Are patients not washed any more in hospital?

[Shortkiwi]

I am a nurse of over 40yrs plus. My 93 yr old father has been in hospital for a week. We have visited every day and had to wash and shave him in the afternoon or evening because it hasn’t been done. When I asked if he could be showered one evening, for the next day, I think they showered him but without using soap or shampoo, basically hosed him down from what he reported. His hair was definitely not washed. His teeth have not been cleaned without us doing them. Shaving is definitely not on the agenda. When I was a young nurse it was a given that patients were bathed each day, either in the bathroom or in bed. Teeth/dentures were cleaned and male patients shaved. We were admonished if these things weren’t done. Dad’s ward was very quiet today with several nurses chatting at the nurses station. They were very happy to get us any personal items we didn’t have. I just think if it wasn’t for us he wouldn’t be clean. He actually said, through his dementia, how much better he felt today after we showered him and washed his hair and said it would last him for a while! Which it won’t of course!
We had a list, in the old days, in terms of total patient care, in which we had to tick off items of personal hygiene for every patient in both our theory and practice. I’m sad for those that might not have relatives to attend to personal hygiene these days. It has never been discussed that we would do it, it’s just not been done. Basically, we have had to take the initiative. Years ago there were charts and care plans at the end of the bed, now it’s all computerised. I can excuse the 3 days of hell in A&E but not these last 4 days on the ward. My Dad is not mobile unless he has a lot of help and he is confused.

Thats the thing though isn’t it, it should be about nursing people back to health.

Yet on another thread there are some awful stories of diabetics and coeliacs not getting fed the correct food for their conditions in hospital. Coeliacs expected to eat food containing gluten or contaminated gf food, diabetics who control it very well though diet becoming ill and requiring insulin in hospital.

It’s a sorry state all round.

I have been in hospital in a ward full of oldies recently and the care there was wonderful. Washing and teeth cleaning was part of the routine after breakfast and took about an hour or more. Bed linen was changed daily (unless there was any reason such as a person sleeping), they would save it til you went to the loo. Water topped up all day, food fed to those who couldn't eat. Changes were immediate if someone soiled themselves which was quite often. I never waited more than about 1 minute for someone to respond to the bell. Cleaning daily, the whole things was an efficient 12 hour shift, twice a day.

One difference was that there was hardly any nurses! Nearly all health-care assistants from around the world, all called the patients darling, love, pet, and were kind and caring with everyone. It's a culture of care, it can be done.

I've also been through many many other hospitals where it isn't like this, and it isn't just about staffing levels although that's part of it. It's about a culture of speaking kindly and realising a lot of the job is older age care, stopping bed sores, ensuring good nutrition and hydration, medicines given on time.

The nurses were excellent, but there was only about 2 of them for 2 wards, the bulk of the care was given by the lovely HCAs, I gave excellent feedback and mentioned many by name.

It’s not the same type of care but when I was on the postnatal ward the care was shocking. I had had a huge episiotomy, I was fine for a couple of days (just in a ‘normal’ amount of pain) but then I could tell something was wrong - my stitches became agonising, like somebody was plunging a knife into them every time I moved. I couldn’t walk or even really sit up. I mentioned it to a midwife who just shrugged at me in a ‘well; what do you expect’ type way, so I carried on with just paracetamol until it was so bad I couldn’t sleep. Luckily another midwife came on duty who was excellent - noticed I had been asking for pain relief through the night, snapped on the plastic gloves and insisted on taking a look. Then called a doctor to come and prescribe antibiotics as the stitches were well infected and totally raw. She was frankly brilliant, very ‘on it’ for the rest of my stay and seemed to spend less time chatting at the station and more time just getting through patients and actually dealing with their problems. She reminded me of a midwife Sgt Cawood from Happy Valley 😆

Looking back there were quite a few midwives who seemed to show disinterest and even open disgust when I raised an issue with them 😮 like they just wanted to palm you off to avoid having to do any ‘not very nice’ examinations or checks. I don’t know if anyone else found this.

