Days Four Five and SixPosted: January 2, 2011
My Mother has not yet regained consciousness but her breathing is not as laboured and she sounds less bubbly. Hope is always there and the drive to support her is high. Energy is flagging a little though……….
I told you I would let you know how the conversation about Mental Capacity went: I spoke with the doctor, always courteous, always with a simple enquiry. He appeared to take some advice from a woman who had interrupted me to ask if she could help but who failed to introduce herself to me – I believe she is one of the consultants, but I still do not really know although she was on the ward for the next couple of hours, as was I. As a professional I have been involved in Mental Capacity Best Interests Meetings before, and have never thought that doctors were somehow absolved from this level of accountability because they have a medical degree. Nevertheless, doctor and Kind Nurse were adamant that being a medical matter it was their decision, and the implication is that I was involved as a courtesy and nothing more, and as I agreed with the outcome that was the end of it. I disagree and will be talking to the hospital about it when it finally wakes up again after the “holiday”.
I asked for some assurances that the ward would be fully staffed sufficient to meet my Mothers needs and that of the other patients. What I received was an acknowledgment that they are short of staff (I know….I know….) and would do their best. Given the evidence so far I have grave doubts about what level their best will achieve……..
I notice that the charts are still not being used effectively. I am promised that they will be.
I receive assurances that I will be called if there are any changes and am told by Kind Nurse that what I am asking for (contact if needed, charts to be used effectively, Mother to be nursed properly) are things they “would do anyway”. I point out, yet again, that as they had not “happened anyway” on our first day I have no confidence that they will indeed “happen”.
Mother sounds even better in her chest but has still not regained consciousness. I am tired, but to be honest I have been tired for years, so what the Heck!
I notice that the charts which I have asked for and been promised are in the file, but are a little chaotic and are still not being signed by all the nurses. I note that the bowel chart records in the correct place that she has not had a bowel movement but not that she has been given movicol although the medicine chart tells me a different story and Kind Nurse J told me he had given it to her. Kind Nurse#2 (who has been very nice, smiled, not been defensive when asked a polite question and I have heard him talking to my unresponsive Mother when nursing her) confirms that she has had movicol. I note that although I came onto the ward at 10.30 and the nurses turned my Mother after that at around 11.00, the chart has been ticked (but not signed) at 10.00. A small but pertinent indicator of the level of competence, as is the fact that my Mothers name and hospital number, while correct, are in the wrong place on the chart.
I realise that I begin to sound picky. The ward staff are now turning my Mother ( allegedly), she has a ripple mattress, they are at least ticking that she has had mouthcare (and she looks as if she has), they are recording that she has unbroken skin and has had continence care, she is getting her NG feeds and her obs are being recorded. Some nurses actually look at her when they walk past and not just at the monitor, some smile at me – apart from Ward Manager who studiously ignores me, which I understand. But it feels like a pretty constant checking process, and if there are basic failings when I am here to monitor, how can I be sure that when I am not there to monitor things don’t slide? Especially with what I have witnessed. Nothing will ever erase that crushing and heart-pulping afternoon when she lay in her own urine, the staff risking her skin, probably causing her chest infection because she was neglected and lay flat, failing to administer her medication, failing to know who her consultant was, failing to introduce themselves, failing to know where her chest x-ray results were or why she had not yet had her medication, and the blank and careless looks I got from the strangers paid to nurse her who didn’t give a shit but tried to convince me I should sympathise with them because they were hard done by. Nothing I have seen since has eroded that huge lump of No-Confidence that I have in these (possibly quite nice) people who allowed this to happen. I do not believe that they will offer us the proper support, or even that they have the ability to do so. I would love to be wrong.
Kind Nurse#2 follows us up the stairs to the ward so I know he is working this afternoon. I find that another Kind Nurse J has been working the morning. I try to relax.
My Mother has still not regained consciousness. She is a better colour. My insides are like ice.
I find that there are about 5 charts in her file, all for similar things, all filled in differently. For example, there is a bowel chart, and another chart for meds and another for bowels, turns, and mouthcare. They all say different things: The bowel chart says she has not had a bowel movement and is dated 1st Jan. The meds chart says she was given movicol 1st Jan but that is not on the bowel chart in the space for just that; I know she has had a bowel movement yesterday and today because I was there, but the bigger chart is ticked in “no” for bowel movements for today and none is recorded for yesterday. There are few if any signatures so there is reduced accountability and no effective way of monitoring her care or her progress. I also find that the cannula that should have been changed yesterday morning has still not been changed almost 36 hours later and the blood sugar test she should have every morning was not done and is now 9 hours overdue. Her hair is not brushed. I feel despair.
I have to leave after 3 hours but my eldest daughter who works in a nursing home, and her sisters, are staying for a while. She tells me later that the two carers who later turned my Mother (an hour later than both the chart and the Kind Nurse#2 indicated) talked over her all the time and never spoke to her once, their riveting conversation centring on their strong desire not to be there , how tired they were, and how unfair everything at work was. The woman in the opposite bed – a frail and muddled and extremely charming elderly woman – asked for the bedpan and was ignored by both carers until my daughters intervened. I know, from a previous life, how difficult it can be when someone repeats a request, but Honey, that’s your job. Suck it up or leave.
So. There it is. Some ok but more that is awful, no assurance that my Mother will have the care and nursing she needs, no real evidence that – even with a battleaxe daughter of litigious proportions in the ward – anything has really changed or improved. The carers are still a mixed bag of mainly shite with some specks of gold, the ward has failed in epic proportions to take on the suggestions about charts and meds most of which are simple in the extreme and should make NMC sense , there is absolutely no evidence of any communication whatsoever, and despite the nice respectable Matron and Kind Nurses that I like and the teeny episodes of kindness and a Herculean effort to do things properly it is still crap.
Over to you. I will continue to blog, I will continue to seek out positives. Don’t hold your breath.