NURSING AND EDUCATION PLATFORM

People need to see the link in  a clear way, lenin Nightingale article who owns care homes? wideshut.

Does not matter who provides care as long as high quality - depends what that is, we know.

Virgin Care own 100plus NHS establishments- still with NHS logo up. So what? Different complaints procedure- harder. More secretive. When did you last read of problems in private hospital? care homes- in local newspapers. So-- govt restrict funding and fine the  NHS hospitals if do not meet unrealsitic targets. Targets not everything, as we know.If fail- become Foundation Trust; so what? Govt not then responsible--- hospital managers control budget . see article Foundatiomn trusts wideshut. All to be Ft anyway from 2014. They fail- govt will sell completely to private company. Hm. If private equity trust- no idea who owns- could be govt via shareholders.If fails- sell back to govt for 1p. Bottom up is does quality really matter to these people?

In otherwords, whilst we fight for NHs only, it is being "sold off" . Who cares about care in the private sector?

Lenin Nightingale

Loads of issues medication- and private sector does differ to NHS. Anybody considered this one?

Nurse on shift told or notices, previous nurse did not sign for a drug.Now it could well be insulin or oromorph. What do you do? If you ring nurse you feel as though you are "picking on her". But if you give it, it may well have been given. Fuirther, if you ring nurse- and she SAYS it was not gven- do you then give it even if care staff told you and plead with you to give it? As a nurse, you are only legally responsible for drugs given on youir shift. My advice- document in care plan not given and action etc. Further problem- agency nurses do not usually know which nurse to ring- so may have to ring manager.Also- who you are ringing, may not be there. In hospital- you could take advice from whoever is in charge .

Also-- beware-- it could be  a set up! Yes some staff collect things against others. Tell you over phone to give it-- but. My advice- never take orders by phone.You could  always ring doctor and ask for advice. Consider:  a newly qualified nurse, new nurse to the team, or an overseas nurse.

lenin Nightingale

Many argue, money does not exist- used as a form of control. A local council receives one million pounds from the govt  to upgrade a historical property to boost visitors. There are many who ask, why not give the money to community care?

Billions of pounds to be spent on Uk high speed train; who will use it? Business men and MPs - nobody else can afford it. We all know this but can do nothing.

Probation services to be privatised. We know- less regulation, govt not responsible, who actually owns it, private equity. Already problems with falsification. Bonus to be paid for success ie less return to prison- nothing to do with probation. Try looking at social aspects instead eg jobs and housing and self esteem.

Life is becoming about survival- dring, food, tablets. Care is low priority. Yet care too is  a factor in quantity, aswell as quality, of life in many cases. We all need to feel loved and needed.

Priority is business. Business rules- OK?

Nobody gets it. Any private company- difficult to complain about. Not just private care. eg Apple do not have  a complaints dept. This is why all govts aim to privatise- take it or leave it. If i dislike meal I would be told to go elsewhere- and would not need telling. A resident in  a care home has little option., when the same company owns 80 % care homes in that district.

see Lenin Nightingale's article "Who owns care homes?" back of book the commodity of care

Talking to many nurses, students and care assistants in all fields, owned by all bodies eg care homes and hospitals. there are many situations that are not due to short staffing although certain bodies prefer not to speak of it

www.nursingtimes.net/.../rcn...patients-association.../5005657.article‎ 27 Aug 2009

For example, leave it till the next shift. How many feel the frustration of "Mr Brown arrived at 9am this moring "Can you (afternoon nurse) start care plan ?" Surely on admission we talk to him and check his pressure areas etc??

Or can you put the great drugs order away? A lengthy procedure, often left to nightsaff who have less staff and are often extremely busy.

Such procedures as checking the oxygen, are often left to the one who knows how to do it.

Weighing, doing dressings, or bathing patients are other issues. It may be documented to bath Mrs Smith but sorry, we did not have time- can you do it? Now not having time is not always the reason. Some indeed, may forget to look in the diary etc. If this occurs for days, GPs are not rung and orders not made etc.

Studying reaons for this, offers reasons for the failure to do certain aspects of care, but not excuses. For example, do many staff avoid certain tasks, or hide in the office, because they feel incapapable or fear doing something wrong? Such staff need to be able to say, how do you do this, without feeling stupid. Some may  argue it is shear laziness and wonder where the manager is in all this.

If you know any more examples- please let me know.

Many agree that failure to report care, or to  deny that it occurs is unacceptable. Yet it happens to such  a degree, that we need to analyse possible reasons why. The book the Commodity of care is an attempt to do that; not a means to excuse such behaviour in any way. For example, in some parts of Africa, it remains acceptable to slap expectant mums when giving birth as was done in the parts of England until 1970 (See book). In Somalia, the mentally ill may be put in cages with hyenas or chained up. Indeed, in history pre 1960s, in the Uk, the menatally ill were chained up etc which was considered to be acceptable treatment until the reforms of Tuke for example.We must remember that in some parts of Africa, witchdoctors still exist and are still believed in. In some countries, there are different meanings of the term "dignity"; it is acceptable to some not to close doors or cover up for instance.

Further, older people are regarded differently in some countries. Highly respected or regarded as "non-contributors". When people come as carers here from  eg India, they often cannot understand why we do not care for old people at home and find it difficult here . There is evidence within the book that people from some countries, are very loyal and so complain less. Hence they are less likley to report or question something. This all indicates the essential need for adequate training once they arrive here, in addition to the sensetivity of the situation. As the book indicates, training of overseas staff is inadequate. If I went to work in China for example, I know my attitude and behaviour would be different to people who have always lived in China.

Also remember, culture applies to within the same country. One example in the agency nurse blog, indicates this well within Africa. Within UK, we have eg the North and South, more deprived areas and affluent areas. This is not meant to generalise, but could well be a factor that determines attitude and behaviour.

There are of course other reasons besides culture, such as the work ethic or gender - all discussed within the book.

One interesting comment about quality measures existing. Research regarding quality has focussed on developing measures, for many years. Measures are used by establishments to gain acceptable ratings. Measures are also paper exrecises- depends on criteria, who fills them in , can be tick box. Indeed, CQC has hushed up poor reports, or upgraded aspects in some cases. Establishments have been given acceptable CQC passes only to be found to be very poor.Indeed, the manager of winterbourne View will have done quality audits but I am sure would not have mentioned the abuse that occured. Even with measures, some abuse or poor care, may not be discovered; it often occurs behind closed doors for example, or is unreported.

If work has been  done on developing measures, the issue is that some care is substandard- or why develop measures in the first place? This book aims to fully analyse why poor care exists and what poor care exists within USA, Australia, UK. It also aims to open discussions as many fear discussing these aspects, which is  a very painful subject.

Lenin Nightingale;

I have been given a complimentary copy of Carol Dimon's 'The Commodity of Care', and am happy to provide this review. As a former nurse and academic of many years standing, I believe that the central theme of this book, that nursing care does not exist in a vacuum, but is profoundly shaped by the 'politics of the time', is a much needed perspective into how those being nursed (in both care homes and hospitals) are being viewed as a 'commodity' to be traded between debt-ridden, profit-seeking corporations. This book unmasks the rhetoric behind which such changes are taking place; and makes a link between poor attitudes to those being nursed and the shaping of society by political dogma that promotes a cult of individualism.

Moreso, the similarity of this situation in the UK, USA, and Australia is explored, giving this book a wider scope than many. The breadth of topics covered is impressive, and those sections concerning nursing students should be of particular interest to those involved in nurse education. The Commodity of Care is well-written, thoroughly researched, and provoking, being strongly critical of organisations involved in nursing, and making recommendations for a more hands-on nurse training regime, based on a selection process that places compassionate attitude as paramount. It is a useful addition to the debate surrounding the future direction of nursing care

Nurses fyi Rich Williams. On article based on book 12.11.13

Carol Dimon’s article about the state of nursing care while confronting and potentially controversial for some, is a positive reflection on what Carol’s perspective is on the quality and quantity of nursing care we as nurses provide to our patients. I as a Patient Transport nurse for the past 14 years have visited dozens of facilities and I have personally witnessed a big cross section of the of nursing care being provided. I found Carol’s article to be one of the most thought provoking I have published so far.

Agency nurses are used within all areas eg prisons, care homes, hospitals- NHS/FT/private or community etc. Being an agency nurse demands great skill at adapting to individual situations and practices within all establishments. It also gives the nurse an opportunity to learn within the field and challenge him or her to deal with various issues and situations. This blog will recount a number of situations that an agency nurse was confronted by. The anon nurse did meet many excellent staff of all levels who were very apologetic about some situations. There were also others who were not so good. As an agency nurse, you can have some option of where to work or indeed, the establishment has some option of who to use. The incidents did take place many years ago and regulations have changed since then. However, the situations may still occur.

 It was the night shift. I arrived at a care home to be greeted by 2 apologetic care assistants- this was their first day at work and one only had experience - within a vets. There were 4 patients to be fed by enteral feeding , which I was unfamiliar with and one patient needed constant care. I was met at the door by the previous nurse who left and handed me the keys. No wonder she failed to give me a handover report.

Another care home. Nightshift. The 2 carers met me at the door- sorry there is only us here. It was the first shift of one carer. Midnight looms- a taxi arrived. the carer grabbed her coat and ran, exclaiming "sorry it is not for me!"

 Many care homes use a lot of overseas nurses and care assistants. On shift in one home, 2 staff were from different regions of Africa. They relayed messages to one another via another member of staff. The 2 regions in Africa did not get on due to different political orientations, so they could not have anything to do with each other. Many forget that within some countries such as Africa or Poland, different regions are extremely different as reflected by cultural attitudes.

 One trainee overseas nurse in one care home, brought a bowl of porridge when asked to bring a pressure care mattress.

 I arrived at a care home for the night shift; great- I was told there were no drugs to do. Why? They had not arrived from the chemist--

 One hospital, the nursing officer often rang me on shift to check everything was OK. Not in others.

