‘I don’t think they care’, was Hubby’s summation of the nurses behaviour, I just think they are thick.
Yes, we have just returned from visiting son. He has been vomiting, he is not eating and is hardly drinking. All his tubes have been removed and he is on his own, as are the other patients in his bay. In the 5 hours we were there the staff spent a total of 10 minutes in the bay, they served dinner, they did a drugs round and they conducted a temperature, blood pressure and pulse check and during those times I didn’t hear them ask one question. The man in the bed opposite son vomited everywhere, as he started being sick son rang his call buzzer, I put on gloves, grabbed some tissues and helped him out. Another visitor found a bowl, as he had filled the first and I cleaned the patient up, made sure he was comfy and then found a nurse. I gave her the full bowls, and that was that. No one came and checked on him, they obviously weren’t concerned. Meanwhile son said that he hadn’t passed urine for 7 hours, since his catheter was removed. I asked if his bladder felt full, no. Looking at his fluid balance chart I noted that it hadn’t been completed, neither had his stoma chart. Twice son was sick, deep green and 500mls each time, I know because I measured it when I took the bowls to the sluice. I told the nurses, they were not impressed and neither did they feel that it was necessary to come and check that son was okay. Hubby went out and found a doctor. She was the cover for the weekend and knew nothing about son but said that she would read his notes. DIL came in, looked at son and burst into tears, I knew how she felt. I went out to the nurses station, and waited. The doctor came up first and I outlined my concerns about the lack of communication and asked to see son’s care plan, there isn’t one. Okay then, I asked to see the nursing care plan, same outcome. A nurse scuttled past so I spoke to her, she ignored me so I followed her and suggested that it would be better that we spoke in the corridor than in front of the patients. I told her that I was concerned about son, she told me that he was fine. ‘Oh, good. When did he last PU, and how much? How much did he vomit? How is his stoma and what are the contents? Have you requested that he be prescribed new analgesia since his PCA (morphine) was discontinued? Where is his care plan and fluid balance chart. Has his wound seeped at all? Are you aware that he hadn’t yet PU’d?’ She had an answer for that one, ‘It’s not unusual not to pass urine for some time after a catheter has been removed’. ‘Really, for 7 hours? Wouldn’t you want to check if they had a full bladder? If it’s not full wouldn’t you be concerned that they may be dehydrated or that the kidneys were not functioning? ‘. ‘Well he told me to remove the catheter, he told me the doctor had said it could come out’. ‘WHAT? YOU DID IT BECAUSE THE PATIENT TOLD YOU IT WAS OKAY? IT WASN’T WRITTEN IN THE NOTES?’
Suddenly the cavalry arrived, the doctor had called her registrar to attend. Hurrah. It was all systems go. Bladder scan revealed 70mls of urine, that is giving an output of 10mls per hour, the average is about 30 – 40 mls per hour, son is either dehydrated or there are problems with his kidneys. I favour dehydration as the cause, but bloods have been taken for kidney function and also to rule out infection. Fluids, with a potassium additive have been commenced and an abdominal X-Ray has been requested.
At last, we have action. I’m furious with the nurses for failing to keep the records which should have alerted them to problems. I’m amazed at the surgical teams lack of a care plan, where is the continuity and how is a stand-in doctor supposed to provide the best treatment? I feel sorry, and concerned, for anyone on that ward who does not have an advocate as we timed how long it took for a response when a call bell was rung, 40 minutes, unforgivable, inexcusable and dangerous. On Monday I shall be having a chat with Matron.