to ask if this is normal elder care practice in hospitals?

[bringincrazyback]

So my father is seriously ill in hospital and receiving enemas as part of his condition. Ward is seriously short-staffed and I can see they're genuinely doing their best and working tremendously hard, but AIBU to ask if anyone knows whether it is standard practice after an enema to leave a patient in bed with a pad under them, which they are then expected to soil and then be cleaned up by staff afterwards? (He's heavy and hard to lift on to a commode, but this has been managed by the staff on previous days when he's received enemas, albeit it's taken two people.) This happened to my father today and the staff didn't seem to understand why he was upset by it (he doesn't have any dementia and is normally in full control of his toilet needs).

I'd rather not give any more context in case I out myself if anyone involved is on MN, as my beef isn't necessarily with the ward or hospital, who have done a great deal to help us. My beef is that the system seems to have come to consider this an acceptable way to manage someone's toileting needs. My family was left feeling very upset by this today (and, on my father's part, humiliated). It's left me wondering how normal a practice this is, because if this is really what the neglect of the NHS has done to the service, I think those up top who have been systematically trying to starve the NHS out of existence should hang their heads in shame.

Just needed to vent and wondered if anyone else had been through same, either themselves or with a relative.

A lot of the time it is safety which determines this. Realistically it could take minutes or even half an hour for an enema to work (if it works which hopefully it does!). Your father sounds like he is able to mobilise with assistance (doesn't matter how heavy he is as we wouldnt be physically taking his weight). The assistance of 2 is more to do with having 2 people there to transfer him safely to try and minimise the risk of him falling. As I'm sure you know this can take a lot of time, firstly to find 2 people free on the ward and secondly for your dad to actually mobilise. The problem is that once someone feels the urge to move their bowels they panic and move in unsafe ways to get to the toilet. They are at very high risk of falling, especially if there are some difficulties in communicating (such as dementia) and they struggle to understand instructions. The alternative is hoisting them over a commode/bed pan which is fairly dignity stripping (especially if not in a private room) but the problem with this is that the nurse cant really hang about until the bowels move (they have at least 5 other patients and have to clinically prioritise) and it's pretty cruel to leave someone hanging there if nothing is happening/again dangerous to leave him on a commode if distressed/requires assistance to move.

The nurse has taken the decision which is definitely the safest but I can understand why it looks pretty dignity stripping. I hope he gets some movement soon.

Oh come off it @tantrictwist

Were I in that position, left to soil a pad without help to use a toilet, without the reassuring explanation such as that offered to @nobaggypants I would be feeling humiliated, infantilised, vulnerable and upset.

The OP isn't castigating any HCP or the NHS, more the political system that has underfunded it.

OP should have politely asked the staff on the ward to explain their actions before castigating them and the NHS on MN.

I did, earlier today, and as it happens, the point about communication was taken on board. Thank you for your interest.

Also, you are miscontextualising my remarks about the NHS. I'm passionately in favour of the NHS as an institution, and that is precisely why I said THOSE UP TOP should hang their heads in shame. I'm not talking about NHS staff. I'm talking about those in government who are making little secret of the fact that they want to dismantle the NHS, hence the ridiculously small budgets allocated to the NHS's needs, and hence why the staff (whom I went out of my way NOT to personally criticise in my posts beyond pointing out better communication would have been good) are left having to do a difficult job under great pressure. I already acknowledged how hard they are working.

Hope that helps.

I think this is normal Op. I've had to have them following an illness and unfortunately this was the practice then too.
I was very distressed by it so I'm sorry this has happened to your dad.
@TantricTwist I hope you're not a nurse with that attitude.

If your dad is unsteady on his feet and needs help to mobilise this may be the safest way. If the enema causes urgency it can cause the patient to try to rush to get on the commode and if they have mobility problems this increases the risk of falls. What they should probably have done is explained to your dad that he needs to stay on his side, that the pads are there just in case, they should have given him the call bell and asked him to press it when he felt the urge to have his bowels open and then offered a bed pan. If he didn't make it onto the bed pan in time they should obviously reassure him and change the pads and clean him. Obviously in confused patients, not saying this is your dad, the call bell and bed pan are not always an option because they aren't always aware of what's happening. It sounds like communication might be the main issue. Maybe ask about a bed pan?

My aunt finds it very distressing to shit herself while being hoisted - often it flies everywhere, gets on the hoist (making it temporarily unusuable), her body, the floor, and basically everywhere except the commode. So now she only uses the commode at the end of the day when there’s less urgency.

As he’s overweight, have you or your DF been offered dietary guidance or support?

Tantrictwist, OP did not "castigate the staff and NHS on MN" as you put it.

She made it clear in her OP that her beef is not with the ward or hospital who helped her dad and family but whether NHS cuts have resulted in what she felt was a humiliating experience for her father.

Turns out it is a lack of communication between the staff and her father for what is a sensible practice which takes the dignity of the patient into account.

I hope YOU learn from this. If you provide any care at all in a medical setting, I truly hope that you do not answer a patient in the same way you answered the OP with a "Yes it is normal practice" and no further explanation.

You say that "OP should have politely asked the staff on the ward to explain their actions before castigating them and the NHS on MN."

Your curt reply is precisely why people don't want to ask the busy staff on a ward. I think you have become jaded and insensitive to vulnerable patients and distressed families and should consider whether you should stay in the caring profession, if that is what you do.

Unfortunately I think this is pretty normal especially when someone’s mobility is limited,still doesn’t make it very nice for the patient. I also think nurses can sometimes be guilty of presuming that everyone knows the process and not explaining things as they are literally just so busy.

