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Revisiting visiting: partners in care

Revisiting visiting: partners in care

Improving family / whanau involvement


What is a 'partner in care'?

A ‘partner in care’ is anyone who a patient has chosen to participate in their care and to have input in their healthcare decisions.

'If we had friends, family members at the bedside, the healing process would begin earlier. Those individuals know more about the patients than we could ever glean in a previous admission assessment, in a protocol, in a handoff, in a shift report.’ - Mary Brimmage Chapman, COO and Chief Nursing Officer, Memorial University Medical Centre.

There has been a global shift away from restricted visiting to a more collaborative approach, where clinical staff embrace and encourage the involvement of family / whānau and supporters in patients’ daily cares and decision making. This includes extending visiting hours. Studies show that having unlimited access to family and loved ones reduces complications and stress, and improves the patient’s experience of care in the hospital.


What are we trying to achieve?

Waitemata DHB Value: ConnectedWaitemata DHB is already embracing an open door philosophy across many of our inpatient wards. We want to make this approach consistent across our hospitals.

Our aim is to formally recognise the importance of family / whānau and supporters in our patients’ journeys and to provide guidance for our staff to encourage and grow these partnerships. We hope to see:

  • increased patient satisfaction
  • increased staff satisfaction and retention
  • decreased chances of harm to patients
  • reduced time that patients need to stay in hospital

What have we done?

Waitemata DHB has recently undergone a change of visiting hours that has seen many inpatient wards extend their visiting hours to 8am till 8pm. Other wards retaining their visiting hours at this time are:

  • Titirangi and Wainamu (medical wards) from 11am-8pm
  • Rangatira (paediatric ward), Mental Health, Lakeview Cardiology, Ward 2 and Ward 12 from 2pm-8pm
  • Elective Surgery Centre from 10am-8pm
  • Special Care Baby Units vary between the two sites:
    • Waitakere visiting from 2pm-4pm and then 6pm-8pm
    • North Shore visiting hours from 2pm-8pm

These variable visiting hours create confusion for our patients and their visitors and restricted visiting has a negative impact on patient experience.


Staff and Visitor Surveys

We have surveyed staff and visitors about their knowledge of visiting policies and the concept of partners in care.

Staff Interview Questions

  1. What are your wards current policies / practices around visitation and involvement of families / whānau in the care of your patients?
  2. What do you and your teams see as working really well in the current environment?
  3. What do you and your teams see as key challenges in the current environment?
  4. What ideas do you and your teams have that would encourage patients family / whānau to participate even further in care and create an even more welcoming environment for visitors?
  5. Are there any specific issues or concerns that you and your teams would recommend be specifically addressed should any changes be implemented?

We spoke to visitors about a range of topics including visiting hours, way finding and involvement in their loved one’s care.

Visitor Interview Questions

Theme

Question

Visiting hours

  1. Could you tell me how you know what our visiting hours are? Did you know prior to coming to visit?
  2. Do our visiting hours suit your schedule? What would be your preferred visiting hours?

Finding your way around

  1. Could you describe how you knew where your friend/family member is in the hospital? How did you know where to go once you arrived?
  2. Could you describe how easy was it to find your friend/family member once you were here

Ward reception

  1. When you entered the ward, could you describe how the ward responded to you? Who did what? How did that make you feel?

Positives

  1. If you could choose the top 3 positive aspects of your visit to see your friend/family member, what would they be?

Improvement areas

  1. If we could do something to improve the experience of visiting, what would be the most important thing that we could do to be? Is there anything else?

Involvement in patient care

  1. During your visits, were you as involved as you wanted to be in providing care for your friend/family member?
  2. Is there anything further you would have liked to be involved in, what would this be? If so, how could we best support you in this? Would you have liked to have been invited to do so?
  3. Could you describe your involvement in helping your family / friend at mealtimes? How did you feel about this?

Patient & visitor info

  1. We are developing an information pack that will be available to patients and visitors. What type of information would be useful to be included?

