The first group are vocal and often know the hospital system well. This might not be their first admission. They ask questions and express opinions about treatment options. They make sure nursing staff know their needs and that we meet these needs. This is perhaps the group we as nurses find hardest to cope with.
The second group of patients say little. They are totally accepting of the system and have infinite trust in us. These patients hate to press their bell for anything but, instead, will wait for a nurse to come into the room before asking for any help. They feel guilty that their demands might add to our workload and are very grateful for everything we do to help them.
The third group are too ill to verbalise their wishes or their feelings. Some of them have caring relatives who take on this role. Others, however, have nobody.
People from the first two groups can move into the third group.
Who receives the better standard of care? This is very much a personal opinion but I feel the vocal and demanding patient still manages to get more out of the system in the frantic and busy world of acute medicine in which I work. How I wish I could say everyone gets an equally good standard of care.
The care of the patient who is lonely and dying causes me most concern. The doctors have withdrawn quietly because there is nothing more they can do. Pain is under control with adequate analgesia and we all await the inevitability of death. Care of the patient is now left completely in the hands of nurses.
There is a well-designed, end-of-life care pathway to follow. Physically we care for these patients very well – we regularly change their position, clean their mouths and wash them. So why am I regularly left feeling that I do not give enough time or attention to those patients who are dying and have no family or friends for company? I know the answer. It is very simple really.
I never have time to stay in the room beyond carrying out my nursing duties. This is because all the other patients I am responsible for
shout much louder for my time and have more visible and immediate needs. There is usually more to be done than I have time to do it in. In the real world of healthcare, nurses do not have the time to take on the role of family or friends. This can leave us all with a feeling of inadequacy tinged with sadness.
Gail Smith is a staff nurse in Cardiff