"Patient Experience of the Royal Victoria Infirmary and the Freeman Hospital "

In 2011 I was admitted to the RVI in Newcastle via A&E after developing an acute medical condition that needed immediate attention. I spent one night in the close observation ward in the Assessment Suite and then was transferred to the Freeman Hospital for one night before being discharged. I would like to say that my stay in Newcastle Hospitals helped and supported me through the discomfort and anxiety of sudden illness but sadly it did not live up to this expectation.

The following is an account of specific observations, experiences and conversations while in hospital.

RVI Newcastle upon Tyne

Thursday

Evening

I was admitted to RVI Newcastle via A&E on Thursday evening after developing a number of acute symptoms including severe vertigo, unilateral deafness and haematemesis. After several hours of tests and histories I was moved to the Assessment Suite close observation ward where I stayed until about Friday lunchtime. Apart from the discomfort of my condition I remember becoming very cold in A and E and eventually having several blankets piled onto me.

Friday

Morning

Early on Friday morning (I think it was about 6am) I was transferred to the Assessment Suite. I understood that owing to haematemesis I had been admitted as a gastric emergency but the nursing staff didn’t seem to realise that I had had a sudden and acute hearing/vertigo problem and couldn’t get out of bed or move around easily. I asked one nurse what I could expect to happen next regarding my ear and she replied “What’s wrong with your ear?” I was also told that I couldn’t have food or drink in case I needed any kind of surgical intervention but then other staff would pour out water for me.

During my time on the observation ward nobody offered reassurance about what had happened to me or discussed any sort of plan for the future.

At about midday I was taken in a wheelchair to the hospital exit to be transferred to the Freeman hospital (without any explanation about why this was happening or how long I might expect to be there.) I was moved without a jacket or blankets and again became very cold. A member of the ambulance crew sat nearby with his feet up on the seat next to me. He looked out of the window and didn’t speak to me for the whole journey.

Freeman Hospital,

Afternoon

I was placed in an 8 bed bay with mainly elderly and frail female patients. Two members of staff came onto the ward during the afternoon and spent a lot of time gossiping with each other about going to the beach, drinking and tattoos. At one point a distressed patient could be heard groaning down the corridor and one of them said that the noise sounded like cattle and they both laughed

Evening

By now new staff had come onto the ward. The elderly lady opposite me called for help and a member of staff came in and said “What’s the matter?” in what sounded like an irritated tone. This member of staff and their colleagues seemed less than sympathetic when she needed lifting onto a commode and was crying out in pain. In my opinion she was treated as though she was nothing but a nuisance. During the evening there were long spells of groaning for help from down the corridor. It seemed to me that some of the patients in the ward were often left slumped uncomfortably in chairs at the bedside.

Since arriving on the ward nobody had asked me how I was feeling, shown me where to put my belongings or how to operate the lights. I was given one dry cheese sandwich for tea – the only food I had been offered in 24 hours.

A most upsetting incident occurred after visiting time on the ward – about 9pm. The elderly lady in the chair next to me became very confused and distressed. She was crying and kept repeating that she wanted her husband and was worried about what had happened to him. I talked to her and tried to reassure her for at least an hour during which time not a single member of staff came onto the bay. Eventually the lady, who was very frail and disorientated, attempted to get out of her chair and started to fall over. With considerable effort (bearing in mind that I was still nauseous and dizzy) I leant hurriedly across my bed and caught her before she fell. There were still no nurses in sight.

At this point I made my way unsteadily along the corridor to the nurses’ station and explained (by now I too was upset) to the staff nurse that the lady next to me was very distressed and had nearly fallen in her attempt to go and find her husband. A fall had only been prevented because I had moved quickly to save her. I made it clear that I wasn’t well enough myself to keep looking after her but couldn’t just leave her distressed. She needed help. I also told them that if it was my mother I would be appalled by such treatment. At this point a nurse (apologetically) came to help the lady and they moved her (I understood) to a bay near their work station. Nobody came to tell me how she was doing afterwards or to ask if I was alright. I felt very agitated.

Sadly, the situation didn’t improve. Shortly after the lady had been moved I lay and listened to another patient on the ward (not in my bay) crying out for help pitifully for half an hour (I was watching the clock on the wall.) I got up again to see if I could locate the sound and was approached by a nurse who asked brusquely if they could help me. I explained that a patient clearly needed help and they replied that it was ok, they had spoken to this person and they had mental health problems. I replied that this was not a reason to not help them if they are in distress. The nurse replied that this person was ok, they knew their job and also suggested I could shut my door. To which I responded that if this person is crying they are still in distress and I can’t stay listening to another human suffering. After this the crying did stop, without explanation.

