Please Help Me!

JKL33 · Sep 2, 2017

Sending a (hug) and my condolences.

I will encourage my peers here to make suggestions for resolution.

Can the most calm and diplomatic family member request a care conference and/or ask for a social work visit, and/or request whatever the patient liaison process is? The reason I think this is the best course of action is that there may be more to discuss than simply whether or not more visitors could be allowed at the bedside.

My thoughts are with you.

elkpark · Sep 2, 2017

What kind of help are you looking for? I'm surprised that your family has been allowed to have unlimited visiting up until now. It's v. common for ICUs to limit visitation. I've never worked in a hospital (and I've worked in a lot of them over the years, including my current employer) that didn't limit ICU visitors to 2-3 at a time. What I've seen over the years is families gathering in the ICU waiting room/lounge, spending time there together and supporting each other, and taking turns spending time in the room with the ill family member.

I'm sorry to hear about your family member. Best wishes to all of you.

RNNPICU, BSN, RN · Sep 2, 2017

Many times ICUs have a rule that only 2 visitors at the bedside at any given time, family members jsut rotate in and out. Occasionally the rules may be laxed if the patient is actively dying or may be close. If the patient stabilized but still very ill, the policy would return to the 2 at a time. The hospital as a whole may not have a specific policy because each unit is different and different patient populations can handle visitors better than others.

Sometimes having many people in an ICU room can impede access to the patient as well as can potentially cause patients that are very ill to have reactions that can be harmful to them. Low stimulation is always the best in an ICU. Sometimes even a hand touch or sound can impact a patient.

I am sorry to hear that your family member is so ill.

caliotter3 · Sep 2, 2017

I agree that the family should wait in the waiting area and take turns going in, two or three at a time.

Here.I.Stand, BSN, RN · Sep 2, 2017

(((Hugs))) I'm so sorry for what you are going through. When you say "terminally ill and comatose," do you mean they are receiving comfort care? As in, artificial life support and most meds have been stopped, and the nurse is giving pain meds and doing other things to keep comfortable? In those situations, as an ICU nurse I do tend to be liberal with allowing visitors.

If the patient is receiving *critical care* -- on a ventilator, receiving life-saving medications, invasive monitoring like devices in the skull or in the arteries and large veins... in those cases while I feel for the family, we simply cannot have a huge group of visitors *at once.* Patient care comes first, and it is difficult to do all the things an ICU nurse does with large numbers of people in those small rooms. In those cases I have them alternate between the bedside and the family waitimg room.

Where I work our policy is no more than four visitors at a time. Some nurses strictly enforce it, some nurses ignore it... which makes it difficult for the nurse and confusing to the family -- "The other nurse let us all stay in the room."

That said, if you truly feel that all seven of you are respectful of the staff's duties -- the RN can freely move to anywhere in the the room s/he needs to, not barraging with questions to the point of taking her attention away from the pt, family respectful of safety rules (true story violations: sleeping on the floor and almost getting stepped on/tripped over, patient's wife sleeping on the couch while her toddler child is unattended, and trying to give an intubated patient water to drink).... (holy run-on sentence!! Sorry!) You can ask to speak with the charge nurse and plead your case -- especially if your loved one is dying. If it is a safety issue that you don't realize you might be stuck, but at least then you would know the rationale.

roser13, ASN, RN · Sep 2, 2017

As has been discussed, there are multiple sound reasons for limiting visitors in the ICU.

Might I suggest, if your family member is comatose and terminal, that your family discuss the patient's status. If it is DNR, why is the patient in the ICU? If hospice/palliative measuresmeasures are opted for, a move to a private room off the unit could serve to allow more flexibility in your family's visitation.

csat · Sep 2, 2017

Thank you, everyone. It was a precarious and sudden situation earlier today because the goal was previously stabilization (invasive procedures), but it has now become comfort care and he is in the process of changing rooms. Although it was frustrating at first, it was actually a good idea rotating 3 people- as a family, we were able to support each other in the waiting room and then take our turns in the ICU room, where fewer people fostered a more personal goodbye from all of us. Thank you again for your kindness, this is really a great community. Also, I want to give a big thank you to all the ICU/hospice nurses out there, you have exemplified compassionate nursing to my entire family for the past few days.

JKL33 · Sep 2, 2017

it was actually a good idea rotating 3 people- as a family, we were able to support each other in the waiting room and then take our turns in the ICU room, where fewer people fostered a more personal goodbye from all of us.

That's a beautiful way to make the most of the situation, csat.

((take care))

elfself25 · Sep 3, 2017

Ask to speak with the charge nurse. When I worked in the ICU, I did not mind having visitors. Some hospitals have a 2 person limit. The hospitals I worked at were pretty liberal during the day time (Seattle, WA). ICU nursing is intense and stressful. I liked to set limits with the family so we could function well together. When I had patient status updates, I would ask all the family members to come in the room. I would tell everyone there what was going on,what to expect, and possible outcomes. I could answer questions. This minimized questions I would get when I was delivering care to typically 2 very ill people. I never minded answering questions, but I asked people to wait till I completed my tasks because my major focus was on saving the life in front of me or providing comfort when life saving was beyond hope. I went to Miami when my sister was having a brain tumor removed. the visitation was 2 people for 15 minutes out of every 2 hours. Individual nurses would let one person stay longer as long as you stayed quiet as a mouse. I was appalled. I hope the charge nurse can help you and if not, some hospitals have advocates you can talk to. Also, you could talk to the nurse manager. Best wishes.