Care of the elderly

[radiohelen]

here

Ok - dons hard hat - I know that the NHS is beleaguered and we should all be feeling sorry for the poor nurses on the front line but WTF is going on???

I have been in hospital a bit over the last five years or so and on every occasion where I have been in or around a ward with elderly people I have been pretty sickened by the treatment they have had dished out to them.

One guy was clearly finding it difficult to feed himself but his food was just left in front of him. He kept ringing the bell to ask for help to sit up but the nursing assistant who came to his bell needed help, went off to get it and never came back. He never got his dinner. I had to leave my husband (with his broken leg) on watch to make sure the chap got fed his dinner. DH says there were also difficulties with toileting.

On another ward overnight an elderly Chinese lady was having difficulties, pain I think, and kept buzzing the nurses. The African nurse who came to her aid made no effort to understand her accent and what she was saying and kept telling her off for buzzing in a thick accent that I had trouble with, let alone the lady on the bed. She just left her.

Surely nurses and nursing assistants can and should do better than this?
Just because you got a degree it doesn't mean you can't wipe someones backside or feed them their dinner. If you come to this country to nurse then you should bloody well make an effort to make yourself understood and take time to understand what others are saying to you.

Just saying.

ducks under parapet

[nailak]

whats so bad about getting family members in when poss to feed and care for their elderly relatives#? is this allowed#? or do family have to stick to visiting hours 4 hours a day or whatever#?

[mamatomany]

whats so bad about getting family members in when poss to feed and care for their elderly relatives#?

Nothing I guess providing it's not a case of if that isn't available then you starve.

[TwoIfBySea]

Nailak, as I had said, in the first ward my dad was in they actually cared and the nurses were superb. We were allowed extra visiting time as it turned out that my dad would accept food from me and the staff worked with that. It wasn't a case of "you do it or else" but more, look this works, were in this to help him so let's do it this way. They would give him breakfast and lunch and keep a stash in the fridge for when I came in as they knew at that point he would actually eat!

The other ward didn't give a crap and when I brought in my own food for him they wouldn't let me give it to him as it might make people think they weren't doing their job! Which they weren't.

[nailak]

thats really sad, whats been going on lately has made me think i would try as much as possible to keep my mum when she gets old from going to a care home! but shes only 50 so not yet!

if people have friends and family willing to helo it would make sense if they were allowed to help so staff could concentrate on those who dont have anyone to help

[LovestheChaos]

First of all NHS general wards have the worst RN to patient ratios in the developed world.

This isn't due to a recruitment problem. It is simply down to management not wanting to pay out for qualified nurses to staff the wards.

Years ago a ward would have 5 nurses per ward per shift to share the workload. That is how it was when I started in the NHS 10 years ago.

These days a ward has one nurse and 3 untrained care assistants who never attended nursing school. The public often confuses these people for real nurses.

Even if I have great care assistants working with me I still have to carry all the drugs, IVs, parenteral, physician orders, discharges, assessments, paperwork, information management, emergencies for all 35 patients all by myself as the lone nurse.

Nurses and doctors have been putting their butts on the line for nearly a decade complaining about this to the unions, the Nursing and midwifery council, the GMC, hospital managers, politicians etc. We have done incident forms and letters. We have written to newspapers and phoned MP's. We have demanded meetings with hospital chiefs. It has all been futile. No one wants to pay for Nursing care.

Not only are the numbers of qualified nurses on the wards these days less than ever but general ward patients are more acutely ill and more complicated. What we get on the general wards now would have been in ITU 10 years ago. The level of knowledge that a general ward RN needs to have these days is massive.

I have worked in the USA, Canada, and in the UK for the last 10 years as a bedside nurse and kept an online journal/blog with another NHS nurse since 2007 describing what is going on.

If you are really serious about understanding the situation please have a look: militantmedicalnurse.blogspot.com/

Remember two things 1. The government and the media lies about the reasons behind bad care and 2. The staff you see gossiping around the nurse's station are probably not nurses. 3. There are no geriatric wards anymore. Elderly patients are mixed in on medical wards where the one or two RN's have critically ill patients on multiple drips that require constant monitoring. The Nurse cannot abandon that stuff to hold hands and be there as soon as a patient wees without the possibility of getting blamed for someone's death.

[LovestheChaos]

Most Nurses in the UK do not have degrees. Of the few nurses on the wards the majority all older trained Nurses who trained under the old system. I personally don't care if we have older trained or new trained nurses as long as we actually have trained nurses.

