A Community of Exceptional Nurses
Mobilizing patients early is critical to recovery, but the logistics make it incredibly difficult. The photograph depicts what could only be a floor patient.
Where are the ventilator, the IVs, the drains and everything else that, along with the patient, require a small army to mobilize? Our hospital tried mobility teams, but the program died because there were numerous back injuries and finding people for the team was difficult. Now nurses struggle alone to provide early ambulation, and it’s literally an uphill battle.
The Practice Alert on family visitation should help every team member visualize the importance of family centered care.
I encourage AACN to retitle the practice alert as “Family Presence in the Adult ICU.” In a 1994 Dimensions of Critical Care Nursing editorial titled “Families Are Not Visitors in the Critical Care Unit,” I told two stories. The story of Gail, who saved her fiancé’s life because the staff made her part of the care team, and my mother, who performed CPR on my dad and wasn’t allowed to see him for hours after admission.
I am encouraged by the progress we’ve made, yet discouraged to read in Facebook age-old arguments and beliefs about incorporating families into a care plan. Family members are not visitors! If a care environment is truly patient-family centered, their presence will always be valued as important members of the team.
Who knows a patient better than the person they designate as family? Whether functional or dysfunctional, they must participate in team planning to ensure a patient has the best outcome.
Nancy Curtis Molter, AACN Past President
San Antonio, Texas
We started limited visitation because several years of open visitation jeopardized patient care and recovery, and invaded the privacy of other patients. We spent so much time explaining a patient’s needs and progress that it took away from our hands-on time with the patient.
No matter how many times we explained that someone was sedated so he or she could rest without feeling the endotracheal tube and ventilator, visitors would try to wake up the person, leaving us with an agitated patient. It works fine when we make exceptions, but limited visiting is a blessing to all our patients.
We’re a rural community hospital that tries to be very community oriented. When I started managing the six-bed ICU in 2000 we had visitation four times a day for 30 minutes. Of course, we made exceptions.
When we doubled in size in 2009, our chief nursing officer suggested we try a shared governance approach and focus on ICU visitation. I was very proud that the nursing staff and some physicians agreed it was time to change.
Based on the evidence-based data they brought, our visitation hours from 6-8 a.m., noon-2 p.m. and 6-9 p.m. allow families to stay with patients for several hours at a time. We make exceptions — visits at other times, all day and overnight — when a patient isn’t doing well or when we don’t expect good outcomes.
I’m sure some facilities have visiting times around the clock. It has been a journey for us, and it’s not over yet.
It reminds of visiting my critically ill sister when two nurses handled the unit’s strict visiting rules very differently. One nurse was the inflexible enforcer.
It made me extremely anxious because I felt I was letting my sister down. She wanted me by her side as her advocate.
Everything changed the next day when a different nurse let me stay in the room. She updated me about the plan of care and showed me how she was my sister’s advocate, too. What a difference!
I became calm and helped my brother-in-law make better decisions on behalf of our loved one. I felt safer when I left the hospital that night and slept well. I had confidence and trust in the care my sister received.
Linda G. Martinez
I’ve been the mom who was kicked out of ICU because of limited visiting hours when my son had cardiac surgery. By the time I was allowed back in the unit I was nearly wild with frustration and resentment.
Some nurses don’t realize families experience emotions like these. When I returned to work after my son’s cardiac surgery, nurses were critical if I let visitors stay at the bedside.
My experience emboldened me to challenge my unit’s team to remove visitation barriers. I told them my story and helped many see the other side, but for some it caused a minor riot.
After eight years of open visitation — I’m now the manager — team members still have a wide range of opinions. I remind them what it would feel like if their spouse, child, mother or brother were in the bed and they were sent to the waiting room.
We must try to understand and anticipate every behavior a stressed family might experience. We must hone our communication skills and adapt our practice to include families. Above all we must have compassion — I’m just saying.
Palm Harbor, Fla.
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