HeartsGalore

I'm finishing this sentence from a bit of a different angle - I hate it when a colleague gives me report on her patients,for break, and says, "so and so is sleeping, DON'T WAKE HIM UP!!!" And I think to myself,because I'm too polite to say so, "what an idiotic thing to say, do you really think I'd give myself MORE work to do,if it's not necessary??!!" Come on,get real!

After reading some of the posts on a similar thread in the Medical ICU section of this site, I thought I'd better add to my previous posting to explain exactly what is meant by 'open' visiting in our unit: - all visitors at all times have to call into the unit to ask if they can visit-alot of times it's a 'yes' and many times it's a 'I'm sorry, his nurse is busy with Mr Smith right now- she will call you in the lounge when she has finished' - visitors are firmly encouraged to end their visits for the day by 2000/2100 hrs or so and are even more firmly discouraged from staying overnight in the Family Room (we,of course, support this if the pt has become critically unstable)- and,no one ever stays in the unit all the time. We emphasize the importance of their own rest/relaxation and reassure them that we will call them if anything changes in their status in a negative way -all visitors are asked to leave the unit during Dr's rounds and during the 2 shift changes/day - for confidentiality reasons/concerns- otherwise, we are fortunate to be in a really,really spacious unit(commonly believed to be too big...but that's another story), so eavesdropping hasn't been a major concern -we (usually) limit the # visitors at a time to 2-this can be subject to cross-culture concerns because it may be important to some of our Native Canadians for instance, to visit in a large family group for religious/cultural reasons - I think for a Sweetgrass ceremony, if memory serves-but that wouldn't happen very often -and, yes I'd definitely agree that sometimes it's inconvenient to have visitors in but, I have found that the majority of folks are reasonable and will respond well to being kindly asked that they step out for awhile 'to let grampa rest' etcetc. In my mind,balancing this inconvenience for us with how important it is for the patient to see loved and familar faces, in the sea of unfamilar faces that surround a typical ICU bedside. -our unit is for immediate family visits only- the exception being those pts who haven't any family or who are estranged or whatever, and would like an old and dear friend /caregiver etc to visit .ICU is never the place for the neighbours/bowling buddies etc. to visit I'd agree -and finally,even with our 'open' policy, it's still not the visitor who always decides when to leave- often you do have to suggest that 'now might be a good time'. Many pts will never be 'forward ' enough to suggest that their family leave,even when they're exhausted,and so you have to be prepared to do it on their behalf If the pt is critical, the visits are usually very brief(unless there's a DNR in place) It's really #1 on my list that allows a reasonable balance in our unit between the nurses' need to get the job done; the family's need for peace of mind ;and, the pt's therapeutic need to be comforted knowing his/her family is there for love and support -I just think that a combination of compassion and a little common sense needs to be stirred into the mix when visiting policies are being established/altered. God knows we nurses will appreciate it when it's our turn to be in the bed instead of standing beside goodnight,nurse!

In our CVICU,the resident on call for that day pulls the cts early on dayshift, or occasionally, the more energetic ones pull them before am rounds, as they're finishing their nightshift. Very occasionally, the surgeon might. Everyone has them pulled before they're transferred to the IMCU- usually on their first post-op am. When I worked in the west,9 yrs ago,everyone was sent to the step-down unit with cts in place. Don't think they do it that way any longer though. I'm quite sure most nurses in the unit would not be interested in taking on this procedure,thank you very much! We've enough 'Delegated Medical Acts' on our plates right now, plus more being added - like doing our own dialysis- oh,joy!!

In our CVICU,we have open visiting except for the hours around both shift changes(0630/1830-0730/1930) and through the hospital-wide rest period,1430-1530 - of course, if someone is dying,this would not be instituted. There has been alot of controversy in our unit about visiting policies-some would rather not have visitors at their bedside except for 5 mins/hr. These, I'm afraid, are usually the same RNs who feel that visits by family members and loved ones have no therapeutic value to the pt,they just get in the way! I have never had a problem with politely explaining why I must ask the visitor to step out now and I can't remember anyone ever refusing to leave. You know, I think it all boils down to treating others the way in which you'd like to be treated,were you in the same situation;And to having a little genuine compassion for folks going through some pretty stressful/scary events.

In my hospital,for all restraints,we must have a Dr's order for the specific restraint and must complete a checklist on the pt EVERY 15 MINUTES!! You must also indicate on the form whether the family is aware and list the other measures you've initiated before resorting to the mechanical restraint. As you can see it's hugely time-consuming,but I'm guessing that it's this way because the hospital likely has had something catastrophic happen in the past. I just don't know how this would be workable on the floors, where the RNs have up to 6+ pts/shift:eek:

Sorry to hear that you're having these palpitations-I know how distressing these must be for you, as my husband has been having them many times every day for months now.I would urge you to see your MD asap -not because there's likely to be anything wrong with your heart,but so you can have some peace of mind, as well as to receive a thorough check-up.My husband is slender,a non-smoker,has no family history of heart disease,and has no other risk factors for heart disease.He was worked up by our GP and then was sent to a cardiologist for consult(largely for his peace of mind, not because she thought anything was really wrong). He was stress tested, Holter-monitered,and his heart was ultrasounded -all was normal. The cardiologist could not pinpoint a cause but definitely had no concerns and did not think my husband was at any increased risk for rhythm disturbances in the future.The pvcs he was having stopped when he began taking an antianxiety drug (which wasn't begun because of this symptom). Alas, the palpitations have returned despite still being on the psych. drug -seeming to shoot holes in my theory that the palps were stress-related. All the best to you -give us an update, if you would, once you've seen your MD. Jennifer

Over the past 23 years of my nursing career, I have definitely noticed a decline in the professional appearance of RNs.Actual uniforms(as opposed to cutesy-patterned scrub sets or street clothes-except in peds or mental health,etc respectively),conservative jewellery,hair off the collar,trimmed nails have become the exception. I always shake my head when I hear nursing colleagues, once again,protesting the fact that there exists,with good reason I think, dress codes for hospital staff,including nurses.I find it curious that you never hear police officers and firefighters(still largely male-dominated professions),complaining about being forced to conform to a certain code of dress. Nor do you often see CEOs,bank managers,airplane pilots,etcetc bucking the dress requirements of their fields to dress casually.But in this still female-dominated profession,my theory is that,we nurses still,as a whole, feel powerless to effect real change in health care decision-making.Because we don't truly value the unique perspective and potential for influence we have from the front lines of health care,we've chosen to take a stand in how we're going to dress to give us a sense of power.It is only an illusion,of course- we nurses,in large numbers,are still not lobbying governments for change, or writing letters to policy makers, or even phoning into local radio forums to make our voices heard.So we remain a largely silent majority-we can b--ch and complain over coffee with each other,blowing off steam but that will never effect change or influence people.Unfortunately for nursing,we now,as well, look less professional,less proud,less respectful of our field. You're fooling yourself if you think appearance doesn't really matter.Standards matter.