It is not unusual to have confused elderly patients ringing the bell every 5 minutes. While I don't advocate losing your temper with them I do understand why the Nurse would get angry at the situation (not the patient). It is a dangerous thing to have confused elderly patients on a ward with critically ill patients where the one nurse has to be able to concentrate to avoid making a fatal error.

The fact that no one wants to hear is that many elderly patients will cry out (often not knowing why) and constantly ring the bell (forgetfullness) and even if you ignored all of your other patients to try and help such an elderly patient they would still cry out etc. It is a normal thing for elderly patients with dementia to cry out even when they have had constant, compassionate care. The nurses do no have magic wants. They nust make very difficult life and death decisions about who gets care.

[LovestheChaos]

Every shift I have worked in the last year has seen us fill in incident forms about poor staffing and officially complain as well. Managements response has been along the lines of "tough" /"stop whining" /"Get on with it" and "your porblem not ours".

[LovestheChaos]

and I will tell you something else OP. In australia and california all the Nurses ARE degree educated and they have a one nurse to 4 patients maximum enshrined in law on their general wards. With that kind of excellent ratio the RN is able to deal with ALL aspects of per patients' care including nutrition and hygeine.. She isn't forced to delegate basic care to overwhelmed care assistants because she is trying to do drugs for 35 patients as NHS Nurses are.

[hymie]

Many people don't have the facilities to care for an elderly person at home, if they had the facilities i'm sure many would choose to do so.

Instead the elderly get stuck in hospitals.

The solution isn't going to jump up and bite us...maybe re-open geriatric wards or fund hospices through govt cash?

[LovestheChaos]

I agree with that hymie. The elderly deserve nurses that can actually spend time with them. But my experience leads me to believe that the government isnt going to spend a penny. The medical wards take geriatric patients who have no place to go. And for that reason those wards always get the worst facilities, get cut off from resources and get the worst staffing levels. Our care assistants work harder and deal with more crap than a care assistant on a surgical ward yet they get paid less. Medical wards are also the wards that have to do without housekeeping and a ward clerk when the trust needs to claw back some money. A lot of this stuff would never happen on a surgical ward. They tend to function a lot better.

[exhaustednurse]

Geriatric wards are open in my Trust.

Nurse to Patient ratios are still poor. There is no flex in the numbers of staff to cover sickness etc.

Massive issue's too with recruitment and retention of these wards - not seen as a 'sexy' or 'exciting' speciality to many compared to ITU, A+E etc.

You used to get a few quid a month more 'geriatric lead' payment which reflected the sheer hard graft this speciality requires of nursing staff. Needless to say, that has long gone.

[TwoIfBySea]

FWIW I trained under the old system. It was very hands on and you learned as you went.

I had left before the trainees under the new system filtered through but friends told me that they wouldn't help out. While they were working the newbies would "observe" as that is what they stated they were meant to do.

Might be a reason why so many don't have the same grafting work ethic. You can't call yourself a nurse until you've cleaned up sh*t, puke and everything else!

[LovestheChaos]

The new system is very hands on and the students learn as they go. They work nearly 4000 hours on the wards over 3 years in order to qualify. Most of those hours are spent doing basic care. The few newbies we have taken on are very hands on. They are often alone up there and don't have a choice. But of course they are really not able to do basic care when they have a drug round, IVs and documentation to do for 35 patients because they are the only RN on duty.

Anyway most of the qualified nurses working in the NHS right now trained under the old system so I fail to see your point.

[dotnet]

I think there's something wrong in the recruitment and in the expectation of what a nursing role is. I do get the impression that the 'looking after' aspect of nursing has been belittled while the technical skills are bigged up.

When I visited an old lady in hospital a couple of years ago I found her with her tongue dry and brown. I asked her if she wanted a drink and she said 'yes'. She wasn't in a state to take it from a beaker, so I went off to ask for a teaspoon. A nurse said she would bring one. Nothing happened. I went back to the nurses' station to ask again. The nurse apologised and I got one. I left the hospital with the feeling that the old lady wouldn't necessarily get fluids as and when she wanted them and could easily slide into that neglected state again. She did die a couple of weeks later. With good care she might have rallied, as she had done before. I didn't feel she had died in 'safe' hands.

[LovestheChaos]

You have to be careful with that as many elderly patients are on fluid restrictions for a reason i.e. hyponatremia, In that case the best way that you can help her is with mouth care swabs. Many elderly patients have swallowing problems and a glass of water would cause them to aspirate and then develop a fatal pnuemonia. Please do not feed or water the patients unless you know their history and diagnosis.

