tag:blogger.com,1999:blog-1406547525301395071.post3525587607512127296..comments2023-09-19T04:20:38.429-07:00Comments on Status Iatrogenicus: Behind Closed Doors Lurk Proxy Wars: Is Visitation Really About Visitation?Scott K. Aberegg, M.D., M.P.H.http://www.blogger.com/profile/17564774546019869201noreply@blogger.comBlogger115125tag:blogger.com,1999:blog-1406547525301395071.post-38473847992395328842017-03-23T09:02:21.961-07:002017-03-23T09:02:21.961-07:00Like that would ever happen!!!Like that would ever happen!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-81055136755898053742017-03-23T09:00:25.032-07:002017-03-23T09:00:25.032-07:00THIS!!!!!THIS!!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-44327261589707685992016-06-06T05:32:03.538-07:002016-06-06T05:32:03.538-07:00 Beautifully said. Thank you. At the end of the... Beautifully said. Thank you. At the end of the day, we are all patients. <br />H.E. Butler III M.D., F.A.C.S. <br /> 757 377 7775 cell phoneHhttps://www.blogger.com/profile/01596213501702795592noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-86194514322734837082016-01-31T20:39:04.443-08:002016-01-31T20:39:04.443-08:00Just to add frosting to this cupcake, has anyone a...Just to add frosting to this cupcake, has anyone asked administration how they feel about this? Not that many of them would actually care. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-59889365935355168922016-01-31T09:37:03.420-08:002016-01-31T09:37:03.420-08:00This is anecdotal, granted, but aren't you gla...This is anecdotal, granted, but aren't you glad Dad "visited"?<br />http://www.nydailynews.com/news/national/texas-man-released-jail-siege-save-son-life-article-1.2474678<br />Anonymoushttps://www.blogger.com/profile/14779148922194647476noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-6466701753938644932016-01-30T22:03:14.227-08:002016-01-30T22:03:14.227-08:00"Instead of taking patients' families out..."Instead of taking patients' families out of the room for an hour here and there, maybe we need to get the nurses out of the room for an hour here and there, giving them much needed breaks from the chaotic ICU environment."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-9348658747024749922016-01-30T21:44:09.391-08:002016-01-30T21:44:09.391-08:00And this, from the Pastoral Caregiver above, is a ...And this, from the Pastoral Caregiver above, is a reasoned and cogent summary of the issues we all face. Indeed, I did not articulate it in the post, but Pastoral Caregivers, especially great ones like the commenter, can help achieve the holistic goals I'm describing in the post. Dealing with these grief-stricken families is best accomplished with a sincere devotion that is reflected in the assignment of adequate personnel support to deal with the issues.Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-18252076798637809202016-01-30T21:22:15.417-08:002016-01-30T21:22:15.417-08:00As a passive observer in the ICU and pastoral care...As a passive observer in the ICU and pastoral caregiver for patients and families, I have seen many of these situations and rebuttals, from admission to discharge. I have observed the complex professional relationships between physicians and nurses caring for a given patient while working tirelessly with families navigating the ICU experience. I have observed a few nurses taking unfair advantage of families in the name of medical care leaving families nervously pacing the waiting room with little forthcoming information. This, based on their perception of what is best for the patient. I have also witnessed families rushing the physician for updates before that physician had had a chance to check lab and diagnostic results or even lay eyes upon the patient. Unfortunately, some families have unrealistic opinions of their loved one's lifestyle (which may or may not have led to the admission) or even delusional idea's of treatment needed. Others come with their own diagnosis in mind and attempt to drive the treatment. I believe families in many circumstances enhance the care by providing pertinent information received over many years of treatment by various physicians. There are other cases where families interrupt the care of the patient by pulling staff away from the patient for hours of nonsensical discussion. Families often do not understand the demands on caregivers and lack a respect for their time in many cases. I advocate for families who just need to get into the room to see that their loved one is alive and getting appropriate care. I also advocate for them to get their rest, especially when an LTAC situation is looming and I sense that the family needs permission to leave and care for their own needs. My opinion on this subject rests on the sensitivities of the needs of the family, the care team and the patient. Unreasonable families keep me employed. I save time for the staff addressing the complex needs of families; some which we will never be able to satisfy, even when sending their loved one home when the patient was not expected to survive initially. I read the anonymous comments and realize that irrational and unreasonable families cause a great deal of stress to the professional staff, people that I feel an obligation to be present for as well. I am a realist and although as a pastoral caregiver for a number of