Did we make a difference?

Staff Survey Results

Charge Nurse Managers on 13 wards were interviewed. Some of the themes from feedback were:

Theme

Question

Involvement of family / whānau and friends in the care of patients

The majority of wards support the involvement of family / whānau and supporters in a patient’s care whenever possible.

Some nurses were worried that involving family / whānau in patient care might cause anxiety if they were not comfortable with carrying out the tasks; and there may be a perception that basic care is a nursing responsibility.

In some clinical areas, involving family / whānau is an essential part of care and recovery.

Increased access to medical teams

Increased access to medical teams was a very strong theme that came through from those wards that have extended their visiting hours from 8am-8pm.

The reported benefits include:

  • better support for patients:  Having family / whānau and friends around for morning ward rounds provides emotional support for patients, particularly when receiving bad news e.g. worrying test results
  • more involvement from family / whānau:  Family / whānau can be actively involved in medical decision making, meaning that they have more confidence and less stress knowing what is happening with their loved one
  • increased productivity for staff:  The number of requests for family / whānau to meet with the medical teams in the afternoon has reduced, increasing overall productivity for staff

Increased flexibility

Extending visiting hours has resulted in a more even distribution of visitors throughout the day, rather than a 'rush' of visitors at 2pm. Some families / whānau are taking ‘shifts’ to be with the patient, allowing the patient more time to rest and reducing stress.

This has also reduced the pressure on the reception and nursing staff dealing with large groups of family / whānau all arriving together.

Privacy and respect

  • Patients:  Privacy and respect was highlighted as a key concern not only for individual patients but others in shared rooms and on the ward. For example patients in a shared room using a commode may be embarrassed if another patient’s visitors are nearby.
  • Family / whānau:  On many wards there is little or no space for family meetings, with day rooms often being used with only a screen across the door
  • Staff:  Staff noted the need for recognition that they need time and space to allow them to complete their work

 

Visitor Survey Results

Results from the survey of visitors showed that:

  • 93% of visitors were family / whānau members
  • 49% of visitors said their family / whānau member or friend had been an inpatient for between 2-4 days, with the shortest being one day and the longest being 120 days
  • 75% of visitors are coming to see their family / whānau or friend on a daily basis

Patients' number of days in hospital

Visitor frequency


Summary of feedback on visiting hours

Theme

Question

Extended visiting hours are more suitable for visitors

The vast majority of interviewees responded that the 8am-8pm visiting hours were suitable.

Variation causes confusion

There is a lot of confusion around ward visiting times. Current signage appears to be adding to the confusion rather than supporting a clear message.

Flexibility of staff

A clear message throughout all the interviews was that while there are guidelines in place around visiting hours, all wards are flexible and accommodating on a case-by-case basis.

 

Feedback on positive aspects

When asked about the positive aspects of their visiting experience, some of the feedback about our staff was:

Feedback on positive aspects of visiting


Areas for improvement

29% of all suggestions were specifically about increasing engagement between clinical teams and families / whānau.

Suggested areas for improvement for visitors


Involvement in patient care

Theme

Question

Visitors are already involved in patient care

76% of visitors are already involved in providing care for their loved one in hospital: 65% of these visitors are comfortable with their current involvement in patient care, with 30% of saying that they would like to be more involved in both the daily cares and decision making.

Only visitors of independent patients said that they were not involved in care of the patient.

Involvement is more than just feeding and grooming

50% of visitors stated that they provide help with eating, drinking and basic grooming. They also help patients with moving, for example to sit up for meals, to go to the toilet or with showering.


 Ways that visitors provide care to patients


Where to from here?

The feedback from visitors and staff strongly supports a 'partners in care' approach. We are aiming to implement ‘partners in care’ as a programme of work. This will include looking at:

  • processes to actively engage of family / whānau as part of the care team and remove barriers to engagement
  • standardising visiting times and updating relevant signage
  • developing family / whānau information packs
  • enhancing community engagement and education
  • providing more staff education and support