A back to front hospital, steam tents and gloopy feeds

After leaving Napsbury I went to work in the Queen Elizabeth II (QEII) district general hospital. The first full hospital to be built by the NHS, the QEII provided healthcare services to the people of Welwyn Garden City and the many villages in the wider surrounding area. The same villages also gave their names to the wards; Datchworth, Digswell, Codicote, Ashwell, Essendon, Knebworth and so on; from these I learned the village names of east Hertfordshire long before I ever knew where they actually were.

The hospital was 5 stories high and was ‘T’ shaped in design. The wards in the main building (the cross bar of the ‘T’) were organised into straight corridors with 4-bedded bays to one side and single rooms to the other. Half way along each ward there was a nurses’ ‘station’, a communal desk area where patient records were stored and the ward clerk manned the phone. The station was flanked on one side by a door to the clean sluice and on the other by a door to the dirty sluice. Commodes, bedpans and urinals were stored in the sluice areas along with the automatic bedpan washer. At the time we used paper bedpan covers to cover the contents of the bedpans and urinals when carrying them from patient to sluice. The covers were supposed to be thrown away prior to placing the bedpan or urinal in the washer, slamming the door shut and hitting the start button. Frequently though, the cover and several ‘disposable’ wash cloths would go in to the washer as well bringing things to a grinding halt more often than not. The engineers who had the unhappy job of repairing the machine (usually on a Sunday morning) were not best impressed by the nurses' continued failure to master the basic rules of using the machine properly. Not surprisingly, having the sluice right behind the nurses’ station also made for some unappealing smells and sights during shift handover or whilst talking to relatives, as well as an awful lot of noise when it was operating fully. 

Opposite the nurses’ station was the patients’ day room, a feature less well used in acute hospitals nowadays as patients who are well enough to watch television in a hospital day room are usually deemed well enough to do it in the comfort (or not) of their own homes. In the bed areas, each 4-bedded bay had large windows facing out toward a wide green lawn at the back of the hospital. The rear of the lawn was screened by tall, densely packed trees. In the misty early mornings, as the dark night hours receded, you could see rabbits and the occasional Mumjac deer nibbling at the grass, quite unfazed by the hospital’s close proximity. I thought this little touch of countryside was a thoughtful consideration of the hospital architects. However, not long after starting there I was told that the entire hospital had been built facing the wrong way round in which case the view was only ever intended for the sight of the x-ray and laboratory staff whose accommodation sat in the upright bar of the ‘T’. I never did find out if this accidental reversal was really the case but if it were it was a happy enough mistake.

After an induction period on an adult ward, I was put to work as a nursing assistant on the ground floor children’s (paediatric) ward. The layout on this ward differed to the adult wards in that it had side rooms either side of the ward corridor as you entered with just two bay areas beyond the mid-way nurses’ station. The ward walls were painted bright colours and curtains screening each bed were patterned with cartoon characters. We cared for very young babies (any baby not requiring neonatal intensive care) through to young teenagers aged 15 to 16. Side rooms tended to be reserved for the babies, the infectious or the very sick and it was in this part of the ward that I was often required. My main duties as a nursing assistant were to clean and set up equipment, make cups of tea for parents and help with feeds and feeding.

At that time (1982) hospitals were still providing nappies and feeds for babies. Nappies were the white toweling washable kind posing two problems, namely getting them on and getting them clean. Getting them on required a bit of a knack as well as an amenable baby, getting them clean required a trip to the sluice to get rid of any solid content and then a drop in the nappy bucket ready for laundering. These were large white plastic buckets with lids, two buckets to each room. Every day the buckets would be emptied and the nappies sent to the laundry for washing, the buckets would then be soaked in a chlorine solution, drained and dried for re-use. This was the responsibility of the nursing assistant on duty and basically required a lot of time in the sluice with smelly nappies and buckets. Another important part of the daily routine was the making of all the milk feeds for the babies. The nursery nurse would organise which feeds were needed and when. Working in the designated feed kitchen (known as the milk kitchen) we would start every day by cleaning the kitchen from top to bottom. We followed a strict cleaning routine which was followed to the letter every single day and included ensuring the bottles and teats were washed and sterilised ready for use, wiping all the surfaces with disinfectant and mopping the floor. After cleaning, the feeds were made up according to each baby’s requirements and each bottle labeled as to when it had been made, when it should be given and to whom it belonged. 

Whilst cleaning buckets, bottles and kitchens presented no problem to me, the making up of the milk feeds was a constant challenge. No one feed ever seemed to be the same. Depending on their illness babies might need a lower strength feed, a more concentrated feed, a small volume feed or most troublesome of all, a thickened feed. The babies who needed this latter type of feed would typically be those with palette abnormalities or severe gastric reflux; babies who either lacked control over their swallow or who could not keep the milk down. For these babies, the feed would be thickened by a gum based thickening agent and, if the baby had difficulty sucking, we would also enlarge the hole in the teat with a snip of the scissors. The thickening agent came in powder form and was added at the time of making the feed up by mixing it with boiled cooled water and milk powder to form a smooth paste (like making powdered custard). Then more boiled cooled water was added until the feed volume was correct. A notoriously temperamental agent (certainly in my hands anyway) the smooth paste would inevitably turn lumpy as the water was added and despite my best efforts, which included a small metal sieve and a lot of frantic bottle shaking, the feed would nearly always end up lumpy and unusable. I am happy to say my unsuitability for this task was quickly recognised and I was moved to other duties. Interestingly though, my custard making skills are unaffected.

The role of the nursing assistant on a children’s (paediatric) ward was less ‘hands on’ than that of a nursing assistant in a psychiatric ward for elderly women. The care then, as is now, was family focused and washing, feeding and entertaining was done wherever possible by the parent, particularly those with babies. With the qualified staff managing surgery lists (an endless round of circumcisions, tonsillectomies, inguinal hernia and pyloric stenosis repairs) carrying out complex care and administering medications, the nursing assistant was left to do all the various background jobs required to keep the ward running smoothly. Aside from cleaning nappy buckets, the nursing assistants stripped, washed and made-up countless cots and beds (the turn-around times in paediatrics often were and still are, very fast), carried out simple observations, fed any spare babies, doled out tea and sympathy where necessary, said goodbye to the better and hello to the poorly.

When children were admitted we would be told before-hand what they needed and this often involved setting up some kind of equipment. Monkey poles and steam tents were commonly called for. Monkey poles are metal poles that lock on to the base of the bed at the head end and arch over the patient’s head. A strap hangs down in front of the patient so that they can lift themselves higher up the bed or over to one side. For a young child with a broken leg in a plaster cast, the monkey pole allowed some freedom to shift position and to do muscle building exercises. The pole also allowed the more playful children to swing side to side when we weren’t looking which wasn’t particularly good for knitting together broken bones. The children on traction, weighted down by weights or water bags (to stretch limbs or re-position fractions) would lift, swing and twist in such imaginative ways, it was a surprise really that some of them ever healed.

The other piece of equipment commonly used was the steam tent. This was a metal framed tent with a plastic covering which was set up to enclose an infant cot. At the back of the bedstead hung a motorised chamber which was filled with ice. A big piece of plastic elephant tubing connected the chamber to the tent and when the motor was turned on the tent filled with a steam vapour which was intended to help the child breath. Used for children with croup it took a while to set up and had to be regularly topped up with ice from the ice-making machine in the kitchen. Sometimes there would be 3 or 4 children sitting in their tents steaming away, the steamer motor chuntering away in the back ground. Of course my description is reliant on a rather a long ago memory so the details are not necessarily replicable (or safe!).

 Next week: At last, applying to be a student nurse