To ask what nurses could do to make the patient experience better?

[shouldnthavesaid]

Not a thread about a thread, just a similar discussion to others..

I'm an auxiliary nurse and I'd be really interested to hear, from a patient perspective, what I can do to make people's time in hospital a bit better.

I know that we all try to do all we can and more, but it seems from several threads on here and in the press, that we might be able to do more and I'd be interested to know what would make a difference.

To give you a bit of background - I work on a medical/surgical unit, with up to 50 different patients a week. I'm not qualified in nursing per se (I'm not a registered nurse) but I have training in all legal requirements. I can't give medication but I can do most other things. Quite often I'm one of the nurses who spends the most time with the patient, doing washing/meals etc.

I don't want to influence the thread by saying what I do myself to try to make things better, but would be very interested to know what people think we could do to improve things.. No matter how small!

Please don't turn this into an nhs bashing thread - I am genuinely interested in getting an opinion on how you guys feel things could be improved at the front line, so to speak :)

Any advice, feedback etc welcome :)

Just a friendly word or a smile and knowing the patients name and something about them. This may not be possible on your busy ward, but even the smile is good enough. Cup of tea or an extra blanket is good too.

For me it's about the lack of funding and staff. I am sure the vast majority of HCPs are doing their best but it's an impossible task.

At an individual level I have met lots of nice HCPs and a few horrible ones (or maybe they were having a bad day) and that's just people isn't it?

So I am sure you are doing a great job with the resources you have and thank you I guess

Friendly, if there's a delay say so rather than keep saying 5 mins, listen to patient .& read their notes rather than ask stupid questions.

Last Thursday evening after a breast cancer op I was wheeled onto a ward.
A nurse came over and did my blood pressure and temp.
Every 45 mins I got myself out of bed and walked past the nurses station and went to the toilet.This went on all night and I mean all night.
Evey time I walked past the nurses/sisters I smiled but not a single one of them smiled back or asked how I was.
I felt ignored and like nobody cared.

Just a single smile would have made a big difference.

I must add that everyone else I came into contact with during my appointments and diagnosis have been absolutely wonderful and kind.

I'm an HCP as well so it probably doesn't count but my single thing to look at would be awareness. Awareness of who's standing at the nurses' station unsure how to get anyone's attention. Awareness of a patient who is more restless, or moving less, than usual. What might they be communicating by their restlessness - pain? they've been in the same position too long? they're sick of the warm side of the pillow? they want a drink? Awareness that eating chocolates at the nurses' station in front of a whole bay who are all nil by mouth is gruesome cruelty? Watching someone's face as you speak to them - are they understanding? Always starting with a simple phrase like 'good evening' or 'hello sir' so that they have a crucial few moments to tune into your voice and you can see if they have understood you - so many patients talk about not being able to understand staff who aren't English but often if staff just spoke a little more slowly and always started with a 'tuner' phrase, the patients would be tuned in to their accent by the time they actually ask anything important, and they'd be able to understand. Awareness that patients may have had to get up courage to ask for anything, and to begin always with 'hello' rather than 'what's the matter then??' which I have heard so so often and which usually sounds accusing, though I know staff mean to sound friendly.

My mum was recently in hospital and the thing that she found hardest was being in the bed closest to the nurses station and being unable to sleep as the noise level in the nurses station was too loud. Could phones ring quieter at night for example, or nurses speak more quietly!

Also food being taken away too quickly, people who are ill might not be able to eat quickly, e.g. She was feeling a bit sick because of the drugs, so wanted to eat slowly, so her meal was taken away before she was done. Also if a patient is feeling sick/has been sick could something off menu be considered, e.g. Toast!

was in hospital this morning, after being ill during the night with a kidney infection, sinus infection and ear infection.

The nurses and doctor who seen me, where amazing, put me at ease, and when I had my ct scan talked me through what was happening and what they were doing.

Thankfully everything was fine, just a bad infection but they are going to send me to urology as its the 19th kidney infection this year, they listened to me instead of foobing me off with antibiotics.

I haven't been to the loo, in over 2 weeks and this was seen on the CT scan, and they gave me meds, after the GP, kept telling me to eat more fiber... and that I will eventually go.

basically they listen and didn't make me feel as if I was wasting there time.

been given lovely antibiotics and tramadol to ease the pain.

