To never want to work on the nurse staff bank again!

[Blossom90]

Im a healthcare assistant. Orginally on the staff bank, then on maternity wards and now back on the nurse bank before i start my training in occupational therapy in September.

I done a night on Tuesday and left so upset. I witnessed a HCA telling a patient with dementia who didnt sleep all night to be quiet because the other ladys in the bed wanted to sleep. The lovely lady kept apologising and then carried on shouting. The assistant stood by her bed and shh'd her and told her to shut up every time she started talking.

I also witnessed a nurse putting pills into another patients mouth when she refused to take them. This said patient was the one i was soley looking after all night. She could get aggressive and when i asked her if she wanted to get in to bed she shouted at me 'would you like to get into bed!' fair enough. I smiled and left her. The two other HCA's came over to me at 12pm and said can you get her into bed please. I explained and they proceeded to draw the curtains and try and lift her out of her chair and into bed. At which point she hit out at them (dont blame her) they were very rude tutting at her, put her back in her chair and stomped off after opening the curtains.

Its left me totally gobsmacked and i do not want to do another shift in the hospital. Its not the only ward i have witnessed this care on. Its so heartbreaking that patients are being treated like this, i am going to report it as i didnt once because i wasnt sure how to when i witnessed a HCA tell an elderly lady with dementia she would give her a black eye if she didnt go to sleep. The most shocking part is that all the staff on night heard her too and did not react. I think if they will do it infront of me a HCA they do not know how do they act when its just regular staff. AIBU to never want to return?

[Suziesome1]

Flip it around, if she had pressure ulcers, was covered in faeces/urine, and had muscular contractures, would you suggest to just leave her, because she said to? Despite knowing she can't safely decision make/may have memory loss/be disorientated to time, place and person or be able to care for herself. Worst case scenario would be forcing her to do anything, but her best interests must come first. To leave her would be neglect. This is all very subjective though, and again context, individual personalised assessment etc all comes into play. Dementia is a horrible disease.

[bakeoffcake]

Those saying the behaviour was ok, would you repeatedly tell an ill child to "shut up"?

[Suziesome1]

Dementia patients aren't awful username the disease is. It must be absolutely terrifying.

[Sallystyle]

OP is not being overly judgmental.

We need more carers who actually care.

Most do the best they can in horrible conditions. We should never become used to patients being treated poorly. Shut up is not professional, of course I have wanted to bloody scream shut up many times, I have had patients drive me to despair but you remain professional and vent in private if needed.

frequently hit...scratched etc by her patients....my sympathies are with the staff as she has told me how awful demented patients can be

My sympathies are with staff and the patients. A patient with dementia attempted to strangle me recently, then kicked me. It was scary but the patient was petrified, living in a world of fear.

Repeatedly telling a patient to shut up is not good care. Would you want your mother of father to be treated that way?

[MeInHoney86]

I am beyond shocked at the PPs saying op is over reacting . People should be treat with respect and dignity. No we don't know the full picture but presumably the OP does as an experienced HCP.
Because people are 'difficult' does that mean we should show any less compassion to them?imagine that was your son or daughter?
Telling a patient to shut up is never acceptable,neither are threats of violence.
OP please report this

[practy]

MelnHoney - I am not shocked. We desperately need specialist dementia nurses working in hospitals. Not nots of staff who think it is fine to treat an elderly person with dementia in terrible ways.

[grannytomine]

It doesn't sound great but I do have sympathy for the other patients. I was admitted to hospital after an accident and the lady in the next bed was in as she had a fall in her care home. She shouted constantly, by the third day I was desperate and my patience was gone. I wish someone had tried to get her to be quiet.

[practy]

Yes needs have to be balanced with other patients. I have been in hospital next to patients with dementia and it is very difficult.

[Lelloteddy]

It is actually quite chilling to read how many people are justifying the behaviour that you witnessed. Two of those incidents are assault.
You are doing absolutely the right thing in reporting this.
But please continue to care. Continue to advocate for vulnerable adults and don't ever start to believe that this is normal or acceptable.

