Your loved one is in the hospital and whether you are visiting them for the first time or for the 10th time, bad visitor etiquette is a little known pet-peeve of nurses. Being a super bedside visitor involves educating and arming yourself with some knowledge about nursing bedside care routines.
The patient bedside can be a busy area for nurses, doctors, and other health care professionals. In older hospitals the beside area was not built to accommodate visitors staying all day or all night. The open door 24 hour visitation policy was an afterthought only put into effect by hospital administrators in the last few years. The thought behind this is if patient relatives are happy, perhaps they may make a financial donation to the hospital in the future.
The official line is however, that family at the bedside make for better recovery outcomes for patients in the new era of patient centered care. In reality, only patients who are fully aware of your presence will have better outcomes. Nursing and other medical staff usually talk to sedated or unconscious patients and tell them what is happening as they may be able to hear even if they can’t respond. Regardless, some patients have only vague memories of this during the course of severe illness. They report hearing voices but can’t remember the conversations or who was speaking to them. Many patients do not remember a stay in Intensive Care at all due to the medications they were given to keep them calm and save their lives.
Nursing in general has become a service and is now tied to customer satisfaction. What would be easier than relatives having 24 hour access to the bedside area? Apparently nothing. This leaves nurses who are are task oriented in a bind. Many nurses like to periodically, but steadily do nursing duties for their patients, not group their tasks together. Grouping tasks together allow relatives to have extended visits before the nurse requests access to care for the patient. However, things may be forgotten or overlooked such as mouth care, eye care, turning the patient, or simply checking the patients skin or private parts to make sure they are not developing a pressure related bedsore. Instead the focus ends up on making sure medications are given on time or visible dressings are changed as needed so as not to disturb the visit.
As well, nurses often get asked a variety of questions many times by different members of the same family:
What are those pills for?
What does that beep mean?
You pushed a button on the monitor, did you change something?
He’s coughing, is something wrong?
His blood pressure was 132/74 and now it’s 115/60, what’s happening?
These questions can indicate curiosity, or that you don’t trust the nurse with what he/she is doing. For the nurse, answering such questions can be exhausting and time consuming. Instead of bedside teaching, they should be focused on taking care of the patient.
Being a super bedside visitor involves educating and arming yourself with some knowledge about nursing bedside care routines.
16 Super Bedside Visitor Tips:
- Be aware that nurses must turn patients who cannot turn themselves – every 2 hours as per hospital policy. Sometimes, this may extend to 3 hours if they are critical, or perhaps not at all if it is going to jeopardize the patients life. However, there is no harm is asking if it is time to turn your loved one yet, and stepping out of the room or unit so that care can be given.
- Eye care (eye drops to keep eyes from sticking together) and mouth care is also given as per hospital policy every 4 hours to patients who are unconscious. Unless, the patient has a breathing tube or some contraindication on the frequency of mouth care you can ask the nurse if they can show you how to give mouth care. Mouth care is essential in helping prevent the over proliferation of mouth bacteria that can lead to certain types of pneumonia’s.
- Ask your nurse if it is okay to stimulate your loved one. By this we mean, touching or massaging their hand or stroking their arm, and verbal cues. In some very sick patients this can be perceived as negative feedback and cause undue neurological stress on the patient. In others, stimulation can be reassuring especially when they are coming around and not as seriously ill. You can tell them where they are and why, and that they are being taken care of.
- If you meet your neurologically impaired relative with their wrist’s restrained don’t be alarmed. The wrist restraints serve as reminders for the patient not to pull out their feeding tube, breathing tube, intravenous lines, or any other devices they may have attached to their bodies. Unfortunately, if these devices get pulled out, they usually have to go right back in and cause undue discomfort to the patient. Ask your nurse if you can remove the restraints, but you will be responsible for making sure they don’t pull anything out.
- Do not administer anything to the patient’s skin or down the feeding tube without first asking your nurse. Also do not touch the buttons on the IV pumps, ventilators, or other machines unless the nurse gave you instructions on which ones to press. Do not overly concern yourself with alarms, and beeping noises, as nurses know what they represent. As well, do not change the position of the hospital bed without asking.
