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District nurses - Carers UK Forum

District nurses

Share information, support and advice on all aspects of caring.
My mum is 87 and can barely walk because of muscle weakness, and also has a heart condition. She accidentally scraped her leg a while back, and left quite a nasty graze. I dressed it and kept it clean, but it started to look and smell a fraction worrying, so I called in the district nurses. After all, they have access to all the dressings and equipment I can't acquire. The nurses duly started to call twice a week to dress the injury. However, as it is always covered and I don't have time to stand and watch the nurse, I hadn't actually seen the leg for a few weeks. I had noticed that no two nurses ever seem to use the same kind of dressing, and that several times there were no dressings at Mum's house and the nurses didn't have any with them, and that they don't carry scissors and always use Mum's kitchen scissors. When I did see it I was shocked. The wound was much worse than when I had called the district nurses in! The nurse who was there was the most efficient of the team - she carries a black nurse's bag, not a carrier bag and writes down in the care folder what she is doing. She pointed out that that the original wound has actually healed, and that this one is new. It turns out that they have been using self adhesive dressings which, because Mum's skin is as thin as tissue paper, have been tearing her leg all the time. It also transpires that Mum is mildly allergic to the sticky stuff on the dressings. The nurse upped Mum's visits from two to three a week, so they were now due to call Mondays, Wednesdays and Fridays. This all happened on a Wednesday.
On the Friday I wasn't with Mum, but the nurse arrived as expected. She was a community matron, and had visited before when Mum had a leg ulcer a couple of years or so ago. I have never met her. She dressed the leg, but also asked a lot of questions about how my parents cope with laundry, shopping, cooking etc. My dad does the basic cooking, heating up simple meals, often cooked by me, and I do all the housework, washing etc so we don't need any extra help right now. We have had social services assessments and OT assessments and they have been satisfactory. Mum remembered that the last thing she said to the nurse was "perhaps you will come again on Monday" and the nurse just smiled.
On Monday the nurse failed to arrive at all. Mum doesn't like to mess them around or keep them waiting, so she literally sat waiting patiently from 8am to 6pm when I finally convinced her that no-one was coming. I phoned on Tuesday to ask them to make sure that someone came on Wednesday, as they have a habit of dropping patients off their list if they are missed once. They apologised and assured me that she would get a visit on Wednesday. On Wednesday no-one arrived so again I phoned and asked. The people you speak to on the phone are just admin staff who take messages, but she promised that she would ask a nurse to call me back. One of the team did call back a few minutes later, but didn't know what was going on either. He is a very nice caring sort of man, and promised to find out. Sure enough he called me less than an hour later, and told me that the community matron had cut Mum's weekly visits down to one, just two days after the other nurse had increased them. I phoned the office four times before I finally managed to get the matron to return a call. While I was waiting I checked Mum's care folder, and found three spelling mistakes in the first two pages and a page of someone else's notes at the back of the folder. The nurses mostly just date and initial when they have visited, as all the information is on their computer system. When the matron finally had the courtesy to return a call (almost six hours after my first call) she said that the leg was so much better that she had decided to reduce the nurse visits. I said that she should have told Mum and she insisted that she had told both my parents and they had both heard and understood. My parents are both a bit deaf I admit, but they are not stupid, forgetful or suffering from dementia. This woman is blatantly lying, but all I could do was tell her I found her attitude sloppy, unprofessional and unacceptable. My mother is reluctant to make a complaint, so this cow will probably just carry on in the same vein with all her patients.
Sorry this is a bit long, but it really upset me. The dog had an operation a few weeks ago, and frankly got better nursing care than some of these people provide. Has anyone else had similar problems?
What a total nightmare. That's awful re the scissors, would you get some for your mum to keep just for dressings? All the dressings your mum is allergic to should be recorded, so different nurses don't keep making the same mistakes. I'm allergic to certain adhesives, me-fix pulls my skin off ... So I can real empathise, your poor mum.

Hopefully others members will be along with more experience / suggestions.

