THE "GOOD" VISITOR

What should visitors know about visiting a patient in the hospital?

1. Do not come to the hospital if you are sick. This includes diarrhea. Patients already have compromised immune systems due to their injury, illness or surgery. They also have to “fight off” hospital-acquired infections to which they are exposed such as MRSA (Multi-Resistant Staphylococcus Aureus) and C. diff (Clostridium Difficile). If you are ill, send your presence in spirit, by phone, through friends or prayer.
2. Wash your hands for at least 20 seconds with soap and warm water before entering any patient room and upon leaving any patient room. Hand sanitizers are not enough! According to the Mayo Clinic, “Alcohol-based hand gels, which are commonly used in healthcare institutions, may not effectively destroy C. difficile spores.” There are many, many risk factors associated with these and other hospital-acquired infections, risk factors that involve hospital procedures and personnel, building environmental factors as well as factors surrounding severity of illness. While hospital attention to minimizing risks can play a big role in the frequency of hospital-acquired infections, these are things over which we have no control. We do have control over our our efforts, efforts which serve both the patient and the visitor. Therefore, scrupulous hand washing by everyone is your only hope for protection.
3. Sanitize the bottom of your purse or bag as well as the bottom of your shoes before contact with anyone following a visit to the hospital. Also, change out of and launder any clothing that may have touched the patient such as a tie. Do so before you enter your home or the patient’s facility. MRSA lives on skin and survives on objects and surfaces for more than 24 hours. C. diff spores survive up to 70 days. Infection rates continue to increase, as do deaths from hospital-acquired infections. This is especially important if you live with someone or visit someone who is:

• immune-compromised;
• on kidney dialysis;
• struggling with a serious underlying illness such as inflammatory bowel disease or colorectal cancer;
• taking antibiotics or over-the-counter antacids;
• recovering from abdominal surgery;
• recently discharged from a hospital; or
• living at an extended care nursing facility.
  

What top 3+ things should hospital visitors leave at home?

1. Complaints. You are there to support them. Having an upsetting conversation with doctors or family members in the presence of your loved one, even when they are heavily sedated, can have extremely negative consequences. So can whispering when the patient believes something is being withheld. State everything in the positive.
2. Plants and flowers for ICU patients. They are not allowed as they grow mold and some patients have allergies to them.
3. Questions about the patient’s condition. Use the services of www.caringbridge.com. The purpose of this organization is to allow all friends and family with Internet access updated on the condition of the patient and needs of the family. With the assistance of caringbridge.com, the family can set up a blog and make comments/requests as well as expressions of gratitude. There is no reason 24/7 advocacy needs could not be placed on this blog, asking for assistance. These postings eliminate the need for the family to personally contact everyone in their network whenever there is a change. It also gives those friends and loved ones who have an interest in specifics the information they crave without bothering the family.
   

What top things can families or visitors do to improve the “care” of any hospitalized patient?

1. Ensure that someone is with the patient, in the room, 24/7. This means twenty-four hours a day, seven days a week. The patient needs a guardian. Maintain that post or pass it to someone else. This is especially true in Intensive Care. A-W-O-L could mean D-E-A-D.
2. Ask the patient if s/he has executed a Durable Medical Power of Attorney and a Living Will, also called Healthcare Directives. If not, help the patient complete them. If you need copies of these documents, go to the Legal or Patient Advocacy office in the hospital secure the forms. No one wants to believe anything bad could happen to them, the very issue that confronted the spouse and parents of Terri Schiavo whose case went to the Supreme Court because she lacked these documents. Regardless of what course of action you believe should have occurred, the fact remains that this painful experience could have been totally avoided had she executed these two documents. With these documents in place, everyone including the medical community, will know the desires of the patient. This action spares the patient’s family from the agony of one of life’s greatest and most difficult decisions. Place copies of each document in the Care Team Notebook and give a copy to the legal department of the hospital.
3. Create a Care Team Notebook. By asking friends, neighbors and family to assist in advocacy, you not only reduce the family‘s personal burden but also benefit from “new eyes.” This notebook will passively “coach” advocates in what should be observed and, as necessary, negotiated with hospital care providers. In order to stay organized and keep track of everything, set up this Notebook prior to or immediately upon hospital admission if your patient’s stay is expected to be anything more than a short, overnight visit! In that way, you are ready to request help whenever well-meaning and caring individuals ask what they can do. It should include:

• Sign-up Sheets – in which you place a sheet of paper for each day with four-hour shifts. Make sure that you do NOT have a change in personnel at the same time there is a shift change at the hospital! This is a particularly vulnerable time for your patient and you want to ensure the uninterrupted presence of an healthcare monitor;
• Doctor Visits – in which you ask each care team member to record every doctor visit/outcome that occurs during their shift;
• Procedures – in which you ask each care team member to record any procedures done and the expected and actual outcomes;
• Notes – in which you ask each care team member to record any observations during their shift;
• Questions – in which each care team member lists any questions they have for medical personnel for future shifts;
• Outside the Hospitals Tasks and Chores – in which you list things that need to be done to keep your family and household functioning, divided into categories such as personal care for your loved one, transportation, household chores, childcare, etc.;
• Legal Documents – including a copy of the Durable Medical Power of Attorney and Living Will; and
• Emergency Contact Information – for the family, the advocate(s), for the trusted medical advisors as well as for key medical personnel. For downloadable forms, visit www.hospitalstayhandbook.com.

How can families/friends better coordinate hospital visits?

1. Honor the visitation hours and policies, especially in the Intensive Care Units (ICU’s). Visits should be staggered and not exhaust the patient. There are good reasons for limiting the number of people in the patient’s room at any one time.
2. Ask the assigned advocate to manage the flow of visitors. Have visitors contact the advocate ahead of time and determine when the best time is to visit. Patients get tired, even when there is not a lot of activity. So do family members who have to answer questions over and over again.
3. Find out when nursing shifts change and procedures are scheduled and avoid these hours. Some hospitals/units even disallow visitors during these vulnerable periods of time.
   

What top things can families or visitors do to make hospital staff jobs easier?

1. Offer to assist the nursing staff. There is a tremendous shortage of nurses that is only going to get worse as “baby boomer” nurses continue to retire. Many things can be done by a visitor to assist the nurse such as securing bedding, running errands for the staff or patient, filling water pitchers, assisting with patient food intake, notifying the nurse when alarms sound (do NOT touch the equipment!), securing supplies, etc.
2. Give the family members a break! They get tired and crabby, too, making the nurse’s job harder to handle. Do not step into this role without learning what needs to be done or attended to while you are taking the family member’s place if they are operating as the advocate.
3. Learn to speak “hospital” speak, even just a little. Machines have names. So do nurses. Doors will open—with the doctors, with the staff and with the patient, who will want to understand what is happening or what has happened to him or her. Calling people and things by their right name supports speedy and compassionate care.
   

Any other hospital visitation dos and don'ts?

1. Take care of yourself. You are of no value to a family member or friend if you go down for the count. Sacrificing your own health for another is not what anyone who loves us would want us to do. Drink lost of water before and after your visit.
2. Manage your own stress, about the patient as well as about your personal fear of hospitals, disease and death. If you can’t, don’t visit. World-renown shaman, Sandra Ingerman, says that “All healing is done by creating space from the heart. Anxiety occurs when you are in a state separate from spirit. If you can’t get emotionally detached, you can’t let spirit through.” This cannot be done when you are operating out of or spilling fear.