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My rights or yours?: Why it doesn’t help to couch the visiting hours debate in the language of individual freedoms

February 11, 2014

I learnt my lesson about visiting early on. It was about ten o’clock on a Saturday morning on my first ward after qualifying when a lady rang up to ask if she could come in and see her mother in the next half hour. I explained there was no visiting in the morning and advised her to come in during the afternoon instead. I thought I was doing the right thing – every ward I had ever been on had enforced visiting hours very strictly and prospective visitors who dared to question the prescribed regime were soon faced down by sister’s basilisk stare and stern declaration that ‘patients need REST’.

Imagine my surprise then, when about twenty minutes later, the duty nursing officer, the very person whom I would have most expected to nod approvingly at my actions in denying visiting rights, stormed onto the ward and tore a strip off me. The lady I had spoken to had refused to let it lie. She’d made a complaint. Of course, I’ll never know if the nursing officer who bawled me out that day was truly supportive of the case for unorthodox visiting arrangements – or if she just wanted to paint herself as Mrs Sweet Reason at my expense; but even now I can hear the serpentine question she floored me with crawling around my brain. “Is this place” she asked “a prison?” Since that day, I don’t think I’ve ever denied a visitor access to a ward.

The recent debate on hospital visiting hours has certainly got people talking. It was kicked off by a blog post in which the estimable Wendy Sinclair described the very distressing experience of being turned away from the ward where her father was being cared for, on the grounds that visiting didn’t start ‘for another thirty minutes’. Even after she tried to explain her personal circumstances and how difficult it would be for her to come back later, staff still did not relent. Can you imagine how angry that would make you? To know that your relative, probably lonely and anxious, was just yards away from you, but you were barred from seeing them because some jobsworth who barely knew them said – for no intelligible reason – that you couldn’t? And that’s that? I’d have felt like blowing the bloody doors off.

Personally, I place myself firmly in the open visiting camp. I’m not in the business of keeping families apart at times of stress. I take the view that if you’re ill, that’s when you’re going to need your nearest-and-dearest the most. I don’t really buy the infection control objections because I don’t think there’s any evidence that open visiting results in patients getting more visitors. I think they get exactly same number of visitors they would have got anyway, bringing in exactly the same number of germs they would have brought in anyway – it’s just that it’s spread over a longer period. To colleagues who worry that longer visiting means that relatives will get in the way or make excessive demands, I’d say try it and see. You may well find that the opposite is true: once people can see how busy you are, they may well decide it’s best to wait until things have quietened down a bit before they ask for their update.

My biggest reason for supporting open visiting though, is that it provides much more opportunity for patients, families and professionals to get to know each other. In the light of proposals to ‘bring back named nursing’ (in some as yet undecided form), this is crucially important. It’s not really possible to act as a named nurse unless you can build up a relationship of trust and understanding with the families (and yes, it’s about families, not just patients) in your case load.

That trust and understanding, however, has to come from both sides. Yes, staff need to rethink the defensive mentality which designates visiting times as one of the few remaining areas of ward life where they are legitimately empowered to exert control – and where control is exerted all the more zealously for that reason. But the patients’ groups also need to be wary of turning visiting into an issue solely of individual rights and freedoms. In doing so, they may end up penalising the very people they most want to help: sick and helpless patients.

A recent exchange on Twitter exemplified this ‘individual’s rights trump everything’ strand, with many contributors agreeing that they wanted a ‘nominated person…to stay at the hospital at all times with vulnerable relative’. One hugely respected and very high profile tweeter even declared that the idea of ‘negotiate[d] patient-centred visiting hours for each patient on admission’ was ‘not good enough’. Sorry? Individualised visiting schedules are ‘not good enough’? So where do you suggest we go with this? Isn’t what you are saying a bit like declaring that the Palace of Versailles is ‘not ostentatious enough’?

