- 20 March 2020
- 12 min read
Here's how the Coronavirus outbreak has changed my learning disabilities nursing job
I work in a care home for people with learning disabilities and here's how the Coronavirus outbreak has changed my job.
Topics covered in this article
How Coronavirus has changed the way the home is run
I am a learning disability nurse, working and leading shifts in a small nursing home.
I work with a number of support staff on shift, and together we ensure the safety and well-being of the people who live there.
The coronavirus outbreak has had an effect on our workplace, our practices, and the people who live there.
Equipment - fears Coronavirus could cause shortages of PPE
In nursing, hand-washing is an important technique that is taught alongside other clinical skills such as blood pressure.
Student nurses are assessed on hand washing during placements.
Therefore, it will come as no surprise that nurses are already proficient at this, and rigorously follow government guidelines to wash our hands even more frequently during the coronavirus outbreak.
Where I work, staff are more vigilant about using personal protective equipment (PPE).
This could include using gloves even to take someone’s pulse, avoiding skin to skin contact with someone we have worked with for over a year or longer.
Aprons, gloves, and sometimes face masks are worn during personal care so this has not changed.
Despite this, there is an air of it being even more important.
People might change their aprons and gloves frequently during personal care, if it got splashed with clean water while checking shower water temperature for example.
All of this contributes to an overall increase in the equipment being used.
This could lead to shortages in some homes.
The home I work in orders equipment in bulk from a company who then delivers to the door.
Under normal circumstances, managers can be comfortably confident the home will need the same amount each month.
Now however, with staff using more gloves, aprons, and other essentials (not to mention hand gel and soap), there is the real possibility of running out.
Some homes ration products, while taking care not to compromise the safety of people they are supporting.
There is a worry suppliers might be overwhelmed.
Staffing issues in the care home during Coronavirus
Each person I support is assessed for how many support workers they need, and then funded accordingly.
If they are quite independent, it could be the case that they do not need one to one support, but could in effect share a support worker with another resident.
This system of assessment ensures each person has the correct amount of support – with funding to match.
This is how the home I work in has ended up with correct number of support staff to meet the needs of the people living there.
It is also the difference between why someone might live in a nursing home, with a full-time nurse, or a care home – which does not have a nurse on shift, as the person is assessed as not needing nursing care.
Government advice asserts that anyone with a cough or temperature (feels warm to the touch – check the gov.uk website for more details) should stay home and self-isolate for 7 days.
If someone you live with has symptoms, you need to stay home for 14 days.
This includes staff who work in the nursing homes.
Several otherwise healthy staff, with no underlying health conditions, were already staying off sick to comply with these guidelines, essential to protecting everyone’s health.
As a virus does not discriminate, this has included support staff, administration, managers, and nurses.
The care industry as a whole often relies on agency staff members due to staff shortages.
The pandemic has increased this reliance.
Thankfully the home I work in has some excellent agency staff, and good relationships with agencies to ensure staffing requirements are met.
Not all homes will be as lucky, with new staff feeling overwhelmed and unprepared as permanent staff may not have time or the skills to give proper inductions.
This is especially true is a manager is in self-isolation and unable to give guidance in person. In healthcare, it is not always just about the numbers.
Some people who need support require men or women only to support them.
If this is not possible, their dignity might be compromised.
In some circumstances, depending on the person, not having the right support staff could lead to the person displaying challenging behaviour – expressing their frustrations and anxieties through physical violence as they try to understand the changes.
This could be towards themselves or others, and might lead to restraint techniques or medication which would otherwise not have been needed.
It is a potentially very stressful outcome for the people we support, which we try and avoid at all costs.
Some people with learning or other disabilities living in nursing homes require their support workers to have specialist training, such as using hoists or other moving and handling skills.
Others might use Makaton or specialist communication skills.
The coronavirus has led to an increase in regular staff needing sick leave, consequently new staff may not have these much needed skills.
