The last two weeks has been rather difficult for me. I’ve been a regular hospital visitor for my Dad and consequently there’s been lots to do in addition to the usually busy daily routines. I work full time, I have a 9 year old daughter and my husband works night shifts. Last Monday, I went to the hospital at lunchtime to visit and also speak to staff, assuming that a ward round would have taken place, so presumably a good time to get an update. On arrival at the ward, the doors were locked so I rang the bell. I was stunned when I was met at the door and told that visiting wasn’t for another 30 minutes. I knew that I wouldn’t be able to come back, I had work to complete and l had to collect my daughter from school. I also knew that there would be no other visitors that day. Even after explaining all of this I still wasn’t allowed to visit until visiting time. I hadn’t even thought about visiting hours, no-one had spoken to me to explain anything. In fact it is incredibly difficult to get any information from anyone. Last weekend I couldn’t visit and so I rang the ward for information. I rang 8 times and each time, the nurse was either busy, with a patient, on her break, on the telephone, not on the ward etc. and each time I was promised a return call. Nothing. I then spent 2 hours telephoning the ward the following morning but nobody answered the telephone. This is incredibly frustrating and so a plea to all nurses…enable and value communication between patients, family and staff, it is crucial for all involved. Of course I understand that staff are busy but in addition to the practicalities, communication also reduces anxiety for both patient and family and builds trust. I am speaking from experience.
So this week I have found that visiting times are not always convenient for visitors…I work, I have family commitments, I live a long distance from the hospital, and the list goes on. I also wonder why on this particular ward, visitors are not welcome at mealtimes. Surely some patients would like visitors at mealtimes, so that they can enjoy the social element of eating a meal and maybe the visitors could/would like to help. So why do we even have visiting times…is it to give the patients some time alone? To limit noise? Because staff want to control routine? Do patients want visiting time or open visiting? Why don’t we ask? Why don’t we offer individualised care and enable the patient and family to negotiate visiting time? Visiting a relative in hospital is already problematic for many people, its a worrying time, its stressful, its expensive and its time consuming (it took me 45 minuted to find a parking space on one visit!), so another plea to all nurses…please review your visiting policies and consider what can be done to ensure that visiting is in the best interests of your patients and is convenient for relatives to visit. You may find it beneficial for your patients and families.
As a paediatric nurse, my experience has always been that open visiting is usually in operation, and one or both parents are able to stay with their children overnight. So I wonder why adults do not enjoy the same privileges? As a close relative of a patient in hospital, I have again experienced the frustrations shared by others every day. Please leave your comments, I’m really interested to hear your views on hospital visiting policies.
wendysinclair 
Sorry to hear you had such a frustrating experience when trying to visit your Dad. As a student I have worked on a great deal of wards, so far they have all had ‘protected mealtimes’ though this hasn’t meant that visitors were not allowed in. Typically, I’ve seen visitors welcomed and encouraged during mealtimes. It, as you say, makes it a more social event and can encourage individuals to eat a little more than they perhaps would without a familiar face.
There was one lovely initiative on an adult rehab ward that got everyone together for Sunday lunch and a weekday afternoon tea, everyone was encouraged to come and share a meal with their loved ones. It was a lovely change to not only promote good food and fluid but for a bit of normality away from the focus of hospital policies and procedures.
I will most definitely take your comments on board and reflect on them during my own nursing practice, fingers crossed others will too.
Best wishes to your Dad.
Laura x
Thank you Laura, I think Sunday lunch and afternoon tea is a lovely idea, and one which may offer visitors an alternative and piece of mind. I’d just like to see some more flexibility and individualised care, so I hope that this prompts further thought. Thank you for your thoughtful comment.
I have experienced various visiting regimes and on balance, I am in favour of open visiting. Evening only visiting is the worst: relatives arrive with questions that would often be better addressed to medical or therapy staff, but of course they have all gone home. Because you don’t want to send them away with nothing, nursing time is then wasted trawling through notes for the answer to some pertinent but arcane question like ‘why was such and such a drug stopped when dad’s been taking it for years and years without any problems..?’ or ‘why hasn’t the physio done anything about his arm…?’ When visitors can attend during the day, they can speak to the person they really need to speak to, and either be satisfied with what they are told, or dissatisfied – but, if hte latter, at least they blame someone other than the nurses!
