Open Visiting Hours in ICU...Yes or No?

[goldenbobcat]

I currently work in a critical care unit that has instituted a policy of open visiting hours. Aside from a two hour time period in the morning (0630-0830) and the evening (1830-2030), up to three visitors are permitted to be in the patient's room at all times thoughout the day. I am told that this a growing trend in the critical care environment across the country, but I have found it to be a source of stress and frustration. Any thoughts?

[CrunchRN, ADN, RN]

Don't beat me up, but I voted yes. Only because if it was my loved one I would want to be there. Of course I would stay out of the way, leave when appropriate, and treat the nurse with the upmost respect. I would like to see policies that were not written in stone. I think 3 visitors is way too many in the unit. A visitor can step out to allow another some time. If behavior is inappropriate or causing stress for the patient or nurse then the nurse should have the authority to enforce a "time-out" away from the unit. I believe there are many disruptive visitors, and there behavior should have consenquences. However, if it is my spouse, please let me be present and if you need me to move, leave, go grab you some dinner.....just let me know.

[elizadream]

In Charleston, SC: we are doing fine with the open policy-we don't like it because people are suppose to ring the door bell and we have a lock to let them in...but most of them will just run through the door if anybody exits,walk right in like it was a floor. Our hours are 9am-9pm except from 7p-7:30p when we are giving report. If someone is DNR and there is pending death but no other beds available , we let family stay 24/7 . If a family is abusive or wanting to run the show, we become very restrictive and allow them to stay for 15 mins per hour. It mostly depends on how the family reacts...if they are quiet and respectful of me, coworkers and the other critically ill patients, I'll let them stay until they wear their welcome out!!!

[LCRN]

Hello,

My facility recently (within the last 8 months) opened a new 30 bed ICU in which open visiting would start. My issue are many with this policy. Number one being when you have codes occurring in other rooms and inappropriate visitors from another room come to the code and ask "Are they going to survive? What's going on?" puts a bit of a thorn in my side. Also when you ask visitors to step out of the room for an assessment or for care and they say--> "you just asked me to step out an hour ago, can't I just stay in the room?" Some RN's allow this and others stand firm and before you know it there's a family member manipulaing the staff. The list goes on but I think it certainly should be limited. Patient's need to sleep at night and have somewhat of a normal circadian rhythm not a family member ringing the call bell for every little thing..."the patient just passed gas". In my opinion it makes for a more stressful work environment. I do agree that there always are circumstances that are exceptions.

[ZASHAGALKA, RN]

The risk for manipulation is great.

The risk for the nurse to now have many more pts (critically ill one AND his/her family members as psych pts) is great.

The risk for playing traffic cop - or 'good cop/bad cop' between the shifts is great.

Critically ill pts need to rest - not be hosts/hostesses.

Spouses/NOK of critically ill pts need rest. Defining limits defines the parameters that allow for that rest. Why on earth would anybody think it's pt advocacy to send a critically ill pt home with someone you just exhausted with the expectation that they needed to be there all the time 'to prove their love'.

Heisenburg Uncertainty Priniciple: the act of viewing an event changes the system of the event. Now, instead of critical care nurses, we are actors/hosts for family members. How much sleep will be interrupted because the family member EXPECTS nurses to be flitting around the room, and so, nurses do JUST THAT to fulfill expectations when what that pt truly needed was 4-6hrs of sleep.

It's easier to grant a liberty to a strict rule than it is to tighten a liberal rule. Anybody remember prohibition? Try prohibiting abusive family members AFTER you've given them a free rein . . .

But most important: critical pts need critical attn and critical monitoring. Constant interruptions to be the attendants of family members is simply dangerous and counter-intuitive to the 'critical thinking' that nips dangerous situations in the bud. With open visitation, instead of acting, we are reacting - not only in terms of the visitors, but BECAUSE OF THE TIME SPENT WITH THEM, AWAY FROM CRITICAL OBSERVATION, reacting to the needs of our pts instead of acting.

Like I said, truly bad idea. People come along and want to change things because of some feel-good theory, but never stop to ponder why things are the way they are in the first place. This is a fad. Closed visitation had a point and rationale - open visitation will only, over time, reveal the wisdom of that point and rationale.

~faith,

Timothy.

[leslie :-D]

yep......what timothy said.

leslie

[OkieICU_RN]

We have a 31 bed MICU which used to be MSICU. Just opened a new TSICU, 16 beds. The new unit is now open visitation. The MICU is still trying to figure out exactly what kind of visitation they are going to have.