Night shift in one hospitals. A patient passed away with half hour of my arrival. Like any unfamiliar nurse, I consulted the procedure files. I rang the doctor on call to certify death. He announced he would not come until the morning. Now, any nurse or carer knows, that it is indignifying to leave a person who has passed away, on a ward and you cannot inform anybody until he or she is certified. Anyway, the doctor did come out! i wonder if  a new face does sometimes make  a difference- or was he trying to pull the wool over my eyes? I know there are some nurses who are now qualified to certify patients, after training.

If you go regularly to the same place, staff may adopt you, especially if you assist them with general care of patients. makes it easier for you also as you know the patients and staff.Day shift. the agency nurse arrived at the care home. During the shift, a syringe driver needed replacing. Training for syringe drivers was additional to the nursing course. this nurse rang the home manager and insisted that she come out- which she did. As an agency nurse- or any nurse- you need to have bottle. Similar situations may occur with other aspects- hoists differ within all establishments, procedure, care plans etc

Night shift in care home. You always get those organised carers. "This is how we do it, you do what we say". They never met me before, "No, I am the nurse in charge you do what I say".

Day shift in a care home. The case of the ghostly chair. If carers did not approve of the poor agency nurses as soon as she walked thorugh the door, he or she was informed to sit in certain chair in the lounge- from where the owner could see her through a window and report her to the inspector for not doing anything.

Working in different establishments, you notice many different practices. Restricted incontinence pads in the day, with residents obviously needing more and carers afraid to oppose the ruling. Of course I informed the inspectors who promptly paid a visit. The fridge that was locked . The cheese that was weighed by the owner. The home that left a written handover as common practice; the nurse had gone. The home that split drug capsules - I refused so was in trouble with the resident but did leave notes and informed the chemist. Such issues are difficult as an agency nurse as you may never return to the home again and there is nobody to discuss it with at the time.

One prison, I queried the drug dosage with a Dr who happened to be there.  Shortly after, I recieved a letter threatening disciplinary for giving the wrong dose. Not me, the drug chart was unclear and staff had been giving incorrect dose. My letter in response, soon ended the battle. No- I would not return to the place again. Somebody was seeking promotion.

Night shift ina hostel as a nurse. Arrived there to find  astaff member waiting with keys who told me to have a rest. all residents had been taken out over night and it was too late to cancel me. Hope they had  a great time! cancel an agency shift too late and it still has to be paid for.

Night shift in  a home for 30residents. a care assistant greeted me with the words "there is only the 2 of us, instead of 4". if I had known, i would not have agreed to do the shift- you can do that in the agency. Fortunately- i knew the home well. 2 staff had gone sick and all efforts to cover them failed but the manager was not allowed to ring agency. After informing the Area health authority, in case anything untowards occured like 2 emergencies at once, we had  a very busy shift without  a break in the 12 hours. Many tube feeds to do and poorly residents. Nor wopuld day staff agree to come in a couple of hours earlier- I rang them myself. Happens a lot.

Worked one day in  a nursing home. Care assistants pleaded with me to take action regarding the condition of  aresident's legs. They had been like it for 6 weeks and no doctor had been rung by the nurses, who happened to be from overseas. I rang the doctor who came and also expresed alarm that she had not been contacted, Of course I made full records.This tale tells us a few facts. Care assistants do report to nurses (not always we know) . When no action is taken, the care assistants are at  a loss regarding what to do. I knew nothing about the manager in this case. If they too were registered, it may well place on them additional responsibility and awareness- hopefully by standardised education .Overseas nurses are inadequately trained when they arrive in the UK (Dimon 2013). Regualtions, procedures and culture differ. In some countries pain patches do not exist for example, nor do specilaised nurses such as tissue viability nurses. Pressure care equipment and procedures wil differ in many countrirs. Indeed in some, doctors are not involved at all in nursing homes (have references). Apart from that, attitudes differ to eg pain . This all warrants further reserach but nobody will do it. Far easier to ignore the situation and blame overseas staff by requiring their attendance at NMC hearings.

Unfortunately at all levels in care, and also in other professions, there are many who prefer not to challenge the status quo. Many old, retired care workers remark, it was the same in our day. Then why was nothing done, and why do some of them block anybody else's attempts to do anything? Could it be guilt or do they believe others are saying that they know more than them? Time everybody worked together and listened.

People who dare to speak out against  intentional abuse (locking in cupboards or dungeons) or unintentional abuse, are crucified by all levels- staff and higher powers, See book the commodity of care- offers some analysis.

ie must all keep job. fear loss of work. fear repercussions. need to be same as group. want promotion. Bullying. Nobody listens or believes.

Another case in a private care home- Devon (Gregory 2013). Residents with leaning difficulties,  put in a dungeon , locked in with a mattress. Eventually, somebody informed CQC. Meanwhile, the Govt insist they are not responsible for the private sector. How could you Mr Hunt? There are many such poor examples of care ( all sectors) across the country, and abroad. Yet only so many hit the national press. Meanwhile, campiagns focus on the NHS .

Article. mailonline (2013) A Gregory

see book updates qualityofnursingcare.webs.com