On the whole, I don’t find that that relatives get in the way or make excessive demands; on the contrary, if they are there for longer, you have a better chance to get to know them, and they often build up a better appreciation of what you do.
The people who dislike long visiting hours are firstly, infection control – restricted visiting is often brought in as a result of concerns raised by them – and secondly patients themselves. It can be very wearing to have other peoples’ families around all day when you feel ill and tired, especially if there are lots of them and they have noisy children – not everyhone is considerate. It can also be embarrassing if you need the toilet for example.
Protected mealtimes started off as a DH initiative – the idea was that patients would eat more if free from distractions. It is supposed to be honoured by staff as well as visitors, but doctors routinely interrupt patients when they are eating.
As a junior doctor, I have mixed feelings about this. If open visiting is in place then a good system for making appointments to discuss care with staff needs to be in place also. I worked once on a ward where visiting hours were ignored and found it difficult to care for patients on several occasions as I was speaking to relatives constantly – sometimes several sets for the same patient! My best experience was where visiting was from 3 30 – we tried to complete the bulk of ward work before this time to give us some availability to talk with relatives, nurses let families know this was the case.
As for doctors ‘routinely’ ignoring protected eating I can assure you that’s not the case anywhere I’ve worked. Sometimes it’s unavoidable but my colleagues and I certainly try to respect it as much as we can. Families are encouraged to come along if they are helping the patient to eat.
Thank you DrS for your comments. I can appreciate the time it takes talking to relatives, however I think it is crucial to communicate with and involve the family in care, particularly in situations where the family are required to care for the patient on return home (as in my case) and I would see speaking to relatives as an essential element of their care. An appointment system may work well, and I would have appreciated an appointment if that had been an option. Whenever I talk about this subject I am often met with ‘patients need protected mealtimes’ but I would argue that protected mealtimes does not mean no visitors for all. Visitors can help, provide a social element, bring food the patient likes and will eat etc. This all needs to be assessed on an individual basis. I agree there are times when doctors and other HCP’s cannot avoid interrupting mealtimes. Thank you for taking the time to write, you comments are appreciated.
Thank you for your comments. When I was refused access to the ward to see my Dad (because I was 30 minutes too early for visiting), I had considered it a good time (it was 1.30pm) to catch a doctor or a nurse who could update me. I never did get updated because I was not allowed in! Following that when I visited during evening visiting hours the nurses were not visible (I suspect minimal staffing numbers meant that they were busy with patients). There were student nurses and HCA’s who promised to tell the nurse looking after my Dad that I would like to speak to them but visiting was over and I was asked to leave before they got around to me. Its a tricky situation which is why I ask for a review and negotiation…I’m not convinced that strict visiting hours benefits patients and families. I’d just like staff to consider the impact of their visiting policies. I’m really looking to find what works well so thank you for taking the time to write.
I think one reason why doctors interrupt patients during meals is because where I work anyway, patient meal times are so early. They have their lunch at twelve noon, which is still morning as far as medical staff are concerned. They wouldn’t dream of going to lunch at that time. The way things are planned makes things difficult sometimes. I personally would welcome relatives who wanted to encourage patients to eat.
It is possible to balance all these things but it takes openness with patients and families and good ward leadership. I was a ward sister in 1986, an medical ward, and we encouraged open visiting. We occasionally had to ask relatives to leave for a while but I cant think of an example where they were unhappy with this. Our patients were very chroniclly unwell and not to allow their friends and family to visit as much as they could seems cruel.
However I have just lost a dear friend and his family and friends, many of them, spent the last day with him and what is more the nursing staff, in a positive and sophisticated way helped his wife manage the large numbers of people who came.
For me this is about practice and leadership and nurses should not need organisational rules to know how to behave.
I will be signing your pledge x
Thank you for your comment. I agree, good ward leadership is key. I share your view that it is possible to achieve a balance, as I know some areas manage it well. I’m so pleased that your dear friend was able to have friends and family around him and that the nursing staff recognised the importance of that. I’d like to see more of this. I agree it is about practice and leadership. Thank you for joining my pledge and for taking the time to write.