All of this impacts on the support we can give to the people who live in the nursing homes.
We do our best, and we still go by the underlying philosophy of person-centred care.
Support plans are in place, and people we support who have capacity are still being given as much input into their care as possible.
Keeping people we support safe during the Coronavirus outbreak
Government advice is that everyone needs to practise social distancing.
People who are particularly vulnerable are receiving advice week beginning Monday 23rd from NHS England.
Social distancing says to avoid large and small gatherings in public places, and also avoid gatherings with family and friends.
This has been a challenge for us.
The very nature of a nursing home is people living together, sharing communal spaces like living rooms, kitchens, corridors, and office space.
People with learning disabilities are vulnerable adults.
They also may forget or not understand that they need to keep a distance from each other.
For a variety of reasons, people with learning disabilities often have underlying conditions including high blood pressure, heart issues, physical disabilities, and are more prone to infections.
This could be because of medication, or invasive medical devices like tracheostomies or feeding tubes.
The guidance for people in this group is to follow stringent social distancing – essential self-isolation, keeping away from other people as much as possible.
How is this possible though, with support workers and fellow residents?
Some homes have taken to confining residents to their rooms.
For people with learning disabilities or dementia, this can cause extreme confusion, and loneliness.
Some people may even believe they are being punished and sent to their room.
Therefore, if this is a route that needs to be followed for peoples’ safety, nurses must check the legal implications for this even in times of emergency.
The Mental Capacity Act tells us each person’s capacity to consent is decision specific – this includes whether they agree to self-isolate.
More information will be available to individuals in our care next week, with further guidance from the NHS expected.
The home I work in has a small number of residents, but is a large property.
Therefore we have been trying to keep residents apart as much as possible, rather than asking them to stay in their rooms.
Staff have been vigilant about washing their hands when interacting between residents – however most staff have been assigned to work with the same people throughout the day where possible, to reduce the risk of cross-infection.
Mental well-being is very important.
The people I work with enjoy trips out to parks, visiting friends and family, the pub, and other social outings.
If these need to stop, it is imperative staff explain to people why – in ways they understand.
At the same time, an increase in engaging activities in the home have been provided.
How we are coping emotionally as nurses on the frontline
Everyone I work with – from the nurses, support staff, administration team, head office, and cleaning staff – care very much for the people we support.
Despite these measures, the home remains a place of optimism and professionalism for the people living there.
We are guests in their home, after all.
Perhaps watching a film instead of endless, often negative, news.
Making sure we laugh and share jokes as normal.
Despite everything, we are trying to go about our daily routines as much as possible.
There is still the morning handover meeting, the morning medications.
Activities continue, although now in-house or perhaps the garden.
Staff can keep in touch via email, phone, and our group on social media.
How you can help care homes - let's stand together
This is a time of coming together, and there are many people who have done so.
Whether it is helping neighbours, people in their community, or friends and family, it has shown the majority of the British public to be caring willing to care for the vulnerable.
If you would like to help those in nursing homes, be aware that some do their shopping at the local supermarkets like everyone else.
Be mindful of buying only what you need, leaving some for others like the people we support – staff will probably be in shops on their behalf during these times, or ordering online.
The home I work in gets a weekly allowance, meaning stock-piling isn’t an option.
Some of the people we support like to use their own money to buy things they like, which again is not a lot and can only last a week.
If you have a relative or friend living in a nursing home, and you haven’t heard anything, do phone before visiting.
They may have had to draw up a no visiting policy.
You could write to your friend or relative, though.
Maybe the home accepts you emailing, and them printing it off to read with your loved one.
They are for everyone’s safety, especially the people living there.
We remain confident
I hope this article has given you an insight into working in a nursing home during this challenging time.
The people I work with are caring, professional, and have a lot of different training, knowledge and experience.
By working together, we can provide a continuity of care relevant for the people we support.
I am confident we will get through this as a team, always continuing to listen to the people who live there, and doing what is best for them.