[ElspethFlashman]

No way should you let someone sleep in a chair all night. They would be buckled in the morning and it doesn't take much to start a pressure sore.

Many dementia patients sleep all day and are highly disruptive /agressive all night and keep everyone else awake. This is why dementia patients are usually given heavy sedatives at night to try to get them back in sync again. And yes, often very important other meds are given at the 10pm drug round too. Often meds are crushed in yoghurt with the consent of the family as the patient will always refuse meds.

I have had horrific nights with patients who won't get into bed. The problem is that they usually don't just stay in the chair. They get up incessantly and get agressive or start interfering with other patients. I had one guy who used to try to push other patients out of bed as he became convinced that they were in his bed (that he refused to get into). These patients he'd assault would be far sicker than him.

Really the only solution is to knock them out with drugs. Cos otherwise it's horrific for everyone else but it's also inhumane for the poor dementia patient who is wearing themselves out in distress all night long.

That said, verbal abuse by staff needs to be reported and acted upon. Always.

[Sallystyle]

But please continue to care. Continue to advocate for vulnerable adults and don't ever start to believe that this is normal or acceptable.

This with bells on.

I try to treat every patient in the same way I would want my loved ones to be treated.

It's not always possible because I don't have time and I don't have the resources but I do the very best I can like most people in care do. If I ever get to the stage where I think telling a patient to shut up is acceptable I know I need to get out of care.

It's a hard job, an often thankless one and it is hugely important to balance the needs of a patient with dementia and other patients.

Working as a nurse or an HCA in a hospital is extremely hard right now. We need more staff and much better conditions, but one thing we can continue to do is treat all patients with dignity and respect and thankfully most do just that.

No one should condone telling a patient to shut up. Yes, I have had to gently tell patients to keep the noise down because others need to sleep, a patient with dementia will not understand that and telling them to shut up achieves nothing. A waste of your time and energy while being a complete arsehole to someone who relies on you for care and understanding. A hospital is the worst place for a person with dementia to be at the best of times.

[Babyroobs]

Well said Elspeth. Great post.

[ElspethFlashman]

If I ever get to the stage where I think telling a patient to shut up is acceptable I know I need to get out of care.

Absolutely.

I once had a night that tested me to the limit. We had a man who was very very disruptive and agressive at night, we had given him enough to drop a horse and it didn't even make him blink. The docs couldn't give him anything more. He was screaming incoherently and wouldn't keep his clothes on. Kept stripping naked. Eventually we had to consult with high ups and about 3am we restrained him in a Buxton chair. Which was terrible. You can't really do that anymore which is why the decision had to be made higher up. We brought him into the nurses office where we were doing our paperwork so we could reassure him all night. He kept screaming at us and he literally ripped his clothes to shreds. We were desperately trying to tuck a blanket around him to spare his dignity but he kept ripping that too. We were all in tears. The student nurse was pale as death. But nobody said a cross word to him. Poor man. But we all wanted to quit nursing after that night. He ended up going to sleep the next morning and slept for 2 days. I'll never forget that night. The screaming.

[Sidge]

I think this needs reporting, the training and assessment of HCAs at your hospital is obviously poor and they are getting away with threatening patients and manhandling patients.

There's a big difference between using persuasive talking and threatening. And there's a big difference between encouraging a patient to go to bed and physically manhandling them into one.

As an aside, I do wish the term 'nurse' was protected.

[Blossom90]

I agree about not having someone sit in a chair for hours but also i dont agree with forcing a person into bed. I tried her every 10 minutes or so and eventually got her into bed by placing her zimmer in front of her and offering my hand, with a smile, without saying a word. She got up no problem and i tucked her into bed, Checked she was comfortable, Checked skin etc and she was happy. All she needed was time. Not someone dragging her from the chair. Which is distressing for her and did not achieve anything.