As a nurse on a busy surgical ward I find having strict visiting hours is a huge help! I have dressings to do which can take up to half an hour or more and if I can get these done before visitors arrive it means my patients can have time with their families uninterrupted. Otherwise I’d have to ask them to wait outside anyway. Obviously I am flexible if people can only visit at certain times or if they’ve travelled a long way. I do try to accommodate individuals, but the visiting hours in my hospital are trust policy not ward policy.
I am so sorry to hear that you were unable to discuss your dads care with the nurses and I think you should speak to the hospital about this directly as it’s not acceptable!
Hope your dad is well!
Clair
I agree wholeheartedly with you Wendy and anniecoops. There has to be flexibility and thoughtfulness applied to the rules and this needs good leadership and an empowered nursing team who have the confidence to make considered choices that best serve the patients and families in their care. I started my training in Bath in 1978 where open visiting was the norm, it worked brilliantly. Relatives accepted that they’d be asked to leave while necessary procedures were performed and they often willingly helped with aspects of care of their loved ones. I recently experienced a nurse telling me that I was too early for visiting after I had travelled from London to the South coast – and I was … 5 minutes early!
Thank you for taking the time to comment Lynne. It seems that many people have similar experiences of inflexible visiting times. Its good to highlight and open up debate, thank you.
You have my sympathies Wendy! My mum is in hospital at the moment, and it certainly does give you a different perspective! I have been a nurse for 27 years, and totally understand why we need to have visiting times, and know how time consuming it is to have to speak to several different relatives, for the same patient. However there has to more flexibility. I live nearly two hours away, and work full time. (Interesting when she was in the acute hospital, there appeared to be much more flexibility.) Now she is in a community hospital I feel that I have had to beg to visit outside visiting hours, the visiting times are only 3.30-5 and 7-8. When I visit I don’t necessarily need to speak to the nurses and I end up providing personal care for my mum, so can actually help the nurses. As for protecting mealtimes (I am all for this – having lead on the implementation in my own organisation) but and integral part of protecting mealtimes is encouraging relatives to help support their loved ones at at mealtime – mum needs loads of encouragement to eat at the minute, but again I feel the ward is doing me a big favour by letting me in at mealtime! And as for trying to get information over the phone………don’t start me on that!!!!
Hi Tracey, thank you for taking the time to comment. Nobody should have to beg to see our loved ones in hospital. Also, protected mealtimes has been interpreted in some hospitals as a time for people to eat alone…where is the social element to eating a meal, or having a loved one help and encourage? I hope your Mum is recovering/improving. Thank you.
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I have had similar problems visiting my dad in hospital and the staff are so rude, what right do they have! I work in a Palliative Care Home were we have open visiting as see their loved ones is so important, and it never gets in the way of receiving excellent care from us. Good Relationships with family is a must in nursing.
Having recently spent a couple of weeks in hospital, I would not like to see a system of open visiting hours. Being on a ward is surprisingly busy and noisy and the day starts very early, with the various medical teams doing their rounds up until lunch time – after lunch things quieten down for an hour or so before visiting hours and it’s a really valuable peaceful time to rest before visitors come and go for 6 hours. I found the lack of restful times really hard, so would hate to see that small window disappear. I do understand that not everyone can fit in with the visiting hours, but unfortunately no system is going to work for all, and ultimately patients resting and recuperating is the priority.
I think what is interesting is that in the children’s nursing setting is that we manage all our tasks alongside an open visiting policy. I’m not suggesting this is perfect for the adult setting, but maybe some review is needed. Wendy, the benefit of reading this poignant blog is truly seeing a family story behind a patient in a bed, that family being a crucial element in the patient we might be caring for. Thank you.
We had a positive experience at The Royal Oldham Hospital when our son was put on an adult ward for the first time. We told the staff one of us would be with him at any one time and there may be six of us with him at some point. My husband was allowed to stay overnight and our older chdren were able to visit at any time. The staff were fantastic, he wasn’t in a side room but with other patients, and can honestly say this experience made our life easier but I think it also made it easier for the staff as we were doing all his cares etc.
