A Thinking Man

The UK National Health Service (NHS), of course, like Mum’s cooking and apple pie, is wonderful. In times of crisis its nurses and doctors will deal gently and compassionately (if not always as speedily as you would like) in A&E, and will mend broken bones, replace hips, insert stents after heart attacks and perform countless other seeming miracles in theatre. And they are always looking to improve things.

Some enterprising staff at the Queen Elizabeth II hospital in King’s Lynn have come up with a new treatment on the ward designed to improve patient care and improve recovery time. The treatment being trialled on several wards is called sleep deprivation.

Yes, I know, that does sound counter-intuitively shocking. After all sleep deprivation is well known to be distressing (ask Bush and the CIA). There is substantial scientific evidence that it affects the body’s endocrine, renal, and alimentary systems, and, amongst other things, causes depression and hypertension. So why consider it for a treatment method when there is such a body of experiential and medical evidence suggesting its likely harmfulness.

Some nurses at the QEII in Lynn started to notice that if patients were on a ward where they had been kept awake at night, they really seemed to benefit the next day. If, for example, their sleep was interrupted by a patient with dementia constantly calling throughout the night for their dead relatives, or by a patient with a urine infection constantly calling for toilet assistance, the patients appeared more refreshed, more lively, less stressed or anxious the next day, and were wanting to stay on the ward rather than be discharged.  It really seemed to facilitate the healing process.

The caring staff decided to add to the unavoidable sleep disruption by planning a programme of continued unnecessary sleep disruption. Several things could be utilized to help contribute to the unnecessary sleep disruption care plan:

• All staff were encouraged to talk loudly at night. Curtains around cubicles are sound proof, but enough noise can usually breech these. After all, why should staff not be allowed to make noise during their working days even if those days are at nights. The staff are awake and at work, so why should sick and dying patients be encouraged to sleep? All night staff are to be reminded that the cute signs pinned to the cubicles reminding staff to be aware of a patient’s dignity and privacy certainly do not apply to a patient’s right, wherever reasonably possible, for undisturbed rest.
• Playing unnecessary musical beds always helps disruption. Of course, emergency ward admissions are a bonus, but in their absence, moving patients between wards in the middle of the night is always significantly disruptive. It gives staff the opportunity to shout loudly to wake the patient up (assuming they are asleep), to continue to shout at the patients in their confused waking state, to bang cupboard doors and rustle loudly while ‘packing’  patients’ possessions, and to joke with the porters and their crackling radios.  And of course, if the patient is a non-English speaker, that is an added bonus, as staff can legitimately shout even louder.
• Cleaning in the middle of the night is the ideal time, of course. There are few annoying people in the way, and there are targets to be met. However, the danger is that this could be done quietly. In order to facilitate the sleep disruption care plan, taking down cubicle curtains and scrubbing them on the ward always helps contribute to the sleep disruption process.

In the early stages of planning this care plan, staff were initially worried that the trial might be spoilt by patients catching up on sleep during the day.  However, it was soon pointed out that there is more than enough noise and activity going on during the day to prevent anything but a cursory nap. There is certainly no danger of the healing deep sleep being reached.

Critics of the ongoing sleep disruption care plan have pointed out that introducing such a revolutionary care plan could be dangerous. Given all the evidence about what we now know about germ control, nobody would seriously contemplate deliberately introducing germs in the hope of improving care. It would seem dangerous and take medicine back at least a century. Critics are worried that the introduction of something known to be harmful, such as a sleep deprivation care plan, would look so ridiculously wrong, archaic, and unscientific, even by today’s standards, let alone in a hundred years’ time. Those behind the new care plan are confident that their results will eventually vindicate their approach. The clinical trial has been running for a number of years at King’s Lynn and, sadly, is likely to continue for the foreseeable future.

Tags: A&E, alimentary, bones, Bush, care plan, CIA, depression, doctors, endocrine, healing, heart, heart attack, hip, hospital, hypertension, King\'s Lynn, National Health Service, NHS, nurses, operations, patient, porters, QE2, QEII, Queen Elizabeth II, renal, sleep, sleep deprivation, stents, theatre, torture, ward