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

[TigerGalLE]

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?

[KelRN215, BSN, RN]

I am a pedi nurse so when I worked in the hospital, there were always children who wanted to visit for some reason or another. Officially the rules were that parents/guardians could visit 24-7 with one parent who could sleep at the bedside and everyone else (including siblings) had to visit from 8A-8P. Adult siblings (over the age of 18) could spend the night if neither parent was going to. The only siblings allowed to spend the night were breast-feeding infants and they were 100% the parents' responsibility. If a child was dying, siblings were allowed to stay. Most parents understood this and got that only the child who was admitted to our services was under our care. Most times it worked fine.

I do remember a particularly odd situation I encountered once... I came in for a night shift and took over care for a new admission who presented with something (I forget exactly what, something visual that raised concerns for an acute neurologic process) that warranted an urgent MRI. He needed sedation so they had to call a team in and he didn't go down until on the night shift. At shift change, both parents and the 6 month old were in the room. They told the day nurse that they both wanted to stay until the child went to MRI. This seemed reasonable enough and she told them that once that happened one of them needed to leave with the baby and that the baby could not stay overnight. The patient was 2 and per hospital policy was in a crib. He was in a double room with an empty bed in the other space. I brought him to MRI and since it was after hours and he was the PACU nurse's only patient, when he was ready to come back she brought him back up to the room. I walked in the room about 2 seconds after they got there and noticed that they had put him on the bed in the first space (which BTW had no sheets on it). I said "Oh, actually, he's in the second bed space." The PACU nurse says "oh the parents said to put him here." If they wanted him in a bed, that was fine all we had to do was inform them that the hospital believes that children under the age of 3 are at an increased risk of falls if they are in a bed (because they're more likely to try to climb out) and that it is their responsibility to watch their child. So I do that and then say "ok, let's move the bed over to the second bed space because that's where he's assigned" and as I go to move the crib out of the room, I notice that the mom has laid the 6 month old in it as if he's going to be spending the night. I tell her that he cannot stay there and all hell breaks loose. All of a sudden the father is screaming that this is America not Russia and we have to give his baby a place to sleep. The charge nurse and I together explained the hospital's policy and reiterated that under no circumstances can a child who is not a patient have his own crib and take up a bedspace on the unit. Mom refuses to leave with the infant because she thinks her older child will be scared without her there. We then suggest that perhaps Dad can take the infant home and Mom says (in English) "I can't stay by myself because I don't speak English." Charge nurse says "Well I'm communicating with you in English right now and we seem to be understanding each other fine." Mom ended up leaving with the baby and then the father tried to tell me I wasn't allowed to touch his child all night. We basically had to tell him "I'm sorry you're upset, sir, but your child is recovering from anesthesia and if he is staying here, he will be assessed overnight."

Then there were always admissions in the middle of the night who showed up with all siblings in tow and insisted that there is absolutely no one to care for the other children and that they have to stay. There's not much to do about that in the middle of the night so we usually just ended up letting them stay and getting Social Work to deal with it in the morning.

[MunoRN, RN]

Doctors will ocassionally write an "order" for a private room, for instance. But if the patient doesn't require isolation for infection purposes or some other reason considered by the hospital as medically necessary, it's not considered a valid order an doesn't have to be carried out. So one could argue that a patient would have a better outcome if they have a private room, or any number of other things, but you have to draw the line somewhere. Open visitation just isn't in the same medical "necessity" category as something like isolation from infection is.

Which is why I didn't claim it to be "medically necessary", there are actually very few things that one can argue is clearly a medical necessity, I said we can't argue it's medically unnecessary, there is very good evidence to show it's medically advantageous, which is Nurses and patient advocates, we should be champions of whatever is to the patient's advantage. Private rooms is also medically advantageous for infection control, delirium prevention, sleep promotion, etc, which is why we also advocate for private rooms and why private rooms have become a standard in hospital design in the past few years. So long as basic rules are enforced to ensure that open visitation doesn't significantly affect the patient's care or the care of other patients, the benefits are well established and should be encouraged.

