Lessons Learned: What Have Visitation Restrictions in Hospitals Taught Us About Patient Centered Care?

One of the most disruptive changes to healthcare during the Covid-19 pandemic were limitations to patient visitations. In pre-pandemic care, it was almost unthinkable to have to go through treatment and recovery alone. Family and friends were important pillars of support for people trying to get better. However, as Covid-19 made its way around the world, it became a necessity to limit interactions within sensitive settings, like hospitals and nursing homes, with vulnerable populations. Adapting telehealth capabilities helped to mitigate this gap in support. However, the reality is visitation restrictions had repercussions on patient health outcomes and psychosocial wellbeing and we are still trying to understand their effects. 

Karin Hugelius, Nahoko Harada, and Miki Marutani performed a systematic review of healthcare literature, published in their article “Consequences of visiting restrictions during the COVID-19 pandemic: An integrative review.” The goal of their analysis was to determine the impacts visitation limits had on patient healthcare experiences and recovery beyond the physical barriers to social support. One discovery was that visitation limits had impacts on communication of pertinent information to families for understanding a loved ones changing conditions and care they were being provided. This not only broke down avenues of communication for family members and care teams but also inhibited a care team's ability to provide patient centered care. Hugelius et al. also identified that neonatal, palliative and intensive care departments experienced unit specific disruptions. In neonatal intensive care, full parental participation in rounding played an important role in easing a family’s mind and fostering a connection between family and baby. With visitation restricted parental rounding reportedly decreased from 71% to 32%. Families of patients in palliative or end-of-life care were distressed because of low-quality or infrequent communications from the care team or with their loved ones. This was shown to prolong grief and affect the quality of dying for the patient. Intensive care patients look to the presence of family as a “lifeline to reality” and family support is a key motivator for intensive care patients in the fight to recovery. 

Care team staff also felt inadequately prepared for how much care changed from limited visitations. Under limited visitations, families needed more frequent updates on their loved ones’ condition. These updates also had to be in much more detail and could sometimes take priority over the emotional support care teams provide to families. These updates could become time consuming and take away time from a clinicians’ other responsibilities. Telehealth did aid in connecting patients with their families and alleviating pressure from staff, however it was no substitute for in-person contact. 

The lesson that we can learn from crisis time visitation restrictions is not that we should not implement these in future times of crisis. Instead the lesson is healthcare organizations should work with patients and families to co-design a visitation experience that is conducive to healing and psychosocial well-being for patients and staff. Care team staff, especially nurses and social workers, must recognize and be prepared for the increased need for support and communication by families. Consistent communication and regular updates are pivotal for navigating families and patients through a challenging ordeal made harder by visitation limits. Improvements to video visitations such as improving video quality, lighting, proper settings on devices and privacy are not only essential for examinations by clinicians but also the quality of virtual visitations for families and patients. 

Visitation limitations were necessary to keep vulnerable groups who were seeking care safe but had unfortunate consequences for patient experience and health outcomes. Access to social support like families and friends while struggling to recover is an important part of the healing process and a pivotal component for any organization practicing patient centered care. For both current and future iterations of visitation implementations, decision makers and leaders need to view how these restrictions affect staff, patients and their families. Decisions to limit visitations with the best intentions to protect vulnerable groups without compensating for the damaging effects have the potential to be damaging and erode trust in the healthcare system. Co-designing a patient centered implementation plan using lessons learned from the pandemic and experiences of patients and staff, create the best possibility to navigate these challenges in the future. Co-design is a practiced and data driven methodology for driving the development and enactment of patient centered processes with numerous champions to take inspiration from. If you’re interested in getting started goShadow offers free resources in our co-design toolkit to jumpstart your projects.  

Source: Hugelius, K., Harada, N., & Marutani, M. (2021, September). Consequences of visiting restrictions during the covid-19 pandemic: An integrative review. International journal of nursing studies. Retrieved March 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196532/

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March 25, 2022