Patient and visitor close door, don't want intruders.

[Johnny Moo Man]

Curious dilemma, a bipolar patient, female, gets a female visitor, she closes the door and says she doesn't want to be bothered. We don't suspect drugs or alcohol, or even sex, but who can be sure? How would some of you handle it, would you allow the privacy or just go ahead and intrude? Have you been unpleasantly surprised when you've given this "privacy?"

-As always, thanks in advance.

[RN1989]

If you are in a hospital or nursing facility, you cannot just tell people that they can't come in. If you are well enough to go without the routine nursing care and checks that are required - you are well enough to be at home.

Yes, generally when people do this, something is going on, could just be a private conversation but.... For someone with a psych hx, I'd be even more suspicious. Have walked in on everything from dope to sex. It does happen in the hospital.

I would explain to her that she is there for some sort of care and that there are regulations requiring that she be checked on. You will not discregard standards and regulations. You will try to coordinate care so that things are done together, instead of something every hour, if you are able, but otherwise, you have a job to do and you will do that job.

Just make sure and knock and wait a second before you open the door.

[tvccrn, ASN, RN]

It depends on the type of setting how I would answer.

If med-surg: for the most part I would honor the request. I would, however, explain the need for ordered vitals, med times, etc. Other than that, she has the right to her privacy.

But, if it's in psych, what are her restrictions? Keeping in mind that I don't work that area, but is there a watch on her activities or anything like that?

[BinkieRN, BSN, RN]

I have no objection to patients and/or visitors closing the door but when they request not to be bothered they are no longer sick enough to be in the hospital IMHO. I don't mind knocking on a door before going in but I'm not going to stay behind a closed door per patient/visitor request. Something goes wrong, who's butt is in a sling?

There's a reason why hospital doors don't have a lock...

[Batman24]

Is this a psych facility or ward?! Does she have restrictions?! If there are no restrictions I would give them privacy but be sure she knows you will be in for vital checks, meds, etc. as needed. Her privacy doesn't override you doing your job. If she refuses care document it and make her doctor aware.

[Jolie, BSN]

What is the policy of the unit? In some psych facilities, patients are not allowed to have visitors in their rooms, unless accompanied by a staff member.

If this is your unit's policy, I would have escorted them immediately to the community room.

In the absence of a firm policy, I still think it would be reasonable to require patients to meet their visitors in a public area, or be supervised by staff.

[iluvivt, BSN, RN]

We had a very abusive man recently in our facility. He was probably angry that he was shot in a drug deal gone bad and is now a paraplegic. He demanded that the door remained closed at all times and that everyone knock and get his permission before entering the room. Quess who did not see the small note posted. I thought it was a bit much to do this 24 hours a day. I explained to him that we needed to have easy access to him to provide his nursing care in this acute care setting. He just wanted to fight with everyone and play very disgusting loud music. Some of the nurses could not deal with him. I told him I was not going to promise I could always do that...more anger..finally I lost it and said I suppose that if your heart stops you would like me to knock then get your permission to enter before we come in.....GoT YA!!!

[nursemike, ASN, RN]

I occassionally encounter patients who wish not to be disturbed for 0400 checks. Generally, I consider the patient's condition, and if they are reasonably stable, I'll contact their physician. In many instances, q4h checks are needed, and I explain that to the patient, but I also try to adjust their schedules to minimize discomfort and intrusions. If the have meds at 0200 and 0600, I'll time their assessments to coincide with the meds to give a better block of undisturbed sleep. Often, though, I'll end up with an order for q shift assessments, or q4 while awake. A lot of our orders come from more or less automatic "service order" sets, and sometimes the doctors are willing to individualize them when they are made aware of the need.

Of course, I'm speaking of med surg patients, sometimes with psych issues but not, strictly speaking, psych patients.

As much as I can relate to "We're a hospital, not a Hilton," I have a father in the hospital right now, and I've seen a few instances where his needs have been subordinated to "the rules." Nothing too egregious, and I do understand the need for rules, but it does sadden me to see times when the nurse's comfort is the first priority. Their fathers would be treated more respectfully under my care.

But, yes, I've had to tell patients' families that their loved ones comfort, and theirs, were important priorities, but not always the top priority.

I'd feel uneasy in the OP's situation. I would recommend consulting the physician treating the patient, then try to work it out with the patient.

But if the patient is competent, they do have the right to refuse a med or an assessment, and a right to reasonable privacy.