female medical patients

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composing a few thoughts

just have been on a lovely medical ward 2/3 1/3 female to male.

and had my first prolonged exposure to ladies who are fully in the PIP mode

don't want to do anything, spend most of the day in bed, are repeated admission for the same reason and don't want to go home so hang on to dear life for whatever ill health reason was the reason for admission. some of the ladies lived alone some had chronic health conditions that could be managed in the community most of the time.

i try to understand why someone would seek refuge in a sense in a hospital, i haven't been hospitalized since a child and haven't yet experiences being older frailer and lonely. My parents and grandparents are in this age range and bar being ill would rather being their homes.

Most of them got to the point of being medically fit quite quickly however the consultant on rotation was a slow discharger.

how do nurse deal with either the frustration of these patients or getting through to them. It can be annoying to deal with ladies who want pillow fluffing, moan about hospital food if the kitchen has sent up altered food from the menu etc, and not having tea as often as they like. For the patient who are stuck there while ill or in rehab i do think hospital food is poor at times and i wish they stuck to the menu's and tea helps the boredom etc, but for people who could be home i have less patience.

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Specializes in Advanced Practice, surgery.

Are alot of these ladies elderly Ayla, it may well be that they are lonely and in hospital they have thier little community. We have groups of pateints that are recurrent readmissions for chronic pain managment. You can be that if one of them is admitted then the rest will visit, they soon will also be admitted.

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age range seemed from mid 60's upwards and yes i think loneliness is a major aspect of their daily lives. Some didn't have much visitors while in hospital probably even less when at home. one had copd and i know their is a lot of anxiety attached, i've seen it on night duty where someone can't get their breath and been able to assist and get help etc. so even a home visiting volunteers scheme or day centers don't address the hours these ladies are alone in their own homes. on a acute endocrinology ward whilst i was there over 5 weeks we have some diabetics some query cushings and mostly general medical.

I enjoy working with elderly patients which in my trust is above 79. however seen more get up and go from the ladies on a COTE ward than these patients.

is revolving door admissions a treatment for loneliness,

two of these ladies developed postural droop a contributing factor may be almost constance self imposed bed rest not altered by efforts and encouragement to sit out for some time.

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we dont have that culture over here because of the money that is involved on discharge, and we have all single rooms where we work. but we do have the homeless or the prison population who will stay there for ever because its better than being in prison or on the streets and its all free for them.

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Specializes in Dialysis, Nephrology & Cosmetic Surgery.

This is a huge problem where I work, every day I need to complete a form (one of many) about the number of pts waiting for various assessments investigations etc.

Friday almost 50% of the pts were med fit but no discharge date in sight. They are mostly over 60 but several are in their early 50s and one has been in for over 6 months, another is still in as his wife refuses to take him home!

I don't know what the answer is but I find the biggest cause of delay is waiting for OT and social workers to do their bit. It annoys me the way they can use the "we're short staffed" or "we have 3 on mat leave" excuse. We are chronically short staffed and have 4 on mat leave but no nurse would deny care because of this - it just means we don't get a break and go home late and exhausted. I have never seen an OT, physio or social worker go without their lunch or stay late - ooooh you've touched a raw nerve!

Incidently my previous job was managing a small private hospital and when someone wanted to stay an extra night they soon changed their mind when I asked how they wished to pay for it. I am not talking about people who still needed to stay in - if they needed to they stayed at no extra cost.

I would like to see some sort of financial implication on the time wasters as at the other end of the spectrum I know there are the acutely ill pts being vented in threatre recovery or A&E majors as there are no ITU beds as ITU cannot discharge their pts to the wards as they are full of people in for R&R (rest & recreation)

I could go on but the sparks are flying off the keyboard now so I best leave it a bit to cool down! Jane

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Specializes in med/surg.

When I worked on an acute medical ward in 2005-6 if the patients were fit for discharge that's exactly what happened to them.

We had a very pro-active discharge team, any social service needs were flagged up on admission and a provisional discharge date was set for them to work to. If the delay was due to the social services not being ready they got fined -funny how they were always ready!

If the patient had chronic needs, medical or social, that could not be dealt with at home then they were moved on to either rehab, long term elderly wards or nursing/residential care as appropriate.

It worked really well and meant that we could have the kind of turnover needed for a proper acute medical unit.

Now I work in the private sector, our NHS patients (of which we have loads at the moment) are booked for a set number of days and if they are medically fit for discharge but want to stay they would get charged our usual rates - i.e. loads! Funny but they all manage to make their dates. We do co-ordinate with social services/hospital at home services so please don't think we chuck 'em out regardless! :-)

I think it boils down to having good discharge co-ordination and pro-active discharge plans. Not to mention the docs on baord!

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RGN lack of push by the consultant was the main reason i feel nursing staff me included made the referrals, however one pat refused to et out of bed and work with the physio so they discharged her, couldn't blame them really due to workload.

i came across a quote here by Nightingale that hospital are good for the sick but bad for the minds of the well. it seemed very apt

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Specializes in Dialysis, Nephrology & Cosmetic Surgery.
When I worked on an acute medical ward in 2005-6 if the patients were fit for discharge that's exactly what happened to them.

We had a very pro-active discharge team, any social service needs were flagged up on admission and a provisional discharge date was set for them to work to. If the delay was due to the social services not being ready they got fined -funny how they were always ready!

If the patient had chronic needs, medical or social, that could not be dealt with at home then they were moved on to either rehab, long term elderly wards or nursing/residential care as appropriate.

It worked really well and meant that we could have the kind of turnover needed for a proper acute medical unit.

Now I work in the private sector, our NHS patients (of which we have loads at the moment) are booked for a set number of days and if they are medically fit for discharge but want to stay they would get charged our usual rates - i.e. loads! Funny but they all manage to make their dates. We do co-ordinate with social services/hospital at home services so please don't think we chuck 'em out regardless! :-)

I think it boils down to having good discharge co-ordination and pro-active discharge plans. Not to mention the docs on baord!

This is what we do - we will refer ASAP - sometimes on admission to other disciplines, but OT won't see pts until they are med fit, the social work won't see them until OT have completed their assessment.

The Drs are good at discharging appropriatley but then OT will delay as they decide pt needs X,Y & Z which they cannot do in a timely manner as they are short staffed - 3 on mat leave etc etc.

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Specializes in med/surg.
RGN lack of push by the consultant was the main reason i feel nursing staff me included made the referrals, however one pat refused to et out of bed and work with the physio so they discharged her, couldn't blame them really due to workload.

i came across a quote here by Nightingale that hospital are good for the sick but bad for the minds of the well. it seemed very apt

I like that quote!! It is indeed very true!

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Specializes in med/surg.
This is what we do - we will refer ASAP - sometimes on admission to other disciplines, but OT won't see pts until they are med fit, the social work won't see them until OT have completed their assessment.

The Drs are good at discharging appropriatley but then OT will delay as they decide pt needs X,Y & Z which they cannot do in a timely manner as they are short staffed - 3 on mat leave etc etc.

Then this is where you need to get the managers of various departments together to do their jobs properly & organise themselves into a coherant team! The beauty of it is that it will save money - & that's a massive selling point on your part.

I can see why you (& many others, who I'm sure were nodding their heads in agreemant because they're in the same situation) feel you're swimming up stream all the time. It was the reason I let you know that it can & does work elsewhere so it's not impossible. It just requires someone like you to bring the problem to management (with an idea for a solution - that's the important bit) going as high as you need to before someone listens!

Of course I appreciate that's not always going to be easy & some managers are just incompetent with a capital "I" but give it a go you never know.

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