[SENSUALBLISSINFL, BSN, RN]

...

Will he wake up? Ever?

Awwww, this almost made me cry. I think this was wonderful, because it provided not only understanding, but some closure of the even at such a young age. They will remember this forever.

Thank you for sharing.

I did my leadership rotation in ICU, and well, there were considering allowing dogs.... yes, that is what my preceptor told me. I was in disbelief, because here I am thinking their hair, the possibility of accidents on the floor, barking, and such, but I supposed dogs sometimes behave better than children.

[HikingEDRN, BSN, RN]

Tiger, don't be hard on yourself. Without knowing the full story, it sounds like you were using your clinical judgment. And as far as throwing prayer in your face, grrr....

However, to the nurse who let me visit my dying father when I was four years old (this was in the late 70s when I'm sure visiting hours were more strict): thank you, thank you, thank you ... from the bottom of my heart. I have very few memories of him but visiting him in the hospital is one of them.

[SENSUALBLISSINFL, BSN, RN]

@ HikingEDRN, that is why I found GrnTea's post so moving. What you feel now as an adult having the chance to see your papa, is why the children on her post are feeling now as adults. It is so wonderful that one act can mean so much and one does not even know the impact we make.

Awesome.

[uRNmyway, ASN, RN]

While I completely get the 'no visitors under the age of 12' rule, I definitely think there should be done flexibility in extreme circumstances. One story comes to mind that absolutely broke the hearts of all the nurses on our mother-baby floor.

Back in the H1N1 crisis, we had a young (like 23) pregnant woman come in for emergency c-section. She had had pneumonia during her pregnancy and then H1N1 kinda piggy backed into that. She was emergently intubated during her c-section, and well, basically, they never managed to extubate. She would desaturate with the lightest touch.

We had her baby in our well baby nursery for around 2 months. He was such a wonderful baby. He was perfectly healthy, miraculously. But daddy, being Muslim, had absolutely no clue how to care for a child without the help of a woman. Not to mention he was completely devastated and overwhelmed that his wife would likely never wake up. He was in ICU every day to see her.

Once we found out she wouldn't wake up, we tried everything we could to get the baby in to see her, so she could get to touch her baby at least once before she died. Even in a coma, we still thought she would know and it might help her have some kind of peace. We also wanted daddy to have one picture of his wife and baby together, to be able to show his son when he grew up. We said we would arrange to have her draped, baby in isolation gear, whatever we needed to do. They never allowed it. She died without ever once touching her precious little boy. Daddy looked so darn broken when they chose to withdraw life support and he and his in-laws took baby home. I don't get why they couldn't make an exception for this. Heartbreaking...

[Ruby Vee, BSN]

While I completely get the 'no visitors under the age of 12' rule, I definitely think there should be done flexibility in extreme circumstances. One story comes to mind that absolutely broke the hearts of all the nurses on our mother-baby floor.

Back in the H1N1 crisis, we had a young (like 23) pregnant woman come in for emergency c-section. She had had pneumonia during her pregnancy and then H1N1 kinda piggy backed into that. She was emergently intubated during her c-section, and well, basically, they never managed to extubate. She would desaturate with the lightest touch.

We had her baby in our well baby nursery for around 2 months. He was such a wonderful baby. He was perfectly healthy, miraculously. But daddy, being Muslim, had absolutely no clue how to care for a child without the help of a woman. Not to mention he was completely devastated and overwhelmed that his wife would likely never wake up. He was in ICU every day to see her.

Once we found out she wouldn't wake up, we tried everything we could to get the baby in to see her, so she could get to touch her baby at least once before she died. Even in a coma, we still thought she would know and it might help her have some kind of peace. We also wanted daddy to have one picture of his wife and baby together, to be able to show his son when he grew up. We said we would arrange to have her draped, baby in isolation gear, whatever we needed to do. They never allowed it. She died without ever once touching her precious little boy. Daddy looked so darn broken when they chose to withdraw life support and he and his in-laws took baby home. I don't get why they couldn't make an exception for this. Heartbreaking...

