COMMENT
T
he other week at work, I was faced by a confused, elderly man who was shouting and swearing at me. I work as a community nurse and this man’s GP had asked the district nurse team I form a part of to visit him to ensure he was taking a course of medication he had been prescribed. As soon as the man realised why I was there, he man became very aggressive, shouting at me, that he didn’t need me there and that he was taking his own medication—even though there were no tablets taken from the packet. The ‘natural’ reaction to this man’s shouting and threatening me would have been to shout back. Of course, I didn’t. I knew that he had dementia and that shouting back at him would not only be unprofessional, but would also serve to make things worse. Even though it took me being there for three times as long as I had expected, I was able to talk this man down from his anger and, in the end, he agreed to take his medication. At handover that day, our team discussed this man and what would be the best approach to take with him. We agreed that he needed extra time for his visits, to take a non-confrontational approach with him (to lessen his anger) and to reinforce that it was his doctor who wanted him to have his medication (which he had responded to well). I don’t expect a pat on the back or a gold star for what I achieved with him. I was just delivering nursing care. I do, however, have the advantage of experience, having worked a lot with confused, aggressive, or drunk patients, among other difficult situations. I have also had a lot of training, over the years, on how to appropriately respond to aggression, violence and confusion. It is a skill I have learned over time. When I watched Panorama: Behind Closed Doors: Elderly Care Exposed (broadcast on BBC 1 on 30 April), I had an angry, knee-jerk reaction—‘Sack them all and throw them in prison!’, I thought. But was this the right reaction? It is true that we should never tolerate patient abuse in any form. But when it is uncovered, we shouldn’t take the attitude that is solely the fault of the staff who are caught doing it. We need to step back and look at the whole organisation. Abuse like that which was exposed on the Panorama programme is rarely just a ‘few rogue staff ’—there are often larger organisational faults allowing it to occur. Staff—who are not experienced, who have not had any training, who are under pressure with heavy workloads and with not enough time, or who do not have adequate support and supervision—can become abusive. It is a natural human response if someone hits us to hit them back. Confused people can lash
702
out when they feel scared or intimidated, when they feel they are being rushed, when their normal routine is not being followed or when they are in strange surroundings.There are a lot of reasons for aggression, not just that someone is a miserable old ____ and is doing it ‘on purpose’, but staff need training and support to recognise this. In a previous role, I went into care homes to do audits and train staff. I know from experience that there are good and bad homes. I also know that good elderly care is not cheap to deliver and yet, the profit margins for running a care home are getting smaller and smaller. One of the first things to go when budgets are tight is training and supervision. A senior carer or a registered nurse on duty ‘just’ to supervise a home is often seen as a ‘waste’. Training takes staff away from their roles and there is an expense in that. There is often a prevailing attitude that care work is just ‘common sense’ and not actually a skilled job. All care delivered should be person-centred. It should meet the person’s needs, respect them and their views, and value them as a person, and not just as a diagnosis or a collection of tasks to be completed. But this isn’t easy or cheap, it needs time and resources. Health professionals need time to work with the person to whom they are delivering care, to work with that person’s relatives, and with other staff. This will help to provide some insight into the person, and their needs, and to work with them towards meeting their needs. We also need resources to deliver the care they need, but this investment can have great benefits for patient care and also for staff. For too long, the nursing profession has seen elderly care as a backwater or a dead end, and not as glamorous as other areas of nursing. But shouldn’t we be seeing it as part of the frontline of health care? We need to change the entire image of elderly care to make it an area of pride within nursing to work in. We need to campaign for resources for elderly care. It should never be done on the cheap or massproduced. We also need to ensure that elderly care has the professional support and expertise to meet patients’ needs with care and dignity. If we continue to ignore elderly care, abuse like that exposed on Panorama, will happen again. We need to learn from this, that organisational problems and failings allow abuse to happen. From the top down, care for our elderly patients needs to be consistently BJN person-centred, safe and compassionate. Drew Payne Community Nurse Whittington Health, North London Contributor, Nursing and Residential Care (NRC)
British Journal of Nursing, 2014, Vol 23, No 13
British Journal of Nursing 2014.23:702-702.
