Bob spent his first week back at the RAH in Ward R8 and it has been a nightmare. This ward is not a geriatric ward and is more general, but is still a locked ward. It has women only rooms and there is a constant beeping as machines monitor the patients and the nurse call bells keep being pressed. There is a constant hustle and bustle in the ward with people always in the main hallway as doctors, therapists, nurses and administrators cram into tiny bays to document the medical changes with each patient. I do not know how the medical team can think as they have up to 10 people in a bay/station in a space that is only 4 metres long and 2m wide. I can see how information would get lost and how mistakes could be made as the environment is often one of disruption and sometimes chaos.
The conversations between people are very public as they have to be had in the main hallway. There are sometimes patients in beds actually in the hallway due to overcrowding. The nurses set up a temporary screen to try and give the patient some privacy, but it is so public and so undignified. The patient is also not safe as wandering patients can grab at the person in the bed and are almost tempting for the mental health patients. As I am a people watcher, I quickly sum up the situation with many patients and work out the routines and personalities of the nursing and medical teams. I usually find out who is in charge (ward manager), introduce myself and then give them the lowdown and caring tips for Bob.
The doctors usually do their ward rounds between 8am and 12 noon. We are often desperate to to catch the doctors, but it is a frustrating wait as they usually come past us at 11.45 at the end of the round. We anxiously wait for hours and often miss them when we have a coffee break or toilet stop. I tend to stand outside the locked doors as I can see all 3 locked wards from this vantage point (R8, S8 and Q8). I look to see when our doctor has entered a ward and can estimate when they may reach us. This time round we were desperate to speak with the doctor to tell our latest story but have a much more low key approach this time as we know we have limited options and ‘saving’ Bob is not an option, this time we are managing him.
The hospital facilities are really run down and no money is being spent on maintaining them. The side rooms are better than a ward, but the setup within them makes for a very frustrating stay. The super thin single cupboard has no hanging rail so all the clothes are piled up on the bottom shelf. Every time you open the cupboard the contents have to be collected off the floor. The window ledges are too narrow and the same problem happens. There are no shelves anywhere and the ledges over the sinks are so thin your toiletries bag usually ends up in the sink. Some small carpentry work could alleviate the problems. I understand the new RAH room will be like hotel rooms, however we have a long way to go before then and some maintenance is long overdue. We don’t care what the rooms look like, but they have to be functional and more shelving would eliminate much frustration as we often have to work fast to grab clothes, pull-ups, towels, cups etc very quickly due to Bob’s behaviours. Shower heads are hand held and will not stay on the wall which means you have to shower the person one-handed, which is extremely difficult. We are trying to protect ourselves at the same time and the setup is simply not suitable.
Bob is now probably the most difficult patient in the ward as he is mobile 95% of the time and will not engage in any activity for longer than a minute. This means he is in the main hallway day and night and often tempted to enter the wards. Bob heads for the locked glass doors every 10 minutes and shakes at them and tries to find a way out of the hospital. The doors were recently fixed but are now once again broken as Bob had ripped the doors apart in a rage and damaged the closing mechanism. Bob has been allocated a ‘nurse special’ 24 hours per day (refer ‘nurse special’ post). They follow him for 8 hours at a time and try and interact with him and keep him out of trouble.
Due to the decline of Dad’s brain his behaviour is nothing short of unpredictable and violent. I do not use the word violent lightly, but is the most accurate description this time round. He will lash out at whoever is in reach when his behaviours escalate and he is in need of medication to de-escalate them. We have timed the meds effectiveness and it takes 45 mins for the prescribed meds to take effect. This means the staff have to identify agitation early and get the meds into Dad before the ‘window of opportunity’ closes and he is too wound up to take them orally. Once the meds are in we have to distract him until they begin to take effect. This is a various tense time and we are all looking for signs of de-escalation. Extra staff tend to be drawn into the situation as Bob becomes verbally aggressive and yells out and hits out at people and the equipment.
Bob engages most people as he walks past them and often grabs at them. This is confronting for all and difficult to handle. His brain decline is at a stage where previous calming strategies no longer work, and he has very little reasoning. This means that changing his pants could take multiple attempts across 3-4 hours and we may not have any success at all. Showers used to be done daily in the nursing home by family members, however we now can rarely get Bob calm enough to have a shower in the hospital. We continue to attempt, but often his behaviour dictates how this goes. Nurses tell us patients from other cultures may not wash for weeks, but we continue to attempt each day regardless.