Saturday

Morning

I pressed my buzzer at 5.55am to ask to be detached from my drip to go to the toilet. In the meantime, the lady opposite me said she desperately needed to go to the toilet. She asked where all the staff had gone to and said that she’d been buzzing for help for some time. She said that she’d already been completely changed once in the night and would now wet the bed and have to be changed all over again. The nurses eventually came into the bay at 6.10 am by which time the lady had the indignity of having to tell them that it was “too late” and that they would have to change her all over again. A staff member responded to say they didn’t know what to do and couldn’t change anything until the patient had been assessed. Another member of staff said that she had a towel underneath her so if she needed to go, just go. The lady replied to say she had never been incontinent in her life.

At 6.20am another elderly and also frail lady opposite me called for a commode. She was told that she would had to wait as the other nurse wasn’t free and they couldn’t manage on their own. The patient replied “If I have an accident so be it.”

Then the member of staff said ‘well it will be my fault if you do’ [As if by taking the blame themselves it made it all acceptable. Ten minutes later they brought a machine (which I think was an aid to lift patients onto the commode) and started setting it up. The lady was apologising to the nurse for groaning in pain when they started trying to lift her onto the commode. [I could have wept.] She clearly suffered from very painful joints.

A lady in the corner of the ward asked if the heating could be turned up as it was freezing. The nurse replied they couldn’t do that and that there was no way of doing it. I intervened and suggested they could get the lady a blanket. They replied that yes they could get a blanket.

I noted to myself that some of the nurses I saw were reasonably pleasant with patients who were compos mentis, cheerful and able to manage most personal tasks by themselves. An elderly lady by the window for example could get up to go to the toilet, wash and dress unaided, eat unassisted and never called for help. She was able to co-operate and was treated with reasonable respect and understanding.

The lady across from me needed the commode again during the morning and it was desperate to hear her cries of pain and distress as she was being moved from her chair to the commode. Her cries of “Enough! Enough!” as the electric seat was being raised were distressing to hear and did not provoke any kind of soothing response from staff seeing to her. Afterwards she said to the nurses that it would be better if she could have pain killers before they started. At another point in the day she needed to be moved from her chair into bed and was clearly in pain. She spoke to the nurses saying “If you’d be a bit more considerate I might be able to do it. Now just take it slowly will you. It’s like a torture chamber in here.”

9.05am - The staff nurse placed the tablets for the same lady in a plastic container on her table and said “Can you take these for me?” she replied “Yes but I can’t get them out of the tub.”

I was offered toast at breakfast-time and accepted but it never arrived. All I had was a bowl of cornflakes. I wondered, if I was going to be here all day, whether I’d receive the government’s recommended daily five portions of fruit or vegetables. Yesterday I had one portion (at teatime): salad in a cheese sandwich. If food was being restricted on medical grounds why wasn’t this explained?

A nurse had a conversation with a patient with a patient on the bay: “There’s more paperwork than anything now. One night there was only me and a qualified nurse. I can only look after one patient at a time – they’ll not give us more staff. “

12pm One of the patients was given a meat dish for her lunch and told one of the other patients that she couldn’t eat it as she’d never eaten meat. I got up to tell one of the staff nurses but ended up telling a nursing assistant. They seemed very irritated and came and spoke to the patient in an exasperated tone saying that the she had not mentioned this all week. She replied that perhaps she had never said anything to her then. None of us had been asked what we would like or lunch that day

Later on that day a member of staff came into the ward looking angry and announced out loud that they hated working this shift with a passion and they were not supposed to do “night shifts, late shifts or long shifts” but that they were having to do “the bloody lot”. The nurse went on to say to everyone that they dreaded coming to work and blamed the government for making them work longer.

I was discharged from the Freeman during Saturday afternoon with medication but without any idea of what I should be doing to aid my return to health.

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In an attempt to organise my feelings about this stay in hospital I have broadly divided my observations of some of the problems into two areas. The first area concerns unsatisfactory personal behaviour and skills amongst nursing staff: I felt there was a shocking absence of basic caring attitudes and skills from some of the staff .The end goal must surely be to send home (as far as possible) patients who are physically and mentally healthy and not just the completion of tasks regarded as necessary for the smooth running of the hospital. Too often I felt that some of the staff were competing with the patients in the race to keep the hospital as well-organised as possible: that the staff were the athletes and the patients the hurdles.

During my hospital stay I witnessed, to my thinking, some instances of unacceptable and at times downright cruel practice, from professional and auxiliary nursing staff. Of course that is not to say that all staff behaved in this way: there were staff who behaved with intelligence, dedication and compassion but the total effect of those who did not, was strong enough to create a general ethos that seemed at best disinterested and at worst unfriendly, insensitive, cruel and uncaring.

