Accident & Emergency

Old Couple, Togan Gokbakar

If your heart stops, do you want to be resuscitated?

The words in the space where my mouth should be

are sewn in with fragile thread, denial embroiders truth,

words unsaid are silent; I shall not talk of it.

If I had known it would be like this,

I would not have gathered history in my bones,

content perhaps to say No! at first onslaught on my breath

as life-congested lungs binding death to concave chest

breathed life again. 

Do you want CPR if your heart should stop?

(I would not talk of it). 

They chant the mantra of abstinence,

abstinence equals good health or all in moderation

as if longevity will somehow become the nation’s wealth.

Value spent, I am old now, three score years and ten,

wit keen, mind still sharp, I hide behind skin leathered,

cracked by toil and sun, back bent crooked, laid heavy

with the burden of my years.  

He must be deaf. 

Do-you-have-a-living-will?

I gathered darkness in my days, sucked down beneath the depths

as each breath issued exquisite pain, brain wracked with black,

black dog dogged; death now circling overhead, spirit broken,

he drones inside my head

If your heart stops,

do you want to be resuscitated?

Care cradle to grave avowed, who will save me now

as I drown ‘neath fluid filling well-ripened lungs;

to old to hold significance, a burden on the state, expendable. 

He must be deaf! 

Do-you-want-CPR-if-?

Lips unsewn, weary of it all, angry irritated,

just to annoy the callous bastard

I whisper Yes.

Anna :o]

The Health Police would have us abstain from doing anything remotely enjoyable to enable us to bounce high with rude health and live forever and ever and ever.  It is now deemed okay to stigmatise and dehumanise smokers and the obese –who’s next I wonder - and how much we enjoy this government sponsored lark of well-deserved ridicule and openness of contempt of those whose habits offend our own self-righteousness.   We must be healthy at all costs.  We must fit the new mould.

Problem is that if we eat sensibly, drink not at all – or at least in moderation - and don’t smoke – we will not become a disease free society, disease will be with us forever.

True, we might live longer – but hey, don’t we have a problem coping with an aging population now?   They are considered a burden, right?  What are we going to do with all those extra old folk of who many will succumb to disease of the body, and damn it the older they get will become diseased of the mind too?

The state is already creaking under the burden of these pensionable folk and to fill the dwindling pot of gold, some of us will be required to work until the tender age of sixty-eight.  Yet, as general hospitals are too creaking under the strain of a large elderly patient population, two thirds of beds being filled by the over sixty-fives and three fifths of these suffering from a mental disorder (80% depression, dementia & delirium) – efforts are being made to ‘treat’ these would-be inpatients in the community…so you will work until sixty-eight – but not be welcome in hospital if over sixty-five...especially if you have a mental disorder…

A ?large proportion of these over sixty-fives are regarded as ‘bed-blockers’ as it is not felt safe that they should return home from whence they came – so provision has to be made for social care – which is a lengthy process as social services have a tight budget too.  What I don’t get is that if it is not felt safe that they return home – how would they be safe if treated nursed (at home) in the community instead – or am I missing something?

So there is much packaging of the pleasures of death with all wonderful agencies sprouting up here there and everywhere to help the elderly on their way…

Mental (ill)health is much stigmatised and so increasingly are the elderly.   Old with mental health problems, hospitalised – what a bummer.  Your ‘care’ will leave much to be desired…  

You only have one life - enjoy it to the full.

…………………………………

mindlovemisery has us writing of stigma, Brenda at The Sunday Whirl gives us the words: space, mouth, circling, vow, drone, sun, broken, cave, crook, chants, first, binding to play with and Tess at The Mag gives us the pic.

Male Elderly Long Stay

Use it or lose it

has no place here. 

What better than

to restrain (by indifference)

in chairs upholstered

in the ghosts of those long dead. 

There is no stimulation here;

they sit in regimental rows,

row on row on row,

like some old soldiers

waiting for their final orders,

or some waiting room,

waiting for a doctor

who never shows.

This reinforced apathy

brings atrophy, weakens limbs. 

A fleeting insight

brings panic,

he rises, knees buckle;

he free falls, hits terra firma

with an almighty thud.

This morning

there is only two of us,

short staffing brings many risks. 

Who knows how many

signs and symptoms missed

as we hurriedly stuff thirty men

into waiting clothes,

stack them in the waiting rows,

stuff them full of
cereals and toast. 

(Well as many as we can,

for at 8.30 – finished or not

the breakfast trolley goes.)

They need time,

there is no place for it here. 

There are the wanderers of course

who will not conform;

who wander on their eternal journey

to God knows where.

There is a new admission;

he still has fight in him.

It will not last. 

Soon he will become like them,

his remaining memories

will leach into the chairs.

They need compassion,
there is no place for it here.

As a student nurse, my first ward placement was on female elderly long stay.  I must admit I was naïve – I had this silly notion that my days would be spent sharing tea and sticky buns with confused little old ladies, enjoying their muddled conversations and listening as they reminisced about the good old days.  How wrong I was.

My first shift was that of a morning, there were two qualified staff, a care assistant and two students (including me and we supposedly supernumery) and we had forty patients to assist to rise – that is eight patients each.  We students had no idea who could weightbear, who was mobile, who was aggressive and so on, but this seemed to only bother us and we had to get on with it.

It took me well over an hour to wash and dress and seat my little ladies in their chairs – in fact they did not have their chairs – anyone was good enough.   I was totally exhausted and perspiration was dripping off my forehead.  I remember thinking ‘What the hell am I doing here?  Is this really what I want to do?’ as I realised my silly notion was indeed that – silly.

The majority of the ladies had dementia and were either admitted from the great outside or were ‘long stay’ patients who had spent much of their life in the hospital and had succumbed to dementia as they aged.  A couple were long stay patients who had not demented but reached the ripe old age of sixty and had been transferred as that is how things worked.  They were floor pacers – like caged lions bored out of their minds – both with ‘acquired’ OCD – their rituals their only means of escape from the eternal ennui of ward life.

All the ladies – bar the two floor pacers - were sat row on row on row, there was no stimulation whatsoever – no radio, no record player, no television, not a thing.  Any new admission that rose from her seat was told to sit down and soon learnt that that was her lot and after a few days did just that – sat (and died inside).

My fellow student and me attempted to converse with our patients – but lack of stimulation had had devastating effects – rarely were words spilt from their mouths – they existed in body only.

Male elderly long stay was my fifth placement and it was very much the same bar a few wanderers - not pacers, most of whom were demented and had held onto remnants of their personality.

I saw an awful thing there – it was not direct abuse but that of sheer and utter thoughtlessness, a manifestation of the warder-inmate mentality that still very much prevailed there, and it reinforced my vow to myself that once qualified I would never work in a psychiatric hospital – this vow I had made on female elderly and it is a vow I kept.

Anna :o]

Entered at Open Link Night at dVerse Poets Pub – thanks dVerse!

Evil Nurses, Care of The Elderly - or Lack of It.

Unless of course we are called to higher office sooner, as sure as eggs is eggs we will, well, all end up old, some of us very old and well past our sell by date, we may succumb to the old arthuritus (sic) and/or diabetes and/or heart disease - perhaps multiple comorbidities and our little grey cells may thin at the same rate as our greying hair.

It is well known that unless a relative of yours, old people are a burden on the state and indeed society itself and are not worthy of the title of human being, okay they might be human but their being here is, well, bothersome.

Never mind, the hope is that they will end up a hospital patient and then – God bless’m – the nurses can finish them off!  What more satisfying than leaving someone’s gran or granddad lying in their own excreta, starving to death or dying of thirst while you read Hello at the nurses station and discuss last nights date in sordid details!   And then there is always the LCP if all else fails!

But of course it is not that easy for when learning of this despicable care via that stalwart of the media The Daily Mail, suddenly the entire world and his brother are up in arms stating that nurses don’t care any more and “They were Angels when I was a lad!”  Suddenly everyone cares about the elderly while they ignore Mrs Miggins next door who is so damn lonely the only friends she has is her GP and that nice nurse who visits weekly to dress her wounds.  (Mrs Miggins sometimes accidentally on purpose pulls off the dressing so that nice nurse calls more often.)

Interesting then that this recent  RCN survey shows that these unfeeling nurses (caring for the elderly) report that due to unsafe staffing levels “that activity was left undone, or was done inadequately on their last shift due to lack of time.”  These activities include comforting/talking to patients (78%), falls prevention (45%), helping patients with food and/or drink (34%), helping the patients use the toilet or manage incontinence (33%), pain management (19%) and care of the dying (17%).  Please read the full list, the full survey yourself.

Read the whole thing and learn that although older people “who often have the most complex and intense needs…  …have a more dilute skill mix than other types of wards.”

Staff (nurse) ratios are thus: 

·        9.1 to 10.3 patients per RN on older people’s wards.

·        6.7 patients per RN on adult general/medical/surgical wards

·        4.2 patients per RN on children’s wards.

This survey mirrors findings of the RN4CAST survey which found:

·        High nurse BURNOUT and job dissatisfaction were common among nurses in Europe and the US.

·        On average, only 60% of patients were satisfied with their hospital care.

·        Those nurses reporting high levels of burnout (notably in Greece and England) also reported an intention to leave their current employment.

·        Each additional patient added to a nurse’s workload increased the odds of a nurse reporting poor or fair quality of care.

·        Patients were less satisfied with their hospital stay in those hospitals that had higher percentages of burn out ore dissatisfied nurses.

Dean Royles, director of NHS Employers, said: "Mandatory staffing levels can not guarantee safe care.

"We do not believe that imposing a crude system of staffing ratios is the right way to tackle poor care."

Well there you go – bloody typical – things will stay as they are!

It is a fact that these unfeeling nurses – alongside completing only tasks they can do such as meds, admissions, discharges, etc, - spend their time completing reams and reams of required (tick box) paperwork that is deemed more important than the tasks they are tick boxing.

It is also a fact that working under these conditions, these unsafe conditions, they are in breach of their Code of Conduct.  However there is always the safety net of the Nursing and Midwifery Council (NMC) who stand up for their subjects and demand change (not)!

“There are now almost 3,500 fewer nurses working in the NHS than in 2010 and the number of managers has also dropped, the NHS workforce census has shown.” ( Daily Telegraph).   So much for Cammers promise of protecting front line staff then folks!  Things will only get worse for granny now the HSCB is soon to be enshrined in law – you were warned!  (See Jobbing Doctor). 

I don’t deny that crappy nurses exist as do crappy doctors, plumbers, electricians and whole (coalition) governments for that matter – but if we continue with this scapegoat (the nurse) crap – nothing will change and granny and granddad will continue to be left to stew in it.

Stand up and be counted – do something – complain about staffing ratios when you see poor care – please do something!  The odds are YOU will be old one day!

What say you?

Anna :o]

Urm - the cutting and pasting shows - didn't before I posted!

Care Homes and Drug Errors

Okay, I admit it, when it comes to adverse reporting on care homes - I am definitely hypersensitive, defensive and probably many more ' 'ives' than I can bring to mind at this moment in time.

I know that in the big bad world out there, there are indeed, many bad care homes - as, as is, dire care in hospital settings (I acknowledge some of the reasons - dangerous staffing levels, etc), but nevertheless, bad care exists there too.  There are uncaring doctors both in hospitals and GP practices.  But, whatever the wrongs outside care homes - it doesn't make bad care in care homes right!

The reason for this post - stuff I read in Pulse today.  It was "Call to reduce 'counter-productive' cardiovascular drug prescribing in the over-80s"  Video to watch at the bottom of this (Pulse) page too.  I have no problem with this and have also considered the chemical cocktails that the elderly receive.  I know I am not a doctor and therefore readily admit, I don't know what the hell I am talking about!  However, it appears to me, that even though drug A does not interact with drug B, or drug F does not interact with drug H (or even if it does - Flossy needs both of them anyway) - does a combination of A, D and E unknowingly interact with drug G?

Is polypharmacy a GP and/or hospital doc initiated (possibly fatal in the elderly - or anyone?) chemical cosh, that falls outside the care home initiated (in your dreams) chemical cosh of antipsychotics?

Nevertheless, I digress!  A bullet point in the aforementioned "Call to...." in 'Problems with care home prescribing' was "On any one day 7 out of 10 patients experienced at least one medication error" - Ooh, dear me(!), this sent the defensive hackles into overdrive!  I am not brilliant at stats, but easily worked out, that on an average day/night; I routinely gave (on my shift), 30% of my lovely residents, the wrong meds!  Am I thick!?  Would I not know?

Yes, on one (known) occasion, I did give a resident somebody else's meds (distracted by World War Three, for care home residents are not continually semi-comatose by home inspired antipsychotics!) - but I instinctively knew that I had!  I immediately consulted the BNF - thought "Oh My God" (possible bad drug interactions) and contacted the local A & E - for I would rather lose my job, than have somebodies death on my hands.  Given instructions on observations and luckily, everything was tickety-boo!

I have digressed again!  Further research at NHS Choices gave a wider view!  I am relieved!  It is not only care home staff, but pharmacists, GPs et al that produce the 7 out of 10 figures.  But will the general public see this?  No - they will not!  They will just see that care homes are dangerous places (and 'Yes', some of them are) and they will be so afraid.

I do remember Copperfield writing a post on this issue, earlier this year - but I cannot find it.  Yet again, Copperfield's understanding of this situation earned my respect.  I don't care that, at times, Copperfield  alludes to 'granny'stackers' for he/she/they are in touch with the real world.

In my experience, many GPs enter homes with a negative view - and the vicious circle continues - mistrust abounds.  The patient  (or residents)  interests are paramount - and we must remember this  For if not, we are doing the most vulnerable a great disservice.

Anna :o]

A Nice U-turn by NICE.

Will our elderly and vulnerable be respected and given the drug treatment they deserve?

Thousands of patients with early stage Alzheimer's could now benefit from drug treatment following a U-turn by The National Institute for Health and Clinical Excellence (NICE).  Presently, doctors are unable to prescribe donepezil, rivastigimine and galantamine to early stage patients to enable them to retain their mental faculties longer.

In 2005, NICE ruled that no Alzheimer sufferer should receive these drugs on the NHS (based on efficacy of treatment and value for money), and they then conceded in 2007 that only patients with moderate disease should receive them.

However, the decision was contested by drug companies and the Alzheimer's Society who queried the 'secret formula' used by NICE to calculate value for money.  The case went to the House of Lords and the secret formula was amended after NICE conceded technical inaccuracies.  This did not lead to a change in outcome.

Further campaigning by doctors, patients, families and the Alzheimer's Society has led to the new guidelines and recommendations.

NICE has also ruled that a fourth drug Ebixa should be made available for those with severe forms of Alzheimer's and for some with moderate disease.

It does appear to be good news!  In fact, brilliant news!

Anna G :o]

PS  For those of you who doubt the integrity of drug companies - you might find this interesting  which I stumbled across while researching.