Visitation and staying the night

dorimar, BSN, RN · Apr 5, 2006

It's really tough when you put all those details in writing. Believe me, you will be held to them by stressed, distraught families . I find it wise to leave it to the nurse's discretion. Hopefully you have nurses with good discretion that aren't Nurse Ratched when the family & patient is dealing with end of life. I would, however put it in writing to limit it to 2at a time. I mean how big are your rooms that they accommodate 10 visitors at at time and nursing care to boot? (I realize that was probably an exaggeration). Good luck.

doris

millkay · Apr 5, 2006

Sometimes it's just a matter of consistently enforcing the rules you do have, with backing from administration. This is on-going in several places I've been. The problem is usually inconsistency of the nursing staff. When a nurse sees it important to enforce visiting hours, they get "talked to" by administration for upsetting a pushy & verbal family member. :madface: Nursing judgement should have some weight in this issue. Physicians, luckily not many, have tried to write orders that "the patient can have as many visitors, or overnight visitors if they choose." They too should understand that some critical care patients require a dimly-lit quiet atmosphere or just a quiet atmosphere to get some rest. You are doing great in looking into which scenarios visitors should be allowed, or dis-allowed, but you cannot predict every possible scenario. Again, nursing judgement, and tact, should be put into play. We're professional nurses and should be respected as such. Just one person's opinion....

LoriAlabamaRN · Apr 5, 2006

I think nurses are more than qualified to make the decision as to whether or not overnight visitors would be therapeutic. My dh was very sick recently and spent 5 days in CCU. The wonderful, WONDERFUL nurses let me stay the night with him each night, and all day. As a nurse, I knew that it was a privelege and not a right, and as such I did whatever I could to make their job easier. I don't think he hit his call light more than a couple times a day as a result.

So many things are left to the judgement of the nurses. I don't think this should be any different.

optimisticSRNA · Apr 5, 2006

I mean how big are your rooms that they accommodate 10 visitors at at time and nursing care to boot? (I realize that was probably an exaggeration). Good luck.
doris

Actually, our ICU rooms are HUGE. I wasn't exaggerating about the 10 people at a time:)

-Nurse Kern

optimisticSRNA · Apr 5, 2006

Thanks for your replies, everyone!

I have a problem with trying to "categorize" these types of patients, however, we definitely need some consistency. The main problem lies in the nursing staff. We are a large Med ICU, (36 beds), and, with that many nurses, there are bound to be differences.

I guess if I could figure out a way to help everyone adhere to some guidelines, I could be a consultant for every company in the world. However, I am realistic and understand that there are always going to be people who have a difference in opinion over "nurse's discretion". As I mentioned in my original post, I didn't even know we HAD visiting hours. As a fairly new employee to this hospital and unit (7 mos) I will have to suggest that they address institutional desires regarding visitors & spending the night.

Any other ideas are welcome, what do you do on your units?

-Nurse Kern

traumaprincess · Apr 5, 2006

I guess my opinion is very different from the others here. I think patients get overwhelmed and stressed especially when intubated when visitors keep waking them and talking to them. I have to wake my patient so many times for patient care that it is no wonder they get so confused after being so sleep deprived. Additionally I have had to have several family members taken to the ED when they had anxiety attacks, chest pain, etc from their own worry and sleep deprivation. When the patients are feeling better, have been transeferred to the floor and can communicate for themselves when they are tired and want decreased stimulation I think that is an appropriate place for unlimited visitation. Many ICU patients benefit from quiet time. This is only my opinion of course. I have worked in ICU with no visitation limits and units that are locked down and have very strict visitation rules. I have found that it is good to have the visitation rules in writing to give all families fair treatment. It is also important to avoid nurses being judged too harshly for wanting their patient to have quiet time. And if there are rules they should be adhered to unless the situation is different, ie: patient is dying, it is a new patient that arrived during the non visitation hours etc.....

These are the visitation policies I have found to work well in the units I worked in:

One ICU allowed visitation from 0830 to 1700. Then from 2000 to 2100. After 2100 patients were allowed to rest between nursing care and there was no one to wake them out of their sleep or to stimulate them out of their sedated state. There were only two visitors at the bedside at a time and we encouraged only close family members to help provide privacy to the patient until they could speek for themselves. It worked well and seemed very organized. My mother was in the Neuro ICU there and I had to adhere to the same rules. Family and my mother were all fine with it and my mom got the rest she needed.

