I was transferred on to one of the rehabilitation units managed by the Norfolk Community and Care NHS Trust. Beech Ward is based in the Norwich Community Hospital. As a former nurse and NHS operations manager, the next months proved an eye-opener to me.
I was initially accommodated in a bay housing six male patients. The staff have since told me how complicated I was to look after as I had a very serious, dense and complex stroke. My left knee (affected side) caused me a lot of pain when I was moved, so rolling in bed and using the hoist with a sling to transfer me was always difficult. The ward sister subsequently described me as a “scruff muffin” when I first arrived on the ward, as I looked very poorly and was all over the place, she claimed. I do know I was still reeling in shock and felt very distressed over what had happened to me.
There were a lot of tears. Stroke affects you not just physically, but also emotionally, and for the next four months I certainly proved this to be true. As I made small physical improvements it seemed as if my mood dived in the opposite direction and the slightest setback or disappointment would set me off. My motivation to exercise and work towards improvement took a battering as the pain I experienced was so bad.
One day when I was being prepared to be hoisted out of bed when a lovely, fun health care assistant came through the curtains and said to me, “Now then you big girl’s blouse, we’re going to get you out of this bed without all of this nonsense.” I rallied with, “For that, young woman, I am going to call you Flossy Knickers!” I found more names for other staff and suddenly life could be fun again. It was this fun and camaraderie that really helped me in my mood; and especially first thing in the morning my spirits were lifted if I had fun and jokes with staff. The staff were lovely and when I was feeling down, maybe crying for all the loss I had experienced, they would sit with me and allow me to cry and talk about it. It was just so important that they listened without giving answers (well most of the time anyway!)
I decided to put a challenge out to the stroke consultant during their ward round. “So,” I said. “You need this bed and I need to go home. What steps do we need to take to make this happen?” I could see they were rather taken aback, and replied that they wanted to see me recover and they were there to help with that. Not the answer I was looking for!
I pressed this question with the head of therapies on the ward, who encouraged the physiotherapist working with me to develop goals with me. This she did, agreed them with me and pinned the sheet onto the wall opposite my bed. This provided motivation for me and when the consultant next came round she noticed them and was impressed. I was surprised this had not been common practice on the ward. Co-production is the popular approach more recently taken across heath and social care. Some weeks previously I would never have believed that I would have eventually been able to take a few, unsteady steps and to be discharged back home.
What does it mean to be in Rehab? Somehow I had imagined that I would start to see a significant improvement in my condition, without really thinking about how this would happen. Superficially, the ratio of staff to patients looked quite good, with maybe 5 therapy staff on a shift for 28 patients. In actual fact, depending on availability, I had maybe half an hour therapy a day, either on the ward or in the gym. Now I am told that the first six months after a stroke are crucial in determining the amount of recovery. One of the things I am having to come to terms with is the regret that the NHS was not able to offer me more time. All those hours when I was just lying there, could I have been doing the exercises myself? But I needed assistance with the simplest task, motivation to ask, the understanding and the energy and these were still missing. If I was back in nursing now what would I change to make the rehab experience more meaningful and profitable: Levels of staffing? An attitude of compassion? A different configuration of staffing? Genuine seven day working? Greater sensitivity to the personal needs of patients would demand all of these.
Without doubt, we live in difficult times for the NHS. Political uncertainties and staffing crises are outside our control, but organisational values, and individual understanding and compassion are not. Nursing and care has always been more than simply a task. It must involve a relationship if we are to see real healing, genuine co-production of goals, and rehabilitation that is meaningful.