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Practice comment

'We should not dismiss the value of Nightingale wards'

When one of my relatives had a stroke in 1994 and was admitted to hospital, she was cared for on a Nightingale ward.

I was relieved because, having done my nurse training on these wards, I knew she would have people around her – there were usually about 20 patients to a ward – and that, if she was in distress, there would always be someone around to alert the staff.

However, she was later moved to a four-bed section where one patient was unconscious and another in great pain. I felt this was dreadful for her – she needed to be in a room where there was more life around her. Subsequently she was moved to a separate room and later to a hospital where there were small units where none of the other patients was able to get up to find staff if there was a problem. Nobody seemed to be keeping an eye on her and it was difficult to find nurses to alert them to her needs.

Had she been on a Nightingale ward, she would have been more visible to staff. Instead, I felt her needs were ignored. She had a nasogastric tube but no one seemed to be paying attention to whether she was feeding sufficiently. She ended up losing so much weight she was unable to fight off infection and she passed away.

If my relative had been on a Nightingale ward, I would have felt more confident that her needs were being addressed when I wasn’t there.

I would like to bring back Nightingale wards. Having a mixture of patients makes for a more stimulating environment. Patients develop camaraderie; they get to know each other and, if they see someone  who seems in need of support or care, they can let staff know.

These wards also help to inspire more confidence in staff’s abilities – relatives can see them looking after patients, unlike smaller units where care is less apparent.

Nurses gain satisfaction from knowing that when they go off duty they have done the best they can during that shift. But a small unit is not the best environment to get an overview of the care that has been given by the nursing team.

Nightingale wards have been criticised for their lack of privacy and dignity. While these are valuable needs, if I’m unwell, all I’m concerned about is that someone notices how ill I feel. When I go home, I won’t be talking about the inconvenience of not having my own toilet and the embarrassment of using a bedpan – I will just be grateful to have recovered from my illness.

I would like the profession to take the positive aspects of the Nightingale wards and see them tailored to today’s needs.

Why don’t we have a debate about Nightingale wards while we still have older nurses who remember them and who know the difference between them and other units?

This would ensure we don’t lose something really valuable because, ultimately, we could create a ward system that’s better than the ones we have now and that would benefit not only patients but also nurses.

Deborah David is a former auxiliary nurse in London

Readers' comments (11)

  • I totally agree Deborah, whilst privacy and dignity are very important, care is crucially why the person is there in the first place and I feel that is better given on a nightingale ward. Relatives do feel reassured that they can see staff and also that those staff might be busy not just sat at the nurses station or not assessible at all.

    I think this should be debated, although I wonder if it is too late already as all new hospitals have been commissioned to have single rooms or very small bays and this is viewed as better by those that don't look after them, sadly it may be too late to change the wheels of motion

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  • There certainly were a lot of benifits of the Nightingale wards as Deborah and the previous comment notes. In particular the fact that patients can see and easily communicate with their fellow patients. How often did we see one family looking out for and engaging with the patient with no visitors as well as their own. As stated the fact that patients and families can see that nurses are around and working hard with other patients can allay fears that "we never saw the nurse".
    However I doubt very much we will be able to change the move to single rooms or smaller groups of patients in the new hospital builds across the countries. The infection control and privacy arguments have held sway in particular in these times and they are certainly strong points.
    The challenge is how can we make the best of what we now have to minimise the loss of the good points about what nightingale wards offered. Not surprisingly, it is through more work for us. It is about educating patients and visitors of how things work on the ward. It is about doing the basics of communicating with families at visiting time. The hourly "rounding" that is gaining popularity could be a help to evidence that patients have been seen, assessed and had their needs met, although it irks me that we are having to start documenting the most basic of care. We will be clocking on and off soon to evidence that we were actually at work.

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  • I’m a nurse who has only worked in a new build hospital accommodating 24 patients on a ward. The ward is very long and comprises of 50% single rooms with three 4 bed bays. Our cliental are those over 65 years with acute medical problems and we also specialise in dementia and delirium.

    While the ward is great for infection control, patients with high risks of falls need to be placed in the bays where they are most visible. With a team of 8 patients it can take me and my carer up to one and a half hours just to make a round therefore if a patient in a side room deteriorates, collapses or falls action is delayed due to lack of visibility. There are no longer any day rooms therefore patients in side rooms often ask if they can be moved out to the bays because they feel isolated, dementia patients will wander because they have no stimulation increasing the risk of falls and dietary intake amongst the dementia patients is reduced as they are eating alone, patients in side rooms will use their buzzers just to check there is a member of staff around taking up more of the staffs’ time.

    For our cliental a Nightingale style ward and the return of day rooms is what they really need. Before hospital designs are approved and huge amounts of money spent, managers and directors should be made to spend a couple of weeks working on such wards so they can see what the true needs of the patients are. The dignity of patients nursed in bays is not diminished and as we are living in an aging population with an ever increasing dementia rate these problems are only going to increase.

    In response to the “clocking on and off” comment, I work for a trust that have already implemented a clocking on and off system, which has benefits, if I’m late clocking off because a shift has been particularly busy the hierarchy get to see that staff often work above and beyond their duty.

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  • I think patient and public involvement had quite an influence on the decision for single rooms too, as it did for telephones and TV at the bedside, the latter is another example of the lack of socialising. All the decision makers, professional or members of the public need to realise we are running a hospital, not a hotel with room service. I support nightingale wards, you could observe and respond to a patient's problem often before they had time to use the call system. Not seeing the nursing staff, and the subsequent perceptions of the public, is often the cause for many complaints that would be unfounded if they saw the bigger picture.

    Anonymous | 29-May-2011 2:14 pm
    What are the hierarchy doing about the results of clocking off late. Is it seen as needing more staff or 'bad' time management? Don't get me wrong we all work later than we should through good will, but it worries me the results could be used for the wrong reasons, I am curious and concerned.

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  • Why are patients in CCUs and HDUs nursed in open areas, could it be for better observation and response?

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  • The problem is when this was being debated not so long ago the views of clinicians were ignored and the public and non clinicians (the government) had far TOO much involvement in the decision making process that led to many new wards being built with predominantly private rooms. This will lead to huge problems in the future. Hospitals are not hotels, and yes privacy and dignity are important, but NEVER at the expense of clinical need. We are there to offer medical and clinical care, THAT should be the focus, not whether the patient has a private flat screen TV or not or whether they want their own room for non clinical reasons.

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  • I completed my training and worked on many Nightingale wards. Infection control was never a problem because the wards were cleaned every day by a team of hospital cleaners who were responsible to each Ward Sister. The cleaners took great pride in having a clean ward.

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  • If all patients are concerned with is nurses noticing how ill they feel & are not worried about such things as privacy using bedpans etc why do so many pay for private en suite rooms - either through private patient or amenity care?

    Research has also shown that patients cared for in single rooms & small units recover faster than those in large wards.

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  • Anonymous | 2-Jun-2011 7:26 pm

    Really????

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  • Anonymous | 2-Jun-2011 7:26 pm no it doesn't. I don't know what you have been reading, but research does not say that at all, the opposite in fact.

    So many pay for private etc because patients do not simply expect medical or nursing care when they re admitted, they want and demand a hotel.

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  • Some of my training was spent on Nightingale wards. Each bed area had sufficient room to accommodate a bed, a bedside locker and a chair, the curtains when pulled round, didn't touch anything. There was so much room between bedends, across the width of the ward, that a dining table and chairs could be used without causing obstrution. I can honestly say that I can't remember wards having to be closed due to Noro Virus, C.diff or anything else.

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