Blogs by Virginia J Allum
Communication breakdowns in healthcare can be fatal
7/16/2012 2:26:30 AM
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A recent case of neglect in a UK hospital has raised questions whether nurses care any more or are able to cope with the complex nursing care needed today. Trying to make sense of the time-line of events leading to the fatal result has raised questions in my mind about the prevention of further adverse events like these.
The Kane Gorny inquest into hospital neglect which was judged to have contributed to Kane's death has been discussed widely on the media recently. This sad case relates to a young man who died of dehydration despite begging for water and trying to get his medication which would have prevented the rapid fluid loss due a medical condition he had.
I listened to his mother explaining her experience of arriving at her son's bedside to find him distressed and confused.She admitted that his behaviour was quite aggressive,however, this was in part due to the worsening dehydration he was suffering. I don't want to comment on the medical aspects of the case because I don't have all the facts,however, some of Kane's mother's words struck home and should be considered.
Firstly, she said that no-one was communicating. Not with her and not with each other from what she could see. She felt there were 'too many people looking after Kane but no-one knew what the other was doing'. How is this possible with all the documentation that we complete, with safety briefings before each shift and with short hand overs between staff happening throughout the shift? His mother also felt that no-one communicated with her. How did this happen? There was mention of 'Matron' - surely the role of Matron includes liaison with the family in these cases? Or,have we established a system of too many chiefs and not enough indians?
The second issue was the feeling that nursing staff were not up to the job. They didn't appear to know how to manage Kane. The problem is that,reading between the lines, Kane may have been a patient who demanded a lot of time which staff may not have had because of the dismal staffing levels common in many of our hospitals. Staffing levels aim to match patient dependency levels and this is assessed during the previous shift .Despite this, the minimum number of staff is provided which does not allow for sudden changes in dependency. Patients such as Kane who are at risk of falls or hurting themselves in some way need individual attention which is rarely possible because of the non-availability of staff or the inability of a Trust to pay the extra costs for an agency nurse or similar. So, staff continue to 'manage'. These are the same staff who are asked to work 13 hour days during which they may or may not have a meal break. The potential for error is already there as is the potential for burn-out.
After the radio interview with Kane's mother, I listened to mooted plans to reduce wages of NHS staff with the threat of the sack if workers don't accept and the offer of reinstatement at a reduced wage. I wonder what plans are going to be put in place to ensure that 'the right people are attracted to nursing'. I heard this question at the recent Nursing and Care Quality Forum I attended earlier this year, ironically at St George Hospital. If we are to attract intelligent men and women into nursing we must be able to offer a supportive environment to work in and a career path. At present in the UK recent grads are offered minimal support and are expected instead to deal with complex health issues and heavy patient loads straight after a course which includes little actual patient contact. It takes time to develop competence in time management and time to feel confident with procedures and documentation. Communication skills are taught but can only be practised whilst on the job and with support from more experienced nurses.
Communicating with relatives after a loved one has died was always rated as the most challenging by my nursing students. It was the thing they feared most because they did not feel equipped to say the 'right thing'.It seems the nurse who was with Kane at the time of his death did not manage the conversation well about what was to happen with his body after his parents had finished viewing it. These sorts of complex communications need to be practised and discussed with nurses as part of on-going professional development. Competence in this area does not happen immediately and,unfortunately, some people are more tactful than others.
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More Blogs by Virginia J Allum
Communication breakdowns in healthcare can be fatal - Monday, July 16, 2012
Why I'm a fan of LSP - Saturday, June 23, 2012
First blog on Authorsden - Wednesday, June 20, 2012