Small children visiting patients in the critical care setting... thoughts??

Specialties Critical

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Specializes in NICU.

I'm wondering what other nurses and even nurses who are parents think about this topic. I haven't been to this forum in a while. But this has really been on my mind and need some opinions.

I work in the ICU. We don't have too strict of rules in my opinion. One rule we have is that no children under the age of 12 can visit. We have this rule in place to not only protect the children but also to protect our possibly immunocompromised patient population. Family members get soo upset about this rule. They don't understand why their 2 year old can't visit grandma on the ventilator who has cdiff and lines and tubes in every hole. We have made exceptions. If a patient is dying and they want to come say good bye or whatever we let the children in. But if we expect the patient to recover we generally do not let the children come in. I have a 1 year old. I've tried to put myself in their shoes. I don't think I would let my child see his grandparents in that shape, nor would I want him exposed to MRSA/VRE/ESBL/CDIFF and I wouldn't want him to bring germs into the unit.

What are your thoughts? Children yes or no? I had a family member really yell at me yesterday, tell me I was a heartless person that needed prayer. I felt like my intentions were good... were they?

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We have the same type of policy in our ICU. Personally, I don't think anyone under the age of about 10 should be allowed to visit ANY patient room. Not only because they are exposed to, and expose patients to, many different pathogens but also for OUR safety. Those little buggers get in the way! And God forbid the nurse ever have to redirect their curious little hands...I've been yelled at for telling kids to sit down and keep their hands off of the equipment. I'm a nurse, not a babysitter. Keep the young'uns at home.

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My unit does not have strict rules regarding this as long as its not flu season and they are accompanied by an adult. We are very patient-family focused so I would say our visitation policy in general is very lax. Good for families, annoying for nurses. It's rarely an issue, but sometimes we'll have to set some limits. We had one preschool aged kid who was misbehaving and his father put him in 'time out' in the hallway. This led to a temper tantrum which the parents ignored. I suppose that might be an okay tactic at home, but when your kid is rolling around on the Petri dish hospital floor and preventing critically ill patients from resting, we have an issue.

Personally I think kids under 12 in an ICU, under typical circumstances, is a bad idea for everyone involved.

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Specializes in Oncology; medical specialty website.

I wish we could go back to how it was years ago, when no children under 12y were allowed anywhere...period. Of course, back then people did what you told them to do and didn't argue.

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Specializes in NICU, ICU, PICU, Academia.

I'm fine with a well-behaved and well-controlled child visiting- under the hawk-like eye of a parent. But since I've really only experienced this once or twice in 36 years of nursing........

PS: Once got seriously yelled at for suggesting that placing the three week old baby in Grandma's bed (c-diff and a raging pneumonia/ wicked cough) was not 'best practice'. sigh

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I think like everything else, it depends. Of course I agree with the infectious disease aspects, in both directions.

I am particularly remembering a young father with kids aged 7 and 9 who had a sudden devastating neurological event. He looked fine, but was never, ever going to wake up. I was his primary for a week or so and got close to his wife, and one day his wife asked if they could come in and would I answer their questions. I went over with her what she thought those might be and how I would answer them, and then we let them come in. It was an ICU but he was in a single room. Mostly they wanted to know if he hurt ("No, he isn't having any pain, nothing hurts, he's sleeping.") and could hear them ("Maybe, we don't know, he's asleep.") Will he wake up? Ever? His wife and I locked eyes across the bed. "No, sweetheart, we don't think he will." They were quiet for awhile and then she took them out. Later she gave me a small oil painting she did with a big tree in the foreground and three birds, one large, two small, in the sky far away. Flying towards the tree? Flying away from its sheltering branches? I still have it.

Another was another young father with two little girls, 5 and 6 or so. He was awaiting a heart transplant but probably wasn't going to get one in time as his kidneys and liver were well on their way to irreversible. Their mom and I got them dressed up in gowns and paper hats and shoes and gave them cut-down disposable stethoscopes, and they came in and played doctor with him and they all just loved it. I hope that happy memory stayed with them, but I never saw any of them again.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I have been a critical acre nurse for a LONG LONG time. I think that there should be an age limit of around 12. The are old enough to understand the world around them and the importance of following the rules. But rules are meant to be broken and used with common sense.

I have on more than one occasion broke the "NO children rule"(I'm sorry Sister M....:x3:). One was a 41 year old brittle diabetic that had a massive MI, going to open heart.....the was probably not going to get off the table (this was YEARS AGO). Her daughter had just had a baby during this MI, IABP, Cath lab, CABG scenario....so......on the night before surgery....after the brass had left...(except for Sister M because she lived there....)I snuck that baby in....briefly. Tom y great relief the patient did make it off the table and went home.

