Single bedded wards and the nursing crisis

When our new rehab unit was built in 1998-9 we designed it to be fully wheelchair accessible and as safe as we could manage. Unfortunately our best efforts were obstructed by the politically correct who wanted to pursue their ideal of single-bedded rooms for all.

Sometimes I despair of policymakers who have no common sense and no ability to see past the end of their short book of dogma and commandments. I doubt many have been in hospital themselves; if they have, the have failed in one of my commandments – look not only at the action but its possible consequence – and indeed another – weigh the risk, and benefit, of doing something against not doing it.

Single rooms are lovely and private, and can have their own washing facilities so people don’t have to share toilets – nice when there’s a lot of diarrhoea about and not many cleaners. But – they are lonely places and unsuitable for the really ill. Wards of single rooms require many more nurses to supervise them; bells and buzzers are fine if they are answered, but you cannot see when a patient collapses and neither can anyone else. If a patient on a Nightingale ward “went off” then all the other patients would raise the alarm. If a severely disabled patient was assaulted by a demented neighbour (this happened on my unit once) then help could be summoned. Suppose I shut you up in a single and featureless room, and the TV didn’t work, you would rapidly go crazy; in a bay, or large ward, there is someone to talk to. Patients can help each other, even do things for each other. And they can make carping comments about staff hygiene, as they can watch whether handwashing takes place.

All of these arguments were raised by our own patient group who were very unhappy, given their heavily dependent state, to be confined to single rooms. Shouldn’t they know best? But worst is the apparent assumption that a ward of 20 beds requires the same number of staff to manage safely irrespective of its configuration – an assumption that is patently untrue. And in these financially straightened times it is nonsense to design single-bedded wards when it will then be impossible to run them because the staff cost is unaffordable. Once more the economic argument must be deployed. Can we afford to be fully touchy-feely and if not, how will we compromise?

Another aspect of the strain in hospitals is the feeding issue. For years there have been stories of disabled patients who have had their food put in front of them and either been unable to eat it (because they cannot reach or see it, or are very slow). Nurses’ patience seems to be shorter, so the trays are removed, usually with a comment such as “Don’t you want it, dear?” and the patients gradually starve.

Recently a government spokesman suggested that if relatives were concerned about the nutritional state of inmates then they should come in and do the feeding themselves. If this does nothing else, it underpins the staff shortages in hospitals. Of course such practices are common in Europe, but two problems are immediately apparent.

The first is that many if not all wards have a notice on the door banning visiting during mealtimes.

The second is that if a relative does manage to slip through and do some feeding, the reaction of the nursing staff is not to say thank you but to suggest, often with a gay laugh, that perhaps they would like to help with some of the other unfed patients.

Oxymoron!!! This is not good.

 

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