In essence, David Cameron's wander around an NHS ward was to highlight 'a new "friends and family" test starting in April and the extra ward rounds being put in place'. A short video clip of a Registered Nurse (assuming they wear dark blue and HCAs wear paler blue) having a bit of a chat to a patient who doesn't look the kind of patient normally placed on Intentional Rounding which seems to be the extra ward round soon to be implemented.
News to David Cameron. Intentional Rounding has been in place in most,if not all NHS hospitals for a couple of years now.It came out of a perceived need to spend more time delivering basic care to patients. The Productive series (Productive Ward etc) which I helped implement into a ward in a private hospital I worked at), is another attempt at 'releasing time to care'.
All well and good but it doesn't deal with the hub of the problem. And that is staffing or lack of it. I've worked in places where you are hard pressed to intentionally visit a patient a couple of times during the shift. It's not that they we don't want to -we can't.
I wonder if David Cameron or the friends and relatives who will be able to rate the NHS service know what the Intentional Round actually is. A typical Intentional Round form which is ticked off each hour or every two hours (see a problem already?Ticked off) is as follows:
Is the patient comfortable?
Has the patient been offered a drink?
Has the patient eaten their meal?
Has the patient been offered the toilet?
Have you examined all pressure points? (elbows, hips,sacrum,heels)
Have you changed the patient's position? (state -back,right side,left side)
Is the bed at the lowest level?
Are bed rails up (if documented as necessary)?
Have you asked- is there anything else I can do for you? (yes, really!)
In the 'good old days' when I trained as a hospital-trained nurse, we had lots of student nurses and the odd nursing aide to do 'back rubs' every two hours. Backs would be scrubbed with soap and water (stripping off important oils) or metholated spirits (a favourite of the old army nurses we suffered under). Different creams came in and out of fashion -I remember one fad of Cream A and B (who knows what was in them?). Patients felt that you were 'doing something' and felt 'secure'. This seems to be the feeling Cameron is wanting to reintroduce.
There are a couple of problems with this. Firstly, as we moved into evidence-based practice we nurses learned that scrubbing backs actually caused friction, the one thing we try to avoid if we want to prevent pressure ulcers. Turning or changing a patient's position to relieve pressure is better practice. Changing a patient's position doesn't make them as confident in the nurse though. It somehow seems as if they've been short-changed. After all, they looked forward to those back rubs. Back rubs which the underlings provided incidentally, never Sister or the Registered Nurse.
The second difficulty with pressure ulcer prevention is that it is labour intensive. We are luckier these days to have a range of pressure-relieving devices which do the same job as a nurse used to - to an extent. Pressure-relieving mattresses mean that the bony protuberances of very thin patients don't rub constantly against hard mattresses (the hospital mattresses of my training days). Heel and elbow protectors also buffer against hard surfaces. We also understand the importance of nutritional supplements to help promote tissue health so fragile tissues don't break down as quickly as they used to. I have to say that they take a long time to administer as I have yet to come across a patient who likes them!
The bottom line though is that we still need levels of staffing that can ensure correct assessment of the needs of our patients ( some of the mountain of paperwork a Registered Nurse has to complete) , supply the pressure-relieving devices that are needed , ensure supplements are supplied and consumed by the patient (assisting when necessary) and regularly check patients' pressure areas and change their positions. All this takes a lot longer than the five minute 'back rub' I used to give my patients in the 'good old days'. Which is most effective? The new method,of course.
You see, Intentional Rounding is not just asking Mrs Smith if she's doing OK today and looking forward to seeing her grandchild at visiting time. It's about caring for vulnerable, elderly, no, very elderly patients who require the sort of care I rarely had to provide in the 1980s. Anyone who was very old in those days, i.e in their 80s, languished in a nursing home. These days patients in their 90s and 100s fill our wards and need vast amounts of time to be cared for. I remember being busy during my training but don't remember being as frantic as I have been in the 2010s. Frantic because there are just not enough of us to deliver the care we want to.
I am fed up with hearing that we nurses don't care or don't care enough. I am fed up with the thought of more forms to fill out. I am fed up with hearing that more nursing positions will be cut from the NHS and that we nurses will just have to 'get on with it'. When will there be an inquiry into the effect of dangerously low staffing levels and outrageous shift patterns? Or is it easier to shove another piece of paper called the 'Friend/Family Satisfaction Scale' into the ever-increasing patient record
co-author of 'Cambridge English for Nursing' Pre-Intermediate and Intermediate+
- Medical English: Spelling