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The case for patient-centred visiting hours

Strict and inflexible visiting hours are at odds with patient-focused care

Strict and inflexible visiting hours are at odds with patient-focused care


Picture: iStock

Earlier this year, my mum was admitted to hospital for major surgery. This was a scary time for me and my family but having spent the past two-and-a-half years studying to be a children’s nurse, I thought I could handle it.

Having spent hours working on hospital wards, surely I understood what being a patient or family member on an inpatient ward involved… didn’t I?

On the day of my mum’s operation, I went to the hospital with her. She was taken down to theatre and I was given the name of the ward she would be taken to after surgery.

I was then sent on my way with no idea how long the operation would take, when I could see her or how I would find out if she was alright. It’s okay, I thought, things must work differently in adult nursing.

Visiting hour

I spent the day feeling anxious, worrying about my mum. When I phoned the ward that afternoon, I was surprised to discover there were stringent visiting hours – relatives were allowed to visit between 7pm and 8pm only.

‘But I’m her next of kin and I’ve got two siblings with disabilities to put to bed at that time,’ I said pleadingly, but I was told I had to stick to the rules. I accepted this, reminding myself again that things must work differently in adult nursing.

I pushed my luck a little, arriving at the hospital slightly early for visiting hour. When I got there, I was confused to see a line of assorted relatives standing outside the door of the ward, waiting patiently to be allowed in by the ward sister.   

Old-fashioned

At 7pm on the dot, the nurse in charge unlocked the doors and let the rabble in. It felt a bit old-fashioned, but it was okay – things work differently in adult nursing, right?

That first evening after surgery my mum was not well. Oxygen dependent with drains, catheters, lines and drips, she was considered a high-dependency patient. I sat with her for the full hour, expecting to be allowed to stay a bit longer, but this was not the case.

When a bell rang at 8pm, it reminded me of primary school, where the teacher would ring the bell to mark the end of playtime and everyone would sigh in disappointment. The staff glared at me until I left, making me feel like a nuisance who was in the way. The rabble who had descended on the ward were escorted out as quickly as we had arrived.

Paediatric services lead the way

On the way home, feeling confused and a little sad, I had a moment of realisation. Things may have been different on this ward, and this might even be common practice in adult nursing, but it wasn’t okay.

As advocates for ‘family-centred care’, paediatric services have long been the leaders for change regarding ‘open visiting’ – allowing family members to visit their loved ones with greater flexibility and frequency in line with patient-centred care.

Since the 1950s, thanks to the work of psychiatrist John Bowlby, significant moves have been made in paediatric nursing to encourage the parents of sick children to stay and participate in the care of their child while they are in hospital.

Open visiting should be encouraged

The evidence showed that children experienced less distress, recovered more quickly and suffered fewer attachment problems if their parents were allowed to come and go as they wished. Now it is universally accepted as good practice to encourage open visiting for close relatives of children and young people in hospital.

Rather naively, I did not realise this could differ quite so dramatically in other services. It was only after my mum was discharged that I stumbled across the work of Nicci Gerrard, the journalist and author who co-founded John’s Campaign.

Nicci’s father John Gerrard had dementia and died in 2014. She has since campaigned to allow all carers of patients with dementia to be allowed open visiting hours when their loved one is in hospital.

Better support for carers

The campaign was backed by former chief nursing officer for England Jane Cummings, who said in January 2018 that the NHS New Year’s resolution should be better support for those with caring responsibilities.

Although I wasn’t ‘caring for’ my mum directly, during her illness I was the main carer to my two siblings, and the strict and inflexible visiting hours enforced on her ward made visiting her challenging.

It would have made all the difference to know that my mum was receiving proper person-centred care, including a true holistic assessment of her and her family’s needs, especially regarding visits.

Patient-centred visiting hours

Critics of open visiting say that allowing relatives to visit whenever they want can disturb other patients, affecting their rest and interfering with the work of the nursing staff.

So if open visiting isn’t the answer, what about ‘patient-centred’ visiting? How hard would it be to ask on admission what would be most suitable for the patient and their family?

This policy could reduce vast numbers of visitors arriving at the same time, and if visitors were spread out through the day, maybe they wouldn’t be ‘in the way’ quite so much? It would also enable family members to participate in the care of their loved one, rather than just being spectators.

My intention is not to criticise hospital wards which still use strict visiting rules, but to encourage them to follow those who are leading the way, such as paediatric services, critical care units and John’s Campaign.

Maybe it is time to think beyond the patient in front of you and think about the family behind that patient too.


Beth Phillips is a third-year children’s nursing student at the University of Surrey

 

 

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