Journal of Gerontological Nursing

EPILOGUE 

Visiting the Hospitalized Elderly

Margaret E McPhee

Abstract

There are few sights in a geriatric hospital or long-term care facility as discouraging as that of a patient or resident and a visitor sitting and looking at one another, or more often at the floor, finding nothing to say. We all know how disastrous this can be - the resident feels more uninteresting and worthless than ever, while the visitor feels uncomfortable and helpless. Eventually the visits stop because the visitor feels despondent about the possibility of ever relating meaningfully to his or her friend or relative. One more source of stimulation and caring is lost.

However, something can be done about this situation by facility staff. Fteople can develop skills that make visiting enjoyable for both parties, and the nursing staff are often the most appropriate people to suggest techniques for successful visiting. With this in mind, I offer the following guide, outlining steps that staff might recommend to visitors (who will usually be family members).

Visitors should realize that it is quite abnormal for two people to sit opposite one another regularly for any length of time under any circumstances and expect them to maintain an interesting conversation. So it makes sense for the visitor to plan ahead how the visit will be spent and not let the visit last too long (unless both parties are engaged in something that is absorbing their interest).

Visitors should usually begin by asking the patient about him- or herself, especially for the latest news about something or somebody mentioned by the patient on a previous visit. Remember that little things may be important to the patient, such as a change in medication, how he or she slept last night, or whether a friend has had surgery yet.

Then visitors should give their news - about the garden, the children, the job, the neighbors, or the church, according to the interests of the patient. If the patient wishes to talk the entire time, the visitor should be prepared to listen. However, some patients have little to say or haven't the energy to talk much and are quite grateful if the visitor does most of the talking. Also, if people don't have much of interest happening in their own lives, they can derive a lot of vicarious pleasure from sharing in other people's experiences.

When facts run out, the visitor can describe or explain things - the events that led up to a political event, or the historical background to a family feud. But watch out for boring or exhausting the patient.

Whenever possible, visitors should include the patient in family plans and decisions and ask for advice - for a recipe, gardening tips, help with investment decisions. This should be done only if the visitor genuinely wants the information. Old people can be sensitive to insincerity.

Visitors should reminisce - recognizing what the patient once did for them such as contributing to their knowledge or their character formation. 'If it weren't for you, I don't suppose I'd ever have been interested in wild birds,' or ? think I'm so honest now because you always said you wouldn't punish us if we didn't tell a lie. ' Visitors may need help to learn this technique.

Visitors should let patients reminisce if they wish to. Occasionally the more sophisticated older person feels that he or she is being patronized by being encouraged to talk about the past; others may not have the energy to do so. But most enjoy it, and respond to questions such as, "What was it like before there were motor cars?" or "Can you remember your first girlfriend?" If…

There are few sights in a geriatric hospital or long-term care facility as discouraging as that of a patient or resident and a visitor sitting and looking at one another, or more often at the floor, finding nothing to say. We all know how disastrous this can be - the resident feels more uninteresting and worthless than ever, while the visitor feels uncomfortable and helpless. Eventually the visits stop because the visitor feels despondent about the possibility of ever relating meaningfully to his or her friend or relative. One more source of stimulation and caring is lost.

However, something can be done about this situation by facility staff. Fteople can develop skills that make visiting enjoyable for both parties, and the nursing staff are often the most appropriate people to suggest techniques for successful visiting. With this in mind, I offer the following guide, outlining steps that staff might recommend to visitors (who will usually be family members).

Visitors should realize that it is quite abnormal for two people to sit opposite one another regularly for any length of time under any circumstances and expect them to maintain an interesting conversation. So it makes sense for the visitor to plan ahead how the visit will be spent and not let the visit last too long (unless both parties are engaged in something that is absorbing their interest).

Visitors should usually begin by asking the patient about him- or herself, especially for the latest news about something or somebody mentioned by the patient on a previous visit. Remember that little things may be important to the patient, such as a change in medication, how he or she slept last night, or whether a friend has had surgery yet.

Then visitors should give their news - about the garden, the children, the job, the neighbors, or the church, according to the interests of the patient. If the patient wishes to talk the entire time, the visitor should be prepared to listen. However, some patients have little to say or haven't the energy to talk much and are quite grateful if the visitor does most of the talking. Also, if people don't have much of interest happening in their own lives, they can derive a lot of vicarious pleasure from sharing in other people's experiences.

When facts run out, the visitor can describe or explain things - the events that led up to a political event, or the historical background to a family feud. But watch out for boring or exhausting the patient.

Whenever possible, visitors should include the patient in family plans and decisions and ask for advice - for a recipe, gardening tips, help with investment decisions. This should be done only if the visitor genuinely wants the information. Old people can be sensitive to insincerity.

