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

 

 

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 1^st of November 2014 until the 5^th of January 2015.

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

Abuse of the Body – Person-centred Care by Dr Ewan Bell

“Abuse of the body” barked the Orthopaedic Consultant at me and my mum. I was a quiet, shy, under-confident 11 year old boy, who had just got into the Under 12 Scotland Gymnastics team, when I noticed a lump on the left-hand side of my left knee. A cyst on my cartilage, apparently all due to me “abusing my body” as a gymnast. I needed an operation I was told and would have to stop doing gymnastics; otherwise “the same might happen to the right knee”. I can remember my mum driving me back to primary school that day, me crying with fear in the back of the car.

Although there was a Paediatric ward in that DGH in Glasgow, the Orthopaedic Consultant told my mum that I was to be admitted to the Orthopaedic ward where “they know what they’re doing”.

Several weeks later, wide-eyed and terrified (both me and my parents) I was admitted to the Nightingale Orthopaedic ward, which was full of elderly patients, every one of them lying in bed. I was clearly the youngest in the ward by far! An officious Nurse showed me my bed (on the left in the middle of the ward) and started asking me questions about my past medical history. My mum and dad wanted to speak to the Orthopaedic Consultant, just to clarify what was going to happen the following day in theatre. They also wanted to know who would be doing the operation. But he wasn’t available the Nurse said and anyway visiting time was over and my parents had to leave. And there I was, with only books and comics and no mum and dad, until the next day. My parents never did get to speak to the Consultant before I went to theatre.

The next day, all that I can remember is vomiting after I was given some intravenous sedation before I went to theatre and then waking up in recovery, vomiting again. My parents were not allowed anywhere near me. I had excruciating pain in my left knee. My next memory is waking up with a bandage wrapped around my left knee and coming round, just as my parents walked in (at visiting time of course). No-one spoke to my parents before they entered the ward, so when my mum approached my bed and saw a tube sticking out my left knee, with blood draining into a bottle lying on the floor, she promptly fainted. When evening visiting time was over, my parents were ushered out the ward. My last memory of that day, was watching my ashen-faced parents walk down the ward to go home, pulling the sheets over my head and crying myself to sleep. Lonely, scared and in pain.

The next day I was still in pain, but that didn’t coincide with the “drug round”, so I had to wait. Never mind, my younger brother (6 years old) and sister (9 years old) were coming to visit me that afternoon –they’d soon cheer me up! But no, they were “too young to come into the ward”, so they had to sit outside and wait. During visiting my parents reported to the Nurses that I had developed a temperature. The Nurses asked my parents if they “wouldn’t mind opening the window behind his bed to cool him down.”

Eventually my parents did get to meet the Consultant who explained that there had been a “bit of a problem”. He had been called away to an emergency and his Junior had performed the operation. He had “nicked an artery and a nerve”, but “don’t worry, everything will be fine”.  And on that note, he had to leave, as he had an important meeting to attend.

Okay, so I can hear you say – “it was just a cyst on the cartilage – nothing serious”, and “it was nearly 35 years ago and things have changed since then”. But have things really improved since then? Do you communicate appropriately and effectively with your patients? Do you actively listen to them? Does your ward have open visiting hours? What are your patients lying in bed at night worrying about?

 

And here’s the challenge. What can you do to make your service truly person-centred?

 

Dr Ewan Bell is a Consultant Clinical Biochemist and is Clinical Director for Diagnostics at NHS D&G

Next Weeks blog will be by the Patient Safety Team who will be giving us some highlights from the International Forum on Quality and Safety in Healthcare 2013