Bladder infections

[holley]

My dad is in a care home and is incontinent my mum goes to see him every day and most days she has to ask for him to be changed as he is soaking wet he keeps getting bladder infections could this be due to the fact that he is sitting in his own urine, just wanted to be sure before I complain. Thanks

[flyingdoc]

Sitting in his own urine is not good for him but would not normally cause a bladder infection as the infection would have to track the length of the urethra (I am saying not normal not that it would be impossible)

 

There are other problems far more likely like skin problems and pressure area problems (if he is not being moved or moving himself enough)

 

Bladder infections may be a sign that he is not drinking enough - or not emptying his bladder properly - sometimes a problem in older men who have problems doing so due to enlargement of prostate.

This may also be the reason that he always seems to be wet - instead of using the toilet maybe half a dozen times a day - he cannot void his bladder and therefore it is constantly dribbling.

 

I would personally ask to speak to the matron of the nursing home and ask why he is so often wet (when there are other options such as sheaths which could carry the urine straight to a bag, although these come with their own issues)

 

In the first instance, were I in charge, (am a RN of many years experience) i would begin a fluid balance chart to monitor his fluid intake, and start a regimen of regular toileting (perhaps hourly to begin with and then increasing period to suit) and see what effect that has on a) his incontinence and b) his bladder infections.

If he appears to be having difficulty passing urine (provided his fluid intake is sufficient) then I would ask the GP to examine him.

 

My suspicion is, having done some shifts in NH, that the carers are not able to spend the time ensuring that he drinks enough, and toiletting him regularly, and that is the root of the problem.

[holley]

Thanks for that

[ErikaPNP]

I'll point out some problematic areas in care homes, if you don't mind, as any number of things could be a factor in this. Firstly though I would say that frequent incontinence (dribbling) is a result of a urine infection rather than a cause of one.

 

Just in addition to what flyingdoc has said, I would encourage your mum to speak to the charge nurse or matron to see firstly if they are aware that he is consistently wet, and if there are any particular reasons for it. Ask if she can look at his care plan too, if she hasn't recently viewed it, to see what they have in place to combat his continence issues.

 

There may be a reason behind it. One of the main issues in today's nursing care are patients right to refusal. Not the right itself but the interpretation of it. A patient refuses to be changed, a nurse/carer cannot physically force them to do so. They can persuade but if the patient is not willing, they cannot force. I have seen it so many times, relatives expecting nurses to be able to "make" a patient comply. (I'm not saying this is the case here) Unfortunately the reality is there is a very fine line between gentle persuasion ("Mr X, you must be very uncomfortable in those wet clothes, how about we get you some clean clothes to put on. I'll help you if you like", - gently lead "Mr X" to a place of privacy where he can have a wash and change) and abuse, where a patient refuses point blank and will not move, a nurse or carer cannot physically "take" them to be freshened up, This can be considered elder abuse and a breach of a patients right to choice. I have seen it many times where a family are blissfully unaware of how patients react when they are not around. (Again not saying this is the case here.) However, there is also a very fine line between right of refusal and neglect.

 

Another common issue is funding. In some care homes, only a certain amount of incontinence pads are allocated to each patient per day, and are based on the need of the patient and it can be very strictly adhered to. Depending on the level of absorbancy, a pad should last a certain amount of time. The longest lasting pads SHOULD last twelve hours, however they rarely do. In any case, whether or not pads are in use, a patient who is incontinent should have assistance with toileting, regularly. Pads are designed to assist with keeping a patient dry, not act as a makeshift toilet. Most pads will "lock" urine in, however similarly to a baby with nappy rash, a pad which is not changed when the wetness comes to the surface and is left against the skin can cause all manner of problems, in addition to being uncomfortable.

 

If it gets to a point where a patient refuses or other problems cause the incontinence pads to soak through in short spaces of time, then there are other ways around the problem, as flyingdoc mentioned, other aids to incontinence they could try. Perhaps your mum could discuss these options with the charge nurse or matron.

 

Or it could be a case of as flyingdoc pointed out, lack of time. There are ratios of staff to patients in care homes and staff are usually working at the minimum number of staff required, and struggle to keep "on top" of times.

 

Another problematic area in nursing homes can be lack of permanent staff. If there are regularly agency nurses hired to make up the numbers, and there is a high turnover of agency staff, this can also become an issue. An agency carer who doesn't work there regularly will not know the patients as well as the full time staff will, they won't know their routines, whether they are continent, incontinent and have to be guided by the permanent staff.

 

One of the most problematic areas is a high turnover of permanent staff, period. When this happens, new staff are regularly recruited most of whom have little or no experience of working in the care sector (I'm talking about carers, here not qualified nursing staff). Some of which don't realise the importance of the "small" things, some of which frankly don't really stop to think about it. This is one of the main reasons it was decided that all care staff should be trained to SVQ/NVQ level in care.