Remember that few of the staff are actually qualified nurses and the ones that are real nurses completely snowed with drugs, IVs and doctors orders. Snowed.

If they dont hang the 35 physician ordered blood transfusions and IV antibiotics (takes hours of rushing around)correctly and monitor the patients during these things because they are off fetching teaspoons they are going to get absolutely nailed when a patient gets hurt. I cannot ask the doctors to stop ordering complex meds and treatments for me to deliver because I would rather spend my day caring and washing patients.

Nurses have to prioritize. Giving geloinfusion to the shock patients with a low BP has to be done before feeding and hydration. The problem is that stat life and death orders are often so numerous that the nurse cannot even go and get a teaspoon. Best to grab the care assistant in that situation. Drug rounds often become very dangerous when Nurses are interrupted.

As a nurse i have a massive problem with people who walk up to anyone they see in uniform...assume that she is a Nurse and assume that she can just leave her shock patient to fetch a teaspoon. Please never assume. And never assume that a patient can safely have a glass of water.

[LovestheChaos]

dotnet try and see it from another perspective. What if your mother was on that ward and she became septic because she didn't get her meds, or died because she didn't get her blood transfusion or died from fluid overload because no one caught onto to the fact that her IVI was going to fast? What if the Nurse responsible for her told you that "I missed those things with your mum because I was making sure my 35 other patients had water and clean mouths"

You'd fucking sue her.

[hymie]

Caring for elderly relatives is impossible with the strict visiting times.

If nurses don't have the time to care adequately for people on the ward they work in then some arrangement should be made so eager relatives can.

[dotnet]

LovestheChaos I'm not convinced by your suggestion that there was no neglect in the case of my old friend - wouldn't there have been a card by her bed head saying 'Nil By Mouth' if she was being dehydrated intentionally?

There are too many accounts of e.g. people being left unfed (because they need help to eat but aren't getting it) to convince me that old and very frail people are always being nursed to a standard of care equal to that of younger people - or, rather, to a standard appropriate to their age.

It may not be callousness, but to the outsider at any rate it looks as if, sometimes, people 'take advantage' of people's inability to speak up for themselves, and so don't bother with them as they should.

[LovestheChaos]

dotnet did I say that there was no neglect?

The whole point of my comment and the militant medical nurse blog is to show why these people are being neglected and explain that it isnt intentional.

[LovestheChaos]

This post was done in 2007 to show why the Nurses are unable to feed and hydrate their patients: militantmedicalnurse.blogspot.com/2008/03/protected-meal-times-what-fucking-joke.html

As I have explained before wards that have elderly patients receive less staff and resources than wards that take younger patients. They need more not less staff on wards that take older patients but the government won't fund it. The nursing profession has no say in this.

[LovestheChaos]

If the visitors would follow rules and behave sensibly I would be all for all day visiting especially at mealtimes. But they behave like apes on acid. In the UK there is no one to monitor their behaviour.

The hospital I work at now (in the states, I left the UK) has all day visiting hours with no restrictions. I think that is good. But we also have a giant security guard with a tazer who will collar them and throw them out if they start acting like idiots.

But I only have a maximum of 4 patients now rather than the 35 I had in the UK which means that if someone cannot feed themselves I can feed them.

[hymie]

Having guards who would tazer visitors

The vast majority of visitors shouldn't need to be tazered should they?

The "Ape" comment doesn't instill confidence. No wonder relatives get worried if an attitude like that is the norm among the nursing staff.

If a relative who is in hospital gets substandard care the nursing staff rightly need pulling up for it...or should they be immune from criticism?

[LovestheChaos]

The guards have tazers. The tazers are for violent out of control people. But their presence helps keep people under control. Visitors are less likely to bring illegal drugs (heroin) into patients and trash the place when we have a security presence. And yes, I have had lots of experience with visitors who behave like that. For every nice one there are many more who are nuts.

Not immune no. The NMC would strike off an RN for anything and we constantly live in fear. But I think you need to be blaming the people who underesource and understaff the wards. IF the nursing profession had any kind of say in how these wards are run there would be no problems with substandard care.

At the end of the day of you are an RN with 35 patients those people are going to suffer and get neglected no matter how good, knowledgable, caring, and hardworking you are. The patients at my new hospital get great care and that is because their is legislation enforcing the one RN to 4 patients rule.

It is too bad that England won't do the same.