Based on my experience of having an ERPC after a missed miscarriage, they could show a little more empathy. We were told at the 12 week scan that the baby had died at 10 weeks and an ERPC was recommended as soon as possible. I know nurses don't have the time to sit and hand hold for hours, but just a bit of eye contact and the odd kind word would have been lovely. I was 'lucky' in having a child already, no fertility issues or history of MCs etc. I can't imagine the grief of someone going through that for the third or fourth or fifth time.

The little things make a big difference. During my very recent hospital stay I would have appreciated:
Night time obs being done with minimal disturbance (the HCA turned the lights on full beam at 2am and 6am and talked at the top of his voice to other staff out on the ward - from my side room. I know it is possible to do full set of obs without disturbing the patient, or with minimal disturbance). I needed sleep, and that disturbance added to the noise from the ward over night meant I got 2 hours of broken sleep every night.
Listen to the patient. Especially if they have a rare medical condition. When I was trying to explain what I needed to keep myself safe I wasn't being difficult - I was protecting myself from the risk of a brain infection or stroke (asking for a filter on IV giving set. I did mention a ward I knew stocked them to save them hunting for them. I got glared at and called difficult behind my back - yes I heard it!)
Keep the patient informed. I was kept nil by mouth for 12 hours waiting for a review that never happened. It was only when I asked what was happening the nurse in charge told me I could have eaten 3 hours earlier.
Patients don't mind waiting as much when they are kept informed.

I am not one for NHS bashing, believe me, I have worked in the NHS - as a HCA and a Nurse. As a patient I have seen some great nursing care, but I have seen some awful treatment and I have received some. The worse I received was when I was kept waiting 10 hours in AAU, without bloods or obs being done. When a new nurse took over it became apparent that my admitting nurse had labelled me a time waster and put me to the bottom of the list, I was nothing of the sort. Just because she had judged me as having a headache - I had increased intercranial pressure...

Eye contact and a hello before doing things that are routine to you, but may well be strange to the person you're treating; making sure food and water are within reach (whatever that means for the individual); letting them know how to ask questions or helping them get answers to any worries.

A smile, a how are you feeling, an offer of a cup of tea (or even someone to show me where I could have made my own cup of tea a little sooner than 3 hours before i was discharged!)......keeping people informed of delays. Delays are fine as long as you now..it's not knowing that gets frustrating.

When DD, then 4, came in to visit everyone was lovely with her...even found her a biscuit and drink and explained in very simple words why I had to stay in hospital. that was very much appreciated.

One thing I would suggest. If a patient is asking for pain relief, don't just keeping saying you'll get some soon.

My mum fell over and badly broke her knee a couple of weeks ago. She had an op yesterday to insert a plate in the leg.

She is in real pain. And one time she asked for meds and it took 2 hours before she was given any. I know she was in a lot of pain as she was biting my head off.

And she's not just asking for them constantly either, it's not as if it was a case of waiting until the right time to have them. She knows when she can have them, keeps an eye on the time, and finds that unless she's asking for them when they are due, she's not getting them until much later.

If mum's in pain she loses her appetite, and the nurses keep telling her she should eat. So give her the flaming pain meds then, that'll go a long way to encouraging her appetite.

Christmas has been postponed.

Oh God, I'm frustrated at the thought of people turning on the lights for night obs.. I've dealt with a full emergency by a bedside lamp because we didn't want to disturb anyone else more than necessary! I can't imagine what goes through people's minds when they stick on every light and start shouting at others..

Delays and waiting I think we all find hugely fustrating. If I could I would put everyone fasting in single rooms, and try to avoid hamming into chocolate in front of people. In fact when I started I was horrified that we were allowed to eat and drink at the desk at all, but that's another story..

And yes, I agree that eye contact, listening and sitting down make a difference. I have struggled sometimes especially when I first started - sometimes it's hard to know what to say or do, when there's nothing I can change about the ending. I think, I hope, that's something that changes over time. There's no excuse though for not making an effort at least, my/their own discomfort shouldn't have affected how they helped you. On the other hand as well, getting used to the situation shouldn't have a negative impact either.

Julio thanks so much for your post! will read that a few times :)

I could list a load of things from time in hospital with ds which have been fantastic but the things which have stood out most -

The doctor who made sure I understood everything that was happening, that used simple (non patronising) language and allowed time for all questions

The nurse who sat with me while I cried and sent another staff member to get me a drink. The ward was mad busy but she made time because she knew it was needed.

