt I consult with the charge nurse and trust the opinion of the RN on the previous shift.

I am very glad to have allowed spouses, parents, offspring, people the patient lives with, and others.

RNs have allowed me to help lift my loved ones, bath and feed. I was blessed to be with my father when he died. And my uncle. I thank God every day for those nurses who bent the rules.

My aunt was with her husband of more than six decades as was the family he loved so much. If not for the explanations and advocacy of the nurses he would have been on a ventilator fore futile care. As it was he was extubated and allowed his last words "Well, this is the room where I'm gonna die."

We didn't need him to tell us he loved us. He showed us all our lives. I am eternally grateful he had us with him when he left for heaven.

As a nurse it is my responsibility to advocate for the best interests and wishes of my patient. The art of nursing is to determine what that is.

mshultz · Nov 28, 2005

I have commented on this topic before. I am not a healthcare worker, but was an ICU patient for 2.5 days in 2003. My parents were very careful to observe visitation rules. I had no more than two visitors at a time, and had two half-hour visitations per day. Even though I no longer needed ICU care after the first day (the hospital was full), I had as much visitation as I could tolerate. My visitors and I had privacy, and I had privacy from visitors during nursing care, which was great (both the care and the privacy).

I have read responses from people on this board who need constant companionship. While I greatly appreciate hearing your views on this matter, I become passive when sick, and need someone to limit visitation for me so that I can rest.

Michael

"Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."

Groucho Marx

pricklypear · Nov 28, 2005

I have read responses from people on this board who need constant companionship. While I greatly appreciate hearing your views on this matter, I become passive when sick, and need someone to limit visitation for me so that I can rest.

I think I commented on this aspect of totally open visitation earlier, but I believe this is true for many people. Especially older folks with large, concerned families, church friends, etc. It's very hard for them to say, "I'm really too tired to entertain you right now." It seems like 7/10 visitors cannot pick up on the subtle (haha) clues that someone is tired, sore, or generally not feeling like visiting. I think it benefits most patients to have some safe time throughout the day that they KNOW they will have some rest, and a break. And it helps if that's the "rule" so they don't have to feel guilty. Even if that time is a couple of hours during shift change 3 times a day.