Most of us head to the hospital to visit a sick or recovering friend or family member without giving it a thought. But you can do many things to make sure the experience is positive and safe for yourself, the patient, and your family.

1. Do not go to the hospital if you are sick. This includes having diarrhea. Patients already have compromised immune systems because of their injury, illness, or surgery. They also have to fight off hospital-acquired infections to which they are exposed. If you are ill, send your presence in spirit, by phone, through friends, or in prayer.
   
2. Wash your hands for at least 20 seconds with soap and warm water before entering and upon leaving a patient room. Alcohol-based hand sanitizers are not enough! Therefore, scrupulous hand washing is critical for protection.
   
3. Sanitize the bottom of your purse or bag and the bottom of your shoes following a visit to the hospital. This includes contact with your pets! Recent studies show we can "share" these pathogens with animals. Also, change out of and launder any clothing that may have touched the patient. 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 should visitors leave at home?

1. Complaints. You are there to support the patient and family. An upsetting conversation in the presence of the patient, even when he or she is heavily sedated, can have extremely negative consequences. So can whispering, causing the patient to believe that information is being withheld. State everything in positive terms.
   
2. Plants and flowers for ICU patients. They grow mold, and some patients have allergies to them.
   
3. Questions about the patient's condition. Instead, use the services of www.caringbridge.com. The purpose of this Internet organization is to update friends and family on the condition of the patient and the needs of the family. With the assistance of caringbridge.com, the family can set up a blog and make comments or requests as well as expressions of gratitude. Advocacy needs can be placed on the blog around the clock.

What can families or visitors do to improve the patient's care?

1. Have someone with the patient 24/7. The patient needs a guardian. Maintain that post or pass it to someone else. This is especially true in intensive care units.
   
2. Create a "care team notebook." By asking friends, neighbors, and family to assist in advocacy, the family's personal burden is reduced and the patient benefits from "new eyes." This notebook coaches advocates in what they should observe and, as necessary, negotiate with hospital care providers. The notebook should be set up before or immediately upon hospital admission if the patient's stay is expected to be more than a short, overnight visit. For downloadable forms, visit www.hospitalstayhandbook.com. The notebook should include:
   

• Sign-up sheets for each day, with four-hour shifts. Make sure the coming and going of advocates does not occur at the same time as a hospital shift change. This is a particularly vulnerable time for patients, and the presence of a health care monitor is critical.
  
• Doctor visits, in which care team members record every doctor visit/outcome that occurs during their shift.
  
• Procedures, in which care team members record procedures done and expected and actual outcomes.
  
• Notes, in which care team members record any observations during their shift.
  
• Questions, in which care team members list their questions for medical personnel for future shifts.
  
• Outside-the-hospital tasks and chores, listing things that need to be done to keep the patient's family and household functioning. Divide into categories such as personal care for the patient, transportation, household chores, child care, and pet care.
  
• Legal documents, including a copy of the durable medical power of attorney and living will (advance directives).
  
• Emergency contact information for the family, the advocates, the trusted medical advisers, and all key medical personnel.

1. Ask the patient whether she or he has executed a durable medical power of attorney and a living will, also called "health care directives" in some states. 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 to secure the forms. With these documents in place, everyone will know the desires of the patient. This 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.

How can families and friends better coordinate visits?

1. Honor visitation hours and policies, especially in intensive care units. Visits should be staggered so as not to 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 to determine the best time to visit. Patients get tired. 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 and units even disallow visitors during these vulnerable times.

What can families or visitors do to ease the jobs of hospital caregivers and professionals?

1. Offer to assist the nursing staff. Visitors can do many things to assist nurses, such as securing bedding, running errands for the staff or patient, filling water pitchers, assisting with patient food intake, and notifying the nurse when alarms sound.
   
2. Give the family a break. They get tired and crabby, too, making the nurse's job harder. Don't step into this role without learning what needs to be attended to while you are taking the family member's place.
   
3. Learn "hospital speak," even just a little. Machines have names. So do nurses. Calling people and things by their right names supports speedy and compassionate care.

Any other visiting 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 lots of water before and after your visit.
   
2. Manage your own stress—about the patient and about your fear of hospitals, disease, and death. If you can't, don't visit. Sandra Ingerman, a world-renown shaman, 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."

Don't stop visiting hospitalized patients! They need your support. Just do so in a thoughtful and compassionate way.