Background of change and intervention
Hospital visiting arrangements during the pandemic have aimed to prioritise the health, safety and wellbeing of our patients, communities and staff. Initial guidance suspended general visiting whilst continuing to support compassionate visiting when needed, for example at the end of life. More recent guidance (June 2020) provides discretion for trusts to define local visiting arrangements having considered wider social distancing policies. This case study focuses on how nursing teams have worked together with patients, families and carers to support a better experience during a required restricted visiting approach.
Learning and advice to be shared
Many nurses reported that they recognised the difficulty visiting restrictions caused patients and their loved ones and the need to support in spending more time with their patients by talking, reassuring them and continuing to deliver high quality care. Those that usually visited were also recognised to be anxious about not being able to see their loved ones and health care professionals spent more time speaking with family and carers on the phone to inform and reassure. Additionally, the lack of visiting also identified that sometimes valuable bespoke information, or history from family members or carers, could be harder to access and opportunities for nurses to communicate (to explain to the family/carers for example simple discharge home instructions) could be constrained.
The absence of the important supporting role from family (especially for patients who had dementia, learning disability, mental health problems and, end of life care needs) was identified as a real challenge. Also, visitors could find the situation stressful, and keen to understand how visiting limitations were being applied and the reasons why.
STSFT developed several initiatives to provide support to patients, visitors and clinical teams:
- virtual visiting using hospital iPads so patients could see and speak to their families via video calling
- supporting outgoing phone calls to families through the bedside TV provision
- encouraging the use of the trust Wi-Fi
- ‘Carers passports’ developed to enable an identified family member to visit, in line with social distancing, to support appropriately identified patients
- ‘Sending Love’ initiatives whereby people can send messages, letters, postcards or photographs to their loved ones in the hospital.
Would it be beneficial to retain these changes?
Many of these changes are enabled by technology. NHS Wi-Fi is now widely available across acute and primary care settings and offers a range of possibilities for staff and patients, including staying connected to friends and family in ways that they are used to. These have provided a vital link with home during the pandemic and are useful for the future.
Clinical staff could signpost patients to useful health apps, for example to support the psychological health and wellbeing of many inpatients. Other patients may simply want to get organised for after their discharge, for example by booking their follow up primary care appointments on the relevant app.
The NHS Long-Term Plan aims to support a delivery of person-centred care, acknowledging “the importance of ‘what matters to someone’ is not just ‘what’s the matter with someone’”. These approaches demonstrate how nursing teams working with other trust colleagues such as those expert in estates, or family liaison teams, can come together to provide this person-centred care
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