I have only had one bad experience with a D/N. I was worried about Dad's legs and the start onother ulcer and like you felt it should be attended by he professionals. The first nurse I mentioned it to, huffed at being asked and was in and out of the houses quicker than you could imagaine and told me to keep it moisturised. The next nurse was heaps better and now Dad is getting regular twice weekly appointments. When D/Ns have failed to arrive before and things were more urgent, when Dad had a bad infection I rang the out of hours 111 number and they got a D/N round in the night and were very helpful.
I've seen quite a bit of them with Dad's legs and have to say on balance they are all fantastic, hugely overworked and sometimes gasping for a cup of tea so don't be too hard on them.
When you get a good one ask what dressings your mum should be having and ask if she can place an order at the pharmacy so you can keep some in stock at your mum's house.
We are having to buy my son his own electric profiling bed and his own pressure relieving mattress as the DN's only give out second hand beds and mattresses and they will not give him the pressure mattress he needs until he has a pressure sore! The whole point of the mattress is to prevent pressure sores from arising in the first place!

Thanks for sharing your experiences. I was starting to think I was the only one. Most of the nurses are lovely and work really hard and really care about their patients' welfare. However, they tell me that they are not allowed to carry their own scissors for fear of cross infection, and it would be too expensive to provide disposable scissors for each patient. Mum had a pair which we bought especially for the district nurses to use, but one of them pocketed them. We bought two identical pairs of kitchen scissors and now reserve one for nurse use. We keep an eye on them to make sure they don't disappear into a nurses's bag.
The local pharmacy only keep small self adhesive dressings in stock, and would only agree to order different ones if the doctor requested them. I asked one of the district nurses what dressings they use, and where could I buy them. They are special ones, and I was told to ask the doctor to prescribe them. I did, and she told me there would be a prescription available at the pharmacy later that day. I went to collect it, and found that it wasn't there, so I went back to the doctor's surgery. The doctor had passed the request on to the practice nurse, I suspect because she didn't know what the dressings were, and I described to the nurse what the required dressings were like. She wrote a prescription, and when I collected it from the pharmacy the dressings were nothing like what I had requested. They were adhesive when I had asked for non-adhesive, a totally different size and shape. I asked the district nurse again where I could obtain the dressings they use, and was told that they are special ones, and that I shouldn't interfere with the work of professionals.
Most of the time there is one spare dressing left at Mum's, supposedly in case of problems. One time, the wound leaked and I cleaned it up and changed the dressing, trying to make Mum more comfortable and prevent infection. When the nurse returned she was furious because I had used the dressing and now she didn't have one. She had to drive about eight miles to collect more, and I was warned again not to interfere. Strange isn't it, that I'm not qualified to change a dressing but just a few months ago I had to learn to give my mum injections every day because they couldn't send a daily nurse to do it.
Mum has a care folder, but most of the nurses just date and initial it. I am told that all the information is on their computer system, but the nurses don't carry tablets or anything to check the system before they treat Mum. No-one seemed to realise for a while that she was allergic anyway.
I must be getting old, but it seems to me that the NHS worked a lot better when the district nurse rode a bike with a wicker basket on the front, when your doctor and his partners covered night and weekend duty on a rota system and the cottage hospital could be reached by one bus.
just a quick thought Florence - have you tried looking up the particular dressings you want on the internet ? I googled "non adhesive wound dressings" and got a lot of hits, perhaps it might be worth a quick look ?
Eun, everything is crisis management; that is ridiculous re waiting for a sore before getting a pressure mattress.

Florence, it's a constant battle, isn't it.

Good idea, Susieq. I looked up dressings on the internet, but there are so many it becomes confusing. I want to make sure I get the right ones. If the nurse would just tell me you need xxx brand, xxx product code from xxx.com I would happily order immediately.
I have found that caring would actually be fairly straightforward if only the agencies who are supposed to help didn't spend all their time placing obstacles in the way. I seem to spend such a lot of time on the phone arguing with the likes of nurses, doctors' receptionists, BT and British Gas that it's a wonder I get anything practical done. I honestly cry sometimes for the elderly and vulnerable who have no-one to fight their corner for them.
Florence wrote:Good idea, Susieq. I looked up dressings on the internet, but there are so many it becomes confusing. I want to make sure I get the right ones. If the nurse would just tell me you need xxx brand, xxx product code from xxx.com I would happily order immediately.
I grabbed the protective paper envelope from Mum's once so that I could try and get them (or something similar) from the information printed on the envelope ! At one point I was cutting up babies nappies (with the stay dry liner) and holding them in place with a tubigrip bandage - that was actually a tip from one of the old school type DN's !