Practice team blog
All posts from: September 2011
Depending on how you want to look at it, our collective parents are either draining the NHS of vast proportions of its resources or keeping an awful lot of health professionals in gainful employment.
A get-together with friends will rarely get beyond the first drink before someone kicks in with “My Dad’s not too good again”. And then we’re off, comparing symptoms, care packages and treatment plans.
For the most part, our parents receive fantastic care from the NHS. But of course, things do sometimes go wrong, and if you’re making heavy use of the health service the chances that something will go wrong for you are obviously greater - particularly if you have complex needs requiring the input of numerous specialties.
So the other thing my friends and I have in common is that we have all, at some point, had to step in and insist that our parents receive a fundamental aspect of care, and that they receive it quickly. I’m not talking about anything out of the ordinary here, but a pressure-redistributing mattress, a diagnostic test or a side room in which to die peacefully.
We have all found it uncomfortable to assert ourselves, despite being generally confident and articulate - and having more knowledge of health and the healthcare system than the average citizen.
So while my friends and I quote stroke strategies and NICE guidelines to get the best for our parents, what happens to the patients whose families don’t know what they should be insisting on, or who don’t have any relatives?
The only thing that ensures frail, undemanding and rarely visited patients getwhat they need is the presence of a skilful and compassionate nursing team that is willing and able to take on the role that we pushy offspring fulfil for our parents.
Most parents will have experienced that terrible moment when their first born child comes home from nursery school with a piece of logo or a Playmobile man tucked into a pocket. Did they put it there by accident or did they steal it? What do you do?
Life doesn’t get less complicated.
Last week I was talking to an NHS manager about fraud in the NHS and we got onto the topic of taking 2 paracetamol out of the drug trolley if you had a headache. Is it theft? Is it only theft if you do it without permission? Is it theft if sister says it’s OK? Or is it just stealing whatever way you look at it?
Some trusts advise wards can keep their own supply of paracetamol for use by staff but this has to be purchased independently at the discretion of the ward sister.
So, even though there is a cupboard full of analgesia, if you have a headache you need to ask someone if they have got a couple pain killers in their hand bag. Wards should also have their own first aid kits for staff to use.
Is this silly? I don’t think it is.
In the past there was a culture that assumed NHS property could be used by NHS staff; the odd paracetamol or bandage wouldn’t be missed. This has been extremely unhelpful. What if it’s not a paracetamol, but ibuprofen or codeine or a replacement for an empty inhaler. Staff need to be clear about what constitutes theft - otherwise they put their job and professional life on the line.
So here are three more dilemmas:
- While you are locking up your bike outside the hospital you cut your finger. Can you nip into the clean utility room and grab a plaster out of the ward supply?
- You miss your tea break at 2am because someone had a cardiac arrest. Can you make a slice of toast using the ward’s supply of bread before you get on with the drug round?
- You discharge 10 patients before lunch and there is loads of food left over on the trolley. Can you put some on one side for your break?
What do you think?
It all seemed pretty straightforward, the drive to have single sex wards and bays.
No question in my mind that it is the best way forward. It is what patients want, it promotes dignity and privacy. But things are not always as they seem. Sometimes they are more complicated.
I visited an elderly relative this weekend, an 83-year old who was being cared for in a six-bedded bay with five other women. She was positive about the ward and about where she was being cared for.
I found myself saying it was a good thing that she was being cared for in an all female environment, how it is much better that it was all women. I felt quite smug as if by writing about the single sex initiative at Nursing Times I had had some part in implementing national policy.
Well, she said, it is a bit of a shame there are no men here as we would be having more of a laugh. Men have a better sense of humour, don’t they?
I was quite surprised by her response and questioned her more closely – what about if you were on the bed pan or having a wash wouldn’t you feel uncomfortable if there was a man in the bed opposite? No apparently not if the curtains were pulled properly.
So perhaps we do need to find ways for the sexes to meet when in hospital as there are social benefits that must not be forgotten in the drive to separate men and women.
A Mail online article which criticised the use of tabards also talked about a crisis in nursing. Detailing a story of poor care the author said: ‘Talk to anyone who’s spent time in an NHS hospital recently and, nine times out of ten, you’ll get a similarly unhappy story.’
I am not saying that the care she received was good. It does indeed sound unsatisfactory. However I do not think that experience can be extrapolated to stating that ‘nine time out of ten’ or indeed 90% of the nursing profession are providing below standard care.
Nurses too long held the position of angel in the public mind. Nurses could do no wrong. When I was a student nurse we would sometimes get free taxi rides home to the nursing home as the driver would wax lyrical about the care a relative had received. However now the media has swung to the opposite position where nurses are ‘begrudging’, ‘uncaring’ and ‘slovenly’ as described here.
Of course the truth lies somewhere in the middle.
As much as the view of the angels was inaccurate – there were nurses giving bad care then as unfortunately there are now – so is the view today that 90% of nurses are giving poor care.
The majority of nurses are struggling to maintain standards of care with fewer numbers of qualified nurses per patients. Having to deliver more complex care for patients and deal with significant budget cuts is putting pressure on already stretched resources.
It is important that episodes of poor care are highlighted but it is a disservice and demoralising to the majority of nurses if we start to see those as defining the profession.