Hope your dad is ok. If he is currently taken assistance x 2 for transfers (and only when there is someone strong enough to do it) I would be trying to find out what provisions will be in place for home example - profiling bed,hoist,mobile commode, positioning sheet etc

There was an elderly man in the hospital bed next to my dad and he was like a little bird and they still used a hoist and didn't lift him. I thought lifting patients was completely out now in case of injury?

Thanks to everyone who's given me helpful/supportive responses. Heading out for visiting now, more later but didn't want to read and run.

LoafofSellotape ‘Civilians’ will often see us assisting patients with one or two of us and generically refer to it as ‘lifting’, for want of a better term (which is ‘assisted transfer with 1 or 2’ if you really want to know) when it is nothing of the sort. If they can fully weight-bear, two of us might have hands on to maintain balance while the patient steps around. We would never lift, such that feet leave the floor, without some kind of handling aid, the hoist being the most dependent example, but there are degrees of aids up to that (patient turner, Sara Stedy, standing hoist).

I think good practice would have been for them to explain they were leaving the pad just in case and to wait 20 mins and help him put on an incontinence pad whilst hoisting/helping df to the commode. No reason there should be poo all over if done this way. It should be standard.
Very undignified just expecting him to soil himself in the middle of a ward. It really can't be 'normal' procedure.

If he’d gone in an incontinence pad mid-transfer, Blue, that’s a lot more difficult and undignified to clean up than if he’d just stayed on the bed - post-enema stools are not tidy. Also the frequently made point above that if someone is desperate for the loo, and they’re already unsteady, the transfer gets that much more risky. Fall plus poo? No thanks, for all concerned. Far better on the bed.

OP I'm really sorry about the lack of communication. Seeing one of my own family in hospital for a prolonged period of time was a stark reminder of the need for this basic aspect of care. He had never been in hospital. Wasn't told what the cannula was, thought the saline flush was his antibiotics, got incredibly worried with the pumps alarming, had no idea nursing staff needed to measure his urine output and was mortified when he was 'told off' the list goes on. It needed explaining to you and your Dad . Enemas can have quite an explosive effect, with someone already difficult to get on a commode unfortunately it can be easier (for patients and staff) to use pads in order to avoid faeces going everywhere. Assisting someone who is difficult to mobilise but is also desperate to avoid an accident can also complicate things. Pad or commode, unfortunately this is one of those things that can cause a huge amount of distress and lack of dignity to patients, particularly when in a bay of other patients (I'm a nurse Consultant, worked many years as a staff nurse and realise my communication was not as good as it should have been)

I have had a number of elderly relatives in various hospitals. I have seen some shocking things.
Staff told by family not to administer certain drugs and they did with the resulting disaster.
Staff thinking the family carers don't actually do anything especially if they have arranged care visits. Anyone who thinks four 10 to 15 minutes visits in a day is going to feed, medicate and care for a patient as well as shop and pay bills and clean the house is not very understanding of what goes on at home.
Staff claiming that the patient ordered certain foods when the family know their relative is not vegan/halal. The patient was fully compos mentos and stated that was not the ordered meal.
There are some right up themselves, power gone to the head types working in the NHS but no-one is allowed to speak out or they are accused of abusing staff.
The NHS are supposed to be caring for patients not making life worse for them and their family members.

The pad is for potential leakage, rather than for him to actually open his bowels into. Also preserves his dignity should staff not be available to get him into a commode quickly enough when he needs to use it.

Hope he recovers soon op.

Having been a nurse for over 30 years I have seen how management of people having enemas has changed. In the past the person lay on a pad after the enema for leakage and about 20 minutes later they were helped onto a commode or toilet ( manually lifted before hoists). It was not expected for the person to defecate on the pad if it could be avoided. Over the years it has become more accepted not to move people onto a commode or toilet. this is only due to staffing levels, there is no clinical benefit ,in fact people will defecate better on a toilet for lots of reasons. I would refuse to do this and I think your Dad has every right to say he wants to use a commode.

Yes he should definitely be hoisted / helped as appropriate onto a commode after 20 mins of lying on a pad if he needed to go.

The pad is just to collect any leakage immediately after an enema and definitely not to be used instead of a commode.

It is now. It certainly was not when I was a nurse 15 years ago.

Do they not use bed pans any more?

I had a feeling it was a staffing thing

my dad had cancer and tbh I am glad his suffering was relatively short in terms of what some people seem to go through. I remember telling nurses that he needed to go - on a commode - and they just looked at me in despair because they didn't have time to deal with that.

it's so awful, I think he had 2 incidents on plastic sheeting and fortunately died shortly after. I don't mean to sound dramatic; I genuinely would want someone to smother me before I had to go through that.

what happened to auxiliary nurses, I presume they don't exist now?

Teddy OP has said her DF is going home for palliative care, why would you think he should have a dietician for being overweight? Surely he should concentrate on the things and people he loves, no?

OP I’m sorry your DF is so ill
You were right to discuss it with the staff, good communication is essential.

just to add, I'm a bit confused by the enemas prior to palliative care.

is it just to tick a box saying he's had a bowel movement?

My experience of my father's care was not great. the pp who said "trust the medical staff" - we have medical staff in the family! I know some of them are wonderful, but my father's last days in hospital were not well handled, and my mother had a drug suggested for her that was known to be dangerous and her GP had flagged up that she shouldn't have it.

so there are absolutely problems in healthcare, we can't pretend there aren't any.

Crikey! I didn't even know this was a thing. How humiliating for your poor Dad, bless him. If this is what is coming for me in my old age, shoot me now and be done with it. Iv never heard the like. I'm a great supporter of the NHS and staff but cripes that's terrible. No advice for you

Enemas are appropriate in some stages of palliative care as the consequences of no bowel movement can cause other problems and increase symptoms of pain,nausea, vomiting.