Quality of Nursing Care Today

I took up nurse training in the seventies as I had been set on a nursing career since my early teens. I found it to be a very rewarding job but on the emotional level I was well and truly tested. Seeing death on a regular basis also meant coping with bereaved relatives. Caring for a terminally ill patient was always very challenging and nursing very sick children could be heart-breaking. I only lasted several years as I found the emotional demands too great. I was perhaps too caring and compassionate. Over the last few years I have found myself in a hospital bed several times and I have thought back to those days of strict nursing practice with fondness. I can see all too well that much has changed over the years but I wonder if some of the care has been taken out of nursing.

My training taught me that not only did I have to address the physical needs of a patient but also their emotional, spiritual and social needs. I took this holistic approach very seriously. When we got a lull and all jobs were done we were encouraged to sit and talk to patients to ascertain if they had any concerns or worries. I would also seek out the patients who I knew had few or no visitors and attempt to cheer them up a bit.

A patient needs to feel they can share their worries and ask questions. Many find the doctors round a daunting experience, and look to the nurses for support with the question they forgot to ask or clarification of what was said. Sometimes patients are scared or feel confused and merely need reassurance. Nursing isn’t just about giving injections, bed baths and handing out bedpans. A patient needs to know it’s okay to voice their concerns, and a nurse ideally should have the quality of showing she/he is available in a willing and friendly manner.

Back in the seventies, at least in the hospital in which I worked, there was no nurses’ station situated off the ward. There was sister’s office. This is where the handover would take place at the end of each shift. After handover there was nowhere to sit during your entire shift unless you were reading up on a patient’s notes or talking to patients, as I said when you had a few minutes to spare in between jobs.

Now we have a nurse’s station usually situated in the ward corridor where it isn’t uncommon to see nurses congregating on a regular basis. I have seen them eating out of tins of chocolates whilst sharing their tales of what they got up to on their days off. This is the lull I speak of, the lull when there is time for extra nurse/patient interaction. Wards tend to be bays now with only a handful of beds in each one. Most are completely cut off from the view of the station and it isn’t unusual to not even see a nurse for an hour or two. This simply wouldn’t have happened in the seventies. We would have been told to find something to do by ward sister if we had been caught chatting and laughing. In effect nurses now have somewhere to hang out when they have nothing to do and it’s accepted.

There will always be good and bad nurses in nursing. I encountered several nurses during my stays that seemed totally uninterested in their work. They appeared to be meeting physical needs like robots but had dire communication and care skills. The word disinterest springs to mind!

Imagine you are going to have a diagnostic procedure carried out and you are feeling worried about it. You lay thinking about it endlessly getting more and more worked up. You need to discuss it all with someone. You see a nurse passing by your bay and put up your hand to attract her attention. She waves you away and says she will come back to see you when she has finished what she’s doing. You wait. You wait and wait and wait until you realise she is not coming back. You may have even seen her going off duty. This is very sad but isn’t uncommon. I experienced this kind of situation several times and saw others being treated in the same way. It can leave you in more despair and add to your misery.

The main excuse these days seems to be the issue of being short staffed. There is no time for extra one to one patient interaction. I can clearly remember when I was nursing, having to bed bath a ward of 28 patients with only two or three other members of staff on duty with me. We managed that and all the other tasks and still had time to give the patients some quality one to one time. Maybe there is more paperwork now; maybe even more diagnostic tests or procedures that require a nurse’s attention. They do seem to be rushing about but only when they are not sat at the nurse’s station. They seem to get the same amount of breaks off the ward as we did. I feel something is going wrong and it’s getting worse.

A smile from a nurse can mean so much to a patient. It costs nothing and isn't time consuming. Such communication can spread warmth and a sense of comfort. People in hospital beds are there because there is concern for their health. Smiling, and even having a joke with a patient helps to diffuse worries about the seriousness of the situation..

Addressing the emotional and spiritual needs of patients is as much a part of the recovery process as diagnosis and medical treatment. The more these needs are met, the smoother the path to recovery can run. I have saved the problem posed for the elderly for another article because the situation must seem much worse to them.