What I learned from the Children’s Community Nursing Team (@wlasinclair)

As a lecturer with an increasing workload, my visits to clinical areas in recent years have become less frequent and have become a functional role of placement audit and problem solving. In an attempt to address this, I arranged to spend the day with a children’s community nursing team. Spending time in this clinical practice setting served several purposes. Firstly I wanted to learn more about the current role of the children’s community nurse and how it might develop in the future. At the university we are currently exploring ways to develop a new curriculum and so I wanted to ensure that children and young people and their health needs are accurately represented. I wanted to ensure that the knowledge and skills we include in our programmes are appropriate to meet the needs of the children, young people and families that we serve. Secondly, I wanted to develop my role with the team and build a stronger relationship between us both so that we can enjoy mutual understanding of roles that I hope will in turn help to inform our curriculum.

My last experience of working with a community children’s nursing team was back in 1997 as a student nurse, on placement with a very newly formed team. I went on to spend most of my nursing life in acute care and education and so it was important for me to begin to understand more about the current role and current service. I learned lots from my time with the team and loved getting out to meet to children and families again. So here are a few things that I learned:

  • #Hellomynameis

Every single visit began with an introduction. I wasn’t surprised; it’s all I’ve ever known in children’s nursing. We just need to continue to ensure that it remains.

  • Service Hours

The service is available 7 days a week from 8am until Midnight. Home visits and nurse led clinics mean that more than ever, we have to ensure our student nurses develop their independent clinical decision making skills.

  • Technology

The team are using an electronic patient records system. There were problems on the day accessing information, as the system was slow. Referrals were still being received via fax machine. It seems to me that this is an area where we desperately need to develop the use of technology. We also have to develop the digital/tech skills of our student nurses who will then be able to assist with the development of technology that will greatly enhance practice in the future.

  • Health Promotion

Many of the visits were used to provide support and offer advice (in the hope of preventing further hospital admissions). Continuing to provide children and families with access to health information is clearly important, and we have to involve children and families in the development of this.

  • Telephone communication

So much communication took place over the telephone with follow up calls and telephone clinics. Telephone communication training is definitely something we need to consider in our nursing programmes.

  • Service appreciation

At every visit, children and families were grateful and thankful. They appeared to really value the service provided. Our children’s community nursing team certainly do a fantastic job and I hope that investment in services like this will assist with future service development.

Overall, I was pleased to learn that in university we are teaching clinical skills that match with those of the service. My time with the team did however help me to understand the problems faced by community nursing teams and see that they are great problem solvers. I now have several things to think about when I contribute to the development of out future CYP nursing curriculum.

I’d like to thank the children’s community nursing team for making me so welcome and giving me the opportunity and for inviting me to return. This is testament to the team’s commitment to ensuring future services meet the needs of children and families.


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….