And i can not believe the amount of people that think telling someone to shut up is acceptable. Yes patients other patients need to sleep there are ways of saying things!

[Babyroobs]

I ahve had many a nightshift as you describe Elspeth. I work in a palliative care unit so we have of patient's with brain metastases which can make them confused, we have dying patient's who are terminally agitated and we have patients with dementia too. I have spent many a night walking patient's around the night as they would not settle in bed or in the chair, we have had confused patients sitting in the nurses office with a member of staff, we have had patient's escape into the grounds and it is a constant battle to try to keep everyone safe whilst trying to look after dying people and their anxious relatives. I don't think our ward is the place for dementia patients, yet managers have decided we must take them. We recently had one dementia patient admitted because the Nursing home was so bad that the relatives refuse to let their loved ones stay there. As a patient it must be so scary in the middle of the night to have a confused/ screaming/ wandering patient next to you especially if you are dying.

[Babyroobs]

Op if a vulnerable patient was dragged from her hair rather than being pursuaded, this needs reporting as asap.

[anyname123]

Report report report. Report to Ward Manager, if no joy report to their senior. Call the safeguarding office for advice. Unfortunately by not doing so you are complicit in the abuse. I know it's really hard as a junior member of the team, but set your standards high and don't ever drop them. Good luck

[practy]

The term nurse is used by patients for anyone who does nursing. It really does not matter to us if you are not officially a nurse.

[ElspethFlashman]

No but nurses have a loooot more training in what is appropriate verbal conduct. They should be highly aware of their registration. It (probably rightly) doesn't take much to be struck off.

HCAs unfortunately often need much more training in that area. And of course a HCA has no fear of being struck off. So this can unfortunately sometimes mean that HCAs can be more brusque without fear of much consequence.

[annandale]

What stands out immediately is the constant attempts to use words - as opposed to nonverbal signals including touch, tone of voice and situational cues like the zimmer. I see people at work using long complex sentences with dementia patients with intonation that's quite difficult to interpret, and of course talking in a gentle tone of voice can be fantastic but lengthy explanations don't seem likely to help.

I really hope you report 'shut up' - I am sure the person saying that was at the end of their tether but it's not OK.

[Lules]

To those people who think treating people like this is ok, I assume if happened in front of you to your mother you'd be absolutely fine with this and it wouldn't bother you at all?

I find society's contrasting attitudes to children and elderly people with dementia very odd

[LanaorAna1]

Dementia patients are, at the risk of stating the obvious, immune to reason or any sort of collaborative agreement. Telling them they need to go to bed can't work, even if they still know what 'bed' means.

They're not children, who have functioning if incomplete understanding. They're not just old people. They're not mad. They're way beyond all these things. They've got major organ failure, the organ being the brain.

The brain diseases they've got - say, a brain with swiss cheese holes in it or a brain which has mostly died in a living body - make people with any of these illnesses incredibly difficult to deal with, not least because we don't understand how to reach the bits that remain, or whether we can. If this sounds horrifying, it is. The more you know about dementia, the less you want to get it.

And, although I wince to say it, the less you might feel like caring for a dementia patient. Clear communication is impossible. Your adorable elderly lady/gent has become a vile, dangerous person with no conscience (that went years ago). While they haven't lost the essential humanity that belongs to them by default, they have lost any humanity towards others.

I loathe stories of HCP being cruel to dementia patients more than most - but I do understand why frustrated carers snap. Especially in hospitals, which weren't designed then or now to deal with the extremities of behaviour caused by complete brain failure.

[Lules]

Sorry I didn't express myself well - I didn't mean that people with dementia are like children. I meant that they are both very vulnerable and open to abuse.

[Lelloteddy]

Lules you make perfect sense. Elsepeth are you a registered nurse?

If the OP had been about abuse of children this thread would be 24 pages long by now and there would be calls for an MN campaign and people to be held accountable.

I despair of any nurse or HCA who thinks it's acceptable to treat elderly, vulnerable people in this way.