to wonder if geriatric and psychiatric patients should be put onto specialist wards

[hardhatdonned]

I'm just watching dispatches and pairing it up with my own experiences of being a hospital in-patient several times I am wondering if IABU to wonder if geratric psych and psychiatric patients in general should NOT be placed on general wards with other non-psych patients? I had the misfortune of being on a mixed ward after two operations mixed in terms of gender and mixed in terms of psychiatric history and age - basically a general surgical ward and whilst recovering from quite serious surgery was witness to bed blocking dementia patients who required quite intensive specialist care from non-surgical wards.

IABU and selfish aren't i. But it really is distressing and upsetting when you're at your most vunerable. The rational side of me says IABU because everyone deserves fair and equal treatment but then part of me is petrified of ever being stuck on a ward with several patients with dementia again terrible isnt it.

it was upsetting. she's ok now though

Only cleaned once in 24 hours?

When Ds has been in hopsital there is always at least one domestic on the ward during the day and at night the other staff do any cleaning necessary.

Am interested to know how one can tell by looking that a patient has dementia & is bed blocking?

Even with years of experience dementia is not diagnoses by looking alone. Certain diseases, dehydration & infections & even treatments hemselves can cause confusion. As the staff cannot divulge a fellow patients diagnosis how can people make the assumption that the patient is not in need of being on the ward & just bed blocking?

I think that the most frightened patients on the ward are often those with confusion, who don't understand where they are or why they are there.

That said I agree that it is far from ideal to have any sort of distress when recovering on a ward but side wards are limited & there isn't an easy answer.
I agree private rooms are better for most patients not just confused patients. But even with private rooms you can still hear shouting & there are a lot of ethical issues in saying that all confused patients have to be kept together; aren't they entitled to the most peaceful recovery possible despite their own condition?

Thankfully we have moved on from the days when such patients were strapped to the bed & hidden out of sight.

I suggest you avoid RAH in Paisley then, it's filthy.

You know what? It's the blanket term geriatric I object to most here. And hysteria about Nhs wards. And over high expectations. I have had surgery and recovery on two Nhs hospitals. Had excellent care and the only problem I encountered with the "geriatric" patients I shared a bay with was that I couldn't sleep because they snored.
During the day they were a delight despite being in pain, and realistically not facing long to live. On the first ward I was on there was an old lady who was certainly suffering from dementia and moaned a lot. I thanked my lucky stars I wasn't in her state, and wept at night because I couldn't sleep - it was a very difficult time. But I got my surgery, I am fully recovered and my bottom line about most Nhs/midwife/healthcare gripes is thank god I live here and wasn't born in the slums of Africa.

When my friend was 10, she had appendicitis and ended up in a ward with a patient with dementia who wandered around the ward at night and stole my friend's hairbrush, which to a 10 year old was very distressing. This is Ireland in the 1970's though! I do think single rooms are the way to go but over here, that only happens if you have private health insurance.

I do think certain patients need to be kept apart from others, as much for their own comfort as that of other patients.

It is a difficult issue but that doesn't mean it should not be discussed or attempts made to change things.

My 80yr old mother was in hospital recently and IMO her recovery was severely compromised by lack of sleep, she was exhausted when she came home. Hospitals are never a particularly relaxing place but when you are disturbed day and night by a confused and demented patient in the ward screaming, sobbing and wandering at all hours it is hard to get well. It also made it difficult for the nurses to offer the standard of care as so much time was spent dealing with just one patient.

That patient is entitled to care but so is everybosy else on the ward.

