What’s hot: Can we be flexible with hospital visiting?

Nursing Conversation Starter written by Emma Heron 

When people become hospital inpatients, they need to be “visited”.  But visitors to hospitals are subject to different rules; some hospitals even having completely different visiting hours across their departments and wards.   Do we ensure visitors are aware of the expectations we have?  Are there examples of innovative ways to do this?

The structure of wards and departments varies significantly.  Some have single rooms; some have 4 patients in a bay.  For day services it may be several people sitting around a waiting area.  This makes the task of rule-making more complex as it changes the rationale for the boundaries set.  There may be a desire to protect other patients in a bay from always having conversations going on around them so a set a visiting time of 2-4pm with only 2 visitors per bed is in place.  And patients may get tired and this needs to be balanced with the need for company.  The purpose of the visit may well affect the amount of energy it might either sap from or give to the patient, thereby positively or negatively affecting their recovery and experience. How do we ensure the privacy of other patients on the ward, as per the NMC Code of Conduct (Standard 5), when visitors are present?

Visitors are an important part of the experience of being a patient.  Green et al (2012) have identified the value in having visitors for the older patient which include “a release from boredom, keeping in touch with family and social life, news of the world outside the institution, reassurance you have not been forgotten or abandoned, showing others on the ward you are not alone.” How do we support those patients who do not receive visitors either because they do not have anyone able to physically visit them or because a ward is closed due to infection?

Thoughts from the profession 5 years ago were captured in a #WeNurses chat hosted by Wendy Sinclair. The conversation had very strong opinions voiced on both sides; now that open visiting is becoming more popular, is it time to revisit the issue and see how (or if!) thoughts have changed?

Next week I am taking a close family member to hospital for a procedure.  I was surprised when I realized the impact of visiting a Trust with defined times I would be allowed on the unit. This prompted me to try and find out other’s views on visiting hours on Twitter. I need to get my relative to the hospital that is 30 mins away by 7.30am, whilst trying to get 2 children, one that is disabled, ready for school.   I now don’t know if I need to drop off then hang around for hours trying to entertain myself while my relative is sat equally bored. My stress levels are already rising, and I feel like I cannot plan the day.  I am not alone.  Other twitter users have shared how they have also had to balance hospital visiting with other caring responsibilities.

The contrast with my experience of being a visitor to a paediatric ward is stark. Following a late arrival at A&E, my presence overnight was not only assumed but welcomed.  A small kitchen with basic tea and coffee making facilities brought relief to me at 11pm and a chair that extended into a place I could lie and rest next to my child was by the hospital bed.  I administered his usual medication, scattered through a packet of crisps and yoghurt kindly provided by the nurse on the ward.  I was a partner in his care and appropriately so.  Are there lessons that can be learned from this model that can be taken through into an adult ward?

Rigid visiting schedules have various rationales behind them.  I would like to think they have the patient at heart such as wards that support John’s Campaign which seeks to uphold the rights of people who had dementia to have a close family member with them during a hospital stay.   As nurses, how do we balance the needs of patients to see their family member/ visitors with the needs of those visitors and also, the needs of the ward e.g. intimate care/ examinations where it is not always appropriate for visitors to be present?

• Are we willing to be flexible sometimes? If so, what circumstances are we willing to flex for?
• How do we support those patients who do not receive visitors either because they do not have anyone able to physically visit them or because a ward is closed due to infection?