My unit has recently started a "Visitor Committee" that deals with visitor issues, and we are working on making some consistencies with our visitation/staying the night policies. Currently our visiting hours are 9a-9p (Until the meeting, I didn't even know we had hours...I work nights, and there are always visitors hanging out all night)
We're trying to find out from other nurses what their suggestions for the guidelines would be. The categories we've come up with are: 1) Comfort care & the dying patient 2)Low stim & sedated/intubated
3)Alert and oriented pt, whether they are on the vent or not. We tried to make the categories as simple as possible. Obviously, there will be patients that don't fit into these categories, and also, the individual nurse will be the deciding factor on visitors for a pt. We are attempting to come up with guidelines to fall back on, and to find some consistency in all the craziness of our unit. Some nurses limit visiting to 2 visitors for 10 minutes of the hour, some let 10 people stay all day. What are your suggestions?
our new visiting hours are wonderful! going for about 3 weeks now.
visiting hours are 1000-1400 and 1600-2000. shift report is at 08 and 20, so no visitors during those times especially. also, during the hours of 1400-1600 and 0100-0300 we have instituted a "resting hearts" program. since we are a ccu.. pts need their hearts to rest as much as possible and we all know that that is difficult to do in icu. so from 1400-1600 and 0100-0300(unless the pt is unstable or something is critical) the lights are dimmed, blinds closed and we limit if not stop interaction with the pt.- try to reschedule lab draws if possible and make an effort to keep the unit quiet. the dimmed lights do help with that because everyone seems to whisper! we have the large glass doors so as to see the pt and several sattelite monitors so you can sit at your "mini- station" monitor your patient, do some paperwork, read the chart, and let your pt get some uninterrupted rest.
we do not allow overnight visitors as a general rule... and all of these things are based on pt condition. of course if it is a death and dying issue, we are not going to "kick" anyone out.
but this took a long time and some good hard research based evidence to get admin to sign off on it. but they did. the research is out there.
forgot this part- the research found that it also gave the families a break- a mandatory one, but a break nonetheless.... to go home, take a shower, get some food, take a breather, whatever. many family members feel that they have to stay at the bedside 24/7 because of many reasons, family values- that someone sit with them, or just plain worrying.
so it is supposed to be a holistic approach as well. you know, if your mom is critically ill, do you really want her to be worrying about how exhausted/hungry/unbathed/sleep deprived that you are? because moms do that, they worry about their kids. no, you want her to rest and get better.
Specializes in CCU (Coronary Care); Clinical Research.
We have fairly lax visitation rules in our unit. The unit is closed between 630-800 both morning and night for shift change (unless there is something major going on with the patient- like life support was just turned off). Other than that it is typically up to the RN caring for the patient. We do have a written "rule" that states two family members at the bedside at a time. But if there are three in the waiting room, I let them all come back. Sometimes, if I don't want to go over things 5 times, I just have them all come back for one short visit so I can answer questions and everyone is on the same page. If the patient is not awake, we also usually only let family members back (unless otherwise specified or the have the "code" number). If we are having problems with the family, it gets brought up at change of shift each time so the nurses are more strict with visiting, etc. We don't typically have families stay the night (unless the patient is actively dying or crazy) - everyone is pretty consistent with that rule. I always tell families that just because I let them stay back for x amount of time or if I let them come into the unit without calling in first that the next nurse may not. Typically it works well, we do have those families that we have to be tougher with for one reason or another but it isn't too bad most of the time. In our unit pamphlet that we hand out the visitation rules just basically state the hours that the unit is closed and that visitation is up to the bedside RN.
MOst of us encourage families to leave the unit, go take a break, take a shower, eat, etc. and I think that most families are fine with that. If the patient is sleeping, I don't usually let them be woken up, especially if they have had family in there a lot. The patient is there to rest and get well, not to be kept awake by a ton of family. I use my judgement as far as that goes, how well the patient is doing, etc...
It seems that there are as many reasons to limit visitation at times as there are to extend it and finding guidelines is very challenging.
When it comes to overnight stays (which are as easily discouraged as allowed in my hospital, situation warrenting)... we only allow ONE visitor in the room for support. That visitor gets a reclining chair, right next to the bed (when possible). We set out to encourage that visitor to sleep as much as possible, or at least rest. If there is a large group that demands to stay as well, they are welcome to in the waiting room and the "rooming in" visitor steps out to update the family as appropriate. Yes they can switch off, as long as they don't impede nursing care (waking up the sedated patient), and are updated by the family member switching out (so you do't spend 15 minutes every hour re-updating the 5th person in the room.
we don't hold this to only imminent deaths... the MICU pt. can circle and be unstable for a long time so we TRY to do this for the family. It has been an equal blessing and hinderance.