The point is that these ideas are wonderful in principle – but until the day we achieve all single-rooms, hospital wards are communities, and often pretty intimate ones. It’s only a few years since we definitively won the battle for all single-sex accommodation. If we are now going to allow (for example) male visitors to stay overnight in female bays, doesn’t that make rather a mockery of this victory? Isn’t there a chance that female patients who don’t have or don’t want companions to stay with them are going to be made more anxious and uncomfortable by the presence of men who are essentially strangers with unknown pasts? If I were a patient, I’m not sure I’d be all that keen. But would there be any mechanism to take my views into account? Or would ‘individual’s rights’ sweep all before it?

Another drawback of a brook-no-arguments-free-for-all is that it comes to be seen as the ‘gold standard’, leaving no room for other experimental and perhaps culturally difficult ideas. The word ‘inspirational’ is bandied about far too frequently in nursing but nearly thirty years ago, when I was doing my training, I did work with a ward sister whom I would genuinely describe as just that. She was also almost the only nurse in my experience to have taken a serious interest in the discreetly (and universally) ignored area of patients’ sexual needs.

It was a stroke ward, and patients generally stayed there for weeks if not months. Several evenings a week, this trailblazing woman had set aside an hour for ‘partners only’. “And that was it” she told me. “The curtains went round the beds and the nurses stayed out, unless someone rang a call bell”.

“Why did you have to discontinue?” I asked.

She shrugged. “Open visiting. Not allowed to keep other visitors out”. I think she believed that was the real reason about as much as I did.

So yes to open visiting – or at the very least, yes to greatly extended visiting interspersed with rest periods. Yes also to twenty-four hour presence of nominated individuals when the patient is in a side room. Yes – I suppose – to female relatives staying all night in female bays (although I’m not sure how much benefit anyone gets from this). But men staying all night in female bays? Especially in the current climate, I think that’s a step too far. We live in a culture where it’s increasingly difficult to tell people they can’t do exactly as they please, but it’s important to avoid couching the debate on hospital visiting in these terms. In a communal environment, there’s still a need to draw the line somewhere.

For Wendy Sinclair’s blogs on the subject of visiting, see:

http://wendysinclair.wordpress.com/2013/11/17/a-plea-to-nurses-please-review-your-hospital-visiting-policy/ and

http://wendysinclair.wordpress.com/

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6 Comments
  1. Elaine Maxwell permalink

    I think that there is a fine balance to be struck between the rights of the individual and rights of the collective. Veer to far in one direction and you get anarchy and too far the other and you get totalitarianism. I do not support completely open visiting, some people feel unable to tell their relatives that they want some quiet time and sometimes other patients want quiet time too. As ever, the solution is to think rather than have blind rules and to have a broad expectation with Senior Nurses considering each case on merit. As used to happen before we disempowered Ward Sisters.

  2. Thank you for your comments. I think the problem is that while it’s nice to have your own visitors around, other people’s visitors can be less congenial. Trouble is, it’s all or nothing – it can’t be one rule for you and one rule for everyone else. What’s important is to think things through and not simply replace one set of problems with a different set. If we decide that it’s in everyone’s interests to set some limits, these do need to be clearly explained along with the reasons for them. But even then there will always be visitors who turn up at ‘the wrong time’ explaining that they have travelled miles and can’t come back. I don’t think I could find it in my heart to turn them away.

  3. junegirvin permalink

    A timely post, I think. I agree with you that your own visitors are welcome (mostly) but other people’s may not be so. When my husband was in hospital last year – 4 different wards, 2 different hospitals – we had very variable experiences. At no point – apart from one night in a side ward pre-operatively – was he ever in a single sex environment. He’s a nurse so he didn’t mind but the principle was clearly not adhered to. There were boarded visiting times, but I was never turned away when I turned up outside of these, and I was never questioned why either. If I thought he needed a rest I would go and get a cup of coffee or something to eat for an hour or so.

