Posted: April 29th, 2024

Are Patient Visitations Endangering Lives?

Are Patient Visitations Endangering Lives?

The COVID-19 pandemic has posed unprecedented challenges for healthcare systems around the world. One of the most controversial and difficult decisions has been how to balance the benefits and risks of allowing visitors to inpatient settings, such as hospitals, mental health units, and maternity wards. While visiting can provide emotional support, comfort, and person-centred care for patients and their families, it can also increase the risk of transmission and infection of the coronavirus, especially among vulnerable groups. In this blog post, we will explore the impacts of restricted visitation policies on patients, family members, and healthcare providers, and some of the strategies that have been implemented to mitigate them.

Restricted Visitation Policies: A Global Trend

Since the outbreak of COVID-19, many countries have adopted strict measures to limit or prohibit visitors to inpatient settings, in order to protect patients, staff, and the public from the spread of the virus. For example, in England, the NHS issued guidance in March 2020 that advised against all but essential visits to healthcare inpatient settings, with some exceptions for end-of-life care, children, maternity, and mental health services. Similarly, in Canada, most provinces implemented no-visitor policies or restricted visitors to one designated person per patient. These policies were based on the principles of infection prevention and control, social distancing, and resource conservation.

However, as the pandemic evolved and more evidence became available, some countries have revised their visitation policies to allow more flexibility and accommodate individual needs and preferences. For instance, in June 2021, the NHS updated its guidance to welcome visitors in a very careful and COVID-secure way, with local arrangements for visiting hours, number of visitors, face coverings, testing, and screening. Likewise, in Australia, the National Cabinet agreed on a framework for easing visitor restrictions in residential aged care facilities in May 2020. These policies were informed by the recognition of the importance of visiting for the wellbeing and recovery of patients and their families.

Impacts of Restricted Visitation Policies: A Scoping Review

The impacts of restricted visitation policies on patients, family members, and healthcare providers are complex and multifaceted. A recent scoping review by Kaur et al. (2021) identified 63 studies that examined these impacts across different healthcare settings. The review found that:

– Patients experienced increased anxiety, depression, loneliness, isolation, fear, confusion, anger, frustration, boredom, helplessness, hopelessness, guilt, grief, and loss of control due to restricted visitation policies. They also reported decreased satisfaction with care, quality of life, comfort, trust, communication, and adherence to treatment. Some patients felt abandoned or neglected by their families or healthcare providers. Some patients experienced adverse outcomes such as delirium, deterioration of cognitive function or physical condition,
and increased mortality.
– Family members experienced increased stress,
anxiety,
depression,
grief,
guilt,
anger,
frustration,
helplessness,
hopelessness,
and fear due to restricted visitation policies. They also reported decreased satisfaction with care,
communication,
information,
involvement,
and support. Some family members felt excluded or powerless in decision-making processes or care delivery. Some family members experienced difficulties in coping with separation,
loss,
or bereavement.
– Healthcare providers experienced increased workload,
stress,
anxiety,
burnout,
moral distress,
and compassion fatigue due to restricted visitation policies. They also reported decreased satisfaction with care,
communication,
collaboration,
and support. Some healthcare providers felt conflicted or guilty about enforcing visitation restrictions or witnessing patients’ or families’ distress. Some healthcare providers experienced challenges in providing holistic,
person-centred,
and family-centred care.

Strategies to Mitigate Impacts: A Call for Innovation

The scoping review by Kaur et al. (2021) also identified some of the strategies that have been implemented to mitigate the impacts of restricted visitation policies on patients,
family members,
and healthcare providers. These strategies included:

– Virtual visits: The use of technology such as video calls,
phone calls,
text messages,
emails,
or social media to facilitate communication and connection between patients and their families or friends. Virtual visits can provide emotional support,
information exchange,
involvement in care planning or decision-making,
and social interaction for patients and their families. Virtual visits can also reduce the workload and stress of healthcare providers by enhancing communication and collaboration with families.
– Alternative forms of contact: The use of non-technological methods such as letters,
cards,
photos,
drawings,
gifts,
or personal items to convey messages of love,
care,
and support between patients and their families or friends. Alternative forms of contact can help patients and their families cope with separation and maintain a sense of presence and identity. Alternative forms of contact can also provide comfort and reassurance for patients and their families.
– Compassionate exceptions: The use of individualised and flexible approaches to allow visitors for patients who have special circumstances or needs, such as end-of-life care, palliative care, critical care, mental health care, learning disability care, autism care, children’s care, or maternity care. Compassionate exceptions can respect the rights and preferences of patients and their families, and promote person-centred and family-centred care. Compassionate exceptions can also reduce the distress and suffering of patients and their families, and enhance the quality of care and outcomes.
– Staff support: The provision of psychological,
emotional,
and practical support for healthcare providers who are affected by restricted visitation policies. Staff support can include regular debriefing sessions,
peer support groups,
counselling services,
wellness programs,
or recognition and appreciation initiatives. Staff support can help healthcare providers cope with the challenges and pressures of their work, and prevent or reduce burnout, moral distress, and compassion fatigue. Staff support can also improve the wellbeing and performance of healthcare providers, and foster a positive and supportive work culture.

Conclusion

Restricted visitation policies in inpatient settings have been a necessary but controversial response to the COVID-19 pandemic. They have had significant impacts on patients, family members, and healthcare providers, affecting their physical, mental, emotional, social, and spiritual health. However, there are also strategies that can be implemented to mitigate these impacts, such as virtual visits, alternative forms of contact, compassionate exceptions, and staff support. These strategies require innovation, collaboration, and adaptation from all stakeholders involved in healthcare delivery. As the pandemic continues to evolve, it is essential to monitor and evaluate the effects of restricted visitation policies and the effectiveness of mitigation strategies, and to adjust them accordingly to ensure the best possible care and outcomes for patients and their families.

References

: NHS England (2020). Visiting healthcare inpatient settings during the COVID-19 pandemic. Retrieved from https://www.england.nhs.uk/coronavirus/publication/visitor-guidance/

: Canadian Foundation for Healthcare Improvement (2020). Essential Together: Supporting Family Presence During COVID-19. Retrieved from https://www.cfhi-fcass.ca/WhatWeDo/covid-19/essential-together

: NHS England (2021). Living with COVID-19: Visiting healthcare inpatient settings principles. Retrieved from https://www.england.nhs.uk/coronavirus/documents/c1606-living-with-covid-19-visiting-healthcare-inpatient-settings-principles/

: Australian Government Department of Health (2020). National Cabinet Statement on Residential Aged Care Facilities. Retrieved from https://www.health.gov.au/news/national-cabinet-statement-on-residential-aged-care-facilities

: Kaur, H., Singh Gill, J., & Kaur Sidhu, S. (2021). Impact of restricted visitation policies in hospitals on patients, family members and healthcare providers during COVID-19 pandemic: A scoping review protocol. BMJ Open, 11(9), e048227. https://doi.org/10.1136/bmjopen-2020-048227

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