Nursing Times Award Winner

Why sensitive interpretation of hospital rules is so important

The lady in the single room was clearly very agitated. As I arrived on the ward with a group of students, I could see how anxious they became when they heard her distressing screams for help wafting down the corridor.

The students were all doing a Level 3 Public Service course. Several wanted to go into the Police Force, some to the Army, some to the Ambulance service. One young boy’s ambition was to work in Border Control. That afternoon, they had come to the hospital, through Kissing it Better, to chat to patients on the Stroke unit and to find out, hopefully, about Public Service many years ago from the older patients who had served their country during World War II. In their smart college uniforms, they caught the attention of patients and their relatives, many keen to share their memories of their own working life in another era.

As we walked down the corridor, all was quiet, apart from the noises coming from Room 3.

I knew the lady. The previous week I had watched as beauty therapy students from the same college massaged her arms as part of their work experience on the ward. She had been shouting then, too. But not while they gave her their gentle treatments.

As a rule, students who work with Kissing it Better do not work in single rooms. It makes supervision difficult and there are other reasons why it is better to leave those patients alone. Some are in single rooms because they are infectious. Others may be having treatments that affect their immune system so are at high risk of catching something from us. Some are in a single room because they benefit from the tranquillity.

But the lady we could hear that morning did not fit into any of these categories. She had severe dementia and she was crying out because she didn’t know where she was. She was frightened. Lying in a bed with cot sides up, completely alone, she was not able to escape. Her screams were cries of frustration similar, I believe, to a tiny child who has just been placed in their cot in their bedroom and suddenly feels abandoned.

I explained to the team that the lady wasn’t dangerous. She wasn’t mad either. She was just angry and very confused. I assured them that she would calm down the moment I entered her room. I checked with a member of staff if it was alright to go into the room. When she said it was fine, I suggested the students wait outside the room, and observed me, discreetly from a distance. But the three students were determined to join me.

As I expected, the moment we walked in, the lady stopped shouting and gave me the most lovely smile. I shook her hand and I introduced myself, and my team, and explained a little bit about them. She gave them a smile too and then said, very quietly, “It’s a privilege to meet you all.”

The next fifteen minutes were a delight as we gently chatted to the lady about the course the students were doing. Seeing some family photos on her table, we talked about them and, in her own way, she explained that the pictures were of her family.

At the end, we shook hands again, and said our goodbyes, assuring her that we would be back again the next day. Then we left, leaving behind a much calmer, happier patient. I had no doubt that, if she was left alone for any time, she would start shouting again. If only there were more people around to sit with her for longer.

The students were clearly very moved by this experience. Although we had explained about dementia, hearing the lady’s cries had been very disturbing for all of them. But having spent time with her, they now understood why she was so upset. I felt confident that they would now be able to deal with a similar situation, whether it was another patient or a member of their family.

Later that day, I met a member of staff in a hospital corridor and told her the story. When I reached the part where I had shaken the lady’s hand and watched her instantly calm down, the member of staff opened her eyes wide.

“You’re not allowed to touch patients,” she informed me curtly. “And, had you washed your hands and checked that you weren’t wearing a cardigan or any jewellery? Failure to do so is an infection risks, you know,” she added unnecessarily.

I do know to check those things. The lady who challenged me knew I had been DBS checked by the Trust. I realise we have to be careful. But her obsession with highlighting any lapse of protocol, rather than appreciating my uplifting story, was both irritating and upsetting. I am a responsible person who has worked in her hospital for several years. She should know I would adhere to the infection control guidelines.

But, surely, the greater good is that I should shake the hand of a frightened 88 year old lady. And the students, under my supervision needed to do that too. She has stretched out her hand to them and it would have upset her had we not reached out to her too. It was our way of telling her we cared. Our way of showing her that we had some time for her. Our way of saying we respected her.

Hospital rules are there for a reason and should always be observed in a way that is of maximum benefit for the patient. But, far too often, rules are so stringently applied by some staff that they do far more harm than good. And that’s when huge issues can arise.

To NOT visit that lady on that afternoon would have been so sad. She would have remained alone and the students would have missed the chance to engage with her and listen to her gentle stories. A great intergenerational meeting of minds would not have happened and the world would have been a worse place for it.

Think for a minute if that patient had been in my own home. Would I have left her to scream for hours on end if there was anything possible I could have done to distract her? The answer is that I would have welcomed anyone who understood her and who cared enough to spend some time with her. Had the patient been a child, I’d have gone to endless lengths to ensure I had countless distraction techniques up my sleeve that I could call upon whenever they were necessary. The ward staff knew me, and appreciated my concern, so why was the first thought of someone who wasn’t a nurse or even on that ward, to pick up on what I may not have done rather than what had gone well. It was utterly demoralising to be chastised in that way when I was hoping that person would be uplifted by our wonderful encounter with a very special lady.

It would be easy to be annoyed with the member of staff who told me off. But was it her fault? She is a member of middle management - someone who is told the rules and instructed to apply them. These rules come from a higher level and it is important that those who put them in place make it clear that they trust those who are applying them to do so in a sensible way. To suggest that I might shake someone’s hand inappropriately is, surely, ridiculous.

But that member of staff did not burst my bubble for long. Responding to one patient’s cries for help, and seeing how spending a few precious minutes with her could make such a huge difference, had been the most memorable part of the afternoon.

And the students learned so much too. At the end of the week, their tutor remarked of his students:

'I have seen them grow in maturity before my eyes as they gain a great understanding of some of the most vulnerable people in their community.'

Across the country, Kissing it Better works with schools, colleges and universities to bring students of all ages, studying specific modules, to share that knowledge with, mainly older, patients. Many of these patients have some degree of dementia and benefit massively from having the chance to recall their long term memories of their own youth. To see the laughter, understanding and, often, mischief that grows between them brings massive benefits to them all. These valuable links, constructed with extreme care, also help older people appreciate that their own community outside the hospital has not forgotten them.

Jill Fraser

Jill Fraser

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