@Cantbebotheredwithchores on what basis precisely do you assume I know nothing about the armed forces? Do please be explicit.

@Crikeyalmighty yes, that is part of an hca role. Two main issues with subissues.
First is that like every job you've got dedicated people and very lazy people who are poorly managed by those above you. I spend a hell of a lot of my working life having to ask repeatedly for things to be done, escalating lazy staff to management and getting absolutely nowhere.
The second issue is staffing and ratios. We sometimes have 1 hca for 25 patients. This includes patients who require assistance of 3 or 4 members of staff to wash such as bariatric patients and combative dementia patients. Just the other day an hca had his head split open by a patient cracking him with a walking stick.
My message is just please for people to look at the bigger picture and don't think that the staff can't be arsed to wash a patient every day, this is a VERY tiny minority of crap staff and unfortunately you get shit people in every job in the world.

@Cantbebotheredwithchores how interesting you assume the patient feels more comfortable chatting to the nurse about their concerns than the Dr. I certainly don't, particularly after the shit that was chatted by midwives when my children were born. The nurse usually answers ",I don't know you'll have to ask the dr", or wants to twitter on about my and their personal lives and I have no interest in engaging with personal small talk with them. I just want to be factual and polite and don't seek any overfamiliarity.

I am absolutely not criticising staff as a whole but seeing this happening with my mum was the start of me losing faith in the NHS. The health care assistants were largely excellent. A couple of the nursing staff were fantastic too, really caring and tender.
The one who was there when she died, not so much. She was rough, snappy, rude, and spent A LOT of time gossiping and bitching on the desk outside my mum's room. Very audibly.
If anyone asked for any help from some of the nursing staff in the midst of these endless gossiping sessions, they would literally roll their eyes and huff and puff. When I asked for an extra pillow when my Mum was struggling to get comfortable, one said 'That's not what we are here for, you'll have to wait for a volunteer in the morning'. The linen cupboard was literally about 6 feet away. At this point my mum was on end of life care and I just wanted her to be able to rest. Luckily, the Dr was just coming onto the ward, overheard the nurse and we got the pillow I later heard a senior nurse (in whispered tones but still clearly) giving the nurse a telling off about levels of care and putting patients first.
Without me there my mum wouldn't have eaten either as they repeatedly left her food out of reach.
I know that staff have little time, but most of them managed to show professionalism and care, and it was obvious that some really couldn't be bothered.

I have had great experiences of staff.
But HCAs are very underpaid and there are lots of vacancies. They can't get people to do the hard work for the pay in offer, so maybe they need to sometimes take who they can get?
The typical NHS HCA salary is £20,809 per year. By April this year that will only just be above minimum wage.

I'm on £19927 a year as a band 2 HCA, and ive been doing the job a few years now.

There's just not enough staff for all the patients, and the number of patients requiring 1-2-1 is ever increasing.

There's certainly no chatting at the nurses station on our ward. Not by my anyway.

I know a lady who is a nurse by profession and if you were to get sick or come down with a condition, if you were to go to her, just in a social setting and not in a healthcare capacity, she would dismiss your health condition. She said in the hospital she works at, if people are able to stand, they are not sick enough to need any assistance or help in their eyes. By the way she way talking, you would have to be dead or dying to get any medical help from her place. There's no sympathy or any level of concern or caring towards other peoples condition and disease. Not that I am looking for sympathy, I am not. It would be nice to receive some compassion instead of being written off.

Not only this she often makes jokes where when she's working the night shift herself and her colleagues take it in turns to find an empty bed and get a snooze in, in the middle of the night.
I think it's wrong.

That is awful. This level of neglect in a care home would trigger an investigation how come it can happen in a hospital

I'm not saying it's right at all, but you can't compare care homes to hospitals. There's so much more to do on an acute hospital ward with poorly patients.

In a care home patients are medically fit. They don't need half the things doing that patients in a hospital setting do.

The answer is more staff.

