"Concern about poor nursing care on Rotherham hospital ward "
Posted by Dave P (as ),
I have worked in the NHS for over 20 years and so I agreed to provide this account for the whole of my family.
Recently, my step-father has died in Rotherham General Hospital. He had been suffering from a series of strokes for many years and was already very frail when he was admitted to hospital. For this reason we all knew that he was coming near to the end of his life. This is important because our expectations were not of cure, or even rehabilitation, but that he was tended in his remaining days in a way that minimised his suffering and preserved his dignity.
Our death, like our birth, happens once so we all get just one shot at it - for this reason the quality of relationships (not hi-tech events) are the touchstone of good care.
This account does not focus on the medical rationale for his care, which was well considered, but on a series of events our family witnessed about the ways in which nursing staff dealt with patients (or, more importantly, failed to deal with them). Most of this account is about his dying days but mention will also be made about what we witnessed of other patients' care. This is important because although we will be making a complaint, in line with this story about my step-father's individual care, we were upset more generally about nursing standards for all the patients on his ward.
Over a two week period, visiting members of the family witnessed the following incidents about my step-father, who was mute and semi-paralysed until his death:
1. On one occasion we entered the ward to find him naked on his bed with no screens around and no staff in attendance. He was moving in and out of consciousness and was unable to move. When we reported this, the senior nurse genuinely apologised but was unable to establish from any staff member on duty at the time how this had come to happen.
2: Twice we witnessed drinks left at the bottom of his bed which had not been drunk. The staff supplying them were obviously oblivious that his paralysis meant that he was unable to take the drink.
3: When on a drip we found this empty on more than one occasion and
he was dehydrated. His urine became dark brown and he developed a urinary tract infection.
4: On many occasions we asked staff for information and we were met with the stock response 'sorry love, I've just come on duty'. This repetitive mantra seemed to be an acceptable standard excuse to avoid engagement with the relatives. To my mind this is inexcusable because good handover of information should be a routine building block of any nursing shift system.
5: He was catheterised for the duration of his stay. After a few days my mother (a retired nurse) found a blood stained pyjama top stuffed into a drawer at the side of his bed. This was the outcome of his change of catheter.
6: One morning he appeared to be very distressed and a staff member admitted that he had become upset about an adjacent patient who had fallen from his bed, which lacked side-guards.
7: On the day he died, my mother was taken to his side by my cousins. They said a prayer for him with screens around him, but the relatives of other patients were present in the (6 bed) bay. No privacy was possible. Moreover, when leaving the ward the staff member handed over a leaflet about the bereavement counselor in a cursory manner. No offer was made to meet in a relatives' room to be with the bereaved party.
That final point brings me to the more general matter of the ethos and manner of the staff on the ward. Here are some particular concerns:
1: There was no meet and greet policy as relatives came to the ward (the 'sorry love I've just come on duty' was a sort of mirror image of a good policy).
2: One old gentleman, who was sitting up and speaking but not ambulant, asked the nurse for a bottle, who in our presence said 'sorry love haven't got time'. He became so upset that my wife (another ex-nurse) went to get him one and pulled his screens around.
3: My brother passed the nursing station on one visit and saw two nurses on an internet site, discussing a foreign holiday one had recently enjoyed.
4: Sitting for long periods by a mute patient, as I did, meant that I looked around at the ebb and flow of staff activity. Although the open corner nursing station means that staff can no longer withdraw into a closed office, this new arrangement gives an illusion of engagement with, and efficient observation of, nearby patients (who are only a few yards away). I watched carefully what was happening minute by minute.
Staff milled around the station. Some interacted with one another. Some were doing paper work. Some were permanently transfixed by a computer screen. Any contact with any patient (which was sparse compared to this station-centred, staff-centred activity) emerged in the main because a relative requested it (leaving me wondering what happens when relatives are absent).
It is as if there is an invisible wall, about yard from the nursing station, which closes the awareness of the staff into a sort of bubble. This seemed to me to be like what we now know of the dangers of mobile phones in public spaces, where drivers and foot-passengers put all at risk because their attention is in an tunnel and oblivious to the immediate environment.
The above lists suggest that care on this ward is simply not good enough. If it were only on this ward then it would be serious but at least rectifiable in the future (by corrective staff training and regular audits). My worry is that it reflects a more general change in the ethos of nursing.
Trained nurses now seem to be obsessed by recording activity than the activity itself. Humane direct tending of patients seems to have been devolved to care assistants. That leaves it to chance about the sensitivity and commonsense and common decency of these individuals one by one. This matter of the care of dying people should not be left to chance - nursing supposedly has over time elevated the care process to an art ('the nursing process', 'holistic care', 'patient-centred care').
Despite these claims, what we witnessed was the antithesis of these aspirations, so that they now look like empty rhetorical claims. What we witnessed overall was the opposite of patient-centered care. The only crumb of comfort was that in the odd honest conversation, some of the trained staff admitted that their profession has lost its way about standards of care. Maybe then a starting point is that this hospital and others in the NHS need an honest appraisal of what nursing standards are for severely disabled and dying patients.
A good question to pose to all staff, from the CEO and Director of Nursing downwards, is this: 'Would I want to be cared for on this ward?'