years have seen the extremes on both ends of the spectrum. I validate the family and the care team. I also understand that there will always be a population of families and patients whose demands can never be satisfied. Staff respond with tighter restrictions in order to sanely work through their day trying to focus on what is best for the patient. Chaplains come in handy with needy families and can sometimes help them to navigate the admission. There are times that no matter what is offered, a lifetime of survival skills and poor coping strategies cannot be managed with any kind of liberal or managed visitation.Pastoral Caregiverhttps://www.blogger.com/profile/01604547700713449546noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-6820020686012027372016-01-30T20:35:13.946-08:002016-01-30T20:35:13.946-08:00Excellent update. We have been in our new MICU for...Excellent update. We have been in our new MICU for a year now. And that's a year of open visiting. Most days, it's not as bad as I expected. Other days, I'm hiding in the med room just to chart. Because a sitting nurse, who is actually charting, has plenty of time to fluff up a patient that isn't even hers. <br />Having bigger rooms with dedicated space for families helps. Knowing they can come and go as needed also seems to help. <br />But we still have to set healthy boundaries. Open visiting doesn't translate to you watching grandma's bronch or EGD. We, at the bedside, need to be empowered to set those boundaries. After over 20 years at the bedside, I have no problem with this but it's a learned skill and it takes practice. <br />We also will have 24 hr coverage in the waiting room. So that extra buffer for staff will also alleviate some stress from both sides. <br />Families are an important PART of the picture, but the patient is the whole picture. And they need to be the priority. Their needs come first.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-39850633627461974772016-01-30T20:34:47.196-08:002016-01-30T20:34:47.196-08:00 I was the Nurse for that pt with the very anxious... I was the Nurse for that pt with the very anxious wife and it was exhausting. There is reasoning to your madness. Well written!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-82886141594784266372016-01-30T20:34:23.345-08:002016-01-30T20:34:23.345-08:00Good stuff Scotty! I did not read through all 100 ...Good stuff Scotty! I did not read through all 100 plus comments but I would like to add, pts. need sleep ! Sleep is a great healer. When you have 6 family members standing over their vented pt and petting them saying" breathe mom breathe". Then they say wake up mom, open your eyes and we have them in an induced coma. Just saying.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-86125687693502954092016-01-10T17:57:38.554-08:002016-01-10T17:57:38.554-08:00I have it on confidence that at least some of the ...I have it on confidence that at least some of the nurses in the "studies" used to support open visitation do not feel as though they are at liberty to disagree with the avant-garde which is pushing this "agenda". If that is so, then the entire research enterprise may represent one giant Hawthorne Effect demonstration. Agenda yields policy yields "research" to support the former. Junk science.Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-44798925859027134502015-03-22T13:54:09.687-07:002015-03-22T13:54:09.687-07:00Story: Family of 5-8 staying in small Icu room fo...Story: Family of 5-8 staying in small Icu room for 3 days have brought in many personal belongings, toiletries, clothes, blankets, books, games, food (including trash from food and drink) and have strewn it all over the floor. I clean it up, and explain the infection risk this poses. They put their stuff all over the floor. I ask them to leave the room for re intubation and I got my butt reamed out. I was very nice and listened, offered understanding of their stress and apologized they they were unhappy. I had to leave the room because the yelling would not stop. This family told me I should be taking temperatures more often, demanded to stay in the room for all procedures, and by their continued interence in care made it impossible to get things done in a timely manner. Don't get me wrong, I am all for patient and family centered care but there is a point where the family becomes a hazard for infection AND for the nurses mental health but when no one says no before you then you become the bad guy. Hospitals, in their quest for better HCAPS, have thrown common sense out the window and cowtow to these horribly behaving families. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-20927097717698094962014-09-27T11:58:34.770-07:002014-09-27T11:58:34.770-07:00In some, perhaps even many cases, it appears to wo...In some, perhaps even many cases, it appears to work, because visitors are thoughtful, helpful, and mindful. Yours appears to be such a case. Unfortunately, like so many things in life, the thoughtless, disruptive, and mindless in society ruin things for the rest of us. Even in a closed visitation ICU, I'm sure you would be accommodated - unless the administrators and nurses there were thoughtless, dismissive, and mindless. I wish your family the best as you negotiate these trying times.Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-75171393617033171602014-09-27T08:28:41.995-07:002014-09-27T08:28:41.995-07:00I am a wife and my husband is dying in ICU. I am h...I am a wife and my husband is dying in ICU. I am here a lot and I stay out of the way. I give him water and. put his head up or down and put him on the bed pan so he doesn't have to call the nurse. When i come he finally relaxes and sleeps peacefully because he knows i am there. I can tell him what is beeping and why so he doesn't worry. I can see that too many visitors would be disruptive but why would a nurse not want this help and comfort from a loved one? This ICU is 24/7 and it seems to work.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-46235246494858184802014-03-15T13:13:41.071-07:002014-03-15T13:13:41.071-07:00Someone should seriously look into whether open vi...Someone should seriously look into whether open visitation units have a higher frequency of aspiration pneumonia caused by families grieving too many water swAbs sargehttps://www.blogger.com/profile/14582415856684023846noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-84450386317547793322014-03-15T13:05:34.176-07:002014-03-15T13:05:34.176-07:00Some die as a direct result of crazy families dist...Some die as a direct result of crazy families distracting nurses from their jobs. Visiting is best done at the nurses discretion. sargehttps://www.blogger.com/profile/14582415856684023846noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-62543338259874772692014-03-04T13:58:35.860-08:002014-03-04T13:58:35.860-08:00The family is absolutely paramount in the recovery...The family is absolutely paramount in the recovery of the patient. How are you supposed to get their buy in to help keep the patient on the treatment plan you have prescribed if you dont have someone to help them stay on track. Exclude them by forcing them into the waiting room is a way to certainly not get their help. The family is also a great advocate for the patient. I have coded numerous people and when physician wouldnt go talk to the family because they "knew" the family wanted to continue resus .... then they finally talk to them and the family stops the code. RNs and MDs do NOT always know what the family would want or what the patient would want. We are to advocate for them and who knows them better than family. The family should be there during their care ... wouldnt you want someone with you? Im an advocate for them being present during codes too. They arent as critical as you would think. They actually leave with a better knowledge that everything was done even though their family member passes away. I know for one I would want my family there even if its my last moments. I dont know the MDs or RNs ... my family knows me and Id feel better knowing they are there. A lot of this is fear that the patients would sue but we have to get over that fear and deliver the same care in front of the families. Answer their questions ... they are scared for their loved one. When you forget the family or exclude the family you should stop practicing.Anonymoushttps://www.blogger.com/profile/14875724146927207142noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-88861846714193245142014-02-27T07:00:29.121-08:002014-02-27T07:00:29.121-08:00The problem isn't the family visitor who sits ...The problem isn't the family visitor who sits and holds their loved ones hand, I venture (based on personal experience) that if you aren't in the way and are respectful of the nursing staff and what they are attempting to accomplish, you'll be allowed to sit there as long as you want (even against visiting policy). The problems<br />are the families that don't get it and feel that the ICU pt's room is the place to hold their family reunion and reconnect with people they haven't seen in 20 years.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-89702939193400029922014-02-27T06:45:50.967-08:002014-02-27T06:45:50.967-08:00Well said. Our hospital now has us tripling our pa...Well said. Our hospital now has us tripling our patients, if they feel that one pt is "less acute". Just because they are less acute doesn't mean the paper work is less. Often because they aren't as ill also means there needs may be more ie: they need to be fed,<br />need at least 2 people sometimes three to get them OOB and ambulating, since they are in a mobility program. (Try finding help when,half your staff is tripled). They admonish us for working past our shift end trying to get the paper work done, because we have made the decision that patient is first and paperwork is 2nd.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-55653675262057576602014-02-27T06:38:42.898-08:002014-02-27T06:38:42.898-08:00As an ICU nurse of 37 years, that has worked in va...As an ICU nurse of 37 years, that has worked in various regions of the country.I can say that there are some people that can not be educated. I spend time with families explaining equipment, treatments, medicines ,etc, just to come back the next day to do it again. I have told them if the curtain is closed, it means we are trying to provide privacy for your (mother , father, brother, son, enter appropriate term) while a procedure is going on. Inevitably family members will just enter as if nothing is occurring.. I have told them "Dad needs at least an hour of rest in the afternoon, after his morning of tests, PT/OT, dialysis, just to have them come in with family, friends and neighbors, and the pt gets no downtime.. I've asked them to please keep visitors 2-3 at the bedside, with an explanation why, (limited space, severity of pt's condition) just to have them complain to my boss that I am keeping them from their family. I've explained to families of pts with head trauma and ICP's why its important to decrease the amount of stimulation the pt is receiving, only to enter the room to find tv blaring, and 8 people holding 4 different conversations over the pt. These are the people who make the job difficult. Depending on where you work, you may only see a few of them or you may have a lot of them.