To care for older people one vital ingredient is needed…time. Nothing can be rushed. Everybody needs to be washed, have their teeth cleaned, their mouths checked and cleaned, and their nails and hair sorted out. Don’t forget the never ending call for the commode, and if they don’t need help to get to the toilet they will need continence care. More rolling and washing, and swishing of curtains.
Suddenly it is medication time. Consider the amount of medication some people are prescribed, and how difficult it is to make sure they actually have it. There are pills that are dissolved, pills that are crushed, sticky elixirs that need to be measured into little plastic pots, subcutaneous injections, intravenous injections, inhalers, and don’t forget to get your gloves out and draw those curtains one more time to administer suppositories. Whoops, we haven’t fed anybody yet, or given them a drink, or checked the IV fluids, done any observations, or changed the artificial feed bag. Why not? Because there are quite a few patients feeling a little confused today and everything is taking so much longer. Phones don’t stop ringing, and the doctor, the physio, and dietitian all want a chat. Shame there’s only one of me.
Until the staffing levels in care of the elderly wards reflect the enormous amount of time consuming tasks that need to be carried out to ensure these vulnerable patients are cared for in an acceptable manner there will continue to be outrage at the poor standards in some wards. A culture that invites families to take part in caring for their relative, especially by visiting at meal times is helpful, but really such a lot of these patients should have been able to access all the nursing care they need in the community, either reducing the length of their hospital stay or preventing it altogether. Many nurses are appalled at this suggestion citing the overworked district nursing service as the first stumbling block.
It takes vision and determination to see that by shifting the provision of much nursing care into the community we can do it better and we can do it at home. Excellent care could certainly be administered in the community in a familiar environment where friends and relatives may be closer. The funding and logistical issues are enormous but certainly not insurmountable. Hospitals are dangerous places for older, sick people. To put in place a service which keeps people in their own homes is a viable alternative. Lets hope “hospital at home” can become a strategy for the future provision of nursing care.
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Alison Spurrier is a nurse. She has been practising in the NHS for 25 years.