One other occasion I had a 28 year old patient that had ovarian cancer with mets to her spine.....some mental giant convinced her to cut herself in half....to have rods placed so she could sit up in a wheelchair....it became clear she was probably not going to leave the ICU....one night we were talking about death and dying...I was 27 myself.....ans she said her dying wish wild be to have her children (3 and 4) sleep with her, a six pack of beer and a pizza from a favorite pizza joint. So.....the next evening she got her wish (thank you Sister for not turning me in)....she died a few days later.

I even snuck a little dog in once.....Shhush...don't tell anyone....;)

Clearly there are exceptions to every rule but the danger to the patient from pulled cords and IV lines let alone the infectious risk...children should be limited.

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Specializes in Critical Care.

One other occasion I had a 28 year old patient that had ovarian cancer with mets to her spine.....some mental giant convinced her to cut herself in half....to have rods placed so she could sit up in a wheelchair....it became clear she was probably not going to leave the ICU....one night we were talking about death and dying...I was 27 myself.....ans she said her dying wish wild be to have her children (3 and 4) sleep with her, a six pack of beer and a pizza from a favorite pizza joint. So.....the next evening she got her wish (thank you Sister for not turning me in)....she died a few days later.

This. Probably one of the saddest stories I've read. Esme, you are wonderful!

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Specializes in NICU.

Now I’m not an evil person. All of these situations sound reasonable for letting children in to see loved ones. And I myself have let children in to see loved ones. But most of the people who get upset are the ones who bring the 3 year old in to see their 2nd cousin who has pneumonia and is on the vent that they haven’t seen in 5 years themselves. So in those situations I say no.

And yesterday I told the family no because grandma would be moving out the next morning and we had some really infectious patients in the unit. They got extremely upset. Said they were going to report me and said I needed to be prayed for. I wasn’t mean about it at all.. i just said “no” and told them our rules. Then when I gave report I found out the night nurse had let the 4 year old in to see grandma the night before anyway. That made me even more upset. Why does she need to see grandma everyday? It just wasn’t worth the risk in my opinion. Our hospital is trying to move towards more family centered care. Like letting families in during codes and procedures. So who know what is going to happen in the near future.

And I snuck a therapy dog into the ICU once too... shhh don’t tell anyone that either :)

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Specializes in Critical Care.
Now I’m not an evil person. All of these situations sound reasonable for letting children in to see loved ones. And I myself have let children in to see loved ones. But most of the people who get upset are the ones who bring the 3 year old in to see their 2nd cousin who has pneumonia and is on the vent that they haven’t seen in 5 years themselves. So in those situations I say no.

And yesterday I told the family no because grandma would be moving out the next morning and we had some really infectious patients in the unit. They got extremely upset. Said they were going to report me and said I needed to be prayed for. I wasn’t mean about it at all.. i just said “no” and told them our rules. Then when I gave report I found out the night nurse had let the 4 year old in to see grandma the night before anyway. That made me even more upset. Why does she need to see grandma everyday? It just wasn’t worth the risk in my opinion. Our hospital is trying to move towards more family centered care. Like letting families in during codes and procedures. So who know what is going to happen in the near future.

And I snuck a therapy dog into the ICU once too... shhh don’t tell anyone that either :)

I guess I'm not really sure why it matters that much if their are other infectious patients on the unit? Are these children visiting and getting in bed with all the patients on the unit?

I agree that my job would be easier and for strict infection control purposes it would be better if nobody ever visited, but then again it's not all about me or unjustified infection control precautions (like saying family can't visit because another patient in another part of the hospital might be infectious).

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Specializes in Critical Care.

Rules are good, but I've never found that young age is an accurate predictor of breaking the rules. For instance, please don't bring family members that require more supervision and care than you can provide, I don't care if they are a rambunctious 4 year old or the patient's 91 year old wife with dementia. Don't visit if you are sick, again it makes no difference how old you are. Don't interfere with my ability to care for the patient, again adults are just as guilty of this as children. While hospitals are dirty places, so is fresh fruit at the grocery store, and you'll often find more and worse bacteria on that fruit than you'll find on a hospital room floor.

Mainly, it's none of my business to judge whether family 'needs' to visit a patient. I've learned from experience that telling family "why don't you just wait until they are out of ICU" can come back to bite you.

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I have an issue with small kids visiting the "sick" floors, critical care or not. I'm sure I have exceptions, but a hospital is no place for a kid.

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