The Neglected Old Man

The author of this article, Joanne Bryant, is an Endorsed Enrolled Nurse who works in various city based hospitals in Australia, as well as travelling and working in rural hospitals. Joanne is passionate about her profession, and concerned about the neglect of patients like Tom, and to point the finger at the deficiencies in nurse education which is compounding neglect.

“I also write this for a personal reason…to give a voice and to be an advocate for the patients like old Tom that I have had the privilege of looking after. Maybe this story will invoke some debate which will return dignity and respect to the many aged care patients who at present are being denied that which is their right.”

By: Joanne Bryant (based on true events)

"I hate aged care", snapped the graduate nurse as we stood at the bedside of an elderly man in a busy acute hospital ward.

"The elderly probably don't enjoy it much either", was my abrupt reply.

"Bud I didn't get my nursing degree to look after old people", she added.

Her response to my next question shocked me even more. "So what were you taught at university about how to settle an elderly bedfast patient for the night?"

She looked at me, seemingly surprised by my question, "We are told that it is not our job".

A wave of sadness washed over me as I felt the very core of our profession being diminished. That core being care, compassion and integrity. The fundamental nature of nursing was changing dramatically before my eyes and I was powerless to stop it.

I pursued in with my line of questioning however, determined to glean some understanding of what she meant. "So whose job is it?"

"That is never explained, it is just accepted that all that stuff will be done by someone else", she continued, unaware the impact her admissions were having on me.

"So if you are not taught basic nursing care, what are you taught?" I persisted.

"The sciences, there is a big emphasis on all the science subjects", was her proud reply.

This was not the first conversation like this I had had during my placement at this busy hospital. Other graduates and students had responded to my questions with very similar answers. The patient in question was an 83 year old gentleman by the name of Tom.

I had cared for old Tom since he had been admitted to hospital several weeks before. He had had a fall, fracturing his femur, and with his blindness and confusion he was a patient that needed full nursing care. No high tech requirements, just general nursing care, patience and TLC.

I had watched him deteriorate as many of the staff found it distasteful to look after him with his care being time consuming and I guess mundane to some, he was also easily startled because of his blindness and would often react loudly if not approached in a mindful manner.

With several of the staff being new graduates and students, to them this was definitely not what they had signed up for.

Tom was not a difficult patient to those of us who understood holistic nursing. When time was taken to explain to Tom what we were doing and to encourage him to participate in his own care, he was compliant and very witty. Those were good days for Tom, he was continent with pre-empt toileting, would feed himself when set up, required little pain relief as he was not left sitting for too long, and was mobilized regularly as per physiotherapy guidelines.

Then there were the other days. When I was allocated other patients instead of him I still prempted to keep an eye out for old Tom. I would watch his meal trays come and go untouched, as no-one set him up so he could eat. I would see him sitting in a hard chair for hours with a grimace of pain on his face. His futile calls to be taken to the toilet would go unheeded, leaving him no choice but to be incontinent because no-one could be bothered to walk him to the toilet. He would go for days without anyone bothering to give him a shave, or as I was to discover, even clean his teeth.

Tom was being neglected, and for no other reasons that ignorance, laziness, and a lack of human compassion.

Compassion and empathy do not even make it to the nursing curriculum, unlike the abundance of science subjects. None of those subjects were going to prevent the neglect occurring to Tom on a daily basis.

"On a night shift, I was checking on Tom and noticed he still had his teeth in. I asked him to pass his teeth to me as I knew he preferred not to sleep with them in.

Imagine my horror when he handed them to me, and they were green with slime. My heart sunk yet again."

Holism in nursing seems to be a thing of the past. Where is the dignity Tom deserves? It is his right. This man was once someone's father, brother, husband, friend, and is deserving of the best of care that we could provide, not this distant, thoughtless, neglectful farce that portrays itself as nursing today.

We are educating our nurses away from the basics, it seems there is no importance placed on the simple needs of patients such as Tom.

The eternal optimist in me has tried to ignore the ongoing trend of neglect that appears to be worsening, hoping they were random cases. They are not.

We are leaving the care of these frail patients to staff that have no raining in aged care, we expect miracles from them, and new graduates who have been taught elitist, irrelevant subjects, with no mention of incontinence and dementia. They have been given a foundation in basic skills, and are inadequate to provide the standard of care our elderly patients deserve. Then we ridicule and vilify them when things go wrong.

Until we give aged care nursing the profile it deserves, and recruit people who understand the importance of kindness, empathy and patience, those people who really want to work in the industry, stories of neglect will continue.

There are many already working in the industry that have a natural affinity for aged care, but they are overworked and unsupported.

So let's start supporting them by giving them colleagues with the same work ethic and propensity for this specialised vocation.