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?
Open visitation is a bad idea and a fad. It fails to take into account WHY units were closed in the first place.
1. Pts are, ummmm, CRITICALLY ill.
2. The need rest.
3. They need plenty of UNDIVIDED attn from nurses.
4. Family members need rest too, and many won't do so unless mandated.
5. It's easier to grant exception to an existing limitation than to enforce a limitation not present.
6. Monitor monsters (see that thread)
7. I'm not a host/concierge/waiter, etc. etc.
8. Infection control.
9. Privacy.
The number one thing to take into consideration when contemplating ANY chance is WHY things are done the way they are in the first place. Closed visitation is PATIENT ADVOCACY.
Specializes in Newborn ICU, Trauma ICU, Burn ICU, Peds.
Open visitation is a bad idea and a fad. It fails to take into account WHY units were closed in the first place.
1. Pts are, ummmm, CRITICALLY ill.
2. The need rest.
3. They need plenty of UNDIVIDED attn from nurses.
4. Family members need rest too, and many won't do so unless mandated.
5. It's easier to grant exception to an existing limitation than to enforce a limitation not present.
6. Monitor monsters (see that thread)
7. I'm not a host/concierge/waiter, etc. etc.
8. Infection control.
9. Privacy.
The number one thing to take into consideration when contemplating ANY chance is WHY things are done the way they are in the first place. Closed visitation is PATIENT ADVOCACY.
~faith,
Timothy.
:thankya: :bowingpur You hit it on the head!!!!
But to address the poster at the top of this page, I don't think ANYONE here would EVER restrict someone from being with their dying loved one. At least I would hope not.
It is a difficult decision to make despite the unit policy. I have in the past when I did work nights allow it on depending on the situation with the patients. There are some nurses that I feel have exerted their power and control over the situation to prohibit such an event despite the situation. Sometimes I have found that if the family stays in the room and the patient is not actively dying they can be disruptive to the patient's sleep. I am aware that many units are trending towards opening up the visitation however we as nurses need to always keep the patient in mind despite the wishes of the administration. Visitation can also become stressful to the patient were given in large doses.
I didn't read any of these replies but I figured I'd offer my opinion on the orignal post.... Visiting hours on the general med/surg floors I think should be up to the nurse....obviously if the patient is staying overnight for an uncomplicated laminectomy or something simple then there don't need to be visitors overnight; all those visitors do is nag (I know that sounds mean) but they do, and they distract the nurse from the patient's with more serious medical issues because the nurse is trying to avoid being complained about for not meeting every glass of ice or new pillow case. If the patient has a more serious medical issue then I think one visitor; the most immediate family member should be allowed to stay, it helps calm their anxiety...and if they are calling you 10 times throughout the night from home then they might as well be staying anyways. If there are psych or confusion issues with the patient, then one visitor should be very welcomed to stay overnight because it helps keep the patient safer and makes the nurses night much easier, allowing them to focus more on assessments and such rather than restraint checks. I think that pretty much covers general med/surg floors.......one visitor for more serious cases, psych issues, or confusion.....everyone else that is just in the hospital to basically sleep for the night and be monitored as a precaution doesn't need a visitor overnight, they can come during the day. Next issue is all forms of ICUs.......in this case I think all visitors should be restricted to the waiting room unless there is a change in the patient's condition where it would be beneficial to the family to have them in the room for the patient's passing. Family members in the ICU create a lot of problems, simply because there are too many things that could be messed up such as pumps, lines, monitors, etc.... Also I've seen a lot of family members in that situation that just won't leave someone alone and let them get some rest that is very beneficial, they always have to have a hand on the patient, rubbing their arm, talking to them, whatever........that patient needs their rest. With that said....I think that in order to get families to stop pressuring the hospital about these issues then there needs to be a posted policy in the waiting room explaining the visiting hours, the policy, the reasons, and it needs to be enforced by ALL the nurses to keep family members from feeling mistreated. Also the waiting rooms need to be more comfortable to get the family to be more apprehensive to staying in the waiting room. That's just the thoughts that I've had on that issue and I think it sounds pretty good.
Having read everyones responses, I've reminded myself of how few times I've actually needed to become a strong advocate of the patient and forcibly remove (call security to do a walk by and a polite escort out) family. I do have a few doosy stories that will stay with me forever. Yes, there a family members that I can't stand and just wish I could "boot 'em out". But those times it was because they weren't nice people and made MY job harder, they really didn't affect the care, just left me with severe heartburn.
But thinking back, more times than not these PIA's just needed more of your time, explanation and it took alot of work to gain their trust so they'd finally be comfortable leaving. Some I've insisted they go home or to the waiting room, some I've gritted my teeth and worked the issues through. But looking back I really can't recall a time that I've gritted my teeth and trucked through the endless family dynamics that it didn't pay off and they became more comfortable, less angry and antagonistic and questioning. (this doesn't account for those that clearly must leave because they're obnoxious, threatening or detremental to the patient).
