Nursing Times Award Winner

It's all about the little things

The old lady had been transferred from her bed to a chair. The nurses who had moved her had been kind, but the ward staff were all busy. Assuring her they would return to give her a wash and make her bed when they had a moment, they left to do other tasks.

The lady looked sad. She was very frail and very quiet. She looked down. Her nightdress was marked with some of the remains of her breakfast and her hair had not been combed. But far worse, by her side, the bottom sheet of her bed was soiled, and exposed. She felt mortified.

No one who passed by her that morning thought how she might feel about her dignity being so badly compromised. No one thought how they might react if they were on show with a dirty nightie and a dirty bed, exposed for all to see. No one thought that, if they were too busy to do anything about it, how little time it would have taken to ask a nurse or healthcare assistant to put that horror right. No one wanted to take any form of responsibility for righting a wrong.

The same can be said for a drink that is out of reach, or a table that needs wiping before a meal is placed before a patient. None of us would choose to sit at a dirty table, or want to be unable to reach a drink if we were thirsty. And all of us would feel hopeless if, in our hour of need, those passing us by were too busy to stop and offer some help.

Yet, it is doing those small,but vital ,things that can mean the most to patients. It will always be those little acts of kindness that they will remember the most. Moving a bedside table so that a patient can reach their book, tissues or a drink. Picking something up that has fallen on the floor. Passing on a message. Ensuring a buzzer is in reach. These are all small gestures that can make an enormous difference.

When I was five years old, I had pneumonia. I was very poorly for two weeks. Once the acute stage had passed, I was allowed to sit up in a chair. One evening, a strict nurse had given me a portion of chocolate sponge and told me I had to eat it all. I don’t like chocolate pudding. I didn’t want to eat it. But I was scared of the nurse. I didn’t know what to do.

Then my doctor arrived. He saw me looking sad, found out why, and ate my pudding. Winking at me he then left. When the nurse came she was pleased about the empty plate. I didn’t say anything.

My wellbeing would not have depended on me eating that pudding. The doctor knew that. But my wellbeing was vastly improved when the doctor ate it. He had made me smile, made me feel I was part of some mischief and, in doing so, cheered me up more than anything else had done for days. Over fifty years on, I shall never forget that moment – so forgettable in the doctor’s mind, so memorable in mine. I wonder if he ever thought about the difference he had made simply by putting himself in my shoes for a moment. Perhaps he had been starving and simply wanted the pudding more than me. But that wasn’t how it seemed at the time.

And then there was the time I spent the afternoon on a hospital ward with my mother, following her massive brain haemorrhage which left her unable to speak and with almost no conscious movement.

I had left her at about 3.00 to take my son back to university. I returned at 7.00 and, when I saw her, I realized she was covered in tea and was crying. In her hand she held a minute piece of tissue and she was obsessively dabbing the stains on her shirt. When I touched her arm, I saw that her shirt was dry. This was tea that had been spilt at tea-time, over three hours earlier. No one had noticed.

I went to the nurses’ desk and told the person in charge. Clearly embarrassed, she told me to wait at the desk while she sorted it. She pulled the curtains around my mother and, together with another nurse, she set about changing my mother’s clothes. I didn’t hear any conversation behind the curtains. It made me very sad.

While I waited at the desk, a student nurse appeared. She was working at the other end of the ward so was not, in any way, responsible for my mother's care that day.

I asked her how long she had been on the ward and she told me she had only been there two days. I asked her how much she knew about strokes and other brain injuries and she told me that she knew very little. She would be taught that information, she told me, during her time on the ward.

As a former Staff Nurse of a similar ward many years ago, I spent a few minutes telling her my thoughts. I told her that every one in the ward had sustained brain injuries that had left one or other side of their body damaged. Some people had lost their speech. A couple of people could not move at all. I then told her that she needed to consider what they might be worrying about as they sat in a chair or lay in bed. Questions would fill their minds. Would they ever be able to work again? Would they be able to pay the mortgage or rent? Would they be able to have sex with their partner? Would they be able to eat without dribbling? Would they be able to walk the dog? Or would they, ever again, be able to drink a simple cup of tea without spilling it on themselves?

I then said that when my mother spilled her tea and nobody at her end of the ward was there to help her for three hours, she must have thought her life was truly worthless. For, during those hours, she knew that nobody near her thought this frail older lady sitting quietly in a corner could have been their wife, their mother or their friend.

A few moments later, the curtains were pulled back and my mother was back in bed. Wearing a clean nightie, all physical evidence of the spilled tea had been removed. But deeper scars stayed forever. I kissed mum and she held my hand.

We can all remember those times when someone did something small but deeply significant. Equally, we remember when they don’t. Sometimes it can be as simple as a stranger giving you a lovely smile when you are feeling very lonely or upset. But, when that happens, you smile back, and that makes their day better too.

The best work is good teamwork. It is much discussed in the NHS. Multidisciplinary teamwork is thought to be a key part of a patient’s good care. But that is not just about a team of people coming together on a set day to discuss someone’s condition. It starts by a team working together on the ward, doing the little things and, in doing so, making life better for everyone, including themselves.

Jill Fraser

Jill Fraser

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