Another hospital allowed visitors to come in at preset times. Every 2 hours and for 1 hour. It was also limited to 2 people at the bedside at a time. Unfortunately during the night people would still come in at 0300 and wake the patient who may have just gotten back to sleep after being turned, given meds, resp tx etc. I thought the 0300 visitation was probably not necessary.

The hours and rules were printed out and given to family on admit. I have rarely heard complaints about this. In fact I have had both family and pt thank me for asking visitation to be limited or calm and quiet. I have had family thankful that the rules were clearly printed so that they would not feel the need to sit and police the door of their family member and they would not have to enforce rules with their own family when they felt there were just too many or too loud of visitors coming.

As much as I value family being involved in pt care, I also really think patients sometimes just need a little time to rest. The ICU is such a stimulating environment with the alarms, frequent treatments, and frequent assessments that sometimes these poor patients just need a little quiet time.

IMHO

I am sorry, I forgot to add this.... In order to have consistency for family and make them feel like they are all special it is important that all nurses follow the visitation rules. If there are exceptions, like once there was only one visitor for a patient and she was keeping the patient calm I let her remain, in a large unit I think it works best if the charge nurse is notified that exceptions are being made. It is just good to know in case there are any complaints. It is nice to be able to tell another familiy member that the rules are not adhered to because this person is dying, etc. Just so they can understand. I really have not had complaints from other family though. They seem to all talk in the waiting room and they know when someone is going through death etc.

pricklypear · Apr 5, 2006

I am sorry, I forgot to add this.... In order to have consistency for family and make them feel like they are all special it is important that all nurses follow the visitation rules. If there are exceptions, like once there was only one visitor for a patient and she was keeping the patient calm I let her remain, in a large unit I think it works best if the charge nurse is notified that exceptions are being made. It is just good to know in case there are any complaints. It is nice to be able to tell another familiy member that the rules are not adhered to because this person is dying, etc. Just so they can understand. I really have not had complaints from other family though. They seem to all talk in the waiting room and they know when someone is going through death etc.

Quite true. Consistancy has been an ongoing and very aggravating problem on my unit. Technically, we're closed between 1830 and 2000 for report and assessments. Just about every day we walk on to the unit at 1845 only to find visitors all over. Who gets to be the bad guy? Even within our own shift some nurses allow visitors during off hours (for no other reason than they don't want to deal with it) while some allow no exceptions and aren't always tactful about it. That makes it difficult to kindly remind my patients' families of the visitation policy, and as they are leaving the unit they walk by rooms bursting with visitors.

We do try to be very selective when it comes to rooming in overnight. Our rooms are pretty small, and it's not fun tripping over a stretched out recliner, purses, pillows and magazines during a code situation. The exceptions are dying patients and confused or anxious patients who are safer with a familiar face in the room.

SKT686 · Apr 5, 2006

We have fairly open visitation, but have arrived there after a slow evolution. Look around at other hospitals websites and the Institute for family centered cares site. This is a huge issue in a lot of places.

Sheila

firstaiddave907 · Apr 6, 2006

Well i think it should be up to the nurses and if the patients visitors are behaving then they should stay as long as they want but if the patients family starts to act up then thee should be restrictions.

BGgirl · Apr 6, 2006

I work nights and our visiting hours end at 8p. Usually visitors stay a little longer than this. We have a no visitor policy on nights for the most part but it's usually left up to the individual nurses to descide whether or not they can spend the night. We have a few private rooms that we tend to be more lenient about with visiting family members just because they don't have roommates to worry about disturbing.

The majority of our rooms are semi-private and I think a lot of women don't like it when male visitors of their roommates spend the night. Sometimes we let girlfriends and families stay in the rooms and tell them if we get an admission into that room they have to leave. We've had some family members get pretty nasty with us when a nurse the night before let them spend the night and now the oncoming nurse won't allow it. There are just too many inconsistencies with allow people to stay in the rooms with patients.

Like LoriAlabamaRN said, it is a privelege to spend the night, not a right. Most people don't see it as that.

burn out · Apr 9, 2006

We have strict visiting policy at my hospital and the times are posted on the locked door ( 9-9:30, 12-12:30, 5-5:30 and 9p-9:30). The problem is that all the nurses do not go along with them. One nurse on day shift lets the families of her patients come and go as they please all day long - so then night shift or the next day the families don't understand and think you are being mean to them and are going to report you. Personally I don't like to have families around that much because they don't seee the patients needs the same as I do. For example how many times and to how many people must I tell that grandma can not have anything to drink while she is on the ventilator, or yes grandpa's sats are low again because he is talking too much and needs to conserve his energy for breathing. Limit visiting times in ICU and make everyone play by the rules is what I say.