Perhaps the concern was the health and safety of the healthy child?

[uRNmyway, ASN, RN]

I know what you are saying, but we offered to put sterile drape over the mommy, basically gown and mask a newborn, just long enough for her to touch her baby, daddy to take a picture, and go. And she was on a vent. I haven't been around those all that much, but I just don't see how pathogens can get around a whole lot from that. Anyways...Just found it really sad for the whole family. Can't help but think it might have brought some peace to this woman before she died...

[NicuGal, MSN, RN]

That is sad But I am sure that the visitation guidelines has nothing to do with it, it comes from ID. We get a few moms per year that are in ICU and we are not allowed to take the baby in, especially if they are still in house. Now if the baby had been home with the dad ( and I find it incredible any insurance paid for the baby to stay for 2 months) they may have let it happen as the baby would not have a chance of exposing the nursery to H1N1.

[uRNmyway, ASN, RN]

Well this is in Canada, there is no fight with insurance to pay for it. And if I remember correctly, by then she had been cleared of H1N1. Unfortunately, the damage to get system had already been done. I do get not wanting to expose healthy babies to any ICU infections, but if precautions are maintained, wouldn't that make it ok? If going in these patient rooms is safe for us when we gown, mask and glove, shouldn't the same rule apply for a newborn who won't be touching anything anyways?

[Esme12, ASN, BSN, RN]

Well this is in Canada, there is no fight with insurance to pay for it. And if I remember correctly, by then she had been cleared of H1N1. Unfortunately, the damage to get system had already been done. I do get not wanting to expose healthy babies to any ICU infections, but if precautions are maintained, wouldn't that make it ok? If going in these patient rooms is safe for us when we gown, mask and glove, shouldn't the same rule apply for a newborn who won't be touching anything anyways?

That is a heart breaking story.....Sometimes as nurses we make difficult decisions....I ma not sure that even I the softie of the world would have allowed the newborn near the Mom....for fear of a double tragedy. Newborn immune systems are NOT capable of "fighting" off infections they are vulnerable.

I know as a Mom...if I was dying from an infectious disease.......the last thing I would allow are my children to be put at risk. I once didn't allow a mother to see her incinerated son from a motorcycle accident.....he was like charred wood and ashes his fingers disintegrated in your hands...it was horrible....I made some lame excuse about the coroner...the rest of the staff agree but I was the "bad guy" I never regretted my decision....while that mother HATED me for quite a while (it was a friend of the family of a friend) she did finally forgive me.

[NurseQT]

I know this post is months old now but I thought I'd add my experiences from the other side... The family side of it. I agree that there should be age restrictions when visiting patients on critical units, but with some "wiggle room". My feeling is that parents may not always understand how visiting a critically ill loved one may effect a child. My older brother recently passed away while in the ICU. He was on a vent, ECMO, and CCRT and was sedated the entire time he was there. My kids (ages 7, 9, 12, and 14) had asked about going to visit him and I wouldn't allow it. I think it would've been really scary for them to see their uncle in that state and as it turned out it would have been the last memories they had of him. I'm glad their last memories are of their uncle healthy and being the goofy guy he was. I'm not aware of there being any age restriction for that particular CVICU but when my 15 yr old niece came to see him they were not going to allow her in the room because she didn't get a flu shot this year. My sister in law was adamant that my niece be allowed in the room and the nursing staff did finally allow it, which was a good thing because my brother passed away the next day. My niece was allowed in the room after the ECMO and vent were disconnected too. It would have been more devastating for her if she wouldn't have been able to be in the room with the rest of us as we said good bye.

Another experience I had was when I was a patient on the maternity ward. I was awoken in the middle of the night by a woman screaming, scared the crap outta me! The screaming all of a sudden got louder as the door to her room was opened and then I could hear a child crying, and I mean this child was wailing and it was obvious this child was terrified! I could hear her/him crying as they were taken down the hall and presumably off the unit. I understand that mom and dad thought it would be great to have the kid there for the birth of their new baby brother or sister but it was the middle of the night and all they managed to do was scare the crap out of their child!