So many things wrong with what you're saying hardhat:

1. Many of these people will not actually have dementia they will have an 'acute confusional state' due to the surgery or other illness they've had. Very, very common in older people who at other times might be as 'sane' as you or I.
2. Psychiatric hospital is for psychiatric illness and definitely not equipped for post op or medically ill patients. I work in one and we can't accept anyone with a drip (they might get strangled with it) or who needs hoisting to stand (we don't have a hoist) etc, etc It might get them out of your hair but they won't get the care they need. We don't have any physio for instance on psych wards.
3. Dementia is very, very common. 80% of people in general hospitals are older than age 65 (5% of people >65 rising to 20% of people over 80 have dementia). It should be their core business to care better for these folk because the problem will not go away. YOU are in the minority as a younger person on a general surgery ward.
4. All the things people are saying could be addressed by better care if only general hospitals saw it as their business, trained their staff and changed their procedures. Care in general hospitals is a major theme of the governments National Dementia Strategy actually. Your idea of shipping them all off elsewhere won't work because there is no elsewhere that caters for all their needs.

One day there is a very good chance it will be you or someone you love and I hope you've found some compassion by then.

I agree it is very hard to give a high standard of care to all patients but that is usually the case wherever you work. I think that most nurses will agree with me that during any given shift you will spend the majority of your time on a minority of your patients. That can be because of their illness (including confused states; I have seen kids in confused states not just elderly) or complex treatment needs or sometimes just because they are more time demanding. That's not a negative judgement but fact that some people seek more reassurance/ input than others who will only call out if they are desperate.

It is unfortunate that hospitals aren't usually peaceful places but I agree with the posters who point out the many different causes of noise & unrest in hospitals. I think any of us that have spent time as a patient on labour & delivery/ post natal wards can testify to that :)

my bottom line about most Nhs/midwife/healthcare gripes is thank god I live here and wasn't born in the slums of Africa.

Ah but presumedly those who live in the slums of Africa wouldn't be taxed to high heaven to pay for their treatment either though, yes we are better off than most but since we pay for the service it's not a charity that I am a grateful receiptant of.

nothing short of sedation would have helped.

I'd have left her outside with a packet of 20, that would have kept her quiet for an hour at least

lookandlearn I totally agree about geriatric being an unhelpful blanket term.

My lovely grandpa got put on a ward with all other elderly patients a couple of months before he died. The nurses obviously didn't realize that he was compos mentis and kept talking to him in baby language, which was really distressing to hear. Eventually we found out why: when he came in one of them said 'so, I see you're Mr. Gerald, is that what I call you?'. Grandpa was quite a formal person (not that unusual in his generation) and assumed she'd got his Christian name and surname swapped around, so he said, 'no, I'm Mr LRD'sSurname.'

They were busy, the ward was full of elderly people who weren't compos mentis, and they assumed he didn't know his name. For 24 hours until got up to visit him.

Sorry, it's a random memory of mine but I think it's so hurtful to people to group them together as 'geriatric' when they're all individuals with different reasons and needs.

I can see why you would want people with dementia/confusion in separate wards, although I accept that it is rarely practical for the reasons given above.

My elderly grandfather died a year ago in a ward with 2 other patients who were confused/had dementia. One of the patients kept trying to get into my grandfathers bed. This understandably upset him and at times physically hurt him. It was distressing to see him being upset by this in the last few days of his life.

So I do understand where you are coming from.

littlereddragon that reminds me of my grandpa, dying on cancer but no signs of dementia. Taken into a and e one night and the nurse called him by his first name so he ignored her. Nurse commented that he was unaware of his name so my dad suggested addressing him as mr x and lo and behold he responded. He hated what he saw as the lack of respect so didn't respond!

My gran was taken into hospital as an emergency case. The nurses kept insisting she had dementia when she didn't. She actually had a urine infection and her family had seen her in the past behave in a very confused way with a urine infection. It wasn't until the antibiotics started to kick in that the staff finally believerd she didn't have dementia.

I think that it would be best if the government invested in hospice care & comprehensive end of life home care packages. I don't think that the hospital environment is the best place for those ending their days regardless of the other patients presentations, staff are too busy to sit with patients who are dying, phones are ringing etc.

Getting rest when you are recovering from an op is desirable but IMO getting peace while you are dying should be a priotity. I don't think moving all the noisy people is a realistic or fair option but having more end of life care options should be.