© 2014 MA Healthcare Ltd
Editorial Board David Aldulaimi, Consultant Physician, Gastroenterologist, Worcestershire Acute Hospitals NHS Trust Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Lizzy Bernthal, Research Fellow and Lead Nursing Lecturer, Medical Directorate, Birmingham Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Jothi Clara, Group Director-Nursing, Global Hospitals Group, Chennai, India Emma Collins, Senior Sister, Practice Development Lead, Brighton and Sussex University Hospitals NHS Trust Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland David Delaney, Charge Nurse, Clinical Research, Alder Hey Children’s Hospital Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Joanne McPeake, Acute Specialist Nurse/Senior Staff Nurse in Critical Care; Honourary Lecturer/Practitioner in Critical Care, University of Glasgow Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Anne-Maria Olphert, Chief Nurse, Director of Quality, Erewash CCG, Derbyshire Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Bernadette Porter, Nurse Consultant, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Angela Robinson-Jones, Consultant Nurse, Gynaecology, Liverpool Women’s Hospital John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Elderly care: reflecting on that ultimate ‘never event’
T
he other week at work, I was faced by a confused, elderly man who was shouting and swearing at me. I work as a community nurse and this man’s GP had asked the district nurse team I form a part of to visit him to ensure he was taking a course of medication he had been prescribed. As soon as the man realised why I was there, he man became very aggressive, shouting at me, that he didn’t need me there and that he was taking his own medication—even though there were no tablets taken from the packet. The ‘natural’ reaction to this man’s shouting and threatening me would have been to shout back. Of course, I didn’t. I knew that he had dementia and that shouting back at him would not only be unprofessional, but would also serve to make things worse. Even though it took me being there for three times as long as I had expected, I was able to talk this man down from his anger and, in the end, he agreed to take his medication. At handover that day, our team discussed this man and what would be the best approach to take with him. We agreed that he needed extra time for his visits, to take a non-confrontational approach with him (to lessen his anger) and to reinforce that it was his doctor who wanted him to have his medication (which he had responded to well). I don’t expect a pat on the back or a gold star for what I achieved with him. I was just delivering nursing care. I do, however, have the advantage of experience, having worked a lot with confused, aggressive, or drunk patients, among other difficult situations. I have also had a lot of training, over the years, on how to appropriately respond to aggression, violence and confusion. It is a skill I have learned over time. When I watched Panorama: Behind Closed Doors: Elderly Care Exposed (broadcast on BBC 1 on 30 April), I had an angry, knee-jerk reaction—‘Sack them all and throw them in prison!’, I thought. But was this the right reaction? It is true that we should never tolerate patient abuse in any form. But when it is uncovered, we shouldn’t take the attitude that is solely the fault of the staff who are caught doing it. We need to step back and look at the whole organisation. Abuse like that which was exposed on the Panorama programme is rarely just a ‘few rogue staff ’—there are often larger organisational faults allowing it to occur. Staff—who are not experienced, who have not had any training, who are under pressure with heavy workloads and with not enough time, or who do not have adequate support and supervision—can become abusive. It is a natural human response if someone hits us to hit them back. Confused people can lash
702
out when they feel scared or intimidated, when they feel they are being rushed, when their normal routine is not being followed or when they are in strange surroundings.There are a lot of reasons for aggression, not just that someone is a miserable old ____ and is doing it ‘on purpose’, but staff need training and support to recognise this. In a previous role, I went into care homes to do audits and train staff. I know from experience that there are good and bad homes. I also know that good elderly care is not cheap to deliver and yet, the profit margins for running a care home are getting smaller and smaller. One of the first things to go when budgets are tight is training and supervision. A senior carer or a registered nurse on duty ‘just’ to supervise a home is often seen as a ‘waste’. Training takes staff away from their roles and there is an expense in that. There is often a prevailing attitude that care work is just ‘common sense’ and not actually a skilled job. All care delivered should be person-centred. It should meet the person’s needs, respect them and their views, and value them as a person, and not just as a diagnosis or a collection of tasks to be completed. But this isn’t easy or cheap, it needs time and resources. Health professionals need time to work with the person to whom they are delivering care, to work with that person’s relatives, and with other staff. This will help to provide some insight into the person, and their needs, and to work with them towards meeting their needs. We also need resources to deliver the care they need, but this investment can have great benefits for patient care and also for staff. For too long, the nursing profession has seen elderly care as a backwater or a dead end, and not as glamorous as other areas of nursing. But shouldn’t we be seeing it as part of the frontline of health care? We need to change the entire image of elderly care to make it an area of pride within nursing to work in. We need to campaign for resources for elderly care. It should never be done on the cheap or massproduced. We also need to ensure that elderly care has the professional support and expertise to meet patients’ needs with care and dignity. If we continue to ignore elderly care, abuse like that exposed on Panorama, will happen again. We need to learn from this, that organisational problems and failings allow abuse to happen. From the top down, care for our elderly patients needs to be consistently BJN person-centred, safe and compassionate. Drew Payne Community Nurse Whittington Health, North London Contributor, Nursing and Residential Care (NRC)
British Journal of Nursing, 2014, Vol 23, No 13
British Journal of Nursing 2014.23:702-702.
© 2014 MA Healthcare Ltd
Editorial Board David Aldulaimi, Consultant Physician, Gastroenterologist, Worcestershire Acute Hospitals NHS Trust Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Lizzy Bernthal, Research Fellow and Lead Nursing Lecturer, Medical Directorate, Birmingham Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Jothi Clara, Group Director-Nursing, Global Hospitals Group, Chennai, India Emma Collins, Senior Sister, Practice Development Lead, Brighton and Sussex University Hospitals NHS Trust Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland David Delaney, Charge Nurse, Clinical Research, Alder Hey Children’s Hospital Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Joanne McPeake, Acute Specialist Nurse/Senior Staff Nurse in Critical Care; Honourary Lecturer/Practitioner in Critical Care, University of Glasgow Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Anne-Maria Olphert, Chief Nurse, Director of Quality, Erewash CCG, Derbyshire Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Bernadette Porter, Nurse Consultant, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Angela Robinson-Jones, Consultant Nurse, Gynaecology, Liverpool Women’s Hospital John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Elderly care: reflecting on that ultimate ‘never event’
