Tuesday, 24 April 2018

Metal Nurse: Open visiting hours

This is possibly going to be the most controversial article I have written. At least amongst my nursing colleagues. It is regarding the dreaded creature called "Visitors". A lot of hospitals in the UK have rather strict visiting hours, often 1400-1600 and 1800-2000, sometimes less, sometimes more. Children wards would often have more lax hours because parents want to be with their kids and the kids want their parents. Not entirely sure where this practice came from or why. There are a lot of reasons bandied about, like that it is protected mealtime hours. Or it is to reduce the infection rate. But honestly, I suspect it is because most nurses just want to get on with their work without being questioned too much. But as a profession, we tend to forget that these relatives are people, people with worries for their loved ones.

Usual reaction
Recently a relatively local hospital to me announced that they will change and extend the visiting hours. At first, my initial instinct was "NOOOOOOOOOO". But then when I started thinking about it I warmed up to the idea. Those strict visiting hours are a probably more of a nuisance because what happens is that visitors throng outside the unit, quite a few of them will try and be cheeky and ask if they can be let in earlier. A fair few of those get angry and start raising their voice, especially at the secretaries who like everyone else are just trying to do their job and do not deserve to be shouted at by people who most likely don't know how hospitals work. Then when the visitors do come in, they come in a drove. Then they form a line in asking a multitude of questions, usually when you are a little busy. They are concerned and worried and want to know what is happening to their loved ones and there is nothing really wrong with that. But when you are busy trying to help someone else it becomes frustrating, and because of confidentiality, you can't divulge why you are busy. So the visitors start to think you are rude and you as a nurse start to think that the visitors are self-centred, both of those assumptions are wrong. But it does get in the way of nurses and doctors work when they are halted in their duty, they do want to make sure that the patients are well cared for and do want to answer any queries and alleviate any worries that are voiced. One of the many problems we face as nurses as that as a profession we are very regimented and task-oriented, which can stifle good care and is not very conducive for the patients. I can hear my colleagues spit and spittle and go "Well, I'm not." I'm afraid that most of you are. This does include me, I know full well that I am and I do try my best to not be. We need to be better.

Now. This is not going to be a popular opinion. But... I think that the above-mentioned hospital is correct in extending the visiting hours. Visitors do have their own lives to lead, their own needs that need to be met. So why do they have to organize their lives around those visiting hours? With those new hours, the visitors can come in dribs and drabs as opposed to coming in like a slow mowing gnu herd which makes everyone miserable. A patient with a large family can have one or two people visiting them throughout the day as opposed to having a whole tribe sat around the bed space, potentially annoying the rest of the patients and their visitors in that bay. Not to mention the issues with parking, which does seem to peak at visiting hours.

A lot of hospitals started giving relatives and friends of patients with relatives access to the ward outside normal visiting hours, after a campaign called 'John's Campaign' which has been extremely helpful to both patients and the professionals that take care of them. The thing is that more liberal visiting hours is better for patient care. You get fewer complaints, the patients get better quicker and they tend to be more settled during their stay. Patients satisfaction of their care improves. Which is always excellent. If visitors come in more infrequently this also gives nurses time to educate both the patient and their visitors, especially in terms of self-management and health promotion, which ideally should be part of all good care. Or it gives you enough time to figure out what happened, why it happened and how (hopefully) it can be prevented from happening again. Because collateral history can make such a big difference in patients care.

It is by no means perfect, but to be honest it doesn't have to be. We are there to try and make sure that the patient gets better. And opening the visiting hours does exactly that.
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