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Memories of a researcher – page 2

Extract from:

David May © Day in the life of a ward in the 1980s

The Patients

The patients are accommodated in either one of the two large dormitories, which are referred to by the nurses as the ‘babies’ end’ and the ‘big end’. Table 1 compares the two groups in terms of age, height and (dis)abilities. Note that the patients in the ‘big end’ tend to be older and more able than those in the ‘babies’ dormitory. The designation ‘babies’, it should be noted, is not particularly related to chronological age or physical size; it is largely determined by ability, or more precisely, the level of nursing care required. Some of the largest patients are to be found in the ‘babies’ ‘dormitory.

Staff and Staff relationships

The ward has the usual complement of nurses. In addition, there are two house-keepers and a ‘bed-maker’, who when the need demands will function as an extra nursing assistant. As is typical throughout the hospital, Ward 14 relies heavily on input from student nurses, who rotate through the ward on six to eight weeks placements.  When students are not available there is a corresponding heavy demand on the permanent staff.

Various consulting and other health care staff visit the ward from time to time, some more often than others, to advise, assist and work with nurses and patients. The main groups are the teachers and the physio-therapists.  The latter usually visit the ward a couple of times a week.  They work with these severely disabled children to improve their very restricted mobility and lessen the possibility of their developing windswept positions, placing them in special chairs, wedges and other improvised supports which are scattered around the room.  Because the time they can spend with the children is so limited, they are keen for nurses to learn these techniques and become involved in the work, if only to reinforce their efforts.  But as Sister noted, usually when the physios arrive on the ward, the nurses will have just completed several hours of hard physical work with the children and have little energy, or enthusiasm, for this.  In any event, nurses for the most part don’t regard therapy of this kind as forming an integral part of their responsibilities; role segregation is highly pronounced throughout the hospital.

Teachers from the hospital school visit the ward daily. They work with those children who are unable to attend the hospital school itself. Recently introduced legislation obliges the hospital authorities to ensure that these children receive an ‘education’, although what counts as such in these cases is little more than limited stimulation. And, it should be noted, there are some children on the ward who are unable to make it even to this level. Once again teachers, like the physiotherapists, would want to encourage nurses to work alongside them, learning their methods, in the hope of extending the work beyond the school day, but once again they encounter reluctance. The ward sister accepted that in principle nurses should be spending more time working with the children on an intensive, individual, basis, but felt that in practice, given the overriding demands of the daily ward routine, this was not practical. In any event nurses were generally of the opinion that the inevitably limited time they would have for this work would make little impact.  For their part the teachers were uncertain of their responsibility for the physical care of the children when in their charge.  For example, it was not entirely clear (to them) who was responsible for changing the nappy of an incontinent child.  They were aware that Sister was not happy with non-nursing staff performing this task and when nurses were present it was usually left to them, but their presence could not always be counted on.  They – the teachers – also felt ill informed of the medical needs of the children; for example, whether with some children certain postures and positions were to be avoided or they should not be exposed to sunlight because of their medication.

Daily Routine

The day begins with the arrival of nurses on the day shift at 7.30am. The night shift staff will already have got several of the children from the ‘big end’ up and they will be in the dining area waiting for breakfast to be served.  The day staff usually take a 10 minute tea break before starting work during which time they will decide who will be working in which dormitory that day, although the usual practice is to alternate.  At 7.45am the nurses begin preparing breakfast.  Only the children in the ‘big end’ are fed in the dining area, so the nurses working in the ‘babies’ end prepare a trolley to take through to the dormitory.  A table is placed in the middle of the room, at which the nurses sit to feed the children, holding them in their arms.  Children who are too heavy to be fed in this way are placed in their wheel-chairs.  Most of the children in the ‘babies’ dormitory have eating problems and require a liquidised diet.  All but one need to be fed.  The one exception is a child who is being encouraged to hold his spoon himself and is placed at his own little table and given a great deal of assistance and encouragement from a nurse.

Of the children (from the ‘big end’) in the dining area, nine require to be fed, four can participate to some extent in the process, although they still need a good deal of assistance, and five can eat unaided from a bowl with a spoon, although this can prove a rather messy and not very efficient affair. Sister, however, is keen for patients with even minimal self-feeding skills to be encouraged to use them, but at breakfast especially when staff are under some pressure to get the children ready for school this is an aspiration more often than not disregarded.

The children in each dormitory are divided into three groups of five or six patients. Each group will contain a roughly equal number of light and heavy-care patients.  The names of the patients in each of the groups, together with their feeding requirements are set down on lists which are pasted onto the wall.  These lists also identify those patients who are to attend the hospital school that day and are to await the school bus.  Three nurses are assigned to each of the dormitories and they will decide among themselves which particular group of patients they will take charge of that day.

For each group of ‘big end’ children there is a trolley, kept in the bathroom adjacent to the dormitory, containing basins and toilet bags for each child, paper rolls, nappies, talcum powder etc. Once the children have finished breakfast they are returned in turn to the dormitory to be washed and dressed in their day clothes.  The first two beds, which are covered with towels to prevent soiling, are used for this purpose, with two nurses sharing a bed.  Children whom the night staff may not have got up and therefore have not been taken into the dining area for breakfast are fed and dressed separately on their own beds.

