Jane is admitted to the hospital following a severe accident. Caregivers rush her to the ICU for an evaluation and ask her husband to stay in the waiting room. He tries to remain patient as the crowd and noise around him swell - children play, visitors talk, and others sit alone, weeping.
Time passes and he still hasn't seen Jane or spoken with anyone about her condition. He calls into the ICU and is told the physicians are placing a central line and the nurse will come for him when they finish.
In the ICU, Jane manages to answer the care team's questions despite being critically injured and in excruciating pain. But more than anything, she's scared and wants her husband with her. The physicians place the central line and her nurse finally goes to get her husband.
It's now close to 7 p.m. when visitors are required to leave the ICU for the patient handoff to oncoming staff who is working the late shift. The nurse knows she has to ask Jane's husband to step out in just a few minutes before he can return at 8:30. It's a difficult decision, but rules are rules.
In my 30 years of critical care nursing, I experienced this same scenario over and over again. It was so hard to ask families to leave when their loved one's condition was so critical. Our schedule was also difficult for family members who wanted to see their loved one on their way to and from work.
In 2012, we were asked to re-examine our ICU visitation rules. As the manager of the Shock/Trauma ICU at Intermountain Medical Center, I welcomed the idea of eliminating visiting restrictions and working to become more patient-centered. We knew some staff would welcome our changes and others wouldn't.
Several concerns came forward when we took our ideas to the nursing staff. They feared family members would interfere with reports and these interruptions could lead to important information being missed during handoff.
They were also concerned that families would hear private information about other patients. And they feared it would take more time out of their days and they'd be leaving late every shift. We listened to their concerns and decided to study them and gather data to determine how to follow up.
SEE ALSO: ICU Nursing and Family Anxiety
We surveyed nursing staff and patient families prior to eliminating visiting restrictions to measure perceived changes. Along with eliminating visitation restrictions, we developed guidelines to help staff orient patients and families to our ICU.
Intermountain Medical Center STICU Family and Visitor Guidelines
Our goal is to give you access to your loved one in this time of need as much as we possibly can. We understand that the healing process includes your love and support.
In order to provide the best care for your loved one, we ask for your help with the following guidelines:
- The ICU does not have set visiting hours - you may visit at any time. However. the nurse may ask you to step out of the patient's room when a medical procedure or certain cares are being performed. This is done for patient safety and privacy. The nurse will notify you when you can return to the room.
- After admission to the ICU, the nurse will seek to identify a FAMILY SPOKESPERSON to be the contact person between the nursing staff and family and friends. This partnership will allow the family best access to the patient---and more importantly, allow family to support the patient by joining us as part of the caregiver team. The family spokesperson will help by:
- Taking phone calls from family and friends regarding the patient's condition.
- Working with us to plan individual visiting guidelines for that patient.
- Please be aware that between 7-8 a.m. and 7-8 p.m., we have change-of-shift report. At these times the caregivers need to share clear and accurate information with one another --- information that is essential for the care of patients. We ask visitors to please limit interruptions.
- Visitors under the age of 12 are not recommended unless prior approval from the care delivery team has been obtained. There are many infections and germs that could be dangerous for children. Children also often have illnesses that could put our patients at risk.
- Cell phones may be used in the patient room, but please be respectful of your loved one and the hospital staff.
Nurse and Family Satisfaction
Staff and family were surveyed again 6 months after we removed visiting restrictions. Data showed our nurses perceived families were more satisfied without the restrictions and unrestricted visiting didn't adversely affect patient handoffs. Families were more satisfied with open visiting and our waiting room scores improved with no modifications to the room. The result of our work was published in the January 2016 edition of the American Journal of Critical Care.
Patients admitted to our ICU have completely different stories now.
Here's an example:
Stephanie is admitted to the ICU from the ER with severe sepsis. Her husband is allowed in the room when the handoff takes place. He's involved with the care team's assessment, and more than that, is considered an important member of our team.
The physicians decide a central line needs to be placed. They talk to Stephanie and her husband about the procedure and her husband requests to stay by her side when it's placed. This is accommodated and Stephanie feels more comfortable as the team does their work. Her husband and other visitors are invited to attend daily rounds with the care team.
Now during patient handoffs, Stephanie's visitors are welcome to remain at the bedside and the handoff takes place in the room at her bedside. Staff knows whom Stephanie and her husband would like present during this time because they have developed a patient-centered visitation plan. Their plan was specific that only immediate family could visit and all other visitors should remain in the waiting room.
James, who is a patient next door, likes all visitors to come into his room. Each patient and situation is different. We work with the patient and their family to develop a patient-centered visitation plan.
Evolving Hospital Culture
Open visiting has evolved over the past four years and is now part of our culture. We have purchased chairs that completely recline, which allow a family member to spend the night in the room with their loved one. We also allow families to be present for some procedures and participate in some of their loved one's care.
The bottom line: Our patients and their loved ones are happier and less stressed, they reap the emotional and often physical benefits of being close to each other - and our staff isn't inconvenienced and feels good that our patients are more satisfied. Our open visitation policy benefits everyone!
Lorie Mitchell is a nurse manager in the shock/trauma ICU at Intermountain Medical Center in Murray, Utah.