Nursing’s existential crisis (part 1)
At PMQs on Wednesday, Cameron was confronted with Ann Clywd’s personal testimony on standards within the NHS. He concluded his reply with:
I set up a nursing care quality forum that I have attended myself to discuss these issues with nurses and nurse leaders. There is no silver bullet and no magic wand, but some simple steps, such as asking every hospital to carry out a friends and family test, asking the patients and the staff whether they would be happy for their family or friends to be treated in that hospital, can make a real difference. So can hourly rounding, which is not something to do with statistics but the idea that the nurse should be there by the bedside of elderly patients once an hour checking that they have had water and something to eat, that they do not have bedsores and that they are properly looked after.
This is utter shit.
I have written before about Cameron’s arrogant, ignorant and patronising insistence that hourly “intentional” rounding promises to embed within nursing a managerialism which will, in, short order, actually reduced standards of care, not improve them. It is difficult to see how a process which requires up to 150 boxes per patient per day to be initialed by nurses will do anything else.
When I wrote to Cameron’s Nursing & Care Quality Forum about this, setting out the kind of implementation research they should study before going down such a path, my letter was at first ignored and then, when I demanded a reply, was dismissed with the assurance that they had seen “some research” from the US with promising results.
It is with a certain grim satisfaction, therefore, that I note that the Hospital Trust where Ann Clwyd’s husband suffered such a sad and lonely death introduced “intentional rounding” some three years ago. A Cardiff & Value University Health Board document reads:
Many improvements are thanks to a new process called ‘intentional rounding’ which guides nurses to deliver more structured care. It includes hourly checks on patients to look at any potential risks such as the position they are lying in and the condition of their skin. In the wards, nurses have made a real difference to patients’ mealtimes. By implementing simple measures such as colour coding food trays and patient food charts, patients’ dietary needs are being more easily recognised and met. The colour coding systems enables nurses to understand what a patient needs, in terms of assistance at meal times, which is important if a patient has difficulty communicating. There is ample evidence, from research and from hospital visitors and family members, that nutrition has direct implications for patient recovery and length of stay. Importantly, it also ensures mealtimes are as enjoyable and comfortable as possible.