THE HOSPITAL SYSTEM UNDER STRESS IN AUSTRALIA

Imagine a health system where sick people are given painful injections, unexplained medication and their blood is taken regularly but apparently at  random.  Imagine patients being woken at any time of night or day by the above intrusions or the noise of a machine blaring its need for service; a patient in distress or one or more professionals performing an intervention with another patient.  It is well known that lack of sleep and intermittent pain are proven torture techniques.  But all the preceding is being done in the name of medical treatment designed to promote health.

I spent 5-6 weeks at the tender mercy of the Australian hospital system.  I spent time in two separate hospitals and my experiences in the first hospital was definitely better than in the second.   Following my discharge, a counsellor asked me what I was going to do with the anger I built up over my inpatient stay, and this article is my response.  (My GP also suggested I might help improve the system by giving the hospital my feedback.)

My main impression of being an inpatient is that staff were so busy they had no time to care about the people who were dependent upon them.  Staff had tasks that had to be done and any other patient needs or crisis of care only interrupted their  schedule.  Nurses were generally pleasant, but I never felt appealing to staff would be productive.  Nursing shifts seemed to rotate staff swiftly and randomly through the ward, and I never got to know anyone, beside the cleaner, well enough to really bond with them.  Separately, two trainee nurses were rostered onto my ward.   I asked both trainees  why they wanted to be nurses.  Both answered they wanted to ‘care for’ people.  I was baffled by these students apparent lack of comprehension that nurses had no time to really ‘care’ about, or for, their patients.

Below are some of my most repeated stories:

I have never been so tired and unable to find times when I could expect to sleep uninterrupted.  I got used to sleeping no more than a couple of hours at a time and (pre operation) wondered how I would ever be able to recover from an operation under such conditions.

Several times I woke in the night to a nurse trying to take my blood without waking me.  Why would anyone think that was possible, or indeed a good idea?

The four bed ward, I spent the majority of my time in, was cramped and noisy with windows available to only two of the beds.  I was one of the lucky ones and believe me, I felt lucky.  Cubicles were crowded with machines, a visitor chair, bedside table and over bed table and had little walking space.  Wards were mixed sex and several times I was eating a meal and could hear a man urinating into a bottle only a few feet away, on the other side of the cubicle defining curtain.  This was difficult for me (even with my liberated 70’s adolescence) both in terms of noise and nausea, it must be so much harder for women from cultures that separate the genders more strictly.

Machines that were designed to call attention to a problem, by increasingly loud beeps were rarely attended to quickly.  It was as if alarms were deemed unimportant background noise, and maybe they were. 

Several times I called a nurse and the response took over 15 minutes.  Once, at night, I was asking for pain relief and, although the nurse responded within 10 minutes, no one returned with the medication for over 30 minutes.  Once a nurse said she was not ’my nurse’ but would advise my nurse.  It took more than a further 30 minutes for ‘my nurse’ to appear.  A total of almost an hour from the first time I called.  Let me be clear that I didn’t call nurses frequently or without good reason, as I was well aware of how busy they seemed.

There were no sound baffles within this ward and the noise was almost constant and constantly varied.  There were the noises made by unwell and hallucinating patients, their bodily functions, coughs etc. and the machines serving them.  Several times patients were transferred in the early hours of the morning.  These patient transfers were accompanied by the noise and commotion of professional staff settling the patient, commenting, questioning and generally discussing the case for an hour or so.

I was woken every night for ‘observations’.  These procedures included weighing, ECG (involving changing 5-6  stick on monitors, and accompanying electrical leads and attaching to a hard wired machine to take a photo and transfer the image), and blood pressure monitoring.  ‘Observations’ needed to be completed prior to handover from night to day shift nurses.

On my first night at the second hospital I was woken by a half naked, elderly woman, opening my curtain to tell me we had to evacuate as ‘they’re all trained assassins’.  She then moved on to other cubicles before nurse intervention was able to attend to her obvious delusions.  Other ward occupants cried out in their sleep, responding to dreams or hallucinations.  I assumed that some patients had mental health issues or were reacting to medication.  Interestingly I was not offered anything to help me sleep.  Perhaps this was situation normal for staff.

The ward toilet had all the charm and cleanliness of a public facility.  It often smelt of urine and was probably cleaned once a day.  It consisted of a basin, mirror and toilet only.  Several times equipment was left on the floor for days.  I was there for about 4 weeks and the door became increasingly hard to open or close (sticking on the door jamb).  I mentioned this to nurses on the ward and then the staff in the administration area.  Nothing seemed to change whilst I was there.  There was also a shower room, with a plastic chair and no shelves for patients items, although there were handrails and a couple of hooks for clothing.  I’m not sure whose job it was to clean up after showers.  However, wet towels etc were frequently left in these cubicles, for many hours, after their last use.

Privacy seemed to be of little concern to most staff and I repeatedly had to ask for curtains to be closed before intimate procedures occurred (such as changing the electrical conductors stuck to my chest).

Following my bypass operation I spent some days in the Intensive Care Unit (ICU). When I was moved from ICU I was given about an hour’s notice from , ‘we may move you’ to’ ‘here’s the bed we’re using to transfer you’.  There even seemed doubt about exactly which bed and ward I was going to, until the transfer had begun.

Discharge was similar.  After my operation, each morning, two separate groups of cardio experts (about 4 to a group) swanned in, one group saying I could go home now, the second that I should be kept for a few days to settle medications etc; this was confusing for nursing staff and me.  Nurses had to follow up with them and sort out the conflicting advice.

Amongst the other issues I was either impacted by or simply observed were:

• I was never advised by staff that there was a separate place I could sit with visitors and or get myself some water, a cup of tea etc,  I’d already spent weeks in this hospital when, after observing other patients with cups, I discovered the patient kitchen.
• Corridors between patient cubicles were very narrow and often crowded by groups of professionals conversing about patients; or nurses typing their case notes.  Nurses were forced to write their case notes on their bulky,  mobile computers /medication dispensing consoles, wherever they could find time and space.

Perhaps my most unnecessarily distressing experience was having the wires (from the operation) pulled out of my chest at the nurses convenience with no regard for my needs.  She chose to extract these wires at a time when my (one hour a day, Covid  19 restricted) visitor had just arrived.  My visitor was asked to wait whilst she pulled the wires out.  She  then advised me that I needed to lie flat for half an hour.  Surely this could have been timed differently!

Finally, I was repeatedly told, by specialist consultants, the increasing percentage of likelihood I would die during the approaching operation; or that it may be less than successful.  However, I was never offered any advice about what support I could use in terms of a bra that wouldn’t rub on the healing wound where my breast bone had been severed.

I can’t help wondering if this lack of time for patient care has flowed from the introduction of Casemix funding.  I happened to be working in the head office of the Victorian Health Department when Casemix funding was introduced.  Casemix introduced a funding allocation process which severely restricts the time and resources which can be allotted to each procedure.  Officially “It refers to the use of classifications that bundle patient care episodes into clinically coherent groups that require similar resources.” (from the Victoria State Government ‘health.vic’ website)

It presumes that all medical procedures can be predicted in terms of intervention time taken and patient needs.  I wonder what impact on nurse moral, staff retention and patient recovery allowing a more flexible response for patient ‘care’ would provide; and if this would be more cost effective in the long run?

Lastly, perhaps we could all imagine a hospital system that has the time to connect, personalise and really ‘care’ for the people it treats.  Perhaps we can put the idea of wellbeing back into wellness.  Who knows, perhaps wishing can make it so?

Alison