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From all the nurses and care assistants we’ve spoken to in the past year, we’ve put together a typical day in the life of a care home nurse.
31st May 2011
Care home nursing is a varied and stimulating nursing job, which allows you the opportunity to work with people at any stage in their life from young child, teenager, and young adult, to adults and the elderly. People live in care homes for a variety of different reasons but the underlying reason will be that they aren’t capable of maintaining a good quality of life living alone. This could be due to a physical disablement, mental health illness such as dementia, learning difficulty or simply old age.
Working in a care home nurse job you will work with the same people every day so it’s important you can form a bond with them in order to promote a positive environment and to encourage their wellbeing. Living in a care home can become a very monotonous routine for an individual that previously used to live alone or had a much more active lifestyle, and as a care home nurse it’s your job to help them in as many ways as possible. In some cases you will be their main source of other human contact during that day.
Wellbeing and personal expression are key to a person’s happiness, and while it can be easier to treat a medical condition or provide pain relief, taking care of an individual’s emotional needs can be a lot more difficult. Every person deserves excellent care, and it’s the job of the care home nurses, among others, to ensure standards are maintained and that the level of care given is appropriate to the individual’s needs. A care home nurse should be continuously assessing each resident they interact with for signs of depression, pain and whether the care plan is working effectively.
First thing in the morning
This time can mean at any point between 6am to 8am according to the size and type of the care home. Residents will be assisted by a team of care home nurses, support workers and care assistants with changing from their night clothes, washing and dressing and getting ready for the day. Some may not be fit enough to leave their beds, in which case a care home nurse will give them a sponge wash if appropriate.
Next there will be breakfast and a medication round. Medication is usually given 3 or 4 times a day, and will be administered by a senior care home nurse or nurse manager. Some drugs will be routine, others will be given if the person is experiencing pain to help them be more comfortable. There will be some individuals that need assistance with feeding, so a support worker or care assistant may be called upon to help individuals feed. This can be a particularly degrading experience for an individual if they have lost the capability to feed themselves, so it’s the responsibility of the care home nurse to ensure that their dignity is maintained and that the individual feels in control of the situation. In other cases where the person is unable to feed orally, liquid food will be fed through a tube directly into the stomach. This requires just as much sensitivity and will need either a care home nurse or support worker with experience in peg feeding to ensure it all goes smoothly.
Throughout this time the care home nurses will be monitoring the condition of the residents, and assessing whether any changes to need to be made to care procedures. For example, if one individual has deteriorated to a point that they cannot feed themselves, then a support worker must be assigned to help them eat that meal and going forward.
By the time everyone has eaten breakfast and the residents that need assistance have been fed, it’s time for those that can to go into the day room or to go and take part in an activity. The less mobile residents may need help to move from their wheelchair into the more comfortable day chairs. This must be done with a hoist by a team of trained staff of either care home nurses or care assistants or a combination. Others will stay in their wheelchairs with the freedom to move about if they wish.
This may also be the time that activities are started or the individual can go out with their support worker, where necessary. The range of activity that an individual can undertake is assessed and managed by the care home nurses and care manager. Some care homes offer residents the chance to be involved in community activities or go out do something active like horse riding, but all external activities will vary between care homes.
In-house activities may also be available such as bingo or music, and in some care homes there are on site facilities including hair dressing and beauty therapy. Some smaller care homes will probably not have the resources to accommodate these services so will book hair dressers to come to the care home on a weekly basis. A care home nurse will help facilitate anyone who wants to take advantage of these services by making all the arrangements for them.
The residents will have lunch at some point in the middle of the day, and again those that need assistance with feeding will have help from support workers and care assistants. The care home nurse will usually be assisting with another medication round during this time, as well as providing care to those residents who can’t leave their beds and require a more expansive care routine. There may be a need to communicate with a GP or a Social Worker if there is a change in an individual’s condition. Other healthcare professionals are frequently involved in the care of one person, so it’s essential that the care home nurse ensures all information is communicated effectively with the multi-disciplinary team.
In the case of a residential care home some patients may need transferring to hospital to receive treatments, which will be arranged by a care home nurse. This process may also involve notifying the family / relatives of the hospital transfer, so it’s key that the care home nurse can communicate effectively with all parties involved in a sensitive and understanding manner.
In the afternoon, residents may choose to rest either in their rooms or in the day room. In some care homes, care home nurses may be able to help residents with individual hobbies such as gardening or crafts. Being a care home nurse is as much about providing nursing care as it about offering companionship and facilitating an individual’s interests. Encouraging a feeling of independence can be a big boost to the wellbeing of an individual.
After an evening meal, residents will usually be helped back to their rooms and either into bed or to watch tv if they are able. The senior care home nurse will also ensure that the last medication round of the day is completed. In all care home environments, each resident will have their own room, usually en-suite, which helps to promote a more independent lifestyle and feeling of control. All residents will be able to call for a nurse on their emergency call system, but otherwