A recurring theme in negative reports about nursing quality in the NHS (National Health Service, UK) seems to be the care given to older patients. Clare Lomas investigates what can be done to meet the challenge. This report appeared in Nursing News. Are South African care facilities as bad as some in the UK described in this report?

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Last month TV personality and former nurse Claire Rayner described the way some nurses treated elderly patients as “cruel” and “demeaning”.

In a foreword to a report from the Patients Association, of which Ms Rayner is president, she said it was “sickening” to see how some parts of the profession had changed since she was a nurse, and called for “bad” nurses to be struck off the register.

The report, which made for tough reading, concentrated on 16 examples of poor patient care, taken from a database of hundreds received by the charity from relatives of patients in England.

It cited elderly patients being left lying in their own urine and faeces, having call bells taken away from them, and being left without food and drink. The report was, unsurprisingly, reported widely by the national media.

But it is only the latest in a long line of reports to criticise NHS trusts for poor fundamental patient care, and in particular, older patients.

A now infamous report from the former regulator the Healthcare Commission, published in 2007, revealed that patients at Mid Staffordshire NHS Foundation Trust had been left in “wet or soiled” sheets. In 2007 an equally high profile report from the commission also found “significant failings” in basic patient care at Maidstone and Tunbridge Wells NHS Trust.

Exposing poor elderly nursing care

Nurse Margaret Haywood risked her job when she went undercover for the BBC in 2005 to expose poor elderly nursing care at a hospital in Brighton. She has since been struck off the register by the NMC for breaching patient confidentiality, a decision which she is currently appealing.

Inadequate NHS care is not exclusive to the elderly, but it is nurses who work with older people who appear to be continually coming under fire, particularly around issues related to patient dignity.

“It would be easy to say this is just a nursing issue, but it is a lot broader than that,” said University College London nurse consultant for older people Jonathan Webster. He highlighted a range of factors that impacted on nursing care.

“There are a lot of factors around delivering essential nursing care, such as the skill mix of the workforce, and how organisations promote practice around the care of older people. I am not defending poor practice, but a lot of elements come into play,” he told Nursing Times.

Highly skilled workforce

RCN’s advisor in nursing older people Pauline Ford said trusts needed to recognise that delivering effective nursing care to older people required a highly skilled workforce that needed to be supported and encouraged.

“We do not condone poor or abusive practice. But instead of punishing nurses, we need to look at the culture of NHS organisations, and explore what is allowing this environment to happen,” she said.

“The majority of nurses who look after older people are highly motivated and committed, but they are overstretched and overloaded. Organisations need to start recognising the level of complexity involved in the care of older people, and start having conversations with ward-based staff about what needs to happen to change practice.

“Nurses need resources and good leadership to be able to deliver effective care to older people. In organisations where staff feel supported and valued, visible clinical leadership is very apparent,” she added.

The way older people are viewed

Despite the push to improve hospital care for elderly patients, examples of poor basic care keep on being highlighted. Some suggest this is a wider reflection of the way older people are viewed by modern society.

According to consultant nurse for older people Linda Nazarko, the perceived image of older people’s nursing is partly responsible for hindering good care.

“Older people’s nursing can struggle to recruit the brightest and the best nursing students, because it is seen as a job of last resort rather than  a positive choice,” said Nazarko, an older people’s nurse for more than 25 years.

Like Webster, she also highlighted the need for more leadership and support for nurses working with older people.

However, helping older people to self-manage long term conditions will not happen overnight, and changing behaviour from dependency on acute care will take time, said Webster.

“Older people are the largest group of service users in the NHS and will continue to be admitted to hospital wards with multiple co-morbidities. We have to have a skilled workforce to ensure their needs are met,” he said.

“Staff need to be able to identify the real issues, who is at risk and who needs help. It is not just about feeding a patient but observing how they swallow when they eat and drink and promoting their ability to help themselves.

“Patient safety and quality have to be at the forefront of care, and nurses need the appropriate training and expert support to achieve this,” he added.

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