The ‘babies’, who have remained in their own dormitory for breakfast, are, once they have been fed, put back on their own bed to be washed and changed. Each child has a locker beside his/her bed in which his/her basin and toilet bag are kept.  These children also have their own towels, also kept in their locker, whereas the ‘big end’ children share a communal supply of towels.  Soft paper rather than face cloths is used to wash the children.  All, with the exception of two ‘big end’ children, require nappies.  The recent strike by the laundry workers caused Ward 14 staff many problems.  Nappies were in short supply and towels would often have to be used in their place.  The lack of towels at lunch-time resulted in dirty jerseys or frequent changes of clothes.

During the breakfast ‘change’ there is little interaction between nurses and patients as the nurses are very much pressed for time. One nurse is usually assigned to assist Sister with her extensive drug round.  When staffing levels are really low Sister, or the nurse in charge, will have to see to one of the groups in addition to doing the drug round.

Some time between 9.00 and 9.30 am the bus arrives to take the children to school. Two children attend outside, local authority, schools: one Coldside (under previous legislation, the old J.O.C.), and the other Lochee primary school.  Those children who attend the hospital school are bussed across; three trips are needed to complete the job.  Helpers on the bus come into the ward to assist with putting on coats and shoes and to ensure that the children are put on the correct bus.  While this is going on the children whose disabilities mean that they are to remain on the ward are carried into the schoolroom extension as each is dressed and made ready.  The teacher arrives at 9.30 am and is joined 15 minutes later by the care assistant once she has finished her bus duties.  A play-room assistant comes in two days a week – at 9.30 am. Meantime, nurses are busy tidying up and, if the bed-maker is not on duty that day, making the beds.  Between 10 and 11 am they take their tea break in staggered groups.

In the schoolroom the first part of the morning is spent arranging the children in positions recommended by the physiotherapist. As noted above this involves the use of special chairs, wedges and other improvised supports.  A couple of times a week the physio will come onto the ward to supervise this and to give some of the children special exercises.

At 10.45 am the children are given juice or milk. The nurses will have prepared this, but it is the teachers who give it to the children, although occasionally some nurses – usually students – will sit in on the ‘school’ session and assist the teacher.  Nurses tend to regard this as a job to be done as efficiently and quickly as possible, whereas the teachers spend more time trying to assist the children to swallow independently and generally seeking to encourage their self-help skills.

At 11.30 am the school children return to the ward and the nurses begin preparing and serving lunch. The ‘back’ shift come on duty at 12 noon and as with the ‘early’ shift decide amongst themselves which groups they will take responsibility for. The usual practice then is for the nurses on the ‘early’ shift to feed the children in their group, while the ‘back’ shift nurses wash and change them. In this way feeding and changing is completed by 1pm when the bus arrives to take the children back to school. Nurses on a half-day shift go off duty at 1.30 pm.

Once the children from the ‘big end’ dormitory have finished lunch and been washed and changed they are put into the extension where they are left to their own devices until it is time to return to school. Sometimes the T.V. will be switched on, but as it sits on a high shelf well above the heads of the majority of the children, many of whom may be in wheel-chairs or who in any case have very poor vision and hearing, this literally goes over their heads and impacts on them hardly at all.

The afternoons in the ward are generally much quieter than the mornings. Not all the children assigned to the ward school continue on into the afternoon.  Four or five will often be found in the extension.  The reason for this is unclear, but one of the teachers suggested that Sister liked the student nurses to have some children to work with.  However, the nurses who do sit in with them tend to adopt a largely supervisory role, with only occasional nurse-patient interaction.  Since most of the nurses are not entirely familiar with the way that the school population may vary from time to time, they tend to want to put all the ‘babies’ in the schoolroom. This can end up with children being moved from one room to another with resultant confusion and tension among the staff.

At 2 pm the nurses take a tea break. At 2.30 pm the children still in the ward are given juice. At 3 pm the two children who attend the outside school return to the ward.  The children at the hospital school return at 3.30 pm, the ward school staff also finish at this time.  Most of the ‘babies’ are put in the schoolroom, while those from the ‘big end’ dormitory are put into the extension or left in the dining area.

The children’s evening meal arrives on the ward at around 3.45 pm. Many of the nurses will take a tea break at this time, while those remaining on the ward will begin feeding the children in their charge. Once the nurses have returned from their break the remaining children are fed while the first group of nurses go off on their break.  The process of feeding takes about an hour.  The children are then washed, changed into their night clothes and the majority put to bed.  The more active children are put in the extension for around one hour.  Some are given suppositories and others are bathed.  Only three or four children from each dormitory are bathed each night, meaning that each child generally is only bathed once a week.  The nurses will only bath the children in their group who are listed for a bath that evening.  Each child usually only requires one nurse to perform this task unless the child is especially large or awkward in which case some assistance may be required.  By 7 or 7.30 pm all the children are in bed.

 

© David May 2015

 

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