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Between a rock and a hard place

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VOL: 97, ISSUE: 40, PAGE NO: 31

Eileen Shepherd, RGN, DipN

To visit a relative who is lying in bed with any form of restraint, including cot sides, is disturbing, but to see a relative lying on a mattress on the floor can appear on the surface to be barbaric.

To visit a relative who is lying in bed with any form of restraint, including cot sides, is disturbing, but to see a relative lying on a mattress on the floor can appear on the surface to be barbaric.

These were the sentiments reflected in sensational local news reports earlier this year, which revealed the case of a patient being nursed on the floor of a local hospital. The negative reporting failed to reflect the difficulties that nurses face when deciding to take such a drastic measure.

The way nurses care for people is invariably based on good intentions, yet it is clear that the public and, increasingly, the media misinterpret and misrepresent what we do. Superficial reporting of apparent lack of care does little to engender a relationship of trust between nurses and patients and their families. It also creates a conflict for nurses as they struggle to meet the needs of their patients but are forced to consider how other patients and relatives will interpret their plan of care.

A friend recently described a number of shifts where she nursed a patient who was disoriented and kept climbing out of bed, putting himself at risk of serious injury. She described two choices. The first was to nurse him in a bed on the main ward and rely on other patients to call her if necessary. The other was to nurse him on a mattress in a side ward, thereby minimising the chance of injury.

From the beginning of a shift to its end, nurses are faced with difficult and complex choices. Work has to be prioritised, yet it is often difficult to distinguish who is in the greatest need. Decisions have to be made on the spur of the moment and reflected on afterwards.

There is no doubt that choosing to nurse someone on the floor compromises dignity but how do you care for someone on a busy medical ward who is continually climbing out of bed and falling over? Obviously the decision must be based on a thorough assessment of the patient and only implemented after consultation with their relatives or friends. The idealist in me demands that a patient at such a high risk of injury requires the continual supervision of a nurse.

Such a demand has financial implications, but to deny one-to-one care puts the patient's safety and dignity at risk. Realistically, achieving safe staffing levels on wards, even with the use of bank and agency nurses, is often impossible. Finding an extra nurse to special a patient,who is confused and disoriented, is not likely to be an option.

Funding and staffing shortfalls mean that nurses have to make decisions on the front line of care that are unpalatable for everyone concerned, not least the nurses involved. The decision to nurse people on mattresses is symptomatic of a health care system that is stretched beyond its limits. Unfortunately, it is the most vulnerable patients who fail to get the service that they deserve. We must highlight their needs and fight for the individual attention they require.

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