So I guess I'm adding, in retrospect to reading everyones reply's, with my practice, that is really has been a patient/family benefit to work through those "tough" ones... although I wish I didn't know better and would have the sense to just kick 'em out some days.
hope this makes sense (worked last night and I'm digressing).
thanks for listening and sharing your views, we all share the same challenges no matter where we're located. Interesting in the least. It would be SO much easier to say "visitation is over".
But thinking back, more times than not these PIA's just needed more of your time . . . But looking back I really can't recall a time that I've gritted my teeth and trucked through the endless family dynamics that it didn't pay off and they became more comfortable, less angry and antagonistic and questioning.
But this is MY point:
While you are spending even more of all this endless time with these "PIAs", whose watching your PT for those subtle signs that avoid the problems BEFORE they occur?
Am I a host/concierge, or am I a high tech, critical monitor and interventioner? Because, if I'm a host/concierge, then give somebody else the LIABILITY that results from taking me away from my critical RESPONSIBILITY.
Am I a host/concierge, or am I a high tech, critical monitor and interventioner? Because, if I'm a host/concierge, then give somebody else the LIABILITY that results from taking me away from my critical RESPONSIBILITY.
I agree with a lot of y'all. A lot of times visitors just need some attention and time spent explaining things, and then they become model visitors...but sometimes nothing helps. And for those people, there have to be set boundaries or they will walk all over you. We've had so many problems with some nurses not enforcing even basic guidelines, and then the nurse who does gets chewed out by the visitors. I'm sorry, but there's no reason for a critically ill pt to have more than 2 visitors! (unless it's a life/death situation) If there are no rules at all, how are you going to enforce nursing judgement??
Another thing to think about is having a rule that the family selects a few people to be the liasons for the family. Those liasons are informed of the plan of care, pt condition, upcoming tests/procedures, etc. Those liasons are also informed that any questions from family/friends should first be directed to them, and anything they can't answer should then be directed to the nurse. That way if the pt has a huge family you don't spend your entire day answering involved questions like "what's wrong with them?" I once had a pt who was circling the drain, and I could barely keep up with her and the other combative pt I had. To top it all off, she had 12 kids, they were all older and had adult children themselves, plus the extended family. It was a nightmare trying to answer the questions.
Anyway, as everyone has said, no matter what the decision, ENFORCE IT!
Something else I forgot to ask, has anyone had problems with HIPPA rules and phones? We have so many family members get upset that they can't call the nurse to check on the pt. We've had some throw such a big fit that upper managment has devised a "code word" that the family members give via phone to get detailed updates. Unless the pt themselves can verbally/written tell me it's ok to talk to the person, I won't give out information. (and how often does that happen in ICU?) How do your units handle it?
Something else I forgot to ask, has anyone had problems with HIPPA rules and phones? We have so many family members get upset that they can't call the nurse to check on the pt. We've had some throw such a big fit that upper managment has devised a "code word" that the family members give via phone to get detailed updates. Unless the pt themselves can verbally/written tell me it's ok to talk to the person, I won't give out information. (and how often does that happen in ICU?) How do your units handle it?
If someone calls asking about a patient, my canned reply is "They are resting quietly." If they press for more information, I tell them it is against federal law for me to release over the phone the information they are requesting and refer them to the family. However, if they provide me with the predetermined password (personally, I don't ask them to provide it over the phone; either they know there is a password or not - some on my unit will ask for the password directly), I'll answer their questions as best I can.
We also strongly encourage all families (especially those with 20 gazillion family members!) to pick a spokesperson. Generally, they will pick the DPOA.
I think that the visitors have to stay whit there relathed.but not so long(sorry about mu english is not good).30 min is ok 2 times in day but in night the patient nead rest. in our wars they can stay from 12.30 pm to 13.00 pm and from 7.30 pm to 8.00pm
from 12.30 pm to 13.00 pm and from 7.30 pm to 8.00pm
Wow, they can only stay for a total of one hour, split into two half hour time periods? I'm all for restricted visiting hours but even I think that is a little slim.
:bowingpur You hit it on the head!!!!
ZASHAGALKA, RN
3,322 Posts
Open visitation is a bad idea and a fad. It fails to take into account WHY units were closed in the first place.
1. Pts are, ummmm, CRITICALLY ill.
2. The need rest.
3. They need plenty of UNDIVIDED attn from nurses.
4. Family members need rest too, and many won't do so unless mandated.
5. It's easier to grant exception to an existing limitation than to enforce a limitation not present.
6. Monitor monsters (see that thread)
7. I'm not a host/concierge/waiter, etc. etc.
8. Infection control.
9. Privacy.
The number one thing to take into consideration when contemplating ANY chance is WHY things are done the way they are in the first place. Closed visitation is PATIENT ADVOCACY.
~faith,
Timothy.