From my observation patients, especially if they were physically disabled and/or slow, hard of hearing, or in need of extra help, were often treated as though they were a nuisance and an inconvenience by some nursing staff who spoke to them in a dismissive and impatient way. Several of the patients in my bay were elderly with multiple health problems that were clearly not all going to be solved quickly, if at all. Even if there were no effective cures, surely the treatment that nursing staff could have offered them was kindness, patience and encouragement. In fact a significant number of nursing staff gave the impression they were just too intolerably busy (keeping the hospital orderly?, complying with rules?, talking to colleagues?) to be bothered with patients. Yet from my observations, there were several staff who had time to stand on the ward and gossip with each other and/or moan about work. Appearances by qualified nurses in the bay, were infrequent.

Thus, even where basic care was being provided adequately from a practical point of view (and this wasn’t always the case – eg provision of food, access to toilet facilities) there was generally an absence of the extra patience, sensitivity and kindness which should have been shown to people who were sick and vulnerable. While of course abusive behaviour towards staff should not be tolerated, good medical professionals should be able to show patience and understanding towards people who because they are ill (and sometimes also frail, disorientated, frightened, lonely and in pain), may be irritable and uncooperative. A part of good care is managing the patient’s psychological state while they are ill, something which is an inextricable part of overall wellbeing. Upholding patient dignity is not just about seeing to physical needs but about having insight into their psychological needs and responding with appropriate compassion and sensitivity. A major part of my distress at being in hospital arose from witnessing other patients, (who were often bedridden and helpless), suffering and then being treated without encouragement, compassion or understanding. I am in no doubt that in terms of fundamental, humane nursing care (rather than specialised clinical treatments) I and probably many others in the hospital would have been better off at home. I thought it was appallingly ironic that notices are displayed prominently and aggressively in Newcastle hospitals protecting employees and warning patients (and visitors) that the abuse of staff will not be tolerated. Yet during my stay I witnessed treatment of frail, sick elderly patients by staff that amounted to mistreatment. Where was their protection or redress?

The second major concern that arose from my stay in Newcastle hospitals was regarding poor communication, both in terms of the inefficiency of hospital systems and the one to one communication with patients. I have talked about staff manner above, but I also felt that the nature and frequency of communication could have been much better. My overall impression was that there was no framework for communicating information on a regular basis to patients and that there did not appear to be well organised communication channels between staff. (This impression was particularly concerning when so much time and money is clearly spent on record keeping.) It is now increasingly recognised in business that anxiety, confusion and anger can be greatly alleviated by communicating effectively with customers. I felt the same benefits could ensue if patients were kept informed by staff about treatment procedures, daily care plans and about ward practicalities. Well-informed people are much more likely to be happy people who feel that their needs are being addressed and their humanity respected; ill-informed patients live with an undercurrent of worry that they have been forgotten or that they may be given the wrong treatment and also with a sense of anger at being treated like an inanimate object when they most need nurturing. I would certainly have felt calmer and happier if staff had talked to me when I arrived at the Freeman, found out what level of functioning I had and shown me where to keep belongings and where facilities were located. Information about food/drink and mealtimes would also have been welcome.

In terms of hospital communication systems, it seemed that there was over-communication in some areas, for example numerous patient histories being taken, but that this didn’t appear to lead to better care (nursing staff seemed unaware of my deafness and vertigo) or communication with the patient about their treatment. Understandably, busy staff cannot be available all the time to explain things to patients but it would be enormously reassuring if nursing staff could have a couple of regular, allocated times during the day to speak to patients about their wellbeing, to explain the plan for care and to address any worries. In an atmosphere where some staff act as though they are overworked and irritated, patients fear to initiate communication themselves and so often worry in silence. Many staff rushed about their daily routine without making eye contact so that patients and visitors could not easily attract their attention to make requests or ask questions.

On a basic practical note, I wanted to know the name and position of the nurses looking after me but hardly any of them were clearly identified. If they wore a name label it was usually attached loosely somewhere at waist level where it couldn’t easily be read. It was also noticeable that some staff, including doctors, didn’t introduce themselves to patients at the bedside. This should be a fundamental courtesy to people who are entrusting their wellbeing to a stranger and an important feature of civilised and respectful communication. Again, there is an incongruity in the signs at hospital outpatient receptions asking patients to stand back and respect the privacy of others, while on the wards patients are afforded little privacy behind curtains and nursing staff would regularly do ward rounds with the loud, public greeting to each patient: “Name? Date of birth?” If it is not possible to offer protection and privacy to patients then at least hospitals should have the decency to be honest about this and not to operate double standards.

I realise there may be multiple reasons for the problems I encountered in hospital. Furthermore, I acknowledge how hard it must be for those frontline staff who are caring and conscientious and yet have to work alongside poorly trained and/or inadequate colleagues and take the blame for problems which are sometimes beyond their control. However, in order to begin to put things right, I would say that some fundamental questions need to be asked about the purpose of hospitals, the role of nursing staff and the nature of caring in a civilised society.