Are care aid communication lost arts? A clinical nurse adviser reflects on the medical and nursing care her parents recieved while in hospital. She observed a worrying lack of professionalism, and communication gaps between doctors and nurses. She poses some challenges to health professionals about the care they give and their communication.

I don't normally put pen to paper. But my experiences over the last two years have given me a voice. In that time I have had a seriously in mother, who required a 14-week hospital stay; more recently, a terminally ill father who received hospital treatment for two months until his death. I felt compelled to begin writing two weeks after my father's death--although it has taken longer to finish it. I decided to write this article as a way of reflecting on and sharing my experience as a family member of a patient in a public hospital I hope writing about my experience assists my own healing, improves patient care, enhances nursing practice and improves communication between health professionals, patients and their families.

When I was a nursing student, a tutor once said to our class: "You won't be a 'good' nurse until you have had a baby and lost a loved one." At the time, I thought "Yeah right'--I'm going to be a good nurse anyway, right from the start." Looking back, I have more of an appreciation of what she meant.

'A difficult family"

I used to be proud to be part of the health professions and still am, at times. But now, some of the things my family and I have heard nurses and doctors say and do, make me cringe. Don't get me wrong--there are some fabulous nurses and doctors working in hospitals and hospital is the best place to be if you need it. But as relatives of a person in hospital, our fatuity was made to feel we were asking for things our family member wasn't entitled to. I'm sure we were labelled a "difficult family". We had to constantly check up on the treatment our parents were receiving, because medications weren't given on time or were missed altogether. Low sodium, potassium and haemoglobin were left untreated for days because brood results were often not followed up until we asked what they were, or we noticed one of our parents was symptomatic--very sleepy or confused. Conflicting medical ideas about treatment added to the stress. One day one doctor would explain why a particular treatment was being given. The next day another doctor would say: "No, I don't agree with that. Let's do this."

Communication problems

Communication between doctors, nurses, patient and fatuity members can be a huge problem. When my mother was a patient, she had four different medical teams not communicating with each other. One of my sisters, who is a doctor, and my father happened to be visiting when the orthopaedic team visited my mother on the ward round. The team updated them on my mother's progress and current treatment. Five minutes tater the infectious diseases team visited and completely contradicted what the orthopaedic team had said. The doctor gave an explanation from which it was obvious she didn't know my mother's case. The doctors had changed rotation and she had not bothered to catch up with the notes before visiting my mother. Not only did she give us incorrect information, she changed the frequency of an antibiotic without Looking at my mother's blood results and vital signs.

We were told by one nurse: "Your fatuity asks too many questions, you need a fatuity meeting." When I asked to arrange a time for one, she said "We'll just ring the doctor when you all come in". She didn't consider the fact we had to organise six adults, who all lived in different parts of the country, and had jobs and families to organise.

When my father was a patient and requested a medication (which had been charted for three clays before he was aware of it) he was supposed to have after every bowel motion, the nurse told him: "You will get your pills when charted and when they are due." She then said he'd had his maximum dose for the day, so he couldn't have it. Dad explained he had only had one dose that day and was allowed a maximum of three a day, but she still refused to give it. My mother rang me at home, distressed at the way the nurse had spoken to them and the fact she wouldn't give my father the medication. I spoke to the nurse concerned and to the nurse who was in charge at the time and asked her to took into this. She simply believed the nurse and didn't took at the chart herself. The next morning the charge nurse followed this up for me and discovered that my father had only one dose all day. He had a further drug error and a second near miss--just as well he questioned the nurses--during his hospital stay.

Medication administration

At the hospital he was in, nurses didn't take drug charts to the bedside and check wristbands. The nurses just took a container with the pills in it and the surname of the patient on it, to the bedside. My sister watched a nurse give a medication at 0900 and sign that it was given at 0600, as it was supposed to be given before meals. My mother was on intravenous antibiotics via a PIC line and I never once saw a nurse check her ID. Where is nurses' accountability in these situations? I know we all make mistakes sometimes, but if a patient questions a medication, surely it is easier to double check with someone else, than deal with the consequences of giving a wrong medication? When someone is sick, they and their family do not need the added stress of inadequate treatment. My brother always says: "Don't be unconscious in hospital--you never know what they'll do to you!"

As well as communication problems, basic nursing care wasn't always apparent. I'm talking about dealing with hygiene, bed-making and answering bells. Putting an immoblie patient on a bedpan or toilet and then not answering their bell, is not only a potential risk for pressure sores and falls, but is also soul destroying for the patient. We shouldn't have to leave our dignity at the door when we step into a hospital My simple message to nurses is--answer your patient's bell; if it's not your patient's bell and you aren't busy, please answer it anyway.

The loneliness of isolation

Methicillin-resistant staphylococcus aureus (MRSA) isolation is an every-day occurrence in some hospitals and many nurses are familiar with it. But for families and patients there are Lots of questions: How did I get it? What does it mean? And these questions need answering. Isolation is just that--very lonely. It is even worse if you are immobile and nurses don't come in to see you for hours and don't answer your bell. It is no wonder family members often want to stay the night, because they fear nurses won't always help their loved ones. Please, when you have a patient in MRSA isolation (or any isolation), visit them often, even if you just put your head in the door once an hour to see if they are all right or need anything. And watch and Listen for your patient's bell. Doctors need to remember to respect people's intelligence. All my family has tertiary education, and two of us work in health. Although my mother is now in a wheelchair, her brain is still functioning; and, although my father was terminally ill, he had all his faculties until he passed away. I would like to remind nurses and doctors that if you don't know an answer to a patient's or a family's question, it is far more professional to say you don't know and to ask someone who does, rather than make up an answer or lie. On one occasion when my father had his temperature taken via the tympanic thermometer, he asked what his temperature was. The nurse said that it was slightly elevated and that was probably because he was lying on that ear! These comments do not give you much confidence in the nurse's knowledge. With both my parents' illnesses, our family felt we had to battle every step of the way to get all the treatment they needed or were entitled to. Fortunately our mother is still with us. We knew there was no operation that was going to cure our father and we accepted this. We were battling to get him strong and stable enough to come home for a while, which we were Led to believe would be possible. Sadly, that wasn't to be. It was awful that with the stress of a sick family member, we had the added pressure of having to fight for every treatment necessary to help them. We were lucky we had medical and nursing knowledge to know what our parents should be getting. I feel sorry for the patients and families who don't question the care they are receiving. This experience makes me wonder how many people are missing out or slip through the cracks? In my role as a clinical nurse adviser I deal with supposedly "difficult families" and conflicts with families and staff often. When we listen to families' complaints or grievances, most of them have good reason to complain. Often listening to their concerns or answering their questions can relieve the situation. It may be a simple matter of updating them on their family member's progress or explaining something in layperson's terms. Or maybe families may need more flexibility with visiting for various reasons, eg they may live far away, or work odd hours, or the patient may have a terminal illness.

I think we all need reminding, myself included, about why we chose nursing as a career. If we remember back to our interview, what did we reply when we were asked why we wanted to go nursing? "I want to help people," or "I want to care for people?" Whatever our reply, we need to remind ourselves of it. Maybe some of us have Lost this caring/helpful attitude toward our patients and it's time for a break or even a career change.

Conclusion

I didn't want to slander the health system in this article. However, I do want health professionals, especially nurses who are those at the bedside the most, to remember how much power they really have. What they say or do, or how they say something can impact greatly on a patient and their family. It is important to think about what would make the patient feel better; what would make a difference to their day; or what would make their hospital stay better. A nurse may not change the ultimate outcome, but their actions can make a huge difference to the patient's experience. We need to stop and think "If this was my parent, grandparent, spouse, sibling or child, what treatment would I like for them? How would they be feeling? If I was in the bed what would I like?"

Nurses, please don't lose your compassion. One day it might be you or a member of your family in the bed.

Prologue 

Eight months on from beginning writing this article, I have experienced an acute admission to a public hospital. It was not the same one as my parents. It was awful and very embarrassing being on "the other side of the bed" However, I couldn't have asked for better treatment and I cannot thank and commend the staff enough for the prompt, professional and expert care I received. They not only saved my life, they have restored my faith in the health professions. It is great to know there is good medical and nursing care out there.

Ruth Cammell, RN, is a clinical nurse adviser at the Manukau Surgery Centre, Counties Manukau District Health Board.