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The bells, the bells...

A few weeks ago, my teenage daughter was at home, on study leave, revising for public exams. I had to nip out and, as there was no one in the office, I asked her if she could answer the phone and take any messages while I was away. Much of our work involves dealing with older people, and many are not comfortable about leaving a message on an answerphone.

When I returned in the afternoon, I asked if there had been many messages. To my surprise, she told me that she had no idea as she'd put the answerphone on within an hour of me leaving. I was horrified. I hadn't thought it would be a particularly onerous task and she has a lovely, confident manner on the phone. So, what was the problem?

Hastily she explained that, the moment I left the house, the phone started to ring. She had answered it and taken a message. Then it rang again, and again. After half an hour, she realised she was not getting any revision done as the phone was seriously affecting her concentration. Even when it wasn't ringing, knowing it would spark into life at any moment was becoming a huge distraction. She, correctly, rationalised that I would rather she worked for her imminent examinations than waste a morning fussing about the calls.

So I wasn't annoyed. But the explanation had made me think. If she could be so distracted by one phone ringing, how do nurses feel when not only the phone but the patient bells and the bell to let people onto the ward keep ringing all day long? Of course, in theory, patients and visitors should expect to be dealt with promptly by a smiling member of staff. But, is it any wonder that there are times when callers not only have to wait, but have to deal with a less than cheerful nurse when they eventually respond.

So, what's the answer to what many see as a significant breakdown in communication?

Across the UK, wards are locked. Unless you have a 'swipe card' or the code, you have to ring the bell and wait for someone to come to let you in. Modern wards often have a long corridor from the door leading up to the main ward area and a significant percentage position the nurses station out of sight of that door.

So, the door bell rings and often there is a delay while staff wait to see who is going to answer it. The staff are all busy and everyone is hoping that someone else will respond. Often the person waiting to enter has to ring again. When someone eventually responds, all too often they either open the door remotely, without checking who it is, or else rush up and press the button, turning to leave without waiting to greet their visitor or to ask them if they need help.

Either way, it is not a good first impression. The visitor is often annoyed by the indifferent approach to them which, inevitably, makes them anxious that this attitude might be extended to the patients. Also, they may be worried that, once inside, that person has not offered to help them find where they have to go next. They may be concerned that the security of the ward has been compromised because no one has asked them who they are or why they have come.

And of course, even if they are asked, how many people are going to admit that they are a burgler, rapist, or someone intent on causing other harm to a patient? I have never been asked to produce any identification. So, why lock the ward? Some staff say it is to stop patients escaping. But, in nearly all cases on general wards, including care of older people, there is a large button next to the door on the inside that will release the lock and let them out.

Of course staff have to be careful, but locking the door may not be the right solution. Just like my daughter, staff find the constant interruption of a ringing bell hugley distracting and, all too often, it ends up making them irritable. Added to the patients' bedside buzzers, the same noise continues intermittantly all day, annoying patients and their visitors and often causing huge stress to staff who are doing their best to fulfill an endless list of jobs. After a while, some people are seriously affected by the noise. So, is it any wonder they look less than pleased, or interested, when they open the door to an unsuspecting guest.

When I was a student nurse back in the late 1970s, I spent many months on the traditional 'Nightingale' wards - one long room with beds either side. We were told that whenever we left that area to go to to sluice, a treatment room or a meal break, always to ensure that another nurse or member of the medical team was in sight so that the patients could feel reassured that they were not abandoned. They all had bells but they rarely needed to use them. The combination of our darting eyes and constant bustle was enough to ensure that we could anticipate many of their needs before they needed to call us. Often a reassuring smile or a nod from us was enough for a patient to know that we knew they wanted us and that we would be with them as soon as possible.

As new hospitals are being built, more and more have small bays of beds and single rooms with en suite facilities. Most patients, when they first arrive, love the idea of this more intimate environment and, initally, don't see the disadvantages. Although staff do their best to monitor patients as regularly as they can, prioritising those in greatest need, as they are not all 'in sight', means there are inevitably times when patients are forced to ring the bell with no knowledge of when it might be answered.

Across the country, many hospitals have devised imaginative ways of making open wards feel more private and also designed wards where patients in either small bays or single rooms can feel less isolated. In the Edinburgh Children's hospital, many patients undergoing chemotherapy are nursed in large wards where each bed is surrounded by a floor to ceiling glass wall allowing the children and their relatives to see what's going on around them without increasing the risk of cross infection.

Sometimes something as simple as turning a desk round so that a bay of the most poorly patients are directly in view of the most senior nurses can not only make nursing them safer but also save large amounts of time. Many patients receive huge reassurance simply from a smile or a knowing look that makes it clear that someone in authority is keeping a close eye on them. Add to that things like ensuring that patients are in view of a clock, so that they know when it's visiting time or a lunchtime or the timing of a doctor's visit are other simple ways of reducing a patient's anxiety and, as a consequence, the number of times they needs to ring that bell.

Being greeted at the door by someone with a friendly smile (our volunteers are keen to help with this) would be a perfect way to make a visitor feel welcome. Perhaps relatives of long-stay patients, who are well known to staff, could be offered swipe cards for their ward doors. This simple gesture would not only save them hassle, it would also make them feel special. Encouraging volunteers to sit and offer simple entertainment and distractions to the more agitated patients would also reduce the times those patients used their call bells. And ensuring that the desk is in sight of the the main door as well as the most vulnerable patients, either directly or through the cunning use of mirrors or, maybe, a cleverly positioned camera, could also reduce to stress caused to everyone by those endless bells.

Jill Fraser

Jill Fraser

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