When the pt. is just too unstable for another person in the room, we allow the family to peek in the room for 5 minutes each hour if they wish to wait in the waiting room, this really seems to settle some out as they can see that you're very busy treating their family member and they can see there is no place for a visit at that time.
Just our routine in a CCU/MICU mix. I also don't want you to think that every nurse feels and acts this way, (and that we all agree here) there are some that say no visitors if the pt. isn't a dying DNR. But generally we try to do as I've stated.
To me, at a certain futile point with pt's who's familys won't make them DNR's, I say camp out and be part of what you're wanting me to do. It give you so much more time to explain and re-explain a situation and sometimes it's the best way I can advocate.... "pull up a chair and stay".
When we've re-evaluated ourselves, we have made alist of questions and called other local hospitals on the night shift to gauge what others in our community did.... generally had some great conversations with our local peers.
Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.
Actually the new data and benchmarking studies show that visitation around the clock (with the understanding that the visitors will NOT disturb the patient if they are sedated/sleeping) is the best thing for both patients and families/loved ones. That is a hard pill for most of us to swallow.
I worked in a mostly adult ICU where visitation was supposedly closed at night (but exceptions were made all the time) from about 11p-8a, and during report times as well as during wound rounds on Mondays, Wednesdays and Fridays. We did let parents of children under 12 spend the night in the room if the child was extubated (I worked in a Trauma/Burn/Emergency surgical ICU and we got burns of all ages).
I now work in a NICU (neonatal) and we have a ridiculous visiting policy. I say ridiculous because I feel it hampers my ability to properly care for my patients at times, and because I am very concerned about the HIPPAA violations it allows. We have four 9-13 bed rooms and parents are allowed to be at the bedside 24 hrs a day, even during report. Other visitors do have to leave during report time. Anyone can visit if that is what the parents choose. The next door neighbor and the milkman can stop in...Though we are supposed to limit it to two adults at the bedside at one time.
Parents interrupt during report all the time, despite multiple conversations with them around how important it is for us to communicate with one another about their baby's (or babies') care. And we are all very uncomfortable talking about other baby's in front of other parents. We have no where to go to give report but to one end of the room or the other, and they can still hear us, even with the attempt to keep our voices low. I have contacted our institution's HIPPAA attorney and he assures me that this falls under the government's definition of "incidental disclosure" and it is fine. I am still not so sure. Would you want someone next to you to hear you tested positive for cocaine or gonorrhea and were a G9, P1 or that you have a restraining order against the baby's dad?
I also miss the chance I had in TBICU to quietly assess my patient without interruption, to check my meds and look at my lines and calculate my drips without a visitor asking me what I am doing, or did I see the game last night. Of course I have developed the ability to say something graceful like "I am just checking things out right now and I'm going to take a listen to your dad, etc. I'd be happy to give you all the information I can in just a sec." Or, "Hang on for a few minutes until I finish looking everything over and getting my shift planned, and then I can give you my undivided attention." But I would still advise anyone developing policies to consider closing at report times to EVERYONE unless the patient is dying.
Good luck with your visiting policy development, you are going to need it! :)
I work strictly night shift and we lock to waiting room door at 9pm until 8am. My DON was pushing for open visitation 24/7 because of some research she had read that showed better patient outcomes. In addition to all the previous stated problems with this, the major problem that we found would happen were the families would become bored in the rooms and frequently stand at the doors looking at everything else going on in the unit(they already do this during regular visitation). Also, here in Louisiana, the families are usually large and just do not listen when they are told not to disturb the patients ( very irritating) and there is always a cell phone going off somewhere in the unit. the most important issue that we discovered was that alot of the MDs said they would not round in the unit if there were open visitation, they would just phone in their rounds to the nurses. Another facility in the area did open visiting and the families would literally move in with sleeping bags and food, needless to say this did not last long.
So my vote goes for regular timed visitation hours.
Not all ICU's are the same. Some smaller-hospital ICU's have patients that would be on the floor or step-down in a "big city" hospital. Some have curtains between the beds or rooms with glass fronts and others have very private rooms. Some rooms have enough space for a family reunion and in others your have to be a contortionist to squeeze between the vent and the wall to get at your half dozen pumps.
That said, I am in favor of more strict visiting hours. That may be because I usually work at "big city" hospitals where the patients are really, really, sick as are all the patients around them. That may also be because as a night nurse I really appreciate the time to bathe the patient, clean the room, straighten and untangle my lines and label my tubes in peace!
