Concerned about DM's state in hospital

[ThePhantomRaspberryBlowerOfOld]

My DM is in hospital for an infection and is in a side room on a ward. she ids desperately unhappy as she says the staff are so rude to her, saying she never bothers to say please or thank you, not answering when she calls (the lady in the room next her cries next to her complained that for help were unanswered all through one night - the nurse in question then challenged me about it the next day and said she'd been in tears about being complained about).

I've just visited DM and she said that last night the sister told her that if she didn't stop buzzing for the nurses then she'd take away her meds.
DM has depression and can be difficult, but the nurses do seem brusque. I tried to talk to the sister to ask how my DM was doing, and to raise concerns about her distressed mental state, and she couldn't have been less helpful.
What do I do? Raise a complaint with PALS? I'm concerned though that DM is actually overreacting as it's all hearsay, but her mental state is genuinely very poor. She's not eating properly, she's very down and keeps asking me to help her get out, she has no interest in books or magazines or puzzle books, she's just lying there stewing for days on end.

Being in hospital is plain awful. Does your dm have an infection, is that why she's in a side room? Infections can lower mood. Is she immobile, does she have a catheter?

The fact is that someone buzzing for a nurse is communicating. They may or may not need nursing care at that point but something is wrong. Is she depressed/low mood and is that being treated? Is her eating being monitored, is tgere a food/fluid chart being completed, and if not eating enough what is the plan? If she's less mobile is the physio involved and what are they saying? Is she sleeping and if not why not?

I would ask a lot of questions and i would write down all the answers. You may or may not complain but things could be a lot better.

Being in hospital can be very depressing, a side room can make patients feel very isolated, does she have a tv or radio in her room,maybe you could ask the staff when she is likely to be moved onto the main ward if that's possible. How do you know about the patient in the room next door, usually the doors are kept shut if patients are in side rooms for infections. Perhaps it would be a good idea to speak to the doctor, tell them she feels wry isolated and is happy, they may suggest she see a mental health worker if she suffers from depression. There is no justification for nurses to be rude, but I've never known of a nurse threaten to withhold medication because of a buzzer going off, she has unmet needs and this should be explored with the whole team looking after her.

Can you take food in that she’d like? Hospital stays are long and boring and food may help break up her day and be something to look forward to. Plus hospital food is pretty grim. Maybe aim for 2 short visits a day if possible. Without knowing her it’s difficult to say whether treatment is poor or she’s just feeling frustrated and ringing the bell a lot for company as she’s stuck looking at the same 4 walls all day. I’d go for speaking to the matron or ward sister tomorrow over PALS initially with a clear idea of your concerns and realistic things you’d like to see things improve.

She is very lonely I think. She looks forward to my daily visits but spends them begging me to let her go home.
She’s recovering from pneumonia, she had been on oxygen and a catheter (now removed), was being feed by some liquid going into her stomach but has also been choosing chicken and soup to eat, though the sister said she wasn’t eating well enough. Saw a nutritionist who said she’s recommend she continues with supplements once discharged.
She has a physio who was apparently the one who said to her ‘you never bother to say please, you never bother to say thank you’. She was in tears after that.
I’ve been told we have to keep the door of her room open so the nurses can keep an eye on her. She wants it shut.
I know about the complaint from the room next door as the nurse who was complained about to her manager accosted me when I went into visit mum the next day in the day room to say how upset she was that a complaint had been made against her and that she’d been in tears because of it as she’s been treating my mum so well, but my mum tends to lose her call button. DM says the nurses deliberately put it out of her reach. Surely a nurse shouldn’t bring a patient’s relative into her complaint? The whole ward seems really dysfunctional, very odd. I can’t make head nor tail about what’s actually going on.
Good idea re: food from outside, I’m not sure what she’s allowed yet but will investigate.