Visitors should reminisce - recognizing what the patient once did for them such as contributing to their knowledge or their character formation. 'If it weren't for you, I don't suppose I'd ever have been interested in wild birds,' or ? think I'm so honest now because you always said you wouldn't punish us if we didn't tell a lie. ' Visitors may need help to learn this technique.

Visitors should let patients reminisce if they wish to. Occasionally the more sophisticated older person feels that he or she is being patronized by being encouraged to talk about the past; others may not have the energy to do so. But most enjoy it, and respond to questions such as, "What was it like before there were motor cars?" or "Can you remember your first girlfriend?" If visitors find that the patient keeps going over the same story, he or she may be trying to resolve something and it may be worth asking someone else to listen and try to understand the problem.

In the course of interacting with patients, visitors should not tell lies or spare sad news, although it might be wise to wait for an opportune moment. Patients should be treated as normally as possible and allowed to grieve over losses. They should also be allowed to talk about their death and the disposition of their possessions. If they wish to discuss these topics, it is frustrating if no one will listen.

Keep in mind that visitors don't have to talk all the time. They can bring newspapers or large-print books to read together; photos, new and old, to look at; old treasures to see and touch; or prizes won by the children at school. They can bring packs of cards or board games to play.

Visitors should stimulate the patients' senses, allow them to smell and feel, by bringing in flowers, a new sweater, or perfumed soap. Visitors can bring animals (onto the grounds if that is all that is allowed). They can bring in children, friends, give rides, or as a gift, pay cab fares for elderly spouses or friends.

The visitor and the patient can sit and knit in companionable silence, or sew a hem on the patient's new pyjamas. The visitor can push patients in a wheelchair around the grounds, go for a walk, or take them to the coffee shop. All visiting does not have to be done in the facility. A patient who is fit to leave can be taken out or home for a meal, an evening, overnight, or even for a holiday.

Some patients or conditions present particular problems for visitors. What about the patient in the next bed who wants to monopolize the attention? The visitor will have to resist these efforts politely but firmly, but could include her in a game or outing if the patient being visited would like this companionship.

Visitors should be aware of the risk of isolation and lack of stimulation among blind and deaf people and should make every effort to communicate. With the blind, speak before touching, say when you are leaving, describe colors, and place objects where they can be easily found. With the deaf, speak clearly and face the patient. Hold the conversation in a well-lighted area, with the least possible background noise. If the patient doesn't understand one set of words, the statement should be repeated using different words.

Visitors may have to face depressed patients. Depression may not be inappropriate and visitors should allow patients to talk about their sadness and losses. (A confiding relationship is one of the main safeguards against depression.) Visitors who knew the patient when he or she was more fit and active could remind him or her of past achievements. Because being dependent can aggravate depression, visitors could do things to help the patient be more independent, such as modifying clothing so that the patient is again able to dress without assistance. Visitors should allow themselves to grieve with the patient if the patient feels sad. Sadness is not threatening; in fact it brings people closer, anxiety can separate.

Visitors, usually relatives, may have to deal with clinging, overdependent patients. They should understand that this is the effect of feelings of uselessness and insecurity. They should not encourage dependency but continue to express concern and caring, and never threaten not to return if the patient does not stop the dependent behavior.

Patients may be anxious or angry because of loss of capabilities. Visitors should understand that the anger is not directed toward them and they should react quietly and calmly. Paranoia is another form of behavior that visitors find hard to handle. Sometimes this may be caused by a lack of clear messages from the environment due to impaired vision and hearing or poor memory. The visitor should make sure that the patient's hearing aid is working and spectacles are worn. Speak clearly, both verbally and nonverbally, and use every possible means to maximize vision, hearing, and understanding. Sometimes the fantastic beliefs of the paranoid may be an attempt to escape from an unsatisfactory present. The visitor might reduce the need for these beliefs by doing whatever is possible to restore the patient's self-esteem.

Patients with brain damage are among the most difficult with whom to visit. Visitors should understand that even when patients appear to understand (eg, that you are not coming tomorrow), they probably do not. Even though they hear messages, they are incapable of acting on them. Memory loss affects every action they could take. Visitors should listen and pay attention to patients and never criticize them, question statements, or treat them as children.

Visitors to dying patients should communicate with them as normally as possible and remember that when with patients who may not appear to be conscious, hearing is the last sense to be lost.

One final word: visitors with any patient should try not to let the public setting of the visit inhibit expressions or demonstrations of affection. If physical displays of affection were common before institutionalization, visitors and patients should continue to kiss, stroke, hug, touch, and in doing so probably meet the needs of both parties.

10.3928/0098-9134-19860901-09

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