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 :)

It's been a while since I was in hospital, but what I would have liked was the nurses to wear a name badge. Such a simple thing, but it would have made life so much easier when trying to remember who you have spoken to.

Speak to patients. Don't talk above their heads. Respect a closed curtain. Offer same sex care - a vulnerable woman in pain may not speak out when a young male HCP wants to give her a bath. Don't assume that if a woman has had children that it's ok to ignore her dignity. Offer male patients a choice of carer.

It's not about YOU- so don't eat, drink and chatter where you can be heard. Quiet voices and low night lights help towards the healing process. Don't promise pain relief until you have it in hand. Don't lie to your patients.

I think one of the good things is that I've experienced some upsetting medical stuff - although in my case it was more doctors. Unfortunately I've been left with post traumatic issues and vaginismus after some of the 'treatment' I had for gynae problems, so I do try to be very careful when it comes to doing stuff down below. We also have a reminder on every single curtain - a stop sign, and a warning to knock and wash your hands .. Realistically that shouldn't be necessary but when you're so busy and needing advice, it's so easy to stick your head in without realising that Mrs J's having a wash. Having that reminder does make a bit of a difference.

I think one of the things I do always try to do is learn everything I can. I go home and google all these medical terms so that I understand in simple terms what's happened before, what's happening now and what will happen next. Unfortunately I've learnt about stuff that's pretty upsetting - coning, midline shift, cerebral abcess but it helps me help the patient if I know what's going on.

I do see a lot of nurses doing things the quicker way, and that I don't always like. I know it's faster to give people 'hot wipes' for a wash, or it's faster to make people toast if there's nothing they fancy for dinner. But it's better to try and organise a shower, or to go the canteen/kitchen and get a decent meal, or to add ice to water so it doesn't go to room temperature within an hour..

One thing that I do question is that we refer to patients as their room number when discussing situations in places that we might be heard. For example, if a patient asks me to get her pain relief. I have to ask the staff nurse if she can do this. I go to the room where the staff nurse is, and it seems that I'd be expected to say '46B would like pain relief'. The whole point in this is that the conversations being overheard by visitors, patients etc and I do worry as to how it might sound! I'm trying to change this myself by saying 'the gentleman/lady in bed xyz would like pain relief..'.

Am horrified at reading some of the stories on here..

With pain relief I'm not qualified at all in giving drugs or knowing anything official but it seems sometimes that if pain relief is written as being needed regularly, it gets given. I remember after my first major operation, I got no pain relief afterwards and ended up rolling around sore. The pain relief I was told was written as per need, and not as a definite requirement, so I wouldn't get it unless I asked for it. In a ward with no buzzers and with paralysis from a spinal anaesthetic, asking wasn't easy.. Second time around, spinal again, same ward, my consultant wrote up pain relief as a requirement and I was given drugs without asking at all. So, so much better. So I would suggest that , it's better pain management I think. No one should be left in pain in this day and age.

I think I've heard of 'hello, my name is' but away to look up again - and that book as well, thanks for the reccomendations :)

In geriatric wards don't leave food in front of patients who are asleep or find it hard to feed themselves and just take it away an hour later uneaten and cold. Don't leave elderly patients slumped in a chair with vomit running down them.

In a post natal ward treat mothers who have had cs or traumatic birth as post operative patients elsewhere are treated.

Take note of patients' allergies / special needs!

My mum had a radical nephrectomy last year, and was asked at pre-op and again prior to the operation on the day about allergies to drugs. She stated that she couldn't take Co-codamol and was wearing a coded wristband to alert nurses to this.

She was really ill for a whole day after the op - could barely stand, was being sick (in fact when I went to visit she had been slumped in the loo next to the nurses' station for at least 20 mins but no-one noticed.

Turns out she's been given fucking Co-codamol. Nearly 18 months' treatment for advanced kidney cancer and that's the most incapacitated she's been.

Also don't stand by and watch a student doctor with shaking hands gouge a cannula needle into both of a patient's hands, and encourage them to keep trying. I now have a piece of plastic lodged permanently in the wrist of my writing hand.

I can understand not using 'the gentleman/lady in 46B' as maybe too identifiable but perhaps 'the patient in 46B'? It does rankle a bit being referred to as '46B needs the bedpan' or whatnot, as if I'm a 46B (don't I wish) rather than a MerryChris.