    On one ward, the person in the next bed had several visitors most of the time. Often as many as 6 or 7 with no member of staff taking any interest. These visitors would be loud and frequently encroach on others’ personal space. On one memorable evening a noisy adolescent girl performed a song and dance that she had performed at school that day. In full voice and with no consideration for any of the other 5 patients in the bay. And she wasn’t cute or small. Again, no member of staff took any notice at all.

    I am fully in favour of open visiting, but someone with authority needs to set the ground rules and ensure that they are kept to – for everybody’s benefit and some people’s sanity.

  4. Thank you for your comments. You highlight what I think may be another problem – which is that nurses often feel they cannot challenge people who are clearly not not acting in the communal ‘best interest’ for fear of creating a scene or provoking abuse. It’s an interesting example of how powerless nurses often feel. I’m not sure whether this is attributable to the fact that nurses are mainly female or to a lack of respect for figures of authority generally amongst the public at large.
    I wonder how we can help nurses to feel strong enough to stand up for patients’ rights to be protected from raucous and rowdy (or just too numerous) visitors?
    Also interesting to hear that as recently as last year your husband was not nursed in a single-sex environment. I thought this was a thing as the past – wrongly as it turns out.

  5. Fiona E permalink

    I enjoy reading your posts, but this one has made my blood boil! A slightly extreme reaction you may think. But you don’t consider patient experience from the other perspective, the hell that is other people. whether in a four bed single sex bay, or much worse, in a large, mixed sex high dependency ward, which included a mix of NHS patients and private, some from from overseas.

    In both cases, hordes of visitors the whole time, including late into the evening. Many different cultures, some beds with eight relatives around, shouting into mobiles, peering at the other patients as they march past (yes,at me, in bed, naked except for a gown, hardly able to move, never mind get away from the bloody people!) No nurse looking out for me, my need for privacy, my need for rest and calm. I shut my curtain, to ‘get away’, the nurse whips it open.

    I concur with the need for relatively open visiting, but there needs to be a strong and clear policy, which nurses feel confident to impose but with sensible exceptions case by case, so that visitors are LIMITED in number most importantly and please, within certain times only. The idea of night time companions absolutely horrifies me. The behaviour of some visitors is unpleasant, loud and would need to be heavily ‘policed” – who by? I’m talking as an articulate 50 year old, what on earth is it like when you are more vulnerable?

    Have experienced heart ops through the ages, 1969, 1975, 1990, 2011, the changing NHS. So snap shot intense experiences. 2011 by far the worse from the perspective of letting all those other people hang out in my bedroom!

    Agree with everything June says, but I am letting off steam here, a lot of intense but unexpressed emotion, so please take it that I find your blogs interesting and well worth reading, thanks

  6. Hi Fiona! Many thanks for your words of encouragement. Hearing that people enjoy reading makes it all worthwhile.
    Thank you too for giving the patient’s perspective. To be perfectly honest with you, and speaking as someone who values privacy and for years has avoided even going to the swimming pool out of distaste for showing off my body in public, I can completely understand your point of view. If I were a patient myself, I’m sure I would share all the feelings you describe. As a professional, however, I have found that open visiting (or relatively open visiting) works much better for all the reasons I describe: less time wasted in often futile attempts to police visiting, more opportunity to get to know patients and families, better understanding on the part of families of the realities of ward life.
    The crux of your comment is where you say that ‘there needs to be a strong and clear policy, which nurses feel confident to impose’. The confidence issue is an important one – nurses these days are often fearful that if they ask people to change their behaviour they will simply invite abuse and then, on top of that, not be supported by their managers (who are themselves fearful of not taking the side of the patients).
    I recently persuaded an enormous group of visitors who had congregated around a bed to decamp to the day room (the patient was well enough to accompany them) by reminding them that they were in a hospital ward and other patients were there because they were ill and in need of rest. If nurses could come to view the limiting of unreasonable behaviour from visitors as an act of patient advocacy – rather than as a jobsworth-ish imposition of arbitrary rules – perhaps it would empower them.

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