- Do ask if you can shave your male relative (if that’s their preference) with the razor you brought in, or comb their hair with their favorite comb. Do bring in their favorite body wash, deodorant, toothbrush, and toothpaste. Ask your nurse if you can wash your loved one’s hands and feet (body parts that are frequently overlooked by inexperienced or busy nurses). Also, most hospitals will allow you to bring in their favorite music through earphones or a TV if there is a cable outlet. Here are some tips on whatelse you should bring.
- Bring pictures from home and make a poster board for your critically ill relative. As they recover they will enjoy being reminded of the people they love. Perhaps keep a ICU diary as they start to become more aware of their ICU surroundings. Read up on Post Intensive Care Syndrome (PICS) and the sources to seek help from if it occurs.
- Give your nurse not only the physical space to do their work, but also the mental space to think and do his/her assessments. It is very difficult to be a chatty nurse when the patient is very sick. Such a patient requires a nurse’s full attention, and it can be difficult to focus properly if a family member needs attention as well. If you need support have another family member or friend at the hospital that you can talk to. Also, you can ask to speak to the hospital Chaplin for spiritual counsel.
- There are no more than two visitors allowed at the bedside at any one time. One is actually a preference of nurses, however for short visits two people can be accommodated. Please do not crowd the room with more than two visitors, because it is against hospital policy, and most nurses are not comfortable going near the bedside with a multitude of visitors.
- Please do not bring food to eat in the room of the very critically ill. Not only may the smell trigger nausea and vomiting in the patient or other patients, but it is impolite to be eating at the bedside when in most cases a mess will be left behind for the nurse to clean up. A non- alcoholic beverage is acceptable.
- Please do not sleep in the bed with the patient. Nurses cannot care for your loved one while you are in the bed with them. Also, sleeping on the floor of the patient’s room is not advised. Both scenarios are not only inappropriate, but patients who are critically ill have difficulty fighting infections from any source including yourself. You may also pick up germs from the patient or the hospital floor. Hospital beds and the room are unsuitable for this type of sleeping arrangement and will not result in the best outcomes for your loved one.
- When a patient who has been stressed and in pain is finally sleeping do not wake them up with touching or speaking out loud! Visiting quietly will be valued, whereas making your presence known, may lead to to further stress for the patient and the nurse who now has to give additional medications to keep them calm. Talk to you nurse to find out if your visit should be at another time.
- If you need an update on tests and procedures you will have to ask your nurse if you can speak to a doctor. Nurses can give you a general update on how the patient’s day or night is going (or has gone) only. Nursing as a profession cannot divulge the outcomes of tests and procedures. Occasionally, a family meeting will be put together by the doctor for the substitute decision maker and other family to discuss the course of events and the prognosis for the patient. Please make sure to have all relevant parties present at the appointed time and date. Also, if a translator is needed let the nurse know in advance of the meeting.
- Please leave the hospital periodically not only for your own well-being, but to get some rest away from a difficult situation. Your psychological and emotional health is also important and you can’t be at your best for your relative when they start getting better if you are sleep deprived or emotionally drained. Continued sleeping in the hospital crisis room or common areas is not endorsed. If you need to stay close to the hospital ask your nurse for the names of lodging places that have discounted rates.
- You can call in 24 hours a day for a telephone update. Just make sure to tell whoever answers the phone – your name, the reason for your call, the name of the patient, your role, and the room number. For example “hello my name is Michael Flynn, I’m calling about Ryan Flynn’s in bed two, I’m his father and I’d like to get a telephone update from his nurse please”. If the nurse is unavailable to speak with you, ask for their name and when you should call back.
- Not every nurse is going to be your favorite. and it’s certainly not
going to help to be critical and suspicious of the people who are helping your loved ones heal. Your primary nurse for the shift will be there for 12 hours. Unless, there is serious discord between you and the nurse, you should try to get along with him or her and reserve judgement. If there’s an issue you can ask to speak to the “Charge Nurse”, however nursing assignments once made are very difficult to change. Usually personality conflicts with the nurse is just that, and can be resolved fairly easily. It is not usually a sign of their professional knowledge or competence.
In conclusion, if you’ve been an observant bedside visitor you would know that nurses absolutely love treats. Whether, it’s Tim Horton’s Timbits for the whole unit, or a coffee or tea for the nurse taking care of your relative, they appreciate the thoughtfulness of the gesture. So, in order to become a super bedside visitor you’ll need to follow the above 16 tips, obey other visitor hospital policy and procedures, and get your nurse or nurses a treat once in a while.