Treat elderly people with care and compassion, not as annoying nuisances.
Yes, dementia patients can vibe very difficult to deal with, but there us no excuse for attempting to prematurely discharge a 88 year old back to her own home and ignoring her previous medical history which made it entirely foreseeable that she would contract another bout of pneumonia.

3 months on and my DM us still in hospital and has been assessed as needing 24 hour a day care in a nursing home. She probably would be dead if I'd listened to that doctor I've first hospital, as three days later she was diagnosed with a pulmonary embolism.

Make time for families. The doctor in the first hospital told me she wasn't available after five pm. The consultant in the second hospital arranged to come in at night to meet with me and exolain just he I'll my DM was and why she could never come home. It was still hard to take but he was treating my mum as a person, not as a nuisance.

I spent months in hospital a while ago and saw the best and worst of patient care. If you're attending to a patient, don't talk over the top of them as if they aren't there. And especially don't talk over the top of them about the party you are attending that weekend, the boyfriend you are shagging, and the alcohol you plan to drink. Especially when the patient can't actually participate in any of those things themselves and will not be able to be released for months. Not cool. Keep your chats and biscuits and chocolates in the tea room, not the nurses station. Don't whinge about patients, even if you aren't using identifying information in public locations. We all know that you need a grumble, and we all do it about our jobs, but there is a time and place for it. Also, accept that not everyone has the same sleeping patterns. Don't come in to a private room at 2am when the patient is watching a dvd on a portable player with headphones in and demand that they go to sleep. Especially don't threaten to take it away from the patient, who is a grown adult and quite capable of deciding when they need to go to bed. Don't manhandle, ask before touching or moving. Just because I may not be able to feel you touching a particular body part does not mean that it is a slab of meat. Explain what you are going to do before doing it, especially if it involves intimate care. Give the patient a chance to ask questions or make their own requests about their care. Give us a minute sometimes. Whilst some aspects of medical care may be routine to you, it's likely to be all new, and frankly, terrifying for us. Just let us catch our breath for a minute after being told life changing information, give people time to absorb it, then go through the options, not expect them to make instant decisions or acceptance.

Tell the truth. You are not protecting anyone by lying to them, you are lying to them.

I had wonderful care during and after my recent mc. I was kept in for a few days due to infection concerns and every member of staff seemed to take time to treat me with care and dignity.

What I would have found useful is more practical things, like a guide to how the meal ordering works, who the different staff are etc so I'm not reporting something to three different people before I get the right one.

A uniform chart would have been a great help, eg white uniform = student (help with obs, report to nursing staff) blue = senior nurse etc. Maroon = housekeeping (so you don't start asking them medical questions)

It's so hard when you're in the middle of it all and deal with so many people. They all know what their jobs are but you have no idea. I was in a side room and felt very isolated even though I appreciated the privacy.

Do what the doctor has told the patient you will do. Eg if they are told they need monitoring every 2 hours and pain relief every 4, then don't leave it 6 hours.

Write stuff down, don't expect the patient to remember what drugs they have been given and when.

Have some understanding of the patient's condition and what you are supposed to be doing to treat it.

These are all examples of bad practice from the last 24hrs (am currently in hospital)

Do what the doctor has told the patient you will do. Eg if they are told they need monitoring every 2 hours and pain relief every 4, then don't leave it 6 hours.

That is making the massive assumption that the doctor has actually told you and the nursing staff the same thing!

Lots of comments on here saying the things I'd like to add.

My father was in hospital at the beginning of the year with terminal oesophageal cancer. He was very deaf and found that his hearing aids were uncomfortable to wear. We told the nursing staff on numerous occasions that his hearing was poor but it wasn't noted anywhere and on me than one occasion we had a HCP asking him from the door of his room whether he wanted a drink and then just went away when he didn't answer, having not heard them.
I stood at the nurses' station and was ignored for a very long time when we had been called in (you know, the call when they say you ought to consider visiting NOW) during his last week. Nobody even acknowledged I was there even though I announced myself. That, I'm sorry to say, is just damn rude.
Specific examples above aside, my overwhelming impression has consistently been that yes of course staff are busy. Of course things are underfunded. Of course you can't always get what you want...but it would make everybody's life that little bit more bearable if the HCPs (sorry for my turn of phrase but it's how it appears) pretended to give a monkeys about the patient as a human being and not an inconvenience.
There are some wonderful medical professionals around. I know how lucky we are to have the NHS and all that goes with it but sometimes it's really not at the forefront of your mind at the most vulnerable times of your life.