I am totally in agreement with the OP.

My great great Aunt was suffering from dementia but living in sheltered housing. After getting a serious chest infection she was admitted to hospital. We visited her in the general ward and wanted to take her for a little walk but couldn't find her walking stick.

After asking her where it was and looking around the bed a woman came over to us and said really angrily that the nurses had taken my Aunt's stick as in the night she had been walking around the ward hitting patients with the stick. Her mother had been one of them, who was recovering from a brake of some kind.

The lady was furious, understandably. My Aunt should not have been on that ward at all. The nurses had been hit and my Aunt took a lot of their time, and even then she wasn't cared for as we would have liked.

The move from her sheltered housing to the hospital meant her dementia got worse instantly (this is often the case when dementia patients are moved).

Look, you are all being way OTT.

It's all great to be PC but it is not acceptable for a patient who has dementia and/or is disorientated because of a confusional state to be allowed wander around a ward and get into bed with other patients, causing them physical and emotional distress. If their mental status results in distress to themselves or others in a hospital environment, something is going wrong.

I mean, honestly! Several members of my family have psychiatric conditions and I am a keen advocate for their right to dignity, privacy and respect but if they are not in a stable condition, it is not unreasonable for people who are ill and vulnerable to feel intimidated if they are not being adequately supervised. There is a "how very dare they!" attitude by some on this thread but we are talking about VULNERABLE patients being wary of a group of patients who are confused/disorientated (for whatever reasons) when they are an unpredictable group. It's not about bloody stabbing stereotypes! Given the current state of staff-patient ratios in general wards, it is unlikely that either the patients who are confused or those patients who are not are going to be given enough care in this situation.

The real answer is better post-operative care for all, but is it NOT unreasonable to question the appropriacy of limited supervision/tending to the needs of patients with psychiatric conditions who are in distress. It is NOT unreasonable to be distressed by the manifestation of this distress if it is rocking, screaming, sobbing, wandering or coming into close physical proximity or contact with other patients, especially when you are in an vulnerable state yourself.

The right to dignity, privacy and respect applies to ALL post-operative patients, not just those with dementia or acute confusional states and if the current system isn't working and staffing isn't likely to change, "segregation" is not about "apartheid" or dehumanising those with confusion or who are disorientated, it's about ensuring an optimal recovery environment for all.

I don't think it's an easy answer but it's certainly not the retrograde insitutionalising step some are making it out to be. Why should patients who are ill and in pain need to be "tolerant" of other patients? They rightly focus on their own recovery in this situation. It does not make someone a bad person to feel a bit intimidated when a person is acting in a confused and disorientated manner and is ambulant when they are unable to protect themselves in a bed.

Sorry, not all of you are being OTT - I was referring to some posters up the thread.

Well said innishvickillaune

to clarify, the OP said "IABU to wonder if geratric psych and psychiatric patients in general should NOT be placed on general wards with other non-psych patients"

I took exception to the idea that all psych patients should be placed on a different ward, I agreed that the older dementia patients should have a more appropriate ward environment, geared to their needs.

I hope you're not calling me OTT.

I just get pissed off with some peoples ignorant attitude to mental health.

Some of the scariest, violent noisiest people I've encountered on hospital wards have been so called 'normal' people

Mamatomany - I know what I said about being in the slums of Africa takes the argument to it's furthest possible point but just remember that taxes are a percentage. Those in the slums might be glad to be taxed "to high heaven" since that would imply they had an income worth taxing and some hope of services paid for by them. I don't want to take the argument away from the original point, but a bit of perspective on what services we can reasonably expect in this country focuses on the genuine fears for safety
expressed by some on this thread and away from the desire for what I see as a rightly desired and aspired after, but ultimately compared to the provision received by many on the planet, luxury service. And don't get me wrong, after three nights in pain with virtually no sleep I'd have given anything for a private room. But the complaint I had is fixed and I am now fit and well. So no long term gripes.