 

Another issue that is happening in a lot of care homes (and I am NOT being racist) is overseas workers being employed in them. Some in their own country are trained nurses, but have to do an adaptation course before they can practice in the UK as a nurse, but there is nothing stopping them from working as care assistants. I've seen extreme language barriers here in some cases. Also, depending on the country the worker comes from there can be a huge cultural difference about the manner in which care is carried out.

 

Those are some reasons. However, reasons are not excuses. Your dad is in a care home because he needs 24 hour care. If he is not receiving that care for whatever reason, then it needs to be addressed. They cannot stop your dad from being incontinent but they can help to combat the effects of it, and they should be ensuring to the best of their ability that he is not left to sit in wet clothes. I would echo flyingdoc again that your mother speaks to either your dads keyworker, the charge nurse or the matron. All too often, they are unaware that a patient has been sitting in wet clothes. However as your mum has regularly had to ask for him to be changed, then you would think that they are aware that it is a problem and addressing it should be incorporated into his care plan and his evaluation.

 

You can also find inspection reports on the nursing home to find out if similar matters have come to the attention of the regulators during their inspections. Here are some links to the regulatory bodies:

 

ENGLAND: National Care Standards Commission England, NCSC , care regulation

 

SCOTLAND: SCRC - Scottish Commission for the Regulation of Care

 

WALES: CSSIW | Care and Social Services Inspectorate Wales (CSSIW)

 

Hope this helps.

[holley]

Thank you so much for that its a help I will ask her to look at his care plan.

He doesnt refuse to be changed he says very little and has dementia as well.

[Sali]

I was extremely interested in the comments made by ErkinPNP. I don't think the issues raised are exclusive to care homes; they happen on the elderly care wards in our hospitals too.

If a patient has dementia, at what point can you judge that you have breached the individual's right of choice? I'd worry that this was used as an excuse by a care home for neglect.

[ukaviator]

Men get bladder infections as a result of a chill or possibly linked to a prostate problem. Bladder infections result from bacteria that cause an inflammation of the bladder's inner lining.

 

From this infection he may get a Kidney infection also, so he may need some anti biotics to get him through this. Best get the doctor to get him checked out, especially the prostate area.

[flyingdoc]

Sorry aviator but this is a particular soap box of mine (probably brought on by my mothers nagging to wear a jumper) but there is NO infection in the world that is caused by a chill (or any kind of cold)

 

Infection requires bacteria.

 

You CAN become more susceptible to catch an infection if your bodys natural defences are lowered by cold or other problems, but cold - in of itself is completely unable to do anything to you with regard to infections or viruses.

 

(cold can obviously kill through hypothermia but thats not an infection)

 

Right - feeling much better - rant over

[ErikaPNP]

I was extremely interested in the comments made by ErkinPNP. I don't think the issues raised are exclusive to care homes; they happen on the elderly care wards in our hospitals too.

If a patient has dementia, at what point can you judge that you have breached the individual's right of choice? I'd worry that this was used as an excuse by a care home for neglect.

 

They are not exclusive to care homes at all. The OP related to a care home, but the issues can and do happen in any care environment. Personally I think there are several manners in which a patient can be persuaded to consent to allowing assistance with personal care, particularly if a patient has a form of dementia, dependant on the stage the dementia is in. Physical force is not acceptable. Gentle persuasion is, and there are many manners in which gentle persuasion can be used. It's simply a case of getting to know a patient and learning what they respond best to. In offering assistance to any patient there are several factors a carer has to stop and think about.

 

*The manner is which they offer assistance

*The enviroment in which they ask if the assitance is required

*The tone of voice used

*Body language

*Assessing if there are any "triggers"

 

One of the best forms of training for care staff is person centred care, particularly, but not exclusively for care staff who have little or no experience in the care sector. Seeing the world from the eyes of a patient is very educating and interesting.

[ukaviator]

Men get bladder infections as a result of a chill or possibly linked to a prostate problem. Bladder infections result from bacteria that cause an inflammation of the bladder's inner lining.

 

From this infection he may get a Kidney infection also, so he may need some anti biotics to get him through this. Best get the doctor to get him checked out, especially the prostate area.

 

I did mention Bacteria Flyingdoc, i admit the chill part is wrongly worded there. Symptoms do include feeling a chill.

 

Why rant, simple mistake ?

[Sali]

ErikaPNP

Person centred care sounds ideal and what we should strive for in our care homes and our hospitals. Empathy is lost in targets and budgets.

[ErikaPNP]

Everywhere is going the same way Sali. Anything that is government run is obsessed with targets which are never really a true reflection anyway as people strive to ensure the targets are met which means quality gets lost along the way.

 

It's a terrible shame, people become nurses because they want to care for others. I bet half the young students who sign up don't realise what they are actually going to end up doing is far from what they expected.