Having worked both places I think it's actually been better with open visitation. If educated well on admission and occasional reminders, family members really do want what is best for their loved one. We have the authority to ask the family member to leave if needed, but most already know when its time to step out for a bit. Also, it seems they feel more comfortable in leaving the room (to get dinner, to go home and get some rest) now they know they can come and go as they please and they have already observed the excellent care their loved one is given.

I can definitely understand with neuro patients and not wanting open visitation. Family just needs to be educated well that it can be detrimental to be yelling in the patients face to "open your eyes, open your eyes."

[CanUSRN]

No, absolutely not, bad thing, never, totaly against it!! Did I say no? Always, always problems when you have the family in the room. That's one reason I work night, I don't want to deal with family members.

[canoehead, BSN, RN]

My mother was recently in CICU and Dad definitely needed the breaks that their visitation rules gave him. He would have loved to sit by the bed and hold her hand, but the reality was that he would have been in the way, he wouldn't have gotten any rest, and he would have worried over every beep or gesture the nurse made.

Intensive care makes it impossible to have someone right in the room because the nurse is constantly working at the bedside. We got 15 minutes every hour to peek in and the nurse seemed to schedule that time around her procedures, and was ready to answer questions. In a crisis families want to do EVERYTHING they can, and will keep going beyond the point of being a comfort, even (especially) with the best of intentions. Some limits in ICU was very appropriate, especially given the days to come were stressful too, and our visits became more important to Mom. I vote no way to open visiting hours from the perspective of a nurse and as a family member.

[RebeccaJeanRN]

I was mildly amused about that visitor to ICU that required special meals and assistance, but only because it wasn't me that had to do it! Its a hard thing because we are balancing our needs as nurses against the needs of the family in crisis. Of course we want to be able to get our work done without hindrance...but how to balance it all? My answer: have liberal visiting but make it a rule that nurses will ask family to step out during some procedures because the nurse needs the physical space in which to work, the patient needs the privacy, and because of the potential exposure to bodily fluids. In other words, make this something that is tactfully worded and actually posted at bedside, so that the family understands!

[Goofball]

We are not allowed to restrict visitors at any time from being in the rooms in our ICU, except maybe for cleaning up stool and even then sometimes they refuse to leave. Most refuse to even use the intercom and they get mad if you say something. Most visitors are anxious and slow you down, but I know they have a need to be there so that's ok. The only time I realllllly hate it, is when they are there around 1730-1930, because that's end of shift then report time, and they are always poking and prodding the pt, insisiting Do you have pain Mom? Do you have pain? You have pain, don't you? My mother has pain! She needs something right now for pain! (or nausea, or wants to be repositioned yet again). Sometimes I think the pt agrees they have whatever need it is, just to make the visitor happy.

[ZASHAGALKA, RN]

We are not allowed to restrict visitors at any time from being in the rooms in our ICU, except maybe for cleaning up stool and even then sometimes they refuse to leave. Most refuse to even use the intercom and they get mad if you say something. Most visitors are anxious and slow you down, but I know they have a need to be there so that's ok. The only time I realllllly hate it, is when they are there around 1730-1930, because that's end of shift then report time, and they are always poking and prodding the pt, insisiting Do you have pain Mom? Do you have pain? You have pain, don't you? My mother has pain! She needs something right now for pain! (or nausea, or wants to be repositioned yet again). Sometimes I think the pt agrees they have whatever need it is, just to make the visitor happy.

That's a hostile work place (management has NO respect for nurses - and it shows.) If all you turned in your notice, I bet your bosses would reconsider a workplace situation that doesn't allow you the tools to do your job.

I know I'd turn my notice in, whether my co-workers joined me or not.

There are better places to work out there.

~faith,

Timothy.

[monkeyman1000]

I personally like having my families around. I work in a Trauma/surgical ICU and we have open hours. I see the family as part of my team. I find that if you educate them and give them some small task to do as early in the process as possible then they feel like they are a part of things. I also like having an extra set of eyes in the room. I have had some families that are hard to deal with but that is only about 5%. Most of the other "bad" behavior has to do with the fact that they are experiencing the worst time in their lives and feel helpless. It also doesn't help when everytime they turn around the media is showing another story of malpractice (they never show the good stuff it seems, even though that is the majority). I find that communication and approaching the family as part of the team and not an enemy, goes along way.