Published Oct 6, 2002
hey all, don't wish to start the visitation thread again, but could use some advise on how to handle;
Had a closed head injury patient in the ICU last night, confused all day, pulling at ngt, pulse ox...on and on. Our day nurse let the family stay ALL day at the bedside, but warned them that during shift change and some time later they would need to step out. All is fine until night shift arrives and it is time for them to step out.
We're not talking hours here... we asked for 45 minutes to give report and assess the patient, give meds, you know the drill.
Family no longer agreeable, have very good intentions of only wanting to help maintain lines... which is very needed, but refused to leave to allow report and assessment. Wife states "I will not leave the room, you can't force me out, I will not leave him, I'm not a visitor, I'm his wife".
Well, I don't much care for her approach, but I agree that we need their help, the night nurse REFUSES to accept the assignment if I allow the wife to "camp out". I change the assignment and take the patient, let ONE person stay with him all night.
Turns out they were VERY helpful, and yes I needed them, but again, I don't mind the "camping out"
So, sorry so long. But what would you do if a family member flat out REFUSED to GO? There are many times where it is cleary not appropriate with a stable mable and they just want a slumber party.
PS... everyone is PISSED that I "gave in to the family". But Management will not back refusing to allow visitors to stay, our manager will override the nurse and allow it, which is why I never began to beat my head against the wall.
I THINK THAT IS OKAY TO LET THE SPOUSE, OR SIGNIFICANT OTHER STAY, BUT THAT IS IT...AND ESPECIALLY IF YOU DO NOT GET THE SUPPORT FROM MANAGEMENT. WHY BEAT YOUR HEAD AGAINST THAT BRICK WALL RIGHT? :):):)
pebbles, BSN, RN
I do not have a problem with wife, mom, whatever, staying. *As long as they are co-operative* ... I do NOT need to be climbing over a family member to do assessment and treatments, take BP's or whatever - and we have a very small bedside area in our step-down. And I think you should be able to have the support of management in asking anybody to leave the bedside, especially since this is less than an hour we are talking about. This shouldn't have to become a power struggle....
What this snowballs into in my unit (We are a 26 bed in-pt unit + a separate 4-bed step-down) "you let THEM stay, why are you asking US to leave?
Also, I live in a city that has a huge problem with native street gangs. Because this is partly a cultural phenomenon, many of the people in the same gang are legitimately brothers or cousins or whatever. I do not have a problem accomodating families. But what we have happen is that somebody will be admitted after trauma (Stabs, GSW's) related to gang violence... the other gang members will try to play on the "family "angle and try to stay at the bedside. They SAY they want to do this to act as support and to make sure he is ok. But what really happens is that pt is not co-operating with police, so the cousin is acting as "protection" in case other gang members try to finish the job.... "He's my cousin, he needs me to be here for him" Yeah right. I do NOT want gang members stomping around in my unit late at night (or at all) for any reason, no matter HOW sick this pt is!!!!
So my manager is weak and lets any family member who complains long enough have special priveledge to stay constantly. But we nurses want more discretion at OUR level... and more backup from management when we do make the judgement call.
Sorry to be the bad guy here, but I'd have put her out. Period. I am sick to death of visitors, family whatever calling the shots and interfering in my ability to do my job. And when I politely ask for cooperation and ask them to step out to assess patients and they refuse, then I fully enforce the visiting rules. You don't like it, go to administration and complain.
I've seen too many well meaning people cause their head injured family members nearly herniate because they insisted on being at the bedside constantly, and if you are watching that family member, they are forever disturbing the patient and making their ICP's go off the chart.
Administration doesn't understand because they are as ignorant and the families that come to visit.
As far as I'm concerned my job is to care for the patient. It is that person's welfare that I am entrusted with. I am responsible only for that person. Family comes second. If that makes me heartless and cruel, so be it...........
renerian, BSN, RN
I guess it would depend on if they were cooperative or not and if they gave me room to work. I have had some be nasty that I called security to escort out and others who were just so afraid to leave they stayed out of the way. Maybe if someone sat down and talked with the person about their fears they would be okay. Sometimes people just are afraid the person will die if they leave.
I don't mind family members staying and for the most part, I find them more helpful than uncooperative. Of course there are always the exceptions to the rule, and then I call security to help me "explain" the rules!
One thing I do try to do early in the shift, especially with large groups, is to explain the whys and wherefors of visitor rules. Alot of it is cultural, but the difficult families are the ones with poor family dynamics to start with.....you know the ones....brother Joe ( who hasn't seen good old Mom in 3 years),doesn't want sister Mary ( who has been taking care of Mom all along) to know anything he doesn't know ....yadda yadda yadda........THOSE are the families I lose patience with.
If the family can follow the rules, like leavng when asked to do so, then fine. If not, call security.
Weak-kneed supervisors need to learn to stand up to higher management in order to support and protect "their" nurses. Otherwise they are only doing one-half of their job (the top-down part).
Family members who stay and are of some assistance are welcome. If they don't help but don't get in my way, fine. One person and one person only and no rotating in and out through the night. If they are hovering over the patient, panicking every time the patient grunt or groans or snores;if they are constantly on the call light wanting service for themselves, they will be asked to leave. If asking isn't working, the supervisor is notified and they are told to leave. If that doesn't work, security is called. Last resort, local police. I actually had a family who wouldn't leave and called administration and complained about the night shift nurse who tried to make them leave. She was not allowed to take care of that patient or work in the hall where he was for the duration of his stay. They kept me as the day shift nurse because the daughters liked me. They were constantly hovering over the poor man. Kept calling me in the room. "Something is wrong with Daddy's hearing". Daddy heard me fine. He just tuned them out. Finally something really did happen. He spiked a temp and his heart rate jumped to 160. They came to get me and there were ten people in the room. Then I put my foot down. I kicked them all out so we could work. I let the wife back in and told her that her family was part of the problem. She needed to tell them to leave so her husband could get some rest. She told them. The daughter called administration on me. Complained that I let him suffer. I showed the administrator my charting and told him that I don't treat my patients to please the family. And I can't treat a problem that isn't there. He backed me up and all but the wife left. And she stayed out of the way.
I still am flabbergasted at the family members who sleep in room, expect maid service, and use the call bell for a coke for themselves. It blows me away. Then, when mamma wants the bedpan, this same lazy-@$$ will hit the call bell and then stand in the door, tapping foot and looking at watch......grrrrrr
dawngloves, BSN, RN
I'd call security, but usually don't have to because they make rounds and tell folks to leave on their own.
Just don't fool yourself into believing that having a family member present at the bedside lessens your legal liability if he DOES pull out that NG tube, a line, iv lines, etc. Just ebcause they are there doesn't mean they are legally responsible!
We too have those who say, well you let her stay why can't I. We also have a ton of aquaintences who come in and call for patient info and get really huffy if we don't tell them anything. If a patient is dying and not a full code, I am all for the family being there. If they want everything done and the patient is circling the drain, the visitors only get in the way. They also lie thru their collective teeth and claim to be family members. Had one woman in her late 20's or early 30" ask me what room her mother was in. I said what is her name. She said I don't know. I said if you don't even know your "mothers" name you don't need to visit her. Buy-Bye now! Anyone else get the sightsee'rs?
I agree that if visitors are difficult, we need to call security. It is so much easier if we all follow the same visitation regulations. I hate asking a family member to leave (when visiting hours ended 2 hours ago and the roomate is exhausted) only to hear "yesterday the nurse let me stay all night"
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