 

I watched that dispatches programme about the NHS and I was very saddened to hear the upset in the nurses voices as they talked about how obsessions with targets and lack of staff were having such a dire effect on patient care. They have all these fantastic nurses there who want to spend time with the patients. It always reminds me of "A nurses reply" poem, in response to the patient's "What do you see poem" have you read it? It's very moving.

[flyingdoc]

UK - rant was not at u but at the world in general and I apologise if it came across that way.

[Sali]

I read the poems Erikapnp - they moved me to tears.

[flyingdoc]

I spent a good many years in the NHS as a nurse - and worked at every level from junior to night manager.

 

I found that the culture in our hospitals changed so much over the last 15 years that I had had enough and now work in claims management.

 

The response to the "what do you see" poem was at the time true but is not true now - things are far worse now.

 

I could write a litany on the problems with the NHS but not all of it is as a result of lack of funding. In fact there is argument that it is better funded now than ever before.

 

It is the mentality with which the Health service is run that is at fault. You cannot run a hospital like a business and yet they try.

 

Services are sourced out to the lowest bidder with little thought for quality and yet companies bid for contracts and make millions in profit.

 

There should be no profit from the health service and while there is - millions of pounds that should be spent on patient care is being syphoned off into the private sector.

 

However it is not just the politicians that are to blame.

 

Take the nursing profession.

 

They have increased their acedemic requrements for entry and made nursing a "degree" profession.

 

This sounds like a great idea - better patient care - but is this really happeneng?

 

The answer is no. All this has achieved is to exclude many people who would have made outstanding nurses but do not have the inclination aptitude towards academia. Consequently we have a lack of UK trained nurses.

 

Also some (not all) of the nurses that we do train - feel that basic nursing care is beneath them, and that they are too highly qualified to wipe a bottom when required.

 

This has left us importing foreign nurses (and I have no beef with them) but their systems of nursing in their countries vary wildly from ours and this makes maintaining standards difficult.

 

Then we have MRSA!!!

of course if a patient contracts MRSA then it MUST be the Doctors/Nurses fault.....

 

As a bed manager in a district general hospital - if a patient came in who was known to be MRSA +ve I had to find them a side ward - even if this meant moving a patient at 3am to accommodate them (for which complaints regularly came in)

 

The problem was then - that the next day I would meet this patient in the hospital shop or canteen. We can Isolate - but we cannot imprison so therefore the MRSA was spread by the patients themselves.

 

(I do not totally vindicate hospital staff - they do have a part to play without a doubt)

 

More and more nurses are expected to fill in for Junior Doctors whose hours have now been capped - Siting IV's, giving IV Drugs, Administering drugs thought central lines - Confirming Death - all used to be the job of the junior doctors - and many nurses are now carrying on this role to take the pressure off them.

However Nurses are still expected to completel their own tasks, looking after patients, nursing cares, administering medicines, dressings, supervision and training of junior staff and HCA's (who themselves are vastly abused and without whom the NHS would have collapsed)

 

And then when the food is cold - or the ward is dirty - who is to blame, the Government who have set impossible targets? The trust who have contracted out catering and cleaning to the cheapest provider who pay peanuts to children to complete the work? no its obviously the nurses fault as he/she has nothing better to do than damp dust all day.

 

Finally the attitude of the patients has changed.

 

It used to be that patients who were grateful for what you did for them, far outweighed patients who complained.

now it is completely the other way around.

 

Too many times in A&E I would be faced with a drunk chav - who would loudly proclaim that "he was paying my wages and I had to do what he said" - when in reality it was MY taxes paying for his drunkenness via various benefits that he claimed...

 

Too often you save a life and then get complained about or even sued for the loss of a cardigan or a PJ top, or because you looked at someone in a way they didnt like - or used a politically incorrect word.

 

I trained to be a nurse because I wanted to help people, I left nursing because I needed to save myself.

 

I am not even going to mention pay.......

[poppynurse]

Well said - it's a crying shame that the Govt and DH don't listen more to the front line staff.

 

Our management accept that we have closed too many beds and shed too many nurses....but won't do anything about it, it's all steam ahead for foundation status (coz the alternatives are too grim to think about according to mgmt).

[Sali]

ErikaPNP - have you ever thought of applying for the post of Chief Exec of a Trust? I think you'd do an excellent job.

I 'm glad that the patients (and their families) attitudes have changed. My parents generation thought that 'doctors knew best' and never challenged the medics, which I think led to them thinking they were God and beyond question. There are still many with that attitude working in the healthcare profession. Perhaps the reasons that people complain more now, is because there is more to complain about. Staff shortages cannot help but lead to poor care. However, I agree with you about the nursing training. I haven't been impressed by what I've encountered. You also cannot teach compassion. I have a sister who trained as a nurse before it moved from the classroom and she shares my views.