The matron who after another long stay went to pharmacy to collect the drugs rather than wait hours for pharmacy to bring them to the ward so we could get home

Nothing major but all things which show compassion and that the staff care and want to help

As a registered nurse who recently spent a month as an inpatient it was an excellent learning experience.

I agree that the HCA at the bedside has the most direct patient contact. Being a patient is very disempowering and you can feel very vulnerable, the staff who made direct eye contact and used therapeutic touch were the ones who made ann impact.

Look up the "Hello, my name is..." campaign, it gives a great patient perspective.

I have never had a serious hospital stay myself, but from my experience of mother's terminal illness, the absolutely most important thing is kindness and a smile. Of which I have no complaints. That was over twenty years ago and nurses were rushed off their feet, I can't imagine how you are all coping nowadays and always being kind and smiling can't be easy but it makes such a difference.

Care - actually care (or pretend to care) about people.

When my mum was in hospital for 5 weeks I was shocked at how little anybody seemed to give a shit, it was a ward full of elderly patients, there was one window, no tv, no radio. Mum became very dehydrated because she couldn't get herself a drink. Her wedding ring went missing and when I spoke to someone about it they just said there was nothing they could do - well yes I appreciate that but as mum hadn't taken her wedding ring off ever in 50 years a bit of compassion might have been nice when she was sobbing that it had gone.

I made a complaint eventually after walking in to mum sitting with bare feet in a pool of her own faeces (she contracted c-dif). I called someone to clean it and the response I got was 'I've done it once'

After the complaint through pals they moved her to a different ward in the same hospital and it may as well have been a different planet, bright, airy, tv and more importantly staff were always chatting to patients and visitors.

I would also recommend every HCP reads "Hannah's Gift" It is a true story, which talks about holistic patient care through the eyes of a child with cancer.
It was a book a tutor recommended we read during our nurse training. It taught me a lot about compassion, and what really matters to a scared and vulnerable patient. Definitely worth a read.

I'm a HCP myself and recently had a hospital stay.
I wasn't asked "How are you feeling"?

I was temperature and BP checked , asked "Do you want pain killers" and everyone was polite and professional. The surgical team came to see me and asked me how I was but no-one on the wards.

Sounds petty but it makes a huge difference.

Just remembering that patients are humans and treat them with kindness and allow them their dignity. I have seen so many dehumanizing experiences because nurses are busy. It isn't really an excuse.

I second nurses turning down the noise levels and lights, obs etc at night. The broken sleep does not aid recovery!

TooManyMochas so sorry for your loss.

I am a student nurse and had recent training on 'gynae procedures' including the one you had. One thing we were told during that training was to make sure we did make eye contact and say how sorry we were. Some women appreciate that, but others just want it done and out of there, hard to know which people are in a very short visit to the hospital but I would rather err on the side of caution and assume they want my kind words than not offer them.

OP, I am sure by the very fact you have started this thread that you are very good at your job, caring enough to ask the question demonstrates that.

You are right about you being more hands on than the nurses, almost making me regret my decision to do my nursing degree.

I shall be one of those nurses who gets her hands dirty though, having done care work since leaving school at 17 and being 47 now.

One thing from personal experience, please do not wheel a patient in urinary retention after a back op into a toilet and leave her where she cannot reach the call bell for over an hour! I'm sure you wouldn't though!

Ooh, I have one from just recently! I had an angiogram in hospital and as I had to keep my right leg totally straight afterward was obliged to wee in a bedpan. Well, just as my lovely nurse was log-rolling me over to slide the bedpan under, didn't one of her colleagues come along and pop her head into the (CLOSED FOR A REASON MUPPET LADY) curtained bay to ask a random question? Please, if you know a colleague is in a closed bay with a patient, do ask if you can peek through before doing so; even though I have borne four children I do prefer to restrict viewing of my lady garden and related bits to a select few.

This is omly a small thing but on our way to an appointappointment in the hospital we were lost and trying to figure out our way. An employee was on her way in/out of work (had an outdoor coat on) and came over to ask if we were ok and did we need help finding our way.

Nice of her to take time out to lessen our stress even though we were outside her ward/shift.

I don't know if she was a nurse, consultant or canteen worker though!