Day TwoPosted: December 30, 2010
It is difficult to believe that an 82 year old woman in day two of a stroke, unconscious, mute and incontinent, could be ignored by a ward full of nursing staff for over 4 hours at least, but, my friend, that is what happened. This blog was intended as a chronicle of the journey of someone who cares about a woman experiencing a stroke: stroke is not talked about enough, the support for people who have had strokes and their circles of support is thin and arbitrary. My intent was to offer support and insight, not to criticise, to have a conversation with you about stroke and its effects. But…..but…..but…..it is hard not to be critical after the experiences we have had within a 48 hour period. I will walk you through it……brace yourself.
Once I had recovered myself from the shock of watching Stroke inhabit my Mother, I did the usual things, bought some new nighties and Simple toiletries, bought the trusty Telegraph to keep me company, packed my sketching things, and set off for the hospital to keep Mother company and get up to speed with her condition. My eldest daughter, who works in a Nursing Home, came with me, and I made sure to take a photograph of Mother with my late Father to reinforce her as a human being with her carers, and plenty of get well cards ditto, which would be displayed on her locker. Arriving in the early afternoon I discovered my Mothers nightie, in which she had arrived at the hospital, soaked in urine and stuffed in one of the drawers in her locker. I recalled the efforts, detailed in my first post, I had expended trying to establish a continence care plan with the nurses the day before………. I checked her charts: the aspirin she had been due at 08.00 had yet to be given by mid-afternoon. She had a chest infection and was on antibiotics – the aspirin was not a luxury. I was concerned, but not yet angry – I understand the pressures on time on a busy ward, and have some sympathy for overworked staff, as you will know from my previous post.
My daughter and I were chatting to my Mother, who slipped in and out of consciousness and did not respond at any point – but we kept up the gentle chat, as you should do. We sat by her bedside, arranged her cabinet drawers, read the papers, chatted with her. After a couple of hours she had had no nursing attention whatsoever – none, nil, nada, zip. It may be difficult to believe that a vulnerable 82 year old stroke patient with a chest infection was effectively ignored by an entire staff of nurses, but that is how it was, and how it stayed. My daughter and I, unable to comprehend the neglect and unable to get the attention of the nurses – when they did appear in the bay, infrequently, they looked distracted and when asked a question replied that they “were not at this end” or “don’t usually work this ward”and shimmied off, and when eventually at a much, much later time I found someone who worked at this end on this ward she was unable to tell me the name of my Mothers consultant or the result of the chest X-Ray she had had that morning and continued to fail to offer any physical nursing – we decided to check Mothers sheets and clothes. We found her continence pad in the wrong place so that it failed to collect any urine passed, which also meant that her sheet was soaked and sticking to her vulnerable skin, for which she had not been turned to relieve pressure. We washed and changed her and her sheets, replacing the pad in the correct place and trying to make her comfortable. We struggled with the electric bed without any assistance from nurses who ambled past and when we asked for a clean sheet we were offered no assistance or support and not asked any questions, and no-one appeared to notice that my Mother was still being neglected by those paid to nurse her.
My daughter and I were in shocked disbelief at the staggering casual neglect. I waited, politely asked to speak to a nurse, waited, asked to speak to a nurse, waited, waited, waited, waited. Eventually, about four hours after we had arrived and during which time my Mother had been entirely and thoroughly neglected by staff, I stalked and held on to a nurse in dark blue, who it appeared was the Ward Manager -I had checked the picture board, as still no-one had yet introduced themselves to me or to my daughter. Courteous and pleasant throughout I asked her why my Mother had had absolutely no nursing attention in the four hours we had been there, and of course we could not know how long she had been neglected prior to that, although the urine soaked sheet might give us a clue. I pointed out, politely, that she would still have been lying immobile and mute in that soggy sheet if my daughter and I had not, in desperation, changed it two hours previously. I asked how I could know if my Mother was turned and washed, had any mouth care as she is nil by mouth, had any continence care or planning, received her medication, and had medical reviews as the only chart in existence, the meds chart, indicated that she was already neglected and had not yet had her 08.00 aspirin and it was now nearly 18.00 and in the four hours we had been there none of those things had taken place. Ward Managers answer was that I should understand that they were short of staff, it was a bank holiday, she shouldn’t even be there herself, it was a busy ward, and that they were very very busy. Still politely, I explained that that was not my problem, and that her job was to manage things so that an 82 year old vulnerable unconscious mute woman received the nursing care that she needed and was not entirely neglected for over four hours at least. I asked why there was no care plan and no charts. Her reply, unbelievably, was that they were not used because they were not a requirement. Quietly, and politely, I pointed out that the evidence seemed to indicate that they were in fact necessary if only to prompt the nurses and assure us that nursing was actually taking place – although given the level of engagement shown so far I am not confident that they would be read anyway.
Just to be clear, as I find it hard even now to comprehend: we were there for over four hours during which time not a single nurse offered my 82 year old vulnerable unconscious mute stroke victim Mother any nursing care whatsoever. No turning to protect the skin, no washing, no pad change, no mouth care, no sheet change, no aspirin which should have been administered at least seven hours earlier, not even any casual checking , no kindness, no words of comfort. There were no charts to record any care that might have been offered so no way for successive nurses, had they chosen to check, to know when care was last given. No-one introduced themselves to the people by the bed who happened to be the daughter and granddaughter of the person they were being paid to nurse and who were still struggling to absorb what had happened and no-one offered any information, comfort, or even an idea of where one could get a cup of tea.
I believe we are in the year 2010. I believe we are told that the NHS is in reasonable shape. I believe nurses think they do a good job, according to their representative bodies who take all opportunities to say how short staffed and undervalued nurses are and how they work hard and deliver. My experience of the past 48 hours tells me that nothing could be further from the truth. I have witnessed the casual abject neglect of a vulnerable elderly woman, been subjected to discourtesy and flannel, and left despairing that any crumb of care or humanity might be left lingering on hospital wards. My daughter pointed out that if she or her colleagues in the private sector behaved in such a way they would be in some deep trouble. I have personally sacked people for less. These people should be ashamed to claim to be nurses, should hang their heads low and reflect deeply on their purpose.
I said earlier in this post that, at that time, I was not angry, just wanted to find out what was happening and extract the best care for my other. Well, I am now angry. Before I left the ward I explained – always courteously – that I expected a chart in place to demonstrate the care given, and that I expected the care to actually be given. Another dark blue uniform clutching a chart destined for my Mothers bedside told me, yet again, that they had been short of staff, very busy, that actually the nurses there were very good. I will say that again: she really did tell me the nurses there were very good. Astonished, I ran by her again the catalogue of neglect I had just witnessed and patiently explained that I had absolutely no confidence that my Mother would be nursed effectively. Given the evidence of our own eyes, nothing she could say would restore that confidence. After I had managed to pin down the dark blue nurse, miraculously two nurses did emerge to offer some basic but quick care to my Mother, changing sheets and using a suction machine for her – if I had not collared the blue nurse I am absolutely certain this would not have happened.
I cannot believe that my experience of the last 48 hours is unusual or unique – the evidence so far points to it being all too common and all too accepted – none of the nurses appeared surprised by or ashamed of the neglect, it did not seem to impact at all. I will continue to post. Let’s hope next time I have something more positive to bring to you. My fears and shame about leaving my Mother with strangers was appallingly accurate. Who do we trust if we cannot even trust people with the word “care” in their job description?