Dose up on ward wisdom
11:00am Sunday 1st September 2013 in News
THE prospect of a stay in hospital is never pleasant but sometimes it's an inevitability we can't avoid.
However, the experience and outcome of your stay isn't entirely in the medics' hands - how you partake as a patient can also play a part.
And after decades of working as a nurse around the world, including in his native New Zealand, Britain and Switzerland, this is something that nurse Michael Alexander knows a thing or two about.
He's written an e-booklet which aims to help hospital patients get the most out of their treatment.
Getting Out Alive: A Guide To Surviving Hospital looks at every stage of the healthcare cycle - before hospital, as an in-patient and after being discharged, explaining how the process works and what to be aware of.
But what Alexander stresses right from the start is that, while it may seem strange, not a lot of curing actually goes on in hospitals.
"One of the most common expectations I've come across in patients is that we're going to cure them. But often we don't - we help you manage your problems, deal with acute crises, and try to stop the problems happening again," he explains.
"You can't always expect medicine to cure your problem, but you can expect it to help you live with it.
"No drug or treatment is as effective as your body when it gets a fair chance at healing itself."
Sure symptoms Being able to describe your symptoms well is a great help to medical staff, says Alexander, who recommends that people keep a symptoms diary noting information such as: :: How severe and often the pain/problem occurs.
:: Does the pain radiate (move anywhere)?
:: How long does it last?
:: Does anything make it better or worse?
:: When did it begin, and what were you doing when it started?
:: Are there any other problems, like diarrhoea?
Alexander says patients will usually be asked these questions when they're assessed, but points out: "Often when a patient's put on the spot, they might not remember to mention everything they could, so having a diary, or even just a slip of paper with a description of the symptoms, is a huge help."
It's also worth keeping a brief record of your medical history, he advises, so doctors can check whether anything is relevant to your current condition.
Alexander discusses what happens when a person goes to A&E, explaining the triage system used to prioritise patients' medical needs. This, he says, is when a symptom diary and medical history are important, plus details of any medication taken.
He stresses it's vital not to put a brave face on, and to be completely honest with medical staff. "You may not like to admit you take drugs or drink a lot, but we're not here to judge. Omitting information like this can be fatal."
Patients will normally be told very roughly how long they'll have to wait to see a doctor, and Alexander suggests that during this waiting time they should try to remain calm and be pleasant and polite, tell a nurse if symptoms change for better or worse, and make sure a friend or family member knows where they are.
Once admitted, either routinely or through A&E, Alexander says there are some "simple but vital" things to do to help ensure your stay goes smoothly.
This includes asking questions if necessary, finding out your doctor and nurse's names, making sure you're in the correct ward to deal with your condition, and that your blood pressure, pulse, oxygen level and temperature are checked again on the ward.
The right stuff
The patient's goal should be to help reduce the possibility of errors or complications, says Alexander, who points out that the most common hospital error is with medication.
He explains that nurses are taught to check the five rights before giving medication - right person, right drug, right dose, right time, right route - and suggests patients make sure the nurse has indeed checked them all.
"Sometimes you have to be your own advocate," he says. "Your request may catch them by surprise, but they'll learn from it, plus you will reduce the chances of error."
Surgical errors are very rare, he stresses, but he suggests the patient makes sure their surgeon writes his initials on the part of the body to be operated on.
A degree of pain can be an expected part of recovery, but Alexander stresses there's no need for a patient to suffer severe pain because many effective methods of relief are available.
He advises patients to always tell someone if they're in pain, and don't let it build up - it's easier to keep pain levels under control with the use of regular painkillers than it is to control pain that's become severe, he says.
Infections can cause problems in hospital, but Alexander is keen to stress that there's not always someone to blame - in many cases it's the body's natural bacteria that's caused it.
However, the chances of developing infection can be reduced by simple measures including making sure all those treating you have washed their hands first; avoiding touching your mouth; following post-surgery instructions diligently, and asking if taking an antibiotic before any surgery is appropriate for you.
Staying mobile, unless advised otherwise by medical staff, can help reduce recovery time for both medical and surgical patients, says Alexander.
The appropriate type of movement will of course vary from patient to patient, but can be anything from sitting upright in bed or standing, to wiggling your toes or changing position in bed.
But don't do anything that makes you feel unsafe, warns Alexander, who adds that any movement should be balanced with rest. "Your body needs rest to recover, and your nurse should know the correct balance to suit your needs, so don't push too hard too soon."
Nearly half of patients don't follow the care plan they've been given once they're discharged from hospital, says Alexander, who points out that the most common area of neglect is taking medication.
He advises that patients shouldn't leave hospital alone - a relative, carer or friend should accompany them. Plus, they should make sure they have enough medication and the hospital contact details, and avoid being discharged at the weekend, as if there are any immediate problems they could be harder to sort out.
Avoiding risk factors like smoking, being inactive and overweight can go a long way to preventing a hospital stay in the first place (or a speedy return), and he adds: "Be nice to the people who are going to look after you or your loved ones in hospital - it's common sense."
Cause for concern
While the title of Alexander's e-booklet is best taken with a pinch of salt, the chief executive and general secretary of the Royal College of Nursing, Dr Peter Carter, says he's worried it may give patients the wrong impression about going into hospital.
"We are concerned that the title and content implies that patients may not 'survive hospital' without the right preparation, which is inaccurate and risks worrying patients and their families and friends," he says.
"UK medical staff provide excellent care to millions of patients who come through the hospital doors each year, and patients should be reassured their individual care needs will be met."
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