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Nurse freedoms over mixed sex accommodation spelt out


Nurses have been given more freedom to decide whether patients should be treated in single sex wards, along with specific examples of where mixed accommodation will not be tolerated.

Updated Department of Health guidance states mixed sex accommodation must be “eliminated” where it is not in patients’ overall best interests or does not reflect their personal choice - appearing to move away from the previous approach of a deadline for its abolition.

It says patients must not be put in mixed wards: for the convenience of staff; to group patients within a clinical specialty; because of predictable fluctuations in activity or seasonal pressures; or because of a predictable non-clinical incident, such as a ward closure.

In addition, decisions must not be based on staff or bed shortages, poor skill mix or restrictions caused by old buildings.

Patients cannot be placed in mixed sex accommodation while awaiting assessment, treatment or a clinical decision, or for regular - not constant - observation.

Royal College of Nursing adviser on acute and emergency care Alan Dobson said it was the first time such clear examples had been provided, which would help staff who “often felt compromised when faced with competing priorities”.

The guidance also gives clinicians significant leeway to use professional judgement in decisions over where to treat patients.

It says staff can mix patients in the event of a life threatening emergency, where a nurse needs to be present at all times, during close observation, or if there is a risk of an adverse drug reaction.

Janice Stevens, the DH’s national director of healthcare associated infection and mixed sex accommodation programmes, told Nursing Times: “It’s a professional decision, based on the patients’ needs.”

For example, she said, it might be more appropriate for a female stroke patient to be treated in a small specialist unit with male patients for the first 48 hours of admission.

The DH announced in April that 95 per cent of trusts in England had “virtually eliminated” mixed sex accommodation.

From January, trusts will have to report any breaches to the DH and could be fined as a result.

When patients may be placed in mixed sex accommodation

  • In the event of a life threatening emergency
  • Where a critically ill patient requires constant one to one care
  • Where a nurse must be present in the room/bay at all times
  • Where a short period of close patient observation is needed
  • On the joint admission of couples or family groups

Readers' comments (11)

  • Well, let's see if it this is adhered to. Where I agree that there are some cases where it may be exceptionally necessary in the interest of speedy life threatening issues, to treat men and women in the same area, (ITU for instance), I am wholly opposed to mixed sex wards. I can just see some Trusts 'bending the rules'. Let's wait for the patient complaints. We still have a mixed ward, tiolets are communal and I think it is stretching the truth as it is to say it is non mixed wards.

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  • you wouldn't stay in a mixed sex hotel room, except with a partner of your choice, or go to a public unisex toilet so why should you sleep on a mixed sex ward and why should the toilets be unisex or any different from those in any other public place?

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  • I do not agree with this. I would like to be treated in a ward where the staff are specialised in the illness I have come in with. We have mixed sex wards but separate bays and toilet, to me this is perfectly adequate. I think we have to be realistic about this, it is not possible in many of the small to medium sized hospitals. Are the public actually really concerned about this? I have never received a complaint about mixed sex wards, I think it is a media fueled argument. We have bigger fish to fry.

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  • From Anonymous | 23-Nov-2010 2:36 pm
    Nobody asked you to agree with me. But I find the whole concept of mixed sex wards inconceivable and if I was ill I certain would not wish to be put on one. It is a matter of personal preference and I am also entitled to mine. I am sure no other civilised Western European countries have mixed sex wards and I don't think you should force people to use them - it may even be against the human right to privacy.

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  • I'm glad I'm not the lone voice in the wilderness anymore saying that this policy is paternalistic in the extreme. Although I support one major political party we now have seen the party supported by all three major parties this year as all have been in government and all have been wrong.

    What about bays where patients with NOF fractures are being worked up for surgery in the limited time available? You couldn't have a mixed bay using the proposed criteria yet fractured NOFs are clearly life threatening emergencies.

    Whether to mix bays/wards or not should be a clinical decision. This dictat from this and the previous government is an insult to all health care professionals and their training and dedication.

    And yes, I do believe in non-mixed wards where appropriate.

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  • @ Anonymous | 23-Nov-2010 9:32 pm

    "I am sure no other civilised Western European countries have mixed sex wards"

    holland is the obvious counter example, although i'm sure some wise alec will say the word "civilised" shouldn't apply.

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  • can someone clarify for me....
    do they mean actual wards or do they mean the rooms within wards?
    If it is the case where wards cannot be mixed why????????? I would want to be cared for in a ward that specialised in my specific care need and see no need to make the male female devide. However, I would not like to share a room with the oposite sex unless in specific cases ITU etc..
    I think this is just crazy!!

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  • It is very difficult,I am a nurse but have also been a patient on and off since childhood having a chronic cardiac problem.
    Last week I was an inpatient in a ccu ward I was the only female in a 6 bed bay as the ward has one female bay,one male bay and an overflow bay which I was in.
    At the age of 52 I was dismayed but did not feel embarassed as I had my trustee flanlette pyjamas on, I no longer have periods,and have developed the art of conversation,but I remember being in the same ward several years ago again the only female in the bay when I was in a hospital gown and had just started my period which was very heavey.I was not allowed out of bed and had to have bedpans and had to beg for sanitary towels( which were apparently very hard to find anywhere )because my visitor didnt turn up with them as requested.
    I knew that at bed making time other patients would see the stains on the sheets as the nurses were hardly discreet . When bearing my chest for the countless ecg's I was painfully aware of curtains not being shut properly or accidently being pulled open by passing traffic. It was an unbearably embarassing situation which was identicle to previous experiences in other ccu wards in other hospitals as there are more male cardiac patients than female.
    I believe that these experiences exsasserbated my condition whilst there.
    For patients in these situations the nursing staff should behave in a discreet,diplomatic
    and sensitive manner so as to help preserve the privacey and dignity of the patient to the utmost whatever sex the patient is.
    Luckily after a few days a sideroom became available because the woman in it couldnt stand the isolation anymore and her daughter kicked up a terrible row with the staff one evening about being moved.I volunteered to change places with her,I dont know what she must have felt moving out to an all male patient enviroment but I dont feel she was that pleased with her daughter!
    This time round the staff were more aware though there was one member of staff who saw me as a cardiac condition not the only female in a male area.

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  • its not a clinical decision its a biological one. in case you do not understand anatomy and physiology males are male and females are female with different sets of physical attributes and should not be forced to mix because of a clinical decision. there is also the right to privacy and an element of prudishess is also involved and everybodys' right!

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  • So, does a "biological" decision over ride a "clinical" decision??? Really??? Glad you're not in charge.

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