Hospital medication

The incident

My mother is Sikh, in her 80s, her main language is Punjabi and she has limited English. She was in hospital when the critical incident took place. My main issue arose when the nurses were giving morning medication to patients very early, according to the medication sheet / schedule.

However, my mother who is a baptised Sikh will usually, after she gets up, have a shower / clean herself, then perform her daily prayers and only after that will she have something to eat or drink.

Without understanding this culture, the elderly woman, who cannot explain this to hospital staff, refused to have medication at that time.  Staff assumed the medication was being refused and insist on this being taken immediately.  The problem was not the patient taking the medication, but the timing of when she was able to take the medication.

Carers were not fitting around her needs, e.g. breakfast at 9.00am which is too late as she is diabetic.  The rules are that medication is at 8.00am which is set in stone.  Nursing staff changed every day so the family have to go through their mother’s needs every day.  Staff are under pressure to give everyone their medication by a certain time every day.  No Punjabi speakers available and the mother usually responds yes by nodding to any question as she is unable to understand what they are saying to her.

1. Identities of the actors in the situation

Narrator: son of a patient, male, 60s, married, father, Sikh, Religious, Chair of the Warwick District Faith Forum, Active member of the community.

The patient: mother of the narrator, female, Sikh, in her 80s has stomach issues, bleeding internally, prone to liver infection, care package lacking, and family support very important and has little English and her main language is Punjabi.

Healthcare professionals caring for his elderly mother in hospital.

2. Context of the situation

Hospital setting in a shared ward between patient and hospital staff.

3. Emotional reaction

Stress and frustration amongst the family members who have to repeat the same thing every day to new nurses due to the lack of continuity amongst the staff.  Her needs do not seem to be recorded for consistency.  The Family feel the stress is impacting on her health / wellbeing.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

Importance of valuing a patient’s religion – the narrator believes the nurses should take into account the patients religion and what she can and can’t do.  This should be asked of the patient when she is admitted.

Diversity management: it should be the hospital’s responsibility to ensure that they can communicate with all patients, even those whose command of English is insufficient for reliable communication. The nurses should make sure she understands the questions being asked and use an interpreter for her.

Extra efforts should be made to adapt and articulate the treatment with the religious preferences of the patients.

Professionalism – the narrator assumes that it is professional conduct to have handover notes and something as important as when the patient can have her medicine should be included. This should not have to be repeated on a daily basis.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The narrator had a negative image of the nurses that were taking care of his mother.

6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

Importance of routine – it is procedure to ensure all patients receive medication at the same time to ensure continuity and are under strict guidelines to ensure timings are adhered to.

Stress – due to staff shortages staff are under more pressure to ensure to care for patients with limited resources.

Importance of handover notes – the nurses value the importance of a handover but due to time restrictions these may not always be as comprehensive as they should be.

Diverse patients – staff deal with a diverse range of patients with different languages and it is not always possible to find interpreters and they therefore understand that when the patient nods her head she is agreeing and if she refuses medication, this is because she does not want to take it.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

The training needs of the organisation are problematic as well as their personal approach to individual healthcare.  They need to see patients as individuals with individual needs rather than just as patients with a one size fits all philosophy.  There is a need for the use of mentors and a positive / friendly approach to patients.  Other issues include:

The code of conduct as a nurse, nurses to be more accountable and ensure that appropriate handover is done to minimize patients having to repeat themselves.

Hospitals need to establish if patients have language barriers at the admission stage and note to ensure interpreters are available.