Category Archives: Medical

EXPIRY DATE

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There comes a time when you have to think about putting your loved one into an aged care facility. This decision is not to be taken lightly. I have been asked numerous times to advocate for a ‘Good Nursing Home’  sorry I cannot do that. I can only say I am not completely happy with any aged care facility I have ever worked in and I’ve been working in aged care for approximately 20 years.

When I began working in aged care, things were so different. If I managed to get a tea break, I would go to the staff room to make a coffee and sitting in that staff room were carers and Enrolled nurses who would all be discussing the care of the residents. These wonderful people (miss them terribly) knew everything about their residents. Off the top of their heads they could give you the run down on their likes and dislikes, allergies, at risk behaviours etc. They would discuss new ways to help their residents. for instance if an elderly person was having trouble with dressing, eating, showering, they would put their heads together to come up with new and inventive ways to address the situation, approach the Registered Nurse with this idea and we would work on it together. From there, it would be taken to an allied health specialist such as Physiotherapist, doctor, nutritionist etc and the life of the resident would be made so much better. These brilliant carers knew about equipment which would make their jobs easier and using it on the resident to make it safer. Safety was a big issue and they understood it and complied with regulations.

Those were the good old days.

Now, walking into a staff room all you see are staff sitting around the tables talking to their friends and relatives overseas. Ask any one of them about a resident and you get an answer like this, ‘Look at the notes’ ‘Look at the care Plan’ or ‘I don’t know’ They have absolutely no idea or any intention of understanding the care of the elderly they are there to care for. Even if the resident had been there for a number of years. They weren’t interested. To the carers these days, it’s just a job and to get through it as fast as possible so they can go home. Now don’t get me wrong. There are a few excellent carers working in aged care facilities. They are the ones who do care. They do their jobs well and will even stay behind to finish doing what they need to do to make it easier for the next shift and to ensure the resident is left the way they are supposed to be left. Clean, well fed, in no pain, comfortable and any issues they have spotted reported to the RN.

If the RN needs to know anything about a resident now, we need to go into the shower to examine the resident ourselves. We are checking for fragile, dry skin. Skin tears, toenail and fingernail length, pressure areas, we check their ears and eyes, nose and a lot more. Ask a carer now and I doubt if they even know who they just showered.

This might sound like I’m bagging carers but it’s the way things are now. Aged Care Facilities cannot run without money, and to make a profit they need to have the least number of staff on the floor at any one time. If there is 35 residents there will be 4 long shift carers for the entire shift and a few short shift carers. The short shift carers are there to help with the showering and meals. They go home early. Meanwhile the long shift carers will remain to assist with toileting after lunch and helping the residents with lunch. They will do a ’round’ which is to check continence pads and to toilet other residents who are able to go to the toilet but just need some assistance. There is no time to sit and talk to a resident. To ask them how they feel or do any little minor thing the resident would like.

Every time I see a commercial showing how wonderful an aged care facility is and how splendid the smiling, cheery staff are I seriously want to barf.. What a load of rubbish.

To see the picture clearly, you need to go there and see staff running their legs off, Sweating under the strain on heavy lifting, carrying, pushing and pulling and count how long each staff member has to attend each resident. I did a count once and it was frightening.

Read my next post for the breakdown.

Aged care facilities are not designed for the happiness of residents, they are there to make money. Full stop. Now I know this is going to sound really disgusting but I was at a facility one day and I asked where all the usual carers were and was told, “They are having an inspection and they only want to see white faces here” I nearly fainted. How racist and bigoted can anyone be??? I wondered who was coming and what sort of people they were to  say this..  If I had called the media over this, there would have been hell to pay. But as I have said before. Nobody wants to know. And it would have been difficult to prove.

I sort of feel fortunate working as an Agency Registered Nurse at times because we get to move around from facility to facility and we see it all.

Every Aged Care Facility has at their front door a charter of rights and responsibilities. These points are a legal requirement and they need to provide evidence to show it. To prove this, they have reams and reams of paperwork and documentation and the staff are required to fill out all documentation to show they are doing the right thing. Ha!

Aged Care Facilities also have people (Accreditation Team) come to check on all their paperwork to make sure this ‘Evidence Based Practice’ is being adhered to. (Stop laughing)  I was hired to do an afternoon shift one day and when I arrived, I saw 4 RNs sitting in the Nurses Office completing forms and filling out papers ready for the inspection. They were even signing medication charts where there were many, many signature omissions. Some signatures were from other Agency Registered and Enrolled nurses from months previous. But as long as the tiny little square had a squiggle in it, it was ok.  All care plans had to be updated with the correct information included which should have been done on admission. If and when the facility passes all their ‘standards’ they whoop whoop for days after and throw a celebration. This is a very serious issue. To not pass ‘Accreditation’ is the worst thing for all staff, the residents and the facility not to mention the boss who runs the facility. It doesn’t reflect well on any of them.. The Government will impose sanctions on the facility to prevent them from taking in any more residents until they meet the ‘Standards of Accreditation.’ The facility will only be allowed to have a certain number of residents. Cuts to funding is taken very seriously.

