Monday, 29 October 2012

Doing The Right Thing

The reporting of abuse at the Winterbourne View
private Hospital near Bristol is nothing new. From our very early days as  student nurses, we was always sobered by tales of mistreatment and bad practice regaled to us by nurse tutors and senior management staff who would not ever permit abuse to occur on their watch, But abuse, especially in the more "unpopular" areas of nursing  ie, psychiatry, the nursing of vulnerable adults/  care of the elderly/ keeps happening, especially when ill trained, non qualified staff are not supervised, supported and developed well enough.
In my career, I have only been involved in one case of potential abuse.
It was in psychiatry, when a seriously ill female patient made an allegation that a male member of staff had assaulted her. The male member of staff , who was a rather dis-likable fellow, denied the charges, and was suspended until a full and proper investigation was carried out.
I recall the atmosphere on the ward could be cut with a knife as petty feuds, gossip, and personal and professional loyalties all clashed terribly and even when nothing was proved one way or another, the fall out for the nurse involved was serious enough for him to leave his post .
Years later I remember discussing the incident with an old colleague and friend and she informed me that she had worked with the patient after she was discharged home and subsequently found out  that the abuse was a mistaken memory of real abuse handed out by the patient's husband. A man that who looked remarkably like the male nurse who was accused.in the first place.
Apparently the husband had beaten his mentally ill wife for years.
No one involved in the original investigation ever realised this fact

The abuse at Winterbourne Hospital by the sound of it was endemic and part of the culture of the place. It reeked of bad management and as a result protocols will be designed and policies will be enforced to make sure that "this will never happen again"
But as I recall that unpopular male nurse from my own nursing past, I do shout out a word of caution here.Let us ,as a profession, remember the nurse in all this as well as the patient.
His career was effectively ended by a mistake, and even though nothing was proved, I think our overwhelming need to blame and our subjectivity took over

19 comments:

  1. Well said. There is no excuse for abuse of patients but it seems to me a difficult job is being done by people who are often not suited to it. Training and professionalism is everything but it still can't protect you against wrong allegations, which can ruin an otherwise blameless career. It takes superhuman strength of character to face an investigation into misconduct these days. Everyone wants someone to blame and where there's a blame there might be a juicy little claim too.

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  2. Interesting point John. That male nurse's career & life was ruined by those allegations and his name was not cvleared. I feel for him and the terribly confused patient.

    Secret filming of actual abuse is shocking to watch but very clear for the investigation into the abusers and seeminglt impossible to deny.

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  3. My mother is in a care home with dementia. I can see quite easily how confusion could have led to the situation you describe.

    But I also see just how much care and endless patience goes into providing for my mother's considerable physical and emotional needs. I take my hat off to anyone who works in that environment. Violence and abuse are never excusable, of course. But these nurses must be frequently pushed to the limit.

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  4. Once a person is accused, it can live with them forever. Even if proven innocent, there are those who will always doubt. I know of a teacher who eventually committed suicide because he was falsely accused by a student.

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  5. On the one hand, patients and patient care is extremely difficult and the best of nurses can be pushed to their limit, though the majority do not cross the line. On the other hand there are people in this world who go into 'caring' jobs for the worst of reasons, ie the news in the media at the moment.
    My sister was severely disabled and in care only during term times for 10 years from 63 until she died in 73 (aged 17), although she was sad to go and glad to come back I feel (and hope) that she was well-looked after. My elderly Parents in Law are in care separately and one is happy and one is not, though I sincerely believe that is down to their individual attitudes to life and people. With one I would believe any tales of misuse and with the other person I would not.
    Those who are genuine and work in the care industry are marvellous and should be better paid and honoured for their work.
    Susan x
    PS My son is at his call back interview for a job in a halfway house style care home and I am proud of him and fear for him all at the same time.

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  6. I have witnessed some abuse at my mother's nursing home and in fact had to document some issues regarding my own mother. We tried to "work" with the Health Care Aid (as they call the non-nursing support staff) but in the end after a a very tearful call from my mum, I approached her face to face and in my rage threatened to sue her for abuse if she ever did anything to my mother again. In the end management got involved and she is not allowed to attend my mother unless it is an emergency.

    That said, a lot of workers here in Canada are new immigrants and this is a way into the country, not their passion or calling in any way. The low pay, lack of training, poor support, language and cultural barriers all contribute to a pretty awful jog dealing with the heavily disabled in a nursing home.

    Good on all the nurse and aids who do such an amazing job. It;s a tiny percentage that blemish the profession.

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  7. Having looked at the 'mug-shots' of the abusers at Winterbourne, it didn't surprise me that they were an evil lot. It would amaze me if they had any training whatsoever! They looked like a bunch of immigrants who could find any other work.

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  8. What angered me most about the Winterbourne case was that the company was being paid a substantial amount to care for their residents, up to £3,000 a week, and yet was clearly not spending that money on high calibre staff. The sooner the government realises that private does not necessarily equal quality the better.