As for hospital infections. My own hospital regularly carried out a deep clean of the wards and the patients were not given a second thought. Thrown in wheelchairs without slippers or dressing gowns. Yet the doctors always (and I mean always) never wore an apron as they moved from bed to bed. I made a comment about this once, but the nurses said they were fed up with trying.

[flyingdoc]

sali was your reply to my post or to the earlier post by Erica?

[davey77]

Don't want to hijack holley's thread here but seems to be a lot of medical folk commenting so thought those who would like to could read my blog (sorry haven't updated it for a while. Will get on to that) and comment.

 

All thoughts and comments appreciated:

IBS-Diaries

[poppynurse]

Hi Davey,

 

Have just read your blog and would like to congratulate you on the dedication you show to your mum. Hope things have continued to improve. It's time the government showed some recognition for folk in your situation.

 

I hope my lads turn out as caring as you.

 

Best wishes x

[ErikaPNP]

Lol. I'm not a registered nurse, Sali. I'm not in the field anymore, packed it in years ago, didn't like what it was becoming. There was a time when nursing care was exactly that, but reduction of staffing levels and various other corner cutting by people (bigwigs) who are only out to make it look good on the face of things and aren't interested in the reality of it (the phrase "fur coat and no knickers" spring to mind) has put paid to quality nursing care.

 

It really is so very sad, as it is not the nurses that are at fault. They do their damndest to make the best of a bad situation, thanks to the idiocy of people who don't know what they are talking about, whose ideas of "back to the floors" is spending ten minutes walking around one ward. I don't want to even get started on how poorly paid nurses are.

 

I too, am glad families have started to speak out, but when it gets to the stage that families have to complain for something to be done, it's too little too late. It shouldn't have to come down to it affecting a family before the problem is recognised for what it is. The problem is that some families do not recognise the extent of the state of how things are, and generally assume that the nurses just don't care, or that they have got the time but choose not to make it.

 

I'll remininsce about the time I was in the post natal ward after having one of my children. The day I was due to go home, a fellow patient's husband was having a rant to me (yes, just an innocent bystander lol) because his wife had needed a rubber ring to sit on and no midwife could be located. He said he'd walked the wards, in search of a midwife. On passing an empty room, he saw three midwives sitting having a cup of tea and summoned them. Well, here he went on ranting and raving and causing a scene on the ward. He was angry that these midwives were having a cuppa, stating that they were paid to work, not to drink tea. I said to him "Was the midwife who gave her the ring one of the ones having tea?" he confirmed that it was. I then went on to say "Well, why do you suppose they were drinking tea on the ward instead of the canteen?" his reply was "What do I care where they were drinking it, they were drinking tea when they should have been working" I responded by pointing out that there seemed to be a staff shortage today as this was my fourth day on the ward and I'd not had my tablet, the breakfast dishes were still lying and the only midwife I'd seen was the one that gave his wife the ring. Normally by that time of day I'd have seen at least four midwives going about their business. I pointed out that if they were drinking tea on the ward then they were most likely taking their tea break on the ward, instead off away from the ward so they would be present in case of emergencies, or if a buzzer was pressed. The tea was their tea break, which had been interupted by someone ranting and raving like a bloody lunatic because her royal highness over there couldn't wait 10 minutes for a silly ring, whilst others around them still hadn't had their medication or their check ups. "They're entitled to their tea break, and had the kindness to cut it short to bring herself that ring when they'd have been quite right to let you wait your turn" I retorted. (They were a right pair of snobs, demanding everything left right and centre, oh and "coffee and biscuits for our visitors, nurse" - of which there were many, each as uppity as the last set. I couldn't be doing with either of them lol)

[davey77]

Hi Davey,

 

Have just read your blog and would like to congratulate you on the dedication you show to your mum. Hope things have continued to improve. It's time the government showed some recognition for folk in your situation.

 

I hope my lads turn out as caring as you.

 

Best wishes x

 

Thanks for the kind words PN.. very nice of you to say.

[andypoth]

It might also be worth asking if someone could review your dad's medication as this might be partly to blame - e.g. diuretics may be increasing his urine output and a change of medication might reduce this. You could perhaps ask for him to be referred to the local dementia service, which may also be called a memory clinic or Older People's Mental Health Service, or something else!

 

Sadly, I would also not be surprised if your dad has been prescribed antipsychotic medication to manage (i.e. get rid of) behavioural symptoms of dementia. As a community pharmacist I see a lot of patients being prescribed drugs like olanzapine, risperidone, amisulpride and quetiapine because the staff in their care home can't cope with them for various reasons. These drugs are being grossly overused in care homes despite the risk of adverse affects associated with them. It's quite possible that your dad is somewhat sedated due to being prescribed these drugs, and therefore isn't alert enough to either notice that he needs to pass water or to attract the attention of a carer to help him.