Inpatient ward nurses' perceptions of extended visiting hours in a Singapore tertiary acute hospital: a repeated cross-sectional mixed-methods study.

BACKGROUND: Extended family visiting hours may support person- and family-centred care but can increase operational burden for ward nurses. The relevant operational domains include noise and rest, procedure timing and ward routines, family interactions and communication, infection control, ward space and workflow, care quality and coordination, and stress and workload. Evidence on how nurses' perceptions across these domains evolve during implementation remains limited. METHODS: We conducted a repeated cross-sectional, quantitatively dominant mixed-methods study using two anonymous hospital-wide surveys: Wave 1 (16-30 March 2025) and Wave 2 (30 March-15 April 2026). The analytic samples comprised 268 and 338 nursing respondents. Thirteen de novo items derived from operational monitoring objectives were compared using Pearson chi-square tests with Benjamini-Hochberg false-discovery-rate correction; binary logistic regression estimated the odds of reporting 'Worsened'. Brief free-text comments underwent structured descriptive content analysis, with operational themes stratified by the common general-suggestions prompt and the Wave-2-only problem-focused prompt. RESULTS: Based on human-resources-confirmed inpatient ward nurse denominators (2,625 and 2,792), response rates were 10.2% and 12.1%. Response distributions were more favourable in Wave 2 for 12 of 13 shared items after false-discovery-rate correction (q < 0.05; odds ratios for 'Worsened' 0.33-0.57). Infection control was the sole estimate compatible with no cross-wave difference (OR 0.92, 95% CI 0.67-1.27), while 46.2% still rated it 'Worsened' in Wave 2. Workload (43.2%), ward space (48.8%), noise (39.3%), and workflow (34.0%) also remained substantial burdens. Prompt-stratified free text described relational benefits alongside persistent interruptions, infection-control monitoring, noise/rest concerns, and variable caregiver participation. CONCLUSIONS: Nursing respondents reported more favourable perceptions in Wave 2 across most domains, particularly relational and communication domains, but the anonymous repeated cross-sectional design cannot distinguish adaptation from differences in respondent composition. The combined pattern is most consistent with partial adaptation rather than full normalisation. Persistent infection-control, workload, noise, and space burdens indicate priorities for structural support and prospective evaluation. TRIAL REGISTRATION: Not applicable.