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  9. Isn't this where we as a country & our politicians in particular realise that the emergency services, hospital staff, nurses, carers, doctors and all those that look after us should really be paid more, respected more and valued more than some bloke kicking a football around a piece of grass or some vacuous idiot appearing on reality tv.
    Good pay, training and decent staffing levels would go a long way to helping both residents and carers.

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  10. EARL Your point - "ill trained, non qualified staff are not supervised, supported and developed well enough" is very salient here and I have some sympathy for the younger "carers" who were drawn into the nastiness of the home's bullying culture. It was down to the profit-focussed management company to train people properly and to create checks and balances to ensure that the care delivered was of a high order. Why aren't the owners in jail?

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  11. There are horror stories all the time about the abuse and neglect of institutionalized patients. There were four girls in a nursing home here who were cruelly abusing Alzheimers patients. They were convicted and placed on probation. However, because of Minnesota's "Vulnerable Adult" laws, those girls can never work with children or vulnerable adults ever again. They can never be teachers, school workers, nurses or any of a host of other careers. People will always wonder about whether they can be trusted to be good mothers or daughters, so even though they didn't go to prison, they are tainted by what they did.

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  12. These abuse cases are the main reason I refuse to work in long term care/care of the aged. I spent the first four years of my nursing life there and have told my husband I'll work in McDonalds before returning there.

    The workload is horrific. The aides are usually immigrants who speak very little English and form cliques of them against the nurses and patients. We also have a lot aides from a country famous for exporting nurses and these nurses have failed our registration exams and take their bitterness out in the workplace. Very hard to work with as a staff member and very often take huge shortcuts with their patients. Yet, when the family visits the aides are sweetness and light to the families.

    Cultural differences are huge. "Back home" the elder is cared for by family with only the very wealthy able to hire nursing care and this attitude shows in the care given.

    Which brings us to the families. Guilt ridden for placing their parents into care but not wanting to deal with the dementia, bitterness, incontinence themselves. Families forget that the nursing staff have 20-40 other elders to care for, not just their Mum.

    I'm very jaded right now. I was assaulted by a patient in active treatment in September. I'm looking at another month of two of light duties and physio. The patient that assaulted me wasn't demented or confused due to post op meds. She comes from a culture where nurses are seen as servants and are there to be used and in many cases abused. Our hospital has a high injury rate among staff and it's usually from this ethnic group.

    Abuse is a two way street and it's time that patient/resident and their families became accountable for their actions. Recent surveys show that I am 50% more likely to be assaulted at work than my husband who is in the Police.

    Families don't like it when chemical restraints are used on the members but sometimes it's the only way. In aged care I have been punched, scratched, nipped, bitten, spat upon and as a student nurse had a male put his hand up my skirts. It was only when the male student nurse who was with me said "would you like it if I did that to your wife, sister, daughter?" that he stopped. When we reported the even, we were told "it's OK, don't worry, he had dementia". That makes sexual assault fine??

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  13. Well said John. I have worked with adult seriously impaired and disabled people in the past and they are often very difficult to deal with and need a great deal of patience and professional care. I do think often in these days of cuts the level of staff in these places is sadly lacking. But then the pay is so awful and conditions pretty awful (cleaning up all kinds of things one would rather not think about)that it really is essential to have only the best qualified people around - and I think we rarely get that. The people who need this care are often ones who are least able to put into words what is going wrong. Very sad situation all round.

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  14. Excellent point. I am here visiting from Starting Over/Arleen. What you described can also happen in teaching. A good teacher can be dismissed or a bad teacher ignored. I look forward to reading more of your posts.

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  15. There are some interesting points written and I am answering them all in this one comment if that's ok...
    In my experience untrained support workers provide the backbone of any ward/ unit. but they need to be trained and mentored as much as any trained member of staff....
    I think it is vital to review the ratio of trained to untrained staff, for I suspect at areas such as winterbourne the trained to untrained ratio was way out....thus
    allowing strong minded support workers to dictate the "way things were done"
    I also blame management in this awful case.
    As a ward manager I was always insistent that I knew what was happening on my ward, very little was missed and I think I always supported and reenforced a culture of good practice
    In general nursing this approach is necessary... for difficult and stressful areas such as psychiatry, elderly care and challenging behaviours, this approach is VITAL

    thanks again for your comments
    and "welcome" to susan K

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  16. Being stuck in back office admin, I didn't expect to have to deal with this. But a few months ago, I had to report a carer for verbally abusing a patient while I was on the phone to them. The threatening tone and clear lack of care it reflected left me in no doubt I had to act. Social services were quick to respond, which made me think they were aware of this carer, but needed solid evidence.

    I never heard the outcome, but I am certain I did the right thing.

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  17. Great post, John! Lots to think about for the care of the elderly and mentally ill.

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  18. Here, here. This is a wonderful post reminding us that there are at least two sides to every story. And gossip, blame and innuendo are the killers that are rarely called to account.

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  19. It's all too easy in these cases for a fixed idea of what happened, and a fixed idea of someone's innocence or guilt, to take over, and once it's established there's little interest in investigating further and getting the full picture. An awful lot of people are falsely accused of wrongdoings, and as you say their reputation is often permanently stained.

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