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-88477257406991292472014-02-24T14:15:05.870-08:002014-02-24T14:15:05.870-08:00OMG? if the family "stand back and rest thei...OMG? if the family "stand back and rest their curiosities" you really think it would be safer? Less accidental mistakes? You are a killing machine and worse the kettle calling the pot black (egotism). Patients don't come to your ICU to be honored by your "trained expertise" they come to see you because they would die if they don't. And you think because you have the upper hand of "training" you don't have to answer questions? Or you are SO BUSY your job wont get done? Like you are doing it now? Do you know how many people die in hospital care due to medical mistakes? Really, someone needs to strut around ICU and prevent errors!!!!!!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-91120023350163635592014-02-24T13:51:47.027-08:002014-02-24T13:51:47.027-08:00Lack of reimbursement? "the hospitals don&#...Lack of reimbursement? "the hospitals don't get paid" That is 1% percent of Medicare’s regular reimbursements not private insurance reimbursement. Do you know how much your hospital CEO is getting paid? The average compensation was approximately $600,000 per year, though this varied widely. CEOs of small rural hospitals earned salaries and bonuses of just $118,000 a year, while those at the largest urban teaching hospitals earned on average nearly $1.7 million per year. And some CEOs earn considerably more than that. Now compare that to 1% of medicare reimbursement or the whopping 2% for 2016. Wow, you have the right perspective at least you think you know where the money is. No problem as long as you get your check, let me guess you are one of those "I just work here" nurses. <br /><br />Also for your information the questionnaire is not based on the call light but are the questions: Did the doctors and nurses communicate well? Was pain well controlled? Was the room clean and the hospital quiet at night? The surveys go to younger patients as well as Medicare beneficiaries. The surveys also ask patients to rank their stays on a 10-point scale, and Medicare will credit only hospitals that receive a 9 or 10.<br /><br />Just so you know, so when your CEO has that hospital wide announcement that your salary is being decreased because of poor customer service you will know what that rich guy is talking about!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-65563497245200429782014-02-24T13:13:00.215-08:002014-02-24T13:13:00.215-08:00Can you not be direct and caring and ask the famil...Can you not be direct and caring and ask the family member to get their own ice water? Or respectfully tell them as soon as you can you will grab them the ice water? It is the biggest Myth that every minute in ICU is critical. And the biggest myth that medical personal do not have the time to fulfill obligation to respect and teach and care for who they are designed to care for. All the examples of "problems caused by open visitation" wouldn't happen at all if the nurse had created the rapport and education in the first place. I wish the man who originated this blog and all the complainers would have to take a dump on a bedpan in front of 4 strangers with the door open to 30 more while keeping their leg straight due to an arterial line, because it would have a profound effect on what you really think you are capable of.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-24429252876903886212014-02-24T12:56:53.674-08:002014-02-24T12:56:53.674-08:00You rock Debbie Bohn!!! Thank you for the testimo...You rock Debbie Bohn!!! Thank you for the testimony that has been something I have observed over the last 18 years of bedside nursing! You as other family/loved one are the only true CONSTANT in the patients life. You have the biggest vested interest in your family getting better. ICU nurses as a general "rule" like to control their environment. This blog is a composite of feelings and fears of nurses who see family members being a threat to caring for people in ICU. When in reality the family is your best most reliable resource and only in RARE/unusual situations are the relationships so dysfunctional that it is actually threaten care of the patient. In 18 years of full time bedside care I have seen that about 5 times and it is easily resolved with designed limits for the patient, not the nurse. The current culture has not grasped the importance and value of making the center of care the patient and family. Healthcare has come a long way but this blog demonstrates some of the barriers in the way. Anonymousnoreply@blogger.com