Why Nurses Should Welcome Special Visitors as Partners in Care
By Joan Fox Rose, MA, RN, contributor
Pres. Barack Obama issued an executive order on April 5, 2010 that mandated hospitals allow same-sex partner visitation rights. As a result, hospital administration teams had to review, revise and apply new visitation rules based on the Special Visitor rule. Policies had to comply with Medicare, Medicaid and Joint Commission guidelines.
“The primary support person rule isn’t an option; it’s a right in this country,” said Terri Nuss, MS, MBA, vice president for patient centeredness for Baylor, Scott & White Health, a Texas-based, nonprofit corporation that includes 49 Texas hospitals.
“Patients have a right to say who they want to stay with them,” Nuss continued. “And family is whoever the patient tells us who are family. Patients have the right to choose one adult they wish to stay with them at any time during a 24-hour period unless safety to self or others, or critical privacy issues, are at risk. However, these are industry problems and not patient issues to solve.”
It’s important for nurses to ask patients who they want to be their primary support person and if they want this person to hear privileged information, or to only have access to them, Nuss explained. “This is an especially important task for nurses who are already juggling a lot of other tasks,” she said.
Nuss led a 2011 study that included 12 Baylor hospitals. Study goals were based on administration team efforts to implement the new hospital visitation system. The results of the study, entitled “The Impact of Opening Visitation Access on Patient and Family Experience,” were published in the July-August 2014 issue of the Journal of Nursing Administration (JONA).
To begin their quest for change, nursing leaders at these Baylor hospitals were asked this question: “What do we need to do to make a difference, to let patients know they’re connected and have access to us?”
“We knew we needed a single system to ensure visitation rights were the same in all our hospitals,” Nuss said. “Our first goal was to undo fear caused by bringing in families into our circle created to ensure privacy issues weren’t compromised. We were fearful that we would violate HIPPA policy, and although our intent was to protect privacy, we didn’t want to build walls to keep patients’ families out.”
In an effort to allay nurses’ fears that they might unwittingly disclose privacy issues, they were told they’d be fully supported by the hospital administration at Baylor. Other important issues that had to be addressed were how infection control and safety impacted on visitation rights.
“In the past 100 years, we’ve created more sterile environments for safety and infection control,” Nuss said. “These measures were implemented with the patient in mind as a way to improve our regimen of treatments, but they were so focused they left emotional supports provided by families in the waiting room.”
Hospital-wide safety protocols were in place before the new visitation policies were initiated, Nuss pointed out. They included securing hospital doors at night and limiting access with security personnel in attendance. “Our new protocol is to ensure we know when special visitors are staying the night and to know who is in the area,” she explained.
Partnering with special visitors for improved patient outcomes
“Loved ones are sources of information because they know patients better than nurses do,” Nuss said. “They’re the people who alert us when they realize their loved ones are not responding well or acting right, and they provide emotional support, especially when there’s a change in health conditions or care protocols. They assist with patient teaching by listening, learning and reinforcing important content, especially when patients may not be listening due to pain and discomfort. Special visitors are observers who witness first-hand how hard nurses work to provide a patient with the best of care.”
The researchers concluded that patients experience less anxiety and fear when trusted special visitors are in attendance. “Special visitors, whether family members or friends, are partners in care who advocate and provide support systems for patients,” Nuss said.
Since the new visitation policies have been enacted in the hospital system, patient satisfaction scores have reflected improved patient attitudes toward nurses who are more courteous and respectful of them. In addition, patient teaching outcomes have improved due to more effective communications between nurses, patients and families.
“Wherever nurses are employed, it’s important for them to know what visitation policies are in place in their hospital,” Nuss concluded.
Travel nurses are advised to clarify visitation policies during their assignment orientations or at any time they begin working on a new unit.
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