How much care can nurses provide on acute wards?

[thighofrelief]

My Dad is 86 and has recently had a heart attack, he's currently on the CCU cardiac care unit. The nurses have been so wonderful but as Dad has mild dementia we have had to set up a shift pattern to sit with him 24/7.

Luckily we have been able to do this but the nurses just don't seem to have the resources to provide 1 to 1 care. What happens when patients need this 24/7?

Btw Dad is getting out and the end of the week and what gift should we buuy the nurses?

I've been on CCU and only received the same treatment I'd had on other general wards. From my experience only HDU (two nurses to three patients) and ICU (I always have a nurse sat one one one sat touching my bed) have the ability to do this.

Of course a ward isn't staffed to give people one to one care, the vast majority of people wouldn't need it.

If a patient needs a one to one they should get one but they have to justify why, they probably don't think your dad does need one.

In my experience only violent types or incredibly high falls risks get one to one'd and even then it can be a struggle to staff it.

Buys sweets and biscuits and a healthy option too. Something they can stick on the station, not something that needs a fridge.

Armchair thank you, that's interesting. The dementia was getting in the way of his treatment, pulling off cpap machine mask, pulling wires, trying to get out of bed when shouldn't be moving. At one stage my sister and I were one each side of his bed.

The dementia was getting in the way of his treatment, pulling off cpap machine mask, pulling wires, trying to get out of bed when shouldn't be moving. At one stage my sister and I were one each side of his bed

If you and your sister were not there he should have been one to one'd. If your family could cover it then there was no need, think of childrens wards. It's the same thing.

They would have had to request extra staff though.

Wards do vary but generally most where I am only have one nurse per ward, the rest are health care assistants. I've been next to many dementia patients and never seen one to one care. I spend a lot of time in hospital.

Tess he wasn't violent but very combative trying to escape and offering to hitchhike home!

I've got him more or less sleeping now but needs reminded every 5 minutes that it's night time. We were thinking of hiring a HCA to sit with him through the night. Don't know how that would go down on the ward. I have no idea how the other patients are sleeping through it all.

We're also doing washing, feeding and pee bottle. I just wondered if there was a silent assessment by the nurses of leaving his care to us.

Armchair I'm sorry to hear you spend a lot of time in hospitals. I never want to see the inside of one again and will eat nothing but broccoli for the rest of my life. I feel like I've done a flight to Australia every time i leave!

I’m in Australia, however here if there is a patient with dementia or have other specialised needs, need 24/7 care they are entitled to a ‘special’- a nurse/assistant in nursing who is specialised in aged care, mental health etc who only sits with that patient for their shift. They then handover to another special, etc etc until they are discharged. If a family member is there, the special can go to another ward.

I live in Canada and we have the same thing.

Usually when a patient is on a regular ward it's 1 nurse for 4-6 patients and then a health care aide to assist. If a patient has major behavioural issues they would be assigned a "constant", a health care aide to sit with them constantly.

I've got him more or less sleeping now but needs reminded every 5 minutes that it's night time. We were thinking of hiring a HCA to sit with him through the night. Don't know how that would go down on the ward. I have no idea how the other patients are sleeping through it all

Couple of bits, I'm shattered so sorry if this is a bit crapply phrased.

-If he is actively trying to leave at night (and this is because he is confused) and you can no longer stay you need to tell the staff that you wont be there. Tell them now then tell the morning shift as well. Tell them they need to sort it out because you can't. You can't just hire somebody to sit with him.

That said..... is he on a DOLS? You should know if he is but maybe go check with the nurses now. If he isn't it either means that they don't think he lacks the mental capacity to decide weather or not to stay or (more likely) they just haven't put one in. If it's the former it's a whole other tin of beans.

Push for a DOLS if you believe he is too confused to consent to be in hospital (and he isn't already on one). He legally should have one in place and hospitals have policies around them that may trigger a risk assessment or something.

If he is on CCU is there a plan to transfer him to Coronary Care afterwards?

Sorry I have to go to bed now and realised I just asked a question and may not come back to respond until tomorrow night. Anyway I asked about coronary care because my advice is dependent on how long he is likely to stay. If he is going to be discharged in the next day or two I would be inclined to just put up with it.

If he has delirium you need to be prepared for the possibility probability that they will want to discharge him prior to this resolving.

Where I work in Australia a patient with dementia who posed a significant risk to themselves would have someone equivalent to a HCA either one on one or between two similar patients in the same bay. If still very agitated they might be given haloperidol to keep them safe.
If you were not there your dad would still be washed, fed and helped to toilet. Difference being that these things would be done by someone with much less time than a family member.
In my experience there is sometimes a gap between level of care given by staff and what family expect. A lot of this is due to lack of time but some is unreasonable - for example expecting call bells to be answered immediately, expecting nurses to stay with their relatives when they toilet/shower but are capable of doing these things independently etc

tomato we were just really scared that he would get out of bed when he shouldn't. Physically he is very strong. A couple of times I have had to go quickly to the loo and told them I would be 5 minutes. I told them he would need watched / restrained. I came back and he had got out of bed and one of the times his heart rate went up to 150.

