What is the one thing you could do to help your loved one recover and get out of the hospital faster?
Make friends with the nurses? Give the consultant a bottle of wine? Make a fuss, complain about everything?
Some or none of these things may work, although there is no guarantee that your loved one will get home faster.
But from what I’ve seen in practice and based on research, there is one really simple but effective step that will make a difference: basically, move with them: visit them as much as you can, bring food for them, help them. eat and drink, and be there as long as you are allowed.
As part of my training as an emergency consultant, I spent a year working on medical wards caring for elderly patients. One woman’s memory stands out clearly because her husband was able to do all this for her. And when he couldn’t due to restricted visiting hours, he effectively killed her.
Visit your loved one as much as you can, bring them food, help them eat and drink, and stay as long as they allow.
This patient was an incredible woman: she had dementia but was very happy, always singing and encouraging staff and other patients to join in with songs.
He was admitted due to confusion after a urine infection. Due to his fragility, we expected him to die within a few days. But for the first few weeks he did surprisingly well. It was nothing that we, as doctors or nurses, did, but what her husband did for her.
Every day he sat next to her and fed her and helped her drink. She brought nutritious and beautifully prepared home-cooked food, in stark contrast to the ultra-processed excuse provided by the hospital for a dinner that sat on the tray at the foot of her hospital bed, untouched by the lack of staff to feed. hers.
After a couple of days, he asked if we could heat up the food I was giving him. Of course he did, knowing that the benefits of him helping to feed her outweighed any risks her food might carry simply because she didn’t have an expiration date.
With his constant care, she began to improve. So much so that she was able to start getting out of bed: he helped her climb to the toilet and then, when she had the strength to do so, he accompanied her to the bathroom.
When the staff saw how invaluable he was to her care, their restrictive visiting hours of 2:00 pm to 8:00 pm were lifted. This meant I could help her to the bathroom before bed and kiss her goodnight.
The day before she was discharged, there was a new head nurse on the ward, who insisted that she adhere to rigid visiting hours. Saddened, but too shy to argue, he left.
He received a call a few hours later. His wife had tried to get to the bathroom alone; the nurses told her to wait a couple of minutes to be taken away. But since they were short of staff, the wait took an hour.
Desperate and also too proud to allow an accident in her bed, she tried to walk there alone. But she slipped and broke her hip. Although she underwent surgery the next day, she never left the hospital and died three weeks later.
Restrictive visiting hours were never listed on the death certificate, but in my opinion, it was certainly a significant contributing factor.
I think you should be able to visit your loved one without restrictions (to some extent during the night, obviously, since you and he need sleep).
If the patient is happy and the visitors do not have any adverse impact on their care or other patients, then there should be unrestricted visits when patients are awake, writes Professor Rob Galloway.
But as we know, outside of emergency and maternity and pediatric wards, most hospitals have standard visiting hours of 2:00 pm to 8:00 pm; The reason is twofold: firstly, to stop the spread of infections and, secondly, because visits to the wards and nursing care are carried out in the morning, and the idea is that the visits would delay the doctors’ work. and nurses.
But this reasoning is irrational and many hospitals are realizing this.
The latest to change was Leicestershire Partnership NHS Trust, which runs several community hospitals. Last month it expanded its visiting hours from 2:00 p.m. to 8:00 p.m. to 11:00 a.m. to 8:00 p.m.
Its chief nursing officer, Anne Scott, said: “We recognize the value that visiting brings to the health, wellbeing and care of our patients and service users.”
Because just because things have always been this way doesn’t mean it’s right or based on evidence of what’s best for the patient.
On the contrary, there have been many studies showing that liberalizing visiting hours so that loved ones can come and go freely improves patient outcomes, reduces length of stay, and saves money; a mutual benefit for all.
How does this work? Having less restrictive visiting hours reduces patients’ stress levels. A review of studies published last year in the journal PLOS One showed that as patients’ stress levels decrease (as influenced by long visit times), their outcomes improve. This was the case for both how patients felt (reducing symptoms such as pain) and more objective indicators, such as length of hospital stay.
Another review, published in the journal Critical Care, found that unrestricted intensive care visits led to both a significant reduction in length of stay (by one day) and a 60 percent reduction in delirium across all patients. patients. The most important thing is that there was no increase in infections.
Attention – and also food – are also important. We all know the terrible impact visiting restrictions had during Covid, but one key aspect was highlighted in a 2021 study in the International Journal of Nursing Studies. Among the negative consequences for patients’ health was that many not only ate less, but also did less physical activity, such as going to the bathroom.
This is in addition to mental health consequences, including depressive symptoms, agitation, and reduced cognitive ability. The nutritional aspects of this study were alarming, and it is often the visitors helping their loved one eat that stops malnutrition.
As reported in the Journal of Human Nutrition and Dietetics in 2022, one-third of patients who enter hospitals well-nourished may leave malnourished. Too often, hurried staff leave food out of reach and don’t have time to help feed those who can’t feed themselves, let alone open their cartons of drinks and yoghurts.
Finally, there is a strong argument for having family members present both in the ward and at medication rounds, when nurses hand out medications to patients.
By being there, they can answer doctors’ questions to help plan care, and family members also get their questions answered, reducing their anxiety.
The stay in the room may be a little longer, but the benefits far outweigh the extra time needed. Additionally, family members can be the final checkpoint for their loved ones in terms of reducing medical errors; for example, checking that they do not receive a medication to which they are allergic.
And having more family members around can keep everyone on task, knowing they’re being watched. A 2006 study, published in the journal Infection Control and Hospital Epidemiology, showed that in five German intensive care units, if staff knew they were being monitored, their compliance with hand-washing rules increased by 55 percent.
Rules may be rules, but if they don’t make sense, then for the sake of your loved ones, challenge them.
In my opinion, if the patient is happy and the visits do not have any adverse impact on their care or other patients, then there should be unrestricted visits when patients are awake.
I’ve seen the benefit of that. A week ago my wife gave birth to our daughter; The room was incredible in the care they provided, but they also allowed me to visit them all the time.
It was important to me, it took some pressure off the staff and crucially helped my wife and our new baby.
But this possibility of visiting should be standard for all patients on all wards.
Ultimately, this is your loved one in the hospital and it is you, above all, who must advocate for them.
That way you can be there for them when they need you most.
@drobgalloway
