The Effects of Hospital Visiting – A Pilot Study Thank you for giving me the opportunity to tell you about my project. 10 week summer scholarship part of RGU. The project arose due to an identified gap in research in this area. It has been found that little is known about the effects of visiting on the hospitalised patient and their relatives. This is suprising as visiting someone in hospital is something that everyone does at some point in their life – but the lack of research does not reflect this. The majority of the research carried out has been in the USA, other countries that have contributed to the body of knowledge are canada, australia, Uk and other european countries. Only 6 of the papers found were from the uk. In total 40 papers were identified. Mandy Watkins, Health Services Research Group

Need for Research The literature research found no studies on the effects of hospital visiting in the orthopaedic setting and very little research for long term settings The effects on visitors in the orthopaedic setting could be quite significant The effects of visitors in the orthopaedic setting have the potential to be significant as the patients are often hospitalised for extended periods of time, the visitors will therefore have their number of visits to see them extended. The research so far has been concentrated in the areas of intensive and coronary care, neonatal care, palliative care and neurology. It has been focused on the family experiences including their needs and anxieties. The effects of children has also been researched along with the frequency and nature of visitor –patient interactions.

Aims of the Study 1) To investigate the effects of hospital visiting on the patients and their relatives 2) To focus on the visitor’s perspective in order to gain an understanding into their experience of visiting

Project Design GRAPHICS KIPKE 2000 BOB 2 GRAPHICS KIPKE BOB 2000 Qualitative approach Literature search and review Observational study of the orthopaedic trauma unit at Aberdeen Royal Infirmary KIPKE GRAPHICS BOB 2000 A study of the interactions. The literature search included a search of the electronic databases Cinahl, Medline, British Nursing Index, Ingenta Select and ASSIA. This was followed by a hand search to identify further relevant papers. The observational study took place over a 4 week period and involved non-participative observation. Observations took place mostly during afternoon visiting times (2-4.30pm), weekend and evening observations were also undertaken in order to see if there were any differences. When observing looking for body language, facial expressions, what visitors brought with them, how long they stayed.

Main Findings Reasons for visiting Patient – visitor interaction Visitor – nurse interaction From my observations able to break the findings down into 3 main categories, areas of interaction

Reasons for Visiting The relatives visit their hospitalised family member to see how they are progressing and how they are feeling They want to help the patient to be as comfortable and happy as possible Many of the previous research findings were identified in the results of this study Visitors acted as patient advocate Ask how they are progressing (OT, physio, pain). Ask the patient to say if they are too tired and want them to leave, offer to get more juice, food for patient, plump up their pillows Categories identified in previous research that i have noticed – commitment to care, wanting to ‘be with’ and ‘see’ the patient. Deaf lady that wanted a cigarette.

Patient – Visitor Interactions Non-spouse male visitors tended to be the ones who picked up the patient chart to check their progress When patients are visited by their spouse there is not much conversation. Often they sit in comfortable silence. 2) Maybe because they are the visitors who are there most days for long periods of time, they don’t have to be chatting all the time, they are just at ease with each other and it is just as if they were at home.

Visitor – Nurse Interactions Visitor – nurse interaction was found to be mostly visitor initiated and on a help seeking basis More visitor – nurse interaction was observed at the weekend when it was quieter on the ward. The nurses were very willing to help the visitors in any way that they could. 2) No physio’s OT’s in at the weekend

Limitations Short amount of time in which to carry out the project Unable to interview patients and visitors Hawthorne effect Scholarship was only for 10 weeks. Unable to get ethical approval for interviewing due to short time available, only able to get approval for observation. The visitors and patients were asked for their permission before being observed. The presence of the observer may have had an effect on the behaviour of the participants. Also the size and layout of the ward presented problems. It is a 69-bedded unit that is divided into 2 wards and then further split into small bays of 5-6 beds.

Recommendations Using interviews as well as observation Increase 15 minute observation spells More observation times Gain access to information about how long patients have been in hospital Using interviews would give a fuller picture of the experience of visiting for the patient and their relatives and the effects. Interviews will allow me to find out about new admissions and delayed discharges – does length of stay affect number and frequency of visitors?? Demographic data of visitors and patients, does this make a difference to the experiences, needs and anxieties – study by Chartier and Coutu-Wakulczyk says anxiety decreases with age, would be interesting to see if this could be backed up. 15 minute observation periods were found to be too short a time to gain enough data Due to the short time available only a limited amount of observations were able to take place. It would be beneficial to future studies to have more observation times in order to gain more information.

Acknowledgements Undergraduate summer research scholarship, RGU Professor Rosemary Chesson, Health Services Research Group Ms Noelle Ruta, clinical nurse manager, orthopaedics, GUHT All the staff at the Health Services Research Group