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Thursday, 13 October 2011

Values and standards - why Ward Sisters matter

The news reports about the Care Quality Commission findings on the care of elderly patients made for grim listening this morning. Their conclusions about what made the difference between good and poor practice identified the quality of leadership and staff attitudes, rather than resources.

It reminded me of a time in my life when I worked with vulnerable, elderly people as nursing assistant for six months. It was 1973, I was nineteen and taking a gap year from my social work degree. My experience chimes with the CQC's conclusion about the importance of leadership.

The Lancaster Moor Hospital was then a 2000 bed psychiatric hospital, almost a small town in its own right with shops and a Post Office.  Over the years my family were involved in the hospital, at times as staff (my Nan and Mum) and sometimes as patients (Great-grandparents and two Aunts).

It had dozens of wards. At the far end of the hospital were the 'back wards' and it was to one of these that I was sent.

Ward 22  had been newly re-furbished and rather daringly, the male and female wards shared a common day room. The patients were elderly men and women with severe dementia conditions.

Presiding over the wards was the senior Ward Sister. A tall imposing presence, immaculate and with a scathing way with words for the young and thoughtless. The first part of her working life had been in the mills and she had that brilliant ability to lip read and to enunciate her words with her lips so clearly that everyone could lipread what she was saying from a distance of twenty yards. She did not need to shout.

The end of my first day saw me walking home in tears. How was I ever going to cope with people in such a complete state of mental and physical disintegration? How was I going to cope with all the shit and urine without vomiting every day?

By the end of the week I was an old hand, able to change filthy bedding in the early morning, wash the excrement off the ladies, wash hands thoroughly, feed them breakfast and then sit down to enjoy my own breakfast break without a qualm.

So what wrought the transformation? Without doubt a growing appreciation on my part of the uncompromising values of that Ward Sister about how the women patients were to be cared for. All patients were to be treated with dignity. With such good standards expected as a norm, I was also given the background of each patient, so that I was able imagine their past and look for signs of it in the present. As a result, what had at first seemed irksome and distressing, became part of a satisfying sense of achievement.

Key practical arrangements that I remember:
- at mealtimes, every member of staff, including the Sister and Charge Nurse, helped to feed those that needed such help;
- the atmosphere was kept cheerful and light, we bantered, sang and even danced with patients;
- it was seen as important that we had time to sit and talk with people, listening to stories of their past and a daily routine was established that allowed this;
- no-one was to be 'toileted' in the dayroom in front of the other patients. If there were any 'accidents' in the day room, portable screens were to be erected around the person;
- teeth did not remain in jars at the side of the patients' bed!

It would have been so easy for high standards never to have been established on those 'back wards'. Doctors rarely came except when there were acute episodes, nor were there many visitors. But the staff on the wards were proud of their work, there was an excellent spirit and good relationships between the staff on that ward. 

My mum was the first Volunteer Co-ordinator appointed by the hospital. She remembers that a formal, measured quality of care across the hospital was established later that decade. One initiative that emerged from that was the recruiting of volunteers to come in to help with feeding patients. 

I wonder what sense of professional satisfaction is being felt by those nurses whose wards came out badly in the CQC report today? What has caused them to lose sight of the values that motivated them to come into nursing in the first place? I hope someone is going to provide them with a proper opportunity to design the right kind of care for their patients. Care that is worthy of their profession and most importantly worthy of the people they serve.

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