I work as a bank HCA, used to be a HCA on CCU.

Typically, if someone needs one to one care, it's up to the staff to cover it. Usually the HCAs will take it in turns until something more permanent can be arranged (like hiring an agency HCA as an extra member of staff). The thing is that it's a system reliant on agency/ bank staff booking shifts. If they can't get the shift covered and you're always there, they won't be as quick to do one to one. We're often advised to leave the patient if the family arrive, as long as the family understand to tell someone when they leave. Also, most families don't want to have staff there with them.

Make it clear that you don't want to be there every second, and that the staff need to do one to one.

@tessliketrees CCU is just the initials of Coronary care unit. They step down to cardiac wards.

@Armchair that's actually quite unusual. Usually a ward will have 1 nurse to 6-7 patients on a standard ward, and then 2/3/4 HCAs in addition that cover the whole ward. At least 2 nurses are needed to sign for some drugs/ check IVs

@Rachanna I know, hence the question.

They'll be so greatfull for your help! So typically relatives just leave hospital staff to take over this kind of care and as you've seen they have a 100 and 1 other jobs to do so it's so difficult to provide this level of care through an entire stay. There are also rules and training around patient restraint so might be reluctant to intervene physically in this situation.

Typically CCU has a very good ratio regards patients:Nurse/HCA compared with other non-ITU wards so he's in a good place. Also if he's just been stented this is a low risk procedure regards risk of damage from further fall, i.e. he's not more likely to cause himself damage then he was before having the procedure, it's not like there will be lots of stitches that could rupture from surgery.

Heart arrhythmias are common post procedure. If his heart rate was 150bpm I doubt it was due to exertion and more likely a short run of
an arrhythmia called VT which and completely normal in this situation - it'll be monitored on his ecg tracing and the doctor will assess the level of risk it poses.

Regards presents any form of chocolate is usually appreciated. Also a voucher for which ever coffee shop is at the hospital would go down well.

I’m a Registered nurse in the states and I always worked on acute cardiac inpatient units-believe me my normal patient load of my last job was 6 acutely ill people-if I had a dementia patient needing extra care sometimes an aide would sit with them but that would mean more work for the staff. As you can imagine giving medications,taking vital signs,charting assessments and dealing with anxious/scared patients and helping with trips to the bathroom or meals a nurse is stretched very thin. Add in teaching patients/families about medications and tests and illnesses you have a very busy shift-throw in discharges and admissions and a few patients returning from procedures needing close monitoring then you may come to realize how ridiculous patient to nurse ratios are here. Imagine 30 patients and over half are on diuretics due to heart failure=bathroom urgency and frequency! One weekend I pushed over 600 mg if an intravenous diuretic each day. Ten milligrams is enough for a normal adult to be running with haste to the bathroom.Some nursing aides have 10-15 patients apiece! Sometimes all the corporate healthcare leaders care about is money here-how I envy the UK/Canadian healthcare system

If the doctor feels he needs one to one care they can discuss this with the ward manager, people are often delirious and agitated in wards including ccu. If you want to hire in someone they need to be authorised by the hospital, I imagine it would have to be someone who is on their bank or agency books, I am sure the staff have considered what level of care he needs. Will he be mocing to a ward soon, maybe he needs specialling whilst he is agitated. Does having the two of you there help him feel calm.

Dad is having an angiogram tomorrow and they are looking at discharging him mid to late this week. He's not going on to the coronary care ward as far as I know. He is able to be coaxed into resting now but needs reassuring each time he wakes. When he was more sick he was desperate to throw everyone and everything off and escape but thankfully he is becoming more himself.

We've set up a vigil to calm him really and prevent him hurting himself. Perhaps he is not as sick as he looks to us as he has not been in ICU or HDU though it was a heart attack and he had a crash team around him on one occasion each of the first two days.

I've got to say amongst all the awfulness there has been some laughs. At one stage he thought one of the nurses was Alexa and shouting instructions to her as though she was the Alexa App. He advised another of the nurses she should just relax and take a bedpan for herself. I've just been explaining that my dog and my sister have different but similar names but only one of them is married to my BIL to which he replied "ha! Good joke" not sure which one of us has lost their marbles anymore.

He "should" get extra care but it isn't always available. Since he is only going to be there for a few days, I'd make sure that your family can cover the extra hours "just in case".

I feel like I have become a member of staff! I was scowled at today for being late. I wasn't, i was on time but my mum had left 5 minutes previously and we passed each other at the ward entrance. I am getting a share of ward sweeties though so that's ok. He didn't have his angio today because there were complications with the patient in front of him. Angio tomorrow hopefully.