Once upon a time I worked at a Catholic hospital with nice, big, private rooms in the ICU. The nuns in their compassion decided to change the visitation in the ICU and have "open" visiting hours. We argued with them and won the right to ask all visitors to leave from 0600 to 0800 and 1800 to 2000 obviously for shift change. I have never had more fights with visitors as I had in that unit. With the open visiting hours there was absolutely no respect by the visitors for the needs of the nurses. Every day there was a fight to clear the unit of visitors for shift change.
I believe that grown up people, just like my children, do better when there is a clear and consistent structure. If you are too lenient you leave too much room for argument. Whatever the visiting hours are, I think that they should not be completely "open" but structured in a way that is appropriate for the setting. I believe that in only rare cases should a family member be allowed to spend the night...for their good as well as the patient's. And, I firmly believe that for any visitation policy to work it must be adhered to by all the staff with only very rare exceptions for compassionate circumstances.
i think pt's family should be able to stay with there family, most of the time there by the bed giving support to there love one..alot of the time pt's family would leave the room for bathing and other things we had to do..i think for some people spending the night may very well be the last time they see there loved one and who are we to take that away from them..
I live in a very small town in Virginia. Usually whenever a family member gets seriously ill they are transferred to a much larger hospital in North Carolina. This is over 100 miles away. When this happens the family usually stays with the patient because of the long drive back home and the inability to get there quickly if the patient started getting worse. Money is also an issue when a family member is sick. If it's your husband, then you have the loss of his income plus the loss of your income also. Add all of these financial problems together, and you just don't have the money to pay for a motel room. I've always been very fortunate whenever this has happened. The hospital has always let me spend the night, brought me a recliner to sleep in, and warm blankets. Now, if the visitors were loud, hysterical, and upsetting the patient, then I agree that the visitors should not be allowed to stay. The nurse must be an advocate for the patient and not allow anything that would disturb them or upset them. I just think that it's wonderful when exceptions are made, because it really does help the family in a time when resources are usually maxed out.
We have a written policy, and visiting hours start @ 8am and end @ 9pm and there is even an overhead announcement made throughout the hospital. We have an ICU/stepdown visit policy in writing to be given to the family members when the pt is admitted. (Often, we get xfers and the family is unavaible until later, and we are bad about giving the policy to families after admission.) It's kind of unwritten in our unit that we'll let visitors stay until 11pm.
I'm kind of on the fence about this one. I work in a large hospital, and the variety of pts makes it so hard to pin down those situations where unlimitied visitation is appropriate. There are times that a family member has been a lifesaver for me- especially with confused pts. And I've discovered that many family members enjoy helping with baths, etc, and can be theraputic for the pt and the family, as well as helpful for me.
Also, we often have pts in "limbo" with us, because they are vent dependent, awaiting home vents or outside placement. I find I can help the families learn things they may need to know (like I&O caths for quads, mouth care, etc) if the pt is going home, time a nurse on the floor with 5-6 pts may not have.
Of course, the anxious/crazy demand/looking into all the other rooms type visitors are trying. You establish limits, etc, but then you get bit in the *&%$ when admins complain about satisfactions scores!
I have been able to reduce overnight visitation by letting the family members know that it is ok for them to take a break- some really do feel they need permission! I also explain that they cannot help the pt if they don't help themselves first. Alot of times it works.
Of course, sometimes people are unreasonable and demanding. I have found, however, that I have few problems with visitors and I'm often able to develop a rapport with many of them.
I have worked in units with both strict visiting hours that were adhered to for all patients except the dying and peds and those with 100% open visiting. Also worked in a unit going through the transition from limited to open. The transition is a hard one to make, but I think most nurses adjust over time and I have not seen patient outcomes adversely affected.
Families seem to appreciate the open visiting very much and we establish rules early on. I usually tell families that they can stay as long as they want as long as they keep the patient in mind. The patient is very sick, hence the need for ICU, and needs their rest. This is not a party or time to catch up with all the long-lost family, this can be done in the waiting rooms. I remind them that if the patient is sleeping, leave them be, and encourage immediate family to be the "gatekeepers" to speak for their loved one. We also discourage them from looking in each room they pass - to protect the privacy of those patients, just as they would want the same done for their loved one.
I was truly amazed at how well families typically responded to the open visiting. They seemed to be more respectful of the patient - less of the "I'm only here for limited time and I must make sure the patient knows I'm here". They also are quite agreeable when we ask them to step out "to protect patient privacy" for baths, procedures, turning, etc.
Again, the journey to open visiting is very painful and meets a lot of resistance, but we all learn to adjust. It's just another sign of the times and how things are changing constantly in our profession!
Geeg
401 Posts
In general, night visitation should be discouraged. I have had plenty of intoxicated visitors, and the majority {surprise} arrived at night.