The one thing you need to make sure of if you put your family member in an Aged Care Facility is to be there on admission and make sure they have all the information on your relative/friend. The admission form is paramount to ensuring staff know who is responsible for having the say over financial matters, who makes decisions regarding their health and welfare, are there any toxic relations between family members which could impact on the health and happiness of your family member. Allergies, every aspect of daily living is included and should be addressed. Do they have a funeral organised and with whom? What are the details? Burial or cremation? Who is the funeral Director? Sleeping times, food likes and dislikes, clothing requirements, continence. Do they use continence aids? Do they have enough clothes and shoes? Are they labelled oh and please remember to label their dentures and spectacles. There’s nothing worse than removing dentures or spectacles to find out your family member has been wearing someone elses. Do they have an ‘End of Life’ care form completed? Don’t leave until it’s done. It will save you so much time and make it a bit easier for staff in the case of a death or an emergency. Do they have any old injuries? Do they have pain? There is so much but it must be included. The admitting nurse needs to get baseline readings. This is Blood pressure, temperature, pulse, weight, height, urinalysis and a whole lot more. So if the resident has any health episode the Nurse has the baseline to go by. Any differences will show us there is something wrong. There is a change in their health status and it needs to be investigated further.

Read my next post for the times given for each resident attendance.

 

 

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Expiry Date

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It was just after dinner and I was almost done with the dinner time medication round. I only had about 12 more people to give medications to and my medication trolley was in the corridor. Out of the corner of my eye I saw two of my carers running toward me. I stopped and looked at their faces. Now something like this is hard to describe and document because I think they were in shock and they were so excited and talking so fast.

I didn’t have time to ask them what was wrong. They burst into a chorus of “Marilyn come here quick.” I parked my trolley in a side room, locked the door and ran. At this time I was thinking there might have been an intruder or a fire.

As I entered the room the two carers were standing either side of a female resident’s bed. One of the carers pulled the bed linen off the elderly woman, and I must say, extremely frail woman only to show me her leg was broken. My mind raced to discover what had happened and how but knowing this elderly lady was a bit restless in her bed and constantly stuck her legs through the bedrails, I felt a surge of vomit in my throat when I realised what had happened.

The break was over the shin and it had a distinctive mark across the thin layer of skin.

Her leg was straight until it got past the knee and to the shin and that is where it turned inwards.  We looked at this broken bone and discovered it had been broken when someone had tried to let down the bed rail and had met some resistance. The bed rail would have then been pushed down very hard which crushed her leg. The perpetrator of this would have then placed her broken leg back into the bed and covered her up and left her.They left her. Left her in agonizing pain. Unable to voice her pain. Unable to do anything about it.

Immediately the Ambulance was called to transfer the poor woman to Hospital, notes were written, plus the mandatory reports. (Lots of them)

Before the woman was transferred to Hospital, I measured the red mark on her shin and compared the width of the top of the bed rail. Exactly the same width. I couldn’t imagine how anyone could do this to a frail and elderly person, then cover them up and leave them to suffer. This would have been excruciatingly painful. She would have been left like that for approximately 4 and a half hours and until the next shift came on and did a ’round.’  A round is where the carers go around to each and every resident and ask them if they would like to go to the toilet and if they were not able to verbalize, they would assist them to the toilet. Otherwise they would be in a continence pad and that would have to be checked.

This poor woman was the last on the list of people to check the pad and so it would have been about 2 pm the staff would have been to her room to check on her continence needs.

There was also a chart to tell who worked where and it didn’t take us long to work out who was responsible. I will tell you know though. After the report I made, I had a complaint made against me to my Agency which sounded something like this

“We don’t want Marilyn G back here again” “She keeps leaving us notes”  Leaving them notes?  Ha!  They couldn’t get rid of my notes because they are a legal document and if these reports I wrote were requested by ‘Freedom Of Information’ the family of this woman would have taken legal action.. I’m glad I wrote personal reports and photocopied incident reports. I have a very large box full of them.

This is not the last report I will write about the Health Care system. Keep your eye out. And if it makes you feel a bit queezey just imagine how it made me and others feel when it happened.I started Nursing 1995 as an RN and just flowed into Aged Care where I remained for nearly 20 years. The work is hard especially if you do the work and the pay isn’t much to sing about but it was very challenging..

The latest news about the abuse of the elderly man in the aged care facility was shown on channel 9 25/7/2016.  I have worked in this facility and never enjoyed it because there was a problem with some belligerent staff. Another facility I will never work in again.

Having cameras in resident’s rooms is a great idea but it infringes on their resident’s privacy and dignity. I don’t think it will ever be tolerated. The public are up in arms now over an incident relating to a young male carer who abused an elderly gentleman in an aged care facility. Sorry to say it but I have seen worse.

