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PRACTICE COMMENT

'Intelligent use of open visiting would aid patient recovery'

  • 6 Comments

Should the visitors’ bell become a thing of the past? Liz Charalambous advocates for a flexible and sensitive use of visiting hours

Many nurses look back with horror at the separation of children from their parents when admitted to hospital in years gone by. They weren’t allowed to see each other until discharge. Thankfully, we now have a more enlightened approach, with parents welcome at the bedside. Unfortunately, the same does not apply to adults, as restricted visiting is enforced in many areas, despite many trusts advertising person-centred care in their mission statements.

New nurses arrive on adult wards and they quickly soak up the organisational culture, use existing esoteric language, such as “obs”, which gives a feeling of importance, of belonging. As a student nurse, I remember having the honour of ringing the visitors’ bell. How powerful to ring a bell and crowds of people suddenly disperse. It is, of course, more subtle now with discreet signs displaying visiting times. The power lies with the nurse, it’s our patch, we call the shots and the uniforms, routines, and general busy working environment add to the power base.

In my experience, open visiting does happen but it appears to be something one has to “qualify” for. Sometimes an overworked nurse under pressure will allow a relative at the patient’s bedside outside of visiting hours to provide essential care, feeding, washing and offering support. Another instance is for the terminally ill who are quite rightly allowed open visiting.

But what about patients? Where is their voice in all this? A useful approach is to put yourself in your patients’ shoes, for example, what would you want if you were a visitor who lived miles away and couldn’t make prescribed visiting times?

The Francis report has put patient and public involvement into the spotlight with recommendations for more focus on patient experience and involvement. As nurses, we must ask questions within our profession and enter into a dialogue with patients and families to improve care.

With open visiting there are issues to consider, such as the difficulties associated with “communal living”; some may not wish to see visitors at all whereas others may want their family there all the time. The ward infrastructure may not be able to support open visiting due to a lack of suitable areas for families to be together. However, I believe the sensitive and intelligent use of open visiting would be a positive contribution to the recovery of patients in our care. We need to take a holistic approach by looking at ways of making adult wards truly “family friendly” with a focus on hospitality and comfort.

So, should we ring the visitors’ bell for the last time? Will we look back in years to come and see that restricting visitors to old, frail and vulnerable people in hospitals was detrimental? Or will we carry on? I advocate that we deepen our understanding of the working relationship we have with people we care for. We need to release the shackles of control and facilitate a shift in power dynamics, by joining hand in hand with families to become part of the patient and public involvement experience.

Liz Charalambous is staff nurse at Queen’s Medical Centre, Nottingham University Hospital Trust.

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Readers' comments (6)

  • Visiting within reason. Visitors often feel that they have to stay for a long time and the patient gets tired. Why not bring a relative in at meal times to feed a patient, they then feel wanted. A rest after meals used to be customary, which was good as the patient had a rest in the peace and quiet. I think I would go demented if there were children around most of the day, or someone in the next bed with lots and lots of visitors. Nothing worse than using a bed pan, or being examined with relatives the other side of the curtain.

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  • I agree that visiting for some patients is a welcome interlude to a boring often frightening day. However I also agree that unless one has a very close and loving relative who is willing and able to remain at the bedside giving personal care all day, then a visit may consist of someone not knowing how long they are expected to stay and running out of things to say after the first five minutes of " how are your feeling". Another problem about open visiting is access; who is going to let all these visitors in and out? Many wards now have some kind of security at the main door, that require a physical presence to open them from inside. I am sure nursing staff do not have time so is it the ward clerk, is he or she there all the time? Lastly what about confidentiality? Surely with a ward full of visitors it is virtually impossible to have a discussion with a patient in a bed without everyone overhearing every word, and how many patients want to use a commode or bedpan with a ward full of visitors to hear (and smell) them?

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  • Open visiting is great in theory, but difficult in practice. As a patient who is trying to recover from an illness or surgery, rest is important - with open visitng, you don't get the chance to formally do this. Yes the visitor may tell you to rest while they are there, but it isn't the same as having protected rest times. Nor is it possible to rest when there is hoards of other visitors - noise levels can get quite high (talking, scraping chairs etc). Also agree with the comments above - where is the time to talk to the patient/do dressings/send for tests etc

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  • Whilst I do understand the comments made I believe the authors point is are we looking at from the patients prospective? We should be asking them what they want and not deciding we know best; we dont know these people so how can we? Of course we can offer general quidance but be aware that's exactly what it is, the patient / carers are the only ones who can personalise it.

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  • From personal experience as a patient, open visiting is torture. I felt ill so my friends and family respected my need to be left in peace, only visiting for 30 minutes then leaving me to sleep - or so I hoped.
    Entire families would come in and visit Gran for 6 solid hours! There was continual noise, banging into patients beds - lack of privacy to use the loo or commode for some other patients was appalling. If staff dared to ask visitors to tone it down or reduce the number of patients at the bedside they were met with verbal abuse so it just went on every day. I couldn't wait to get home to recover! I now need further surgery and am absolutely dreading hospitalisation simply because of open visiting..............

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  • I also was an inpatient when open visiting was 'in' and also say that it is not restful, and it means there are always strangers on the ward when the most intimate procedures are being performed on you.
    I felt vulnerable and very tired as the hubub just continued all day.
    I am not a fan of open visiting, there needs to be rest times.

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