The ward I work on is elderly rehab. Patients are encouraged to do as much as they can for themselves, if they are able. A lot of them want you to do it all, but if we do they aren't rehabbing and we get told off by the physios.

Eg, lots ask for the stedy (a chair type mobility aid to wheel patients to the toilet) when they can walk. If we did this they would go backwards in terms of their rehab, not forwards.

It's awful some of the things I've read on this thread.

You said 'being busy' was a smokescreen, implying it is a ruse to disguise the real reason for poor care. I asked you for evidence of this, which you have failed to do.

I took my car in for a service recently. I was told I could collect it in 5 hours, but it ended up not being ready until the next day. I know they were really busy, they told me, but perhaps they lied and this was just a smokescreen because they were too lazy to work on it.

I agree with Highdays above. It’s a standard set my the ward manager (senior sister). If you insist teeth and hair are brushed every day, and either a shower or basin wash daily, it can work.
carrying out these tasks also involves chatting to a patient, who lives at home with you, how will you manage when home, do you have help etc. knowing your patient, and you can see improvement or decline every day when you do this.
I work in a dept now, doing procedures (kind of DPU) and we have had toothbrushes etc ordered as the inpatients coming down, their mouths are a disgrace. No excuse for it.

She refused the nurse trying to wash her today. The relative who is the main person is away for 2 days with work, male relatives will be going in to visit, obviously won’t be happy to do personal care (one has 3 kids and works away 2/4 weeks so probably very busy)

At what point will they just override her? She isn’t mobile due to not having eaten for days/dehydration. She’s normally very capable and walks up the stairs/street no bother. I feel that it’s the beginning of the end. I might be catastrophising. I just don’t know what to do, I’m hours away, I work full time, I was in A&E myself this week and can’t travel. My sibling is arriving from abroad in a week and is very capable, hopefully they will sort out everything.

Can I ask, at what point do you override the refusing patients? My dm has refused help from the nursing staff since Thursday. I appreciate she wants family to help, but there is nobody to do personal care for the next few days and she is in the same clothes she was admitted in. She’s very weak, so can’t do anything herself currently.

My 86 year old husband has been in hospital for over 2 weeks now. He has serious mobility problems caused by several medical conditions. He is given a bed bath daily by hca, his call bell is answered quickly and he has daily changes of linen plus pjs as required. I cannot praise the hospital and staff highly enough. My only complaint is no refreshments for visitors at weekends.
The hospital is RJ&AH hospital in Oswestry Shropshire. To be fair there is no A&E department which reduces the pressure.

@Brigante9

You can't override it, if the patient hasn't consented then you can't do it.

My only complaint is no refreshments for visitors at weekends.

Huh? what are you expecting, apple turnovers? Pumpkin spice lattes? NHS hospitals aren’t there to provide ‘refreshments’ for non-patients.

I totally understand the lack of consent, but does that mean patients will be left to acquire bedsores/just get filthy? When I was in hospital after a horrible accident, I didn’t want to move in case I further hurt myself, but the sister didn’t allow me to say no. She insisted on changing bedding/clothing etc.

@Brigante9
I'm not really sure, I guess if patients keep declining you just need to gently persuade them until they change their mind.

We absolutely don't just tell them we are doing it anyway. We have to gain their consent.

@Brigante9 If she has capacity she can refuse. Can you talk to her and try and get her to agree to letting them wash and change her?

I’m hours away. She isn’t answering her phone unless a nurse happens to be passing, she’s always been very poor with using it. She spoke to me for a minute yesterday but was desperate to put down the phone. She’s been shown so many times how to use it, it’s unreal. I’m having to rely on family who live nearby and see her daily, but some are away for 3 weeks, others for a few days, the rest are male.

@Brigante9 Then I really think you need to travel to see her.
It is illegal for staff to over ride consent, it would be assault. I have seen staff persuade pretty forcefully patients. But if they are insistent and have capacity they can do nothing. Everyone has the right to refuse care and medical treatment even when it is foolish to do so.