I don't want to comment on the specifics of the case,nor should I as I don't know all the facts but I do want to go through some of the issues I think this case raises. And these issues are not new. They are raised again and again.
Firstly, I listened to a radio interview which asked the inevitable question 'Why don't nurses care about their patients any more? It wasn't a phone in programme or I would have expected to hear a lot of retired nurses phoning in to say that they managed wards filled with 60 patients and managed to feed and water them and fluff their pillows as well. The inevitable question is then asked about the value of university education versus hospital training.
I trained in a large public hospital in Sydney from 1979 to 1982. Hospitals were full of trainee student nurses as we had three intakes a year. The work was task oriented. One nurse did all the dressings,one nurse did all the washes, one nurse did the Obs. The dressings were simple and done several times a day, not allowing for any healing to occur. Either saline packs, dry dressings or Eusol 1:8. No documentation of what was done apart from 'dressing attended' written in the notes. These days, a Wound Care Assessment is made,often by a specialist Tissue Viability Nurse. A photograph of the wound may be taken after written permission has been gained ( a different form to fill in). Selection of a dressing is then made using specialist knowledge which needs to be updated frequently as policies change or new dressings come on the market. After the dressing is 'attended' , the care is documented. Compare this procedure to the 15 minute dressing done in 1980. Do we want to return to the 'good old days' when dressings only took 15 minutes and used less resources and staff time? Of course not. Nurses know what they do now follows best practice and their patients expect this.
Now, extract ' performance of dressings' and replace with any of the many nursing activities performed during a shift. Nurses don't just perform an activity. Each activity is assessed, planned,implemented and evaluated; this follows the so-called 'Nursing Process'. Paperwork must be filled in to ensure that care plans are followed and treatment is consistent. This is part of good communication but it takes time.
In a previous hospital where I worked I was asked to be the Project leader for the implementation of the Productive Ward Project. The Productive Ward aims to 'release time to care' by ensuring that the ward and its procedures are performed in as efficient a way as possible. This is a useful project ,however, whilst it doesn't pretend to deal with staff shortages, these are critical to address if time is to be available to spend with patients. No amount of tidying and reorganisation of stock will solve the problem of insufficient staff numbers. This is the second issue to come out of this sad case. Patients who are at a high risk of adverse incidents such as falls need one-to-one supervision or at the very least need a nurse to be present in the bay to keep an eye out for them. The set up of many hospital wards does not allow for constant visualisation of patients. This is especially true of the bay ward set up and also isolation 'side rooms'. Nurses need to enter the bays to see their patients and/or remain in the bay to monitor patients who are at a high risk of an adverse incident. Wards which are stretched for staff find that allocating one staff member to 'special' a confused or aggressive patient causes impossible strain on the remaining health care assistant who is left to manage the rest of the patients. And ,remember that some patients need two staff members to assist them to mobilise or use the toilet.
I have been in the situation at work where I don't know who to help first. To relatives who sit with their loved ones, it seems as though the patient has been forgotten. As nurses, we find ourselves saying 'We're just coming now to help' over and over. It was for this reason that NHS hospitals instituted the system of 'Intentional Rounding' for vulnerable patients. Every hour or two hours (whichever is assessed as appropriate) , nursing assistants do a round of vulnerable patients and offer fluids and toileting and check the bedside environment for safety. Pressure areas are also checked as it is known that pressure ulcers can start to develop within hours in immobile patients. Intentional Rounding ,whilst it may be seen as 'yet another form to fill in' ,is a good way of keeping basic nursing care in the forefront of the mind.