If the staff are happy for the door to be kept open then maybe she could be moved out onto the main ward, that would be a bit of company for her. If she wants the door shut then that could make her feel more isolated and lonely. With the food I would ask to speak to the nurses and dietician before you bring anything in as it may be she is on a special diet at the moment. Her callbell may have a clip that could be attached to her bed linen, does she drop the bell or do the nurses leave it out of reach, it could just be ,eff on her bedside table and pinned to something to stop it falling on the floor. It does sound a bit confusing, but you can relay your concerns to the sister and doctor and maybe ask if the physio did make that comment.0

If you are going to take this up the line - and I it sounds as thought you should - then do talk to PALS but before you do make sure you are absolutely clear what is going on. Is your mother being reasonable? is she telling you the truth? does she buzz for nothing all the time? are the ward staff being responsive? are they telling the truth?

Also worth asking what has to be achieved before she can be discharged (eating well? clear of infection? able to mobilise? care package?) and what is being done to progress that as quickly as possible.

is tgere a food/fluid chart being completed,

When DMIL was in hospital, we got told off for looking at her notes. Data protection and all that - we could ask in writing if we wanted and a staff member would provide details.

We discovered that we had to learn to identify the most senior person on the ward, and ignore the rest, as no one seemed very clued up on details.
(DMIL has dementia and also didn't want DH to know anything! He is her only child and has POA so that she can get the right care! this may not apply in your case.)

The nurse was absolutely out of order reacting in that way; obviously it is always horrible having a complaint made about you but reacting by grabbing the relatives and telling them what a tough time you are having is just ridiculous. It does, however, suggest something serious lacking in the management of the ward. The sister should be absolutely all over a nurse who has had a complaint made - both in support of the nurse and also in working out what has happened. Suggests either there are so many complaints that they have become unable to manage them or blasé, or in general just not very good at management. Scary.

Agree with Purple's posts about your focus needing to be 'what are the barriers to DM getting out of here'? Hope she is on the mend.

She has a physio who was apparently the one who said to her ‘you never bother to say please, you never bother to say thank you’

Hospital staff are only human. If your mother never says please or thank you, staff will feel less inclined to go and attend to her. I know the place might seem awful to you, but your mother might help herself by showing some gratitude when people do things for her. You can be unhappy but still show some good manners.

I couldn't disagree more Birdie, it's nice to be thanked, but it's absolutely not a condition of nursing care.

I also disagree with Birdie - most people who are in hospital are in a pretty bad place both physically and mentally, so demanding “good manners” from them is a bit much really!!!

Who complained about the nurse, the patient in the room next door or your mum, I don't understand the connection or why the nurse got upset. If course it's nice to have a please or thank you but physio don't expect this do they or comment on it if they are professional.

If i only treated patients who said thank you i'd have a nice relaxed time for a bit but i would be sacked. Tbh i'm always amazed when people do thank me as what i do is no fun for them (not a physio)

is it possible that your DM has delirium, especially if her behaviour is very different to her usual behaviour? When DF was in hospital he told me how he had been taken to a room at night and been interrogated! He also said that they were given their dinner at 11pm one night. He was just so confused, and it is quite common especially in the elderly when they are in hospital

I’m a nurse, and some patients are just PITA, some are confused for whatever reason, some are in pain, frightened, whatever. It doesn’t matter if they buzz 50 times, I never get cross, I never make them feel bad, I always try to help in whatever way I can.
The fault lies with the staff. End of. The physio is completely wrong.
The nurse wailing about a complaint being put in? Completely unprofessional.
Bring your mum nice soup in a flask, sandwiches etc. Help her get up and walk, walk, walk, then she can get out of there!

Ineed I’ve seen that happen too. The other patients spoke up and said the nurse involved was so kind all night, despite confused patient being a complete nightmare and putting a complaint in. It was all resolved. But the patient believed their reality, they should not be made to feel bad!

