Disabled patients in acute hospital wards

Abstract

Seventy-five patients who had a clinically diagnosed disabling disease and who usually had difficulty with one or more activities of selfcare were identified in a 10-month survey of the acute wards of a large teaching hospital. Their dependence on assistance for specific activities at home and in the acute wards was recorded by a research nurse in interviews carried out in the patient's home within two weeks of hospital discharge. The study showed that although most of the disabled patients were able to continue with their daily selfcare activities, their increased dependence on assistance in hospital in comparison with their home was often due to limitations in the provision and use of ward facilities. The effects of these limitations on the selfcare of disabled patients are illustrated. It is concluded that disabled patients would enjoy greater independence in selfcare activities in acute wards and could be less dependent on nursing staff if there was improvement in ward design and the provision of aids and equipment whilst the abilities of disabled patients for selfcare were recognised by ward staff.

Perforation of gloves in an accident and emergency department.

“…A study in Edinburgh showed that limitations in the provision of facilities on the ward led to increased dependence by the patients on the nurses. 6 The haphazard provision of ward toilet rails has been observed elsewhere.7 A survey of 140 elderly people at home showed 5% using raised toilet seats, a further 8% needing them, 9% using a fixed toilet rail, and a further 11% needing one. 8 One survey found that 33% of people over 75 at home used toilet aids and 43% of women over 85 could not get to the toilet without aids or personal assistance.9 Such people are disadvantaged when admitted to hospitals where…”

“…Toilet:bed ratio 1:3 to 1:4 1:26 to 1: [6][7][8] Standard met only on psychogeriatric ward. Worst ratio on 3 geriatric wards Signposting Clear signposting by words and symbols Only 1 toilet signposted Labelling Large clear labelling on door 10 Had small labels; 7…”

Risky Discharges: Are We Too Cautious?

“…In the old and the disabled there is evidence for both deconditioning and increased dependency in hospital (Hoenig and Rubenstein 1991;Creditor 1993). Sklaroff (1987) reports an increased dependency in hospital, compared with home, due to limitations in the provision and use of ward facilities. Sklaroff (1987) reports an increased dependency in hospital, compared with home, due to limitations in the provision and use of ward facilities.…”

Are we equipped to rehabilitate old people?

“…In acute wards, access to the toilet may be difficult because furniture, equipment and visitors' chairs are stored near access routes. 1 Even in a rehabilitation ward, wheelchair users complained that the lavatories were cramped. 2 Toilets may be cold, stark and ill-equipped.…”

“…Only one-third of hospital inpatients who normally used a high-seat chair at home were provided with one in hospital. 1 In every other case, nurses had to help the patients in and out of their chairs, thereby diminishing the patients' independence and increasing the nurses' workload.…”