Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust.
Having nursed in different areas for over 30 years, she currently balances her time between clinical work, research into the prevention of delirium and studying for a MSc. in Advanced Nursing at the University of Nottingham.
Here she discusses whether PPI (Patient and Public Involvement) can contribute to person-centred care. Liz tweets from @lizcharalambou
Recent media coverage highlights loneliness in the elderly population and how some organisations are taking steps to combat this, such as the ‘Be a friend’ campaign launched recently by Friends of the Elderly http://www.beafriendtoday.org.uk/ . Patients and relatives must breathe a sigh of relief that when their loved one is admitted into hospital, at least they will be surrounded by others and therefore not at risk of loneliness.
Unfortunately, this is not always the case. Despite NICE guidelines for Delirium (2010) https://www.nice.org.uk/guidance/cg103 and Dementia (2006) http://www.nice.org.uk/guidance/cg042 calling for the involvement of families, as well as the much-vaunted Holy Grail of PPI (Patient and Public Involvement) post Francis, many older people remain at risk of confusion and developing delirium purely by virtue of the fact they are over 65 years of age and clinically unwell. Staff are very often tied up with the clinical side, and rightly so. A blocked airway, arrhythmias, acute kidney injury and clinical deterioration remain a priority over holding someone’s hand.
But what of the patient in all this? Think of that elderly person, probably moved to several wards in a short space of time, lost hearing aid, mislaid glasses and strangers everywhere, compounded with loved ones struggling with strict visiting times and unable to visit when the institution allows (Charalambous, 2014) https://www.readbyqxmd.com/read/24984369/-intelligent-use-of-open-visiting-would-aid-patient-recovery. Where is their voice in all this?
Financial constraints mean there is no money spare for extra staff. Clinical needs are becoming more intense with multiple co-morbidities and pressure on beds. How can we address the issue of loneliness and possible confusion in acute hospital environments? One solution is to involve the public. It opens the doors to PPI and shows, at worst, that we have nothing to hide. At best, it allows us to showcase the fabulous care that happens every single day on HCOP wards up and down the country. It also provides an opportunity for the public to benefit and helps bridge the gap between ‘us’ and ‘them’. Combine this with open visiting, and you have the key to the kingdom of person centred-care, or at least a glimpse of it.
We have had tremendous success with volunteers on our ward, not least in part because of the warm welcome they receive and how they tell us they feel part of the team. Some of them are themselves pensioners, thus promulgating a virtuous cycle of care and sense of community involvement. The idea is snowballing, people are excited and want to be involved, nurses are grateful for the extra help and patients benefit from the mosaic of personalities that appear at their bedside.
I am optimistic that this is one of the pieces to the prevention of delirium jigsaw that faces us. It works, and adds the extra human dimension necessary for the implementation of true person centred care.