I haven’t been supported by the aged care facility or the Agency I worked for when making these complaints to the managers of these said facilities. They just don’t want to know about it and while they are raking in the money, they don’t give a hoot. Many times I’ve told family members to install  a secret camera in the room to catch the abusive staff members.

Carers take these jobs in Nursing homes because that is the only job they can get at the time and Centrelink encourage them to take it. Even if they are not suitable for the position.

Attitude play a big role in caring for elderly people. Staff cannot afford not to treat these people any other way but with respect and give them the dignity they deserve.

Channel 9 News asked for a comment from the ‘Council for the Ageing” and we hear there is a 5% to 10 % abuse incident rate. Well, lady. To that I say bull! I know it is more than double that.

Overall, I blame the Government for the compete lack of care in any and all Aged Care Facilities. Money is what drives them. Cheap labour. Hiring staff who cannot speak English and who give medications which cause damage to resident’s health.

When they have a Plebiscite on ‘Assisted Suicide” I will sign it and say yes please. I refuse to go into an Aged Care Facility.

I can’t believe it… $8,500 for a shoddy job…

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Took young girl to the orthodontist today to get braces on her teeth which cost about $8,500.
Drove little grandson and his mum home after her work and then had a look at the braces.
They are so crooked, the wires look like a 3 year old glued them on. 3 of the braces are loose and falling off. Two braces are glued so far to the side of each tooth they will twist the tooth out of it’s socket..
The rest of them are glued so far down they are resting/sticking to the gum line.
Rang her friend who has braces and she emailed us a photo of her mouth with the braces. Hers are beautiful. Straight and dead center.

I’m so mad I could scream.. I was a bit surprised to see a very young girl doing the job and not the Orthodontist who we are paying, so they will be getting an earful from me tomorrow, after I show a certain person who has a great closeup camera…
The Orthodontist apparently came into the room after the first two braces were applied (the two top center ones) and mumbled something then he left her to finish the job. I had my little grandson with me and my mother so I decided to sit in the waiting room..Tomorrow I will be on the phone at 0900 and demand they all be removed and the Orthodontist apply them correctly. Or else! How do they have the cheek to charge so much and yet leave the job to a beginner? She’s probably not even out of Uni yet… Arghhhhh
Will let you know how it goes tomorrow…

Will have more photos tomorrow Bad skin!

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The eczema on my hands doesn’t look too bad today but I will definitely post another photo of my hands tomorrow. You probably can’t tell the difference today unless you look at them under natural light and photos don’t do them any justice at all. I will say however. They are improving. I was up until about 0230 cleaning my laundry out. Emptying cupboards of crap stored there for years (Just trying to avoid scratching while I’m sleeping). Scrubbing dirty scum build up with the most brilliant cleaning solutions and all whilst wearing my creams, sterile dressings, crepe bandages and rubber gloves. When spring comes my house is going to be done! Cleaned and shiny. Oh what a treat.. Ok so I’ll see you all tomorrow.
Oh, and if you have nice gooey pics of wounds and their diagnoses by your doctor… Post them so we can all see. I find it interesting as I’m a Registered Nurse and am interested in them and the treatments.
Marilyn xxx

1 of the many pitfalls of nursing. Don’t be shocked.

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As nurses we are supposed to wash before attending each and every client (I hate the word client) I feel as if I am trying to sell them something. I do wash my hands thoroughly between clients and this is what I’ve ended up with.
A severe dose of eczema.

My consant washing with harsh chemical soaps and drying with cheap paper towels in these facilities has defatted my skin and dried them to a crisp. I spent last night cleaning my kitchen from top to bottom and all the time wearing crepe bandages, cotton gloves and latex gloves over the top of that.

On the weekend, one of the areas on my right hand was showing signs of infection so I debrided the sloughy areas with a clean set of surgical scissors, treated the area for a couple of days with Tea Tree Oil and clean dressings. Oh the expense! I keep a good stock of dressing supplies and I’m almost out of them now so will have to go for more soon. McNeil Medical supplies in Adelaide. Or the local pharmacy but the latter are quite expensive. Best to buy a few simple items like Melolin, Melolite, Micropore and crepe bandages. That way you will have a good supply of the most used dressing equipment needed for any type of wound unless it’s a wound with exudate and then you will need to purchase something to soak up the excess moisture. Jelonet is a good buy too. This keeps a dry wound slightly moist and tissue likes to gow in a warm, moist environment.

As promised on twitter, I am posting a picture of my right hand at it’s not so bad state. Should have seen it 4 days ago!
Have commenced a topical cream called ‘Novasone 1%’ and will be using it for a few days. Cortisone creams can only be applied for a few weeks as it can thin the skin. I have to sit around and do nothing as ordered by the LMO. Oh, what fun. Now I suppose I will bore you to death with tales of fungating wounds and macerating ulcers, spontaneous fractures and other such delights. Oooh and what about sinuses. That will thrill you if you like horrid, gooey tales/tails..
hehehehehe
Da da daaaaa! My right hand.
It looks very greasy because it is a greasy ointment.