Flexible Visiting – Who is really the visitor? by @KeriVannuil

As a staff nurse in ward 12 acute stroke/ respiratory, my day is governed by time- medication rounds, breakfast time, personal care, observations etc the list can be endless. There is one time of the day that can strike fear into the hearts of many medical professionals and that is VISITING time!

Why is it seen as such an inconvenience on our day?

Why do we feel we don’t have sufficient time to spend with the patients and their loved ones giving accurate information about their current treatment plan?

And why do we feel we won’t be able to get on with the other tasks requiring our attention if the visitors are present?

Last year a member of my family was admitted to DGRI and this is when I became a visitor for the first time. At the time the trust was operating an open visiting policy from 2pm to 8pm. As a nurse I thought that was ample time for anyone to fit a visit in to their loved one. However I soon discovered that if I was on a late shift from 1.30pm until 9.30pm I was not going to be able to spend as time with my relative as I would like.

How do people on shifts fit everything in? Surely there is a friendlier approach to visiting?

Following the recent person centred care collaborative I have been thinking a lot about DGRI’s previous trial of “open visiting”. Having listened to experiences of other colleagues within NHS Scotland I was embarrassed to say we do not have open visiting.

During a trial of open visiting the wards were open from 11am which meant we did not have an influx of visitors at 2pm which was usually our busiest time. The early visiting also meant we could catch up with relatives and discuss care plans and discharge planning.   Since having our new open visiting times we have unfortunately gone back to the influx at 2pm.

As a ward we are very good with palliative/ dementia patients at saying visitors can come any time if it’s what they want or need. But this surely must happen for every patient every time by every nurse to be truly person centred?

In our area we did a 3 month pilot of flexible visiting. The aim of the pilot was to allow patients to have their visitors come in at a time of their choosing and allowed the visitors to come at a time which fitted in with them, even to just say a quick “Hello” before or after work. 

Goal-All patients should be able to see their loved ones/ visitors at any time of their choosing.

The aim of this trial is to assess the impact of unrestricted visiting on the following areas of patient experience

                                   – Patient Centred Care

                                   – Reduction in complaints

                                   – Patient experience

                                   – Staff experience.

                                   – enhanced access to MDT

                                  – enhances professional behaviours.

                                   – Creates a transparent working environment

 Keri 1

 

I know that many people will have their reservations about this trial but I would hope those people would put themselves in that patient or family member’s position. As members of a profession that work shifts we should also be able to understand the need for flexibility for each patient and their loved ones.

Getting the information right for patients and staff is crucial to the success of this trial and if the information uses a common sense approach I would hope this will give staff the confidence to get on board, take ownership and make this a success for everyone involved.

As a nursing team we decided to begin the trial on the 1st of November 2014 until the 5th of January 2015.

Keri 2The most challenging aspect of the flexible visiting was actually the amount of time it took explaining it to the patients and visitors. As this was a small scale trail the only information available was the posters and booklets produced by our team.

 

The flexible visiting was very well received by patients, visitors and staff.

Staff commented that it reduced the influx of visitors at 2 pm and meant the staff could then spend more time updating relatives and answering any questions they had throughout the day.

During the trial there was no incidence of confrontation when relatives were asked to step out while personal care was carried out or when privacy was required by the doctors.

After the trail a discussion was held with staff regarding their experience and also patients and relatives. It was felt flexible visiting did not have any detrimental effect on the daily running of the ward and it enhanced patient and relative experience. It also reduced the workload at peak times on nurses as they were able to speak to visitors throughout the day

As a team we made the decision to make flexible visiting standard practice within ward 12. I would encourage all wards to approach this with an open mind and give it a try. With the new build in a few years it will be even more important to be flexible with visiting.

As a medical team we are just with the patient a relatively short time so I guess it’s really us that are visiting.

 Keri 5

Keri 4Keri Van-Nuil is a Staff Nurse on Ward 12 and a Capacity Manager at Dumfries and Galloway Royal Infirmary

5 thoughts on “Flexible Visiting – Who is really the visitor? by @KeriVannuil

  1. Fascinating stuff, and isn’t it what a lot of us staff do when we have someone to visit, whatever the actual visiting hours. If there was one piece of advice would give to colleagues it is that if you do anything that affects a patient or relative, you should try to imagine what it feels like from their point of view.

  2. In some countries the relatives are expected to come with the patient and feed them, bathe them and stay with them. I think flexible hours visiting is a good idea. However, excessive visiting to one patient can cause tiredness and not allow the patient sleep/nap times to help heal. Hospitals are noisy places at the best of times and open visiting is a comfort to patients feeling scared in an alien environment. . I hope other departments consider doing the same thing – with the proviso that if a patient needs rest -then some limits are set for that patient.

    • Totally denies the patient centredness and treats patient and family like children, imho. The patient has a voice and can tell ppl not to come, being in hospital is one of the most lonely places to be – lots of time to sleep, nap etc. Families often organise themselves on a rota of visiting. What is more disturbing to patients rest time is to be constantly disturbed by phones ringing, trolleys, alarms on ivs, obs rounds etc etc, as you do mention the ward environment is not restful. Frankly, (as an ex clinician myself) focusing on visiting time as the problem with pt rest in hospital is an old fashioned myth and should have been exploded years ago. What’s more calming to a patient -a visit from someone who chat with them and gossip or trying to sleeep but can’t because a Dr is on the phone in the corridor next to your bay and is giving an indepth handover about a pt, which included all of his personal details, diagnosis, current issues?

  3. Helpful reflection on how if we put our patients first then decisions around how we organise care become obvious- thanks for sharing your experiences.

  4. Hiya Keri, interesting blog. I think your trial may prove to be more successful in looking ahead to the new build DGRI. I have concerns for those vulnerable patients, lonely and isolated in 100% single rooms, increased visiting times would certainly reassure myself if family were more present. Keep up the good work and get those beds emptied.

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