Friday, February 3, 2012

Against Open Visiting Hours in Hospitals

I will preface my comments by saying that I do believe in open visiting in Pediatrics, where no nurse can care for or comfort a child as well as its mother. I believe in very liberal visiting hours in Adult care, and open visiting when a patient is dying or there are other special circumstances.
If my patient has been married for sixty years, and has never spent a night away from his wife, I will not be the person who separates them. She is welcome to a cot and a tooth brush and a towel and washcloth.

But let us consider open visiting for everyone, all the time, for it is now the law of the land and happening everywhere. And I can speak to this ,for I recently left a hospital that had open visiting before it was a mandate.

Like all modern American hospitals, this one was a Petrie dish of unholy bacteria-VRE,MRSA,Clostridium Difficile,Acinetobacter. No number of reminders could keep isolation gowns on the families. Toddlers spent the night on cots with their mothers. Babies crawled on the patient's beds. The window sills looked like Mini-Marts- Six packs of Doctor Pepper, bags of cheetos and oreos, twizzle sticks, candy bars, half-eaten takeout in styrofoam boxes. One older man had moved a Coleman camping refrigerator into his wife's room. Many nights I felt as though I was nursing in a motel. And some families, mistaking it for one, grew angry when the lights had to go on when the nurse needed to check the patient, or the IV pump. Their cots might be cheek by jowl beside the patient's bed, making attempts to reach the suction catheter or the tube feeding pump hazardous. I cannot fathom how nurses in the small rooms in an ICU will be able to work.

Nurses argue that open visiting will disturb the patient's rest. Probably true. That it will sacrifice the privacy of other patients. Again, probably true. That it will make a mockery of Infection Control. Undeniably true.

Yet there are other dangers and other problems. In today's world , where hospitals provide free wireless to families with computers, a nurse may find every move she makes questioned and second guessed by people who do not care that they are distracting the one person they should never distract- the person who holds their loved ones well being in her hands. "What is that you're giving him", they ask. "How do you spell it? I don't want you to give that till I look it up."

A nurse I know who worked in a local trauma unit had a family tell her "Don't try to pull anything over on us. We watch all the medical shows."

Doctors can walk or run away, for they can always claim they have somewhere else they were supposed to be five minutes ago. Indeed I once saw a heart surgeon so averse to talking to his patient's family that he ran out the fire door and down the back steps to the loading dock to avoid them. Nurses cannot do this. We are omnipresent, expected to patiently answer the same questions over and over, to be endlessly available, always pleasant, always understanding, always presumed to have unlimited time.

Instead we are distracted and harassed by people and circumstances. Interrupted while trying to
prepare and give dangerous medicines. Interrupted when we need quiet and peace to think and make decisions. Interrupted by people who think Web MD makes them an expert on the level of a doctor and nurse.

Perhaps we should take open visiting to the next level. Why not allow the family in the Operating Room? Perhaps the surgeon could consult them on what size heart valve he needs to use. Maybe they could go to the Cardiac Cath Lab so they can tell the cardiologist how many vessels he needs to stent.

Absurd? Of course. But remember that in some hospitals families are allowed to stay when a patient is getting CPR and being resuscitated. All nurses know how violent this can be. Broken ribs, ruptured pulmonary arteries with so much blood spraying that the Intensivist has to block his face with a sheet. "This is absurd", he says, horrified at the pointlessness. Would he be able to stop, to do the decent thing, to say what needed to be said with a distraught family present?

Hospitals are serious places, not reality shows where everyone gets to act.


Out on the prairie said...

I hear you on too many around.When I worked in a surgery family many times stood right outside the door wanting updates and info. Little could we offer, let alone want to share, not knowing just who they were.Working with psych patients now, I am amazed when family doesn't want a med given.

troutbirder said...

Yikes. And this is the "law of the land". After my spouses recent double mastectomy I asked the Mayo doctor why she would go home the next day. The answer seemed to be that hospitals are no place to get any rest and (your point) their full of bad germs. Yikes...