I share your experience Wendy. I too was refused access to my husband when he was in hospital. Actually, I wasn’t so much refused access because the ward doors were wide open, but I was asked to leave because I was 4 hours too early for visiting. The ward was quiet, he was the only patient in his bay, (the other gentleman was in theatre) but because he was post-op, the nurses explained that he needed to rest, which apparently, he would be unable to do with me sat quietly next to him. I asked for their rationale and was told it was the rule. I asked for the evidence base and they couldn’t give me one. I then asked whether visiting for the gentleman in the bed next to my husband would be allowed as he was due back from theatre right in the middle of visiting time and on the basis of their own argument, would need rest, to which they also had no answer. I left, but because I had already paid the extortionate car parking fee, I sat in the hospital car park for 4 hours and then returned to the ward. Never one to take anything lying down, I made a formal complaint and had a face to face meeting with the matrons which was a positive experience. They explained that the visiting restrictions were due to the government’s drive to increase standards of privacy and dignity and asked how we manage open visiting in children’s nursing whilst maintaining privacy and dignity. Easily, was my reply.
Many thanks for your interesting blog Wendy. I think it’s so frustrating when you have the emotional turmoil of an ill relative and also feel that you have to ‘battle’ staff in a sense. When I’ve spoken with ward staff about flexible visiting and the possibility of it on their ward, their concerns seem to centre around the ward being turned into a ‘fair’ somehow! I think the vast majority of people are very reasonable, not looking to stay all day and every day but just looking for a degree of flexibility.
That’s why I feel strongly too that relatives/carers should be given the option of attending the ward round….if the patient consents. When my mum and my sister were in hospital if I’d been given the option of, say, going to the ward between 11-12 in the morning knowing, at some point, the doc would be seeing my relative and I could join in that discussion, then I’d have been delighted. I think that could only be beneficial to all. It also saves relatives trying to catch the doc at another time, which is usually the case.
What do you think Wendy? Should we test this out in NHS Ayrshire & Arran?
I hope your Dad is keeping better, kind regards, Angela.
Thanks Angela, my Dad would have loved me to be present for ward round. He didn’t understand what was said and therefore couldn’t relay any of that information. As you say, I’m pretty sure visitors wouldn’t stay all day and surely we have staff skilled enough to negotiate and work with patients & families effectively. I’d be really interested in hearing how it goes if you test it at NHS Ayreshire and Arron. Thank you for taking the time to respond.
Hi Wendy, I am have just found this via Twitter. I am an ICU nurse on a unit with open visiting, visitors will only be asked to leave for ward round, handover and cares/procedures and are allowed in 2 at a time. I find often that patients with large families make providing high quality, timely care difficult as time is often spent giving the same info and answering the same Qs to many different people, despite asking them to talk to each other. Visitors regularly attempt to wake non sedated or sedatedpatients up, depriving them of important rest – I am all for an afternoon nap. I spent 6 weeks visiting my Mum in 2 different ICUs a few years ago. The 1st had visiting hours 12-2 & 4-10, allowing for medical updates and rest for the patients, the 2nd the hours were only 6-8 and medical updates difficult to get. On balance and experience of both sides I feel some structure works well, allows all members of the mdt to do their jobs and gives good access for visitors to their loved one. It also ensures some self care for families during a stressful time. Visiting hours give people permission to eat, sleep, generally take care of themselves, not to feel they have to be in ICU all the time for when x wakes up. I even went grocery shopping (although that was just to get out of the house and do something normal!)
Hi Liz, thank you for taking time to comment. For me, visiting at the prescribed visiting times was often impossible (and even more so during my dads last admission where visiting was only 7-8pm daily. Not only was it impossible, the impact of this for my dad was huge. Also within that hour, as the main carer, I couldn’t get to speak to a doctor or a nurse as doctors weren’t available and the queue for the nurse was too big. Discharge planning was impossible. I feel sure we can strike a balance with individualised planning, discussion and negotiation. I like the idea of some structure and some hospitals have a visiting code which I like too. Thank you, I really appreciate your comments.
It is so sad to hear of your story. We should treat carers as an asset! And as for not allowing visiting outside of ‘visiting time’ is ridiculous!! Visiting times have some benefits and depending on the clinical area may be required for lots of reasons but these ‘rules’ must be flexible and tailored to the needs of the patient and their family/loved ones.
Thank you Donna, this was almost 3 years ago and I am so pleased to see the work you are doing at CMFT, its good to hear your support for carers. Thank you 🙂
Have just finished a project on open visiting its been very interesting and you make your point really well. I am hoping to influence future policy
Hi Helen, I’d be really interested to read about your project. I’m so pleased to hear about your plans to influence policy, thank you