Today on my ward we are trying to make it nice for the patients who are stuck in hospital for Christmas (one of them is my Nan's best friend).

I'm not working today (worked last Christmas) but I know that all the patients are getting presents from the ward; crackers; a turkey dinner (except for the vegetarian lady); sherry, wine & mince pies; and visitors are allowed in at 11am instead of 2pm provided all the washes are done.

It's difficult to improve the patient experience at Christmas because for some patients it can be a depressing time of year & they don't all celebrate Christmas, but we try really hard.

The rest of the time I like to improve my patient's experience by being friendly to them & giving holistic care.

1 if a clinic is running late - tell the patients then they will stop asking you

2 if a waiting room or ward is boiling hot/freezing cold don't be surprised if your patients (remember they are already unwell) start fainting or shivering

3 when a patient is in pain or feeling sick don't ignore them. Recovery will be much faster if pain relief is efficient

4 don't leave an elderly patient on the floor for 10 minutes when they fall out of bed or if you do, don't be surprised when the family complain!

5 communicate with your patients and their families. It is not unreasonable to ask when a doctor will be seen or what medication is being given. You'd want to know too if it was you.

6 don't complain about a patient's family or a patient when they can hear you

7 don't stand around chatting and giggling with the other nurses for 10 minutes while a patient is crying with pain, another patient needs the toilet and a third patient is pressing the buzzer because they are so fed up with the first two patients suffering for no reason

I've noticed huge variations between different wards and departments even within the same hospital. I suspect most HCPs do a fantastic job but there are a few that really don't care and don't enjoy their job. Being friendly and kind costs nothing and its amazing how a smile or a quick 'good morning' makes all the difference.

My local rheumatology department, pharmacy staff, physiotherapy, radiology, podiatry,occupational health, cardiac, ENT, GP practice and day surgery department are fantastic. I couldn't have better treatment no matter how much I paid (and its NHS!)

Sadly the same high standards are missing from certain wards in another local hospital.

Latara, sounds very much like my ward :D

The head consultant is dressing up as Santa, and giving everyone presents. All the patients are getting offered chocolates, fudge etc and as far as I know, will be offered a full christmas lunch :) My colleague and I spent a couple of hours last weekend jazzing the ward up - as much as we were allowed to. I'm not sure if they're giving anyone alcohol, as much as it would be lovely to do so.. I think the nurses that are on are going to play christmas music this afternoon if they can, so hopefully everyone will get a lovely day :)

I always try to smile, but I'm not great at saying who I am straight away - although I do have a name badge, and we wear standard uniforms across Scotland so hopefully no one will struggle to know what I do! I do try to introduce myself when patients arrive, and if someone has dementia I introduce myself every time I meet them. I'm not sure if that's quite the right thing to do, but it seems OK.

Thank you so much for all your advice :) and emery christmas to you all as well of course!

I had a op very recently, and the nurses were truly, truly wonderful. They really are the human face of the NHS - they stopped to have a laugh and a joke with me, to cheer me up, and to hold my hand when I needed it. Despite the fact that they were really busy ALL the time, they were unflappably sunny. I honestly have nothing but praise for the way that they showed care.

One thing I think the NHS as a whole could do better with (particularly doctors, but sometimes nurses too) is communication - telling people in very precise terms what is going to happen, including giving information between appointments so people don't worry or feel uncertain while waiting.

Please try to remember that you might have standard uniforms but probably it will still only be HCPs that know the difference.

Treat me with respect and maintain professional credibility at all times, even when asked to explain a point a 2nd time around or you may be short of time (don't be afraid to say the 2nd one either, it sets expectations, but do it clearly and friendly).

Respect, as in... there's a difference between speaking in jargon your audience won't understand, to patronizing them as if they don't have the mental capacity to understand complex ideas.

I work in a field which isn't medical in nature, and if we spoke to clients in the same way as some HCP have done to me, we'd be fired for regular, inexcusable poor communication skills.

You just need to be able to actively listen to pick up on what the right level of detail is for your audience. What kind of questions are they asking? How interested do they look? What level of language are they using? What non-verbal feedback are they giving?

Actually I guess my answer is really "get good communication skills". It sounds basic but is such a fundamental I don't know why it seems to be so lacking at every level.

I've met excellent HCP but, as with e.g. civil engineering, professionalism isn't only about what you can do technically.