Can family be there more with her ( obviously they can't be there all night ) but it sounds like she's lonely in the side room and therefore maybe buzzing a lot. I agree with Eleanor- some patients drive me crazy but you have to remain professional and kind. I have once been a little brusque on a 12 hour nightshift when there was an over whelming amount of patients buzzing , but recognized and apologised straight away , we are all human.

I would also add that I have a few colleagues who pull patients up on not saying please and thank you and I really don't like to see patients embarrassed like that. As the poster above says many people are in a bad place mentally and physically and their normal personality becomes completely overshadowed. I cringe when I hear members of staff walking away muttering "thankyou" sarcastically under their breath. It's just not necessary.

Side rooms are a real problem IMO. And all the new hospitals are built with side rooms only, for inf. control purposes. I get that. But it is extremely isolating for people when they are very vulnerable. Years ago on wards other patients looked out for people, chatted on the ward, made friendships and went to the shop etc for each other. Side rooms have stopped all that. And no day room even where they can go to chat/watch strictly/comfort each other, help each other. It’s dreadful.
I worked on a ward that had a day room recently, patients went there for meals, and it was great. The patients made friends and ‘walked’ together, chatted etc. It was fabulous!

I understand its not easy and we had the same begging to get out when DM was in earlier this year. However the continuous pressing of the call button is not acceptable. There was one woman in when DM was in and she would press it upwards of 10 times an hr and shout nurse nurse after anyone in uniform, then it would be pass me a tissue, get my bag, I need a drink when its sat in front of her.

There has to be a balance of making sure your Mum has everything to hand and encouraging her to do for herself.

But yes also there needs to be better comms with the ward - many are understaffed and under increasing pressure to get things done in reduced time frames. Auxilliaries are the best to have on side to get things done and we found often the ones that knew what else was going on. We befriended them but we also provided 24.7 cover for Mum as she was more than a handful and her injuries we didn't feel were taken seriously. If you choose that route (24.7 attendance) make yourselves useful and pretty much do everything for your Mum and they are not too bothered about you being there all the time and doing shift changes - we were lucky as there are plenty of us to do that (6 kids) but it was still a killer as it was mostly 4 of us doing it. We managed to cover about 6 weeks worth of stays over a 3 month period

Some staff on general wards (not all) really can’t seem to manage patients with mental illness, they struggle to manage behavioural and psychological symptoms of dementia or depression and can’t show any empathy or care towards someone who may not be presenting in a “normal” manner. Eg the physio complaining that she doesn’t say please or Thankyou
I would speak to the ward manager ask if your mum can be seen by the mental health liaison team maybe she would be better on a ward that won’t disregard her mental health. Also agree with the pp that said she might be better out of the side room in a bay so she can feel less isolated.

This is why I stopped nursing in a acute setting as I really struggled with how rude people were. For some reason it bothered me more than being assaulted. I had people click their fingers, use the buzzers regularly for things they could easily do themselves etc. I met one man who had asked me to reposition his wife and as I was asking my team members to assist shouted “I said now bitch”. Maybe stop and observe your mother and her behaviour before complaining.

You need side rooms for infection control and end of life care, being on a hospital ward can be really noisy and disruptive. It was different before when patients helped each other, did the tea rounds and stuff like that but they are not allowed to now plus the relaxed visiting hours doesn't give other patients much privacy and peace. Sometimes a hospital ward seems more like a social club that a place for people to rest and recover.Unless you hear a member of staff or a patient being rude then you can't really complain, it's just heresy and some people do exaggerate and make stories up, not always deliberately. The staff may be keeping a record of her concerns, buzzing, anxiety. I'd ask for a meeting with the doctor and ward manager

Have you spoken to the consultant in charge of your mum's care about what exactly is going on? If she has got to the point of needing to be fed with a NG tube from pneumonia, then she has been v sick indeed. Do you know how well they think she is now or what the chances of recovery are?

I would agree with Holey that you need a meeting with her consultant to understand medically what is happening and the ward manager to understand what the nursing care plan is, and to clarify the call button/please/thank-you issues.