by Anne Federwisch, OTR
Illustration by Malcolm Garris
June 18, 1998

Visiting hours are getting longer at hospitals across the country. At some healthcare facilities, they’re never over. As hospital administrators weigh the benefits of liberal policies against the disadvantages, they’re opening their doors wider—and more often—to patients’ friends and families.

The resulting throng can challenge health professionals. Yet experts agree that clinicians can surmount the obstacles without compromising patient care.

Today’s shorter stays create a greater need for families to visit patients in the hospital, said Ginny Smith, PT, assistant manager of the physical therapy department at The Institute for Rehabilitation and Research (TIRR) in Houston. "Visitation has become more important," she said. In the past, families didn’t necessarily have to observe therapy because patients were not discharged until they were fairly independent. "Now it’s very likely that they will be discharged at that [dependent] stage and will continue with outpatient therapy," she said.

Longer hours, happier patients

Longer visiting hours correlate with greater patient satisfaction, said Nancy Corcoran, director of admissions and guest services at Hackensack University Medical Center in New Jersey. Focus groups at her facility revealed that patients were happier—and more satisfied with their care—when they felt that their families were being treated well, such as when they are allowed to visit more often.

"The mental and emotional needs of the patient are extremely important," Corcoran said. "So we try not to separate the patients and their family and loved ones any more than necessary."

The medical center allows general visitation from noon until 8 p.m. Like most hospitals, the rules vary by ward. While fathers can be in the maternity department from 8 a.m. to 10 p.m., visitors to the ICU are restricted to four 15-minute sessions daily. But, said Corcoran, "If you have someone who is in imminent danger, certainly families are given more access to the patient."

"More lenient and more appropriate visiting policies are part of the movement toward more family-centered care," said Joan Forte, RN, clinical operations manager for the intermediate intensive care nursery at Lucile Packard Children’s Hospital at Stanford University in Palo Alto, California. The facility revised its guidelines in February. In most parts of the hospital, parents can now visit 24 hours a day. Children of any age can also visit (though not overnight), but those under 5 must be accompanied by a parent.

"I think that children’s hospitals are more lenient in general in their visitation policies," Forte said. "But I would like to think that even within children’s hospitals we are moving to the cutting edge."

Exceptions to the rule

Despite Packard’s liberal policies, there are times when visitors are asked to leave a room, Forte said. "When we need the space to effectively take care of the child, or if there’s confidential information being discussed and we want to protect another family’s privacy, we will ask families to leave," she said. Explaining to families why they need to leave increases their willingness to comply with the request, she said.

Likewise, exceptions to the visitation policy are occasionally warranted at TIRR, Smith said. The general guideline is that as long as the department is open for treatment, visitors are allowed. The department is open from 8:30 a.m. until 4 p.m., and regular visiting hours for the facility are from 10 a.m. until 9 p.m.

"Visitation during therapy is not beneficial when the family is not on the same page as the therapist," Smith said. For example, a family that believes the patient will soon be walking may convince the patient that instruction on wheelchair transfers is unnecessary. In that case, the visitors may be asked to leave during treatment.

Visitors may also interfere with therapy if they begin to take the focus off the patient by asking a lot of questions. To minimize this, Smith advised providing information about every stage of treatment. If the visitor tries to monopolize a therapist’s time, Smith suggests acknowledging the family’s concern and setting up a different time to answer their questions. "You don’t want to shortchange the patient during therapy," she said.

The other side

Though the trend is toward increasing visiting hours, many administrators still favor imposing some limits, Forte said. The most common argument for limiting visitation is a concern about infection control, she said. The theory is that more people translates to more germs. "We continually monitor our [infection] rates, and if anything, they’re lower than they’ve ever been," Forte said. "We really do not see anything to substantiate those concerns."

She does agree, though, that having extra people around can make treatment difficult for health professionals. Sometimes space is an issue. "It can be hard to get in the room without disturbing anyone," she said. "It can make the work a bit awkward at times."

Open-door policies can also create an atmosphere in which clinicians feel they are being constantly observed. "When families are here frequently, as they are on my unit, there’s no real down time for the staff to freely discuss how they’re feeling, what’s going on with families. They’re constantly ‘on,’ " Forte said. "In order to talk freely—and in some cases to vent—they have to leave the unit." Yet the advantages still outweigh the disadvantages, she said.

Families are an integral part of care, said Sheila Rucki, PhD, RN, president of the Society of Pediatric Nurses. By allowing families frequent contact with their sick loved ones, you facilitate a patient’s recovery. "So much healing depends on the family’s support," Rucki said. "You risk delayed healing and delayed response to treatment if you don’t involve the family from the beginning."

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RELATED
Web Sites

Hackensack University Medical Center

The Institute for Rehabilitation and Research

Lucile Packard Children’s Hospital

Society of Pediatric Nurses

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