My NHS Change Day Pledge: To Challenge Restrictive Hospital Visiting Hours…the story so far

Back in November I blogged about my experience of visiting my Father in hospital (you can read it here). After recently tweeting about my experience @KathEvans2 and @Thebestjoan encouraged me to make a pledge for NHS Change Day 2014. I was so astounded by the strict visiting regime enforced by nursing staff that I now intend to challenge restrictive visiting hours and encourage ward staff to review their visiting policies. After some heated debate on a Sunday morning (you can read the storify here) a few weeks ago, @WeNurses asked if I would like to guest host a #WeNurses chat. Of course I took the opportunity to learn more about why nurses enforce such strict visiting hours and to prompt discussion and debate. In preparation for the discussion I started with a very quick literature search and quickly found that research was limited. During the chat, there was much more heated debate, much based on experience from various perspectives and here are some of the highlights (you can read the full transcript here):

These reasons were cited during the chat as the case for restrictive visiting hours:

– It helps with infection control

– Open visiting exhausting for sick patients

– Patients said they were too tired for open visiting

– Causes patient’s stress

– Occasionally need to ‘make’ visitors go home and rest

– Nurses and patients need structure

– Visitors are too noisy

– Visitors are not carers and need rest

– Procedures need to be done without visitors present

– No consideration for patients from visitors

– Open visiting would diminish time that nurses spend with patients

– To allow washes and rest

– To enable cleaners to clean around bed spaces

– Protected rest period improves delirium rates

– Visitors change ward dynamics

– Relatives often anxious to leave

– Open visiting would be a logistical nightmare with cleaning, personal care and ward rounds

– Those with no visitors may struggle to interact with others

– Families wont get reassurance from staff in the morning – wards are too chaotic

– A lack of space

– To ensure privacy and dignity

– Wards are too busy

– Ward rounds and physio make visiting unfeasible

– Patients feel rude asking visitors to leave

– Health and safety, children running around

These reasons were cited during the chat as the case against restrictive visiting hours:

– Enable partnership between family, friends and professionals

– Families can help with care

– To enable person centred care

– No right to stop patients seeing loved ones

– To encourage collaborative care

– Because restrictive visiting creates bottle necks

– Visiting hours are dictatorial, not conducive to caring

– Restrictive visiting is stressful for families

– Children’s nurses manage it successfully

– Improve patient expeience

– Some people cannot rest without their loved ones

– Empowering to involve family in care

– Encourage ‘normality’

– More relaxed, less pressure

– Component of healing process

– Reduces anxiety and social isolation

– Reduces the car park stampede

– Patients feel ‘lifted’ after seeing visitors

– Patients are capable of discussing timetables with their family

– To prevent boredom

– Useful when family is concerned about poor care

– Helps with work and family commitments

– Shared mealtimes are a social event

– Better co-operation

– Visitors will be spread out through the day

– It’s less disruptive

– Restrictive visiting hours are controlling and intimidating

– Its a hospital not a prison

During the discussion there were lots of calls for individualised visiting plans and nominated visitors. There were calls to remove restrictions and calls to keep them in place. There was participation from nurses in various fields of practice, patients, carers and nurses from beyond the UK but in the end there was no conclusion to this very heated debate.

Although consensus could not be reached, I am delighted that I have been able to work toward my pledge of challenging practice and encouraging a review of restrictive visiting hours. It is a subject close to my heart and I am now in the process of planning how to take this forward. There appears to be much paternalism and rituals in visiting hours practice and so it is clear that more research is needed to provide the evidence to support practice. I’m not asking for a blanket ban on visiting hours, I’m aware one size doesn’t fit all but I would like to see change based on evidence.

As the debate continues, I will continue to work toward meeting my pledge…will you join me?

To be continued….

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