| Attention to Care
1 Introduction
A
large number of patients admitted to hospital are older
people. During 1997, the Dignity on the Ward campaign organised
by The Observer newspaper highlighted concerns about the
quality of care given to older people in hospitals in England
(Health Advisory Service 2000, 1998) (see page 31 for full
list of reports mentioned in this report). Members of the
Eastern Health and Social Services Council (EHSSC) asked
for the care given to older people in local hospitals to
be monitored. As a result, the EHSSC decided to carry out
research into the quality of care given to older patients
in hospitals in the EHSS Board area. This report gives the
results of the research which was carried out from October
2001 to October 2002.
Standards
for the care of older patients in hospital are as follows:
| 1)
|
A
named nurse and the nursing care plan |
| |
The
Charter for patients and clients states that every patient
admitted to hospital should have a named nurse, that
is, a particular nurse who is responsible for coordinating
the patient’s nursing care during the hospital
stay (EHSSB, 1999). Each patient should also have a
written care plan that records the nursing assessment
of the patient’s needs, the goals that have been
agreed between the staff, the patient and her/his family,
and dates for checking progress and plans for the future
(Bowers and others, 1999). |
| 2)
|
Giving
information to patients and helping them make decisions
|
| |
Giving
information to patients makes them less anxious, helps
them to make choices about treatment and encourages
them to cooperate with the treatment (Clinical Standards
Board for Scotland: CSBS, 2001; Southern Health and
Social Services Council: SHSSC, 2002). However, patients
should have privacy when talking to staff (CSBS, 2001;
PRIAE, 2001). An older person should get a clear explanation
from the staff of her/his illness and of any treatment
choices, in writing if needed (CSBS, 2001; SHSSC, 2002).
Help should be given to patients who have difficulties
hearing or understanding information or who speak in
a language other than English, for example, by giving
the patient hearing equipment or large print leaflets,
by assessing the person for confusion or dementia or
by organising an interpreter for older people from ethnic
minorities (CSBS, 2001; PRIAE, 2001). Any decisions
made should be based on what the older person herself
wants (British Geriatrics Society, Royal College of
Psychiatrists and Royal College of Nursing, 1993; PRIAE,
2001). Although relatives may be involved in making
decisions if the older person wants, their views should
never be used instead of the older person’s own
wishes (HOPe, 2000). |
| 3)
|
Making
choices about care |
| |
Older
patients should be given the chance to make choices
about their care and the staff should respect their
choices. The older person should be supported to care
for herself where she is able to do so (DOH, 2001a).
Where help is needed with personal care (for example,
washing, dressing and eating) the staff should make
sure the patients get this help (SHSSC, 2002). |
4) |
Privacy
and dignity |
|
|
Every
patient has a right to privacy during washing and bathing
(BGS, RCP and RCN, 1993) and they should be protected
from unwanted public view by curtains and screens (DOH,
2001a). Older people themselves should decide what time
to get up or go to bed and they should be given the
choice over whether, and how often, to bath (SHSSC,
2002; BGS, RCP and RCN, 1993). |
5) |
Attitudes
of staff |
|
|
It
is very important to older people that staff are kind
and friendly and treat them with respect (Davies and
others, 1999; DOH, 2001b; SHSSC, 2002). For older people
from ethnic minorities, it is also important that staff
are sensitive to their particular racial and cultural
needs (PRIAE, 2001). |
6) |
Living
conditions in wards |
|
|
The
living conditions in every ward should be pleasant,
comfortable and acceptable to patients. In particular,
women and men should be admitted to separate wards or
bays (sections of wards) and have use of separate washing
and toilet facilities (Bowers and others, 1999; PRIAE,
2001). In addition, there should be a high standard
of cleanliness and hygiene in all ward areas (Bowers
and others, 1999). |
7) |
Food
in hospital |
|
|
The
food in hospital should be of a high standard and look
good (Bowers and others, 1999). For older people from
ethnic minorities, it is important that they get meals
which are suitable for their particular culture (PRIAE,
2001). Nurses are responsible for making sure that older
patients get a balanced diet (BGS, RCP and RCN, 1993),
so patients should get help with eating and drinking
where this is needed (SHSSC, 2002). Where patients miss
meals they should be offered other meals and they should
be able to get snacks at any time. The National Health
Service standard for the number of drinks to be given
to patients in hospital is at least seven drinks and
drinking water every day (DOH, 2001a). |
8) |
Helping
patients to stay continent |
|
|
Older
patients should be helped to stay continent (DOH, 2001a),
for example, by getting help to walk to the toilet where
this is needed (SHSSC, 2002). Guidelines from the EHSSB
state that patients with continence problems should
be assessed and treated by staff trained in continence
care (2001). |
9) |
Medication
for pain |
|
|
Older
people who have had operations should get good pain
medication from staff with specialist experience in
this area (DOH, 2001b). |
10) |
Handling
death on the ward |
|
|
Getting
support after the death of another patient is an important
aspect of the care of older patients (Davies and others,
1999). |
11) |
Older
patients who are confused or have dementia |
| |
Older
people who are confused or have dementia should be admitted
straight to the ward where possible, instead of waiting
to be assessed in an Accident and Emergency Department.
Their relatives should be able to help with their care
where this is appropriate and the patients should be
allowed to wander (Davies and others, 1999). |
| 12) |
Promoting
equality |
| |
Public
bodies in Northern Ireland have to promote equality
of opportunity between different groups of people, for
example, people of different ages, religious beliefs
and racial groups (Equality Commission, 1999). Where
older people from ethnic minorities are admitted to
hospital, staff need to be sensitive to their particular
racial needs (PRIAE, 2001). It is important that round-the-clock
interpretation services are available in the main ethnic
minority languages for patients admitted in emergencies
(Dunn and Morgan, 2002). |
| 13) |
Rehabilitation |
| |
It
is important that older people are fully assessed in
hospital and that they get rehabilitation where this
is needed. Rehabilitation helps the older person to
be more independent and reduces the time spent in hospital
(CSBS, 2001). |
| 14) |
Planning
for discharge from hospital |
| |
Planning
for discharge should start as soon as possible after
admission. An assessment of the patient’s home
circumstances should be carried out so that any health
and social care services needed after discharge can
be organised (Bowers and others, 1999; SHSSC, 2002).
The older person’s ability to carry out activities
of daily living, such as dressing and washing, should
also be assessed before discharge (CSBS, 2001). |
| 15) |
Making
a complaint |
| |
The
Charter for patients and clients states that every Health
and Social Services Trust should have a procedure in
place for patients to make complaints, if problems occur
(EHSBB, 1999). Leaflets explaining how to make a complaint
should be displayed on the ward, including large print
and other versions where needed (Bowers and others,
1999; DOH, 2001b). |
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