Nursing Concerns and Visiting Hours

Case Study: Visiting Hours

Q1. Given the evidence of visiting hours and the evidence related to individual and system level implementation of evidence, what are the key issues related to implementing appropriate visitation policies?

According to evidence-based medicine, flexible visiting hours are beneficial for both patients and families (Ciufo et al. 2011). Touch and human contact can be very beneficial for patients, even those with severe illnesses (Tabatabaee et al., 2016). For example, one study found touch to be therapeutic in helping cancer patients with nausea, pain, and fatigue (Tabatabaee et al., 2016). Patient families may not always be able to visit the patient during convenient times, and limiting patient visiting hours may have an undue burden on families with complex working schedules. However, nurses may find patient family and friend visiting burdensome in terms of their workflow, and the need to answer family questions, which can be intrusive, or to provide care to the patient without visitors getting in the way. Administrators understandably wish to retain quality nurses and prioritize nurse efficiency. Ultimately, this helps patients stay healthy and recover, as well as improves hospital quality measures.

Q2. What might be key individual barriers to evidence implementation?

Individual barriers may include nurses struggling with stressors, such as having many patients and tasks. Patient’s families may struggle with appropriate boundaries, such as coming to the unit very late, when nurses are already coping with high levels of fatigue and patient demands. Patient families may not appreciate that their loved one is one of many loved ones on the ward. On the other hand, nurses may be struggling to implement a mode of caring and empathy into their overstressed routines, and not fully appreciate how the incentive of having patient families nearby can itself be therapeutic and beneficial. Also, certain families may find it impossible to visit loved ones during standard hospital visiting hours, which can be quite restrictive.

Q3. What are system-level barriers to evidence implementation?

From a systems level, hospital administrators are more apt to keep an eye upon nurse retention and efficiency, rather than to prioritize more indeterminate quality measures such as the psychological benefits of frequent visiting for patients and their families. Nurses themselves are more apt to prioritize getting tasks accomplished versus simply enhancing subjective patient well-being, which is not necessarily something which will be factored into a quantitively driven performance review.

Q4. What are evidence-based strategies that enhance evidence uptake at both the individual and system level?

Evidence-based strategies include using research to substantiate the benefits to patients from touching, human contact, and expanded visiting hours. Establishing that this can reduce time spent in the hospital and can enhance recovery time and save costs (as well as reduce the burden upon nurses in providing care, due to patient satisfaction and the attentions of families) are all examples of how evidence-based research can support a change in hospital visiting hours.

Q5. How might you design an evidence-implementation strategy to overcome barriers and maximize facilitators of evidence uptake?

This is not a black and white issue; the concerns of both sides must be taken into consideration. First, a feasible plan, in consultation with nursing staff, must be constructed to expand visiting hours. For example, this might include extended hours on specific nights, or an application for certain patients to see loved ones later at night, if the patients are critically ill and could benefit from additional attention, or if the family schedules do not permit seeing patients during regular hospital visiting hours. Other possible proposals include limiting the number of visitors during late night hours or weekends, or limiting visits to patients who are critically ill or who are on long-term stays. Using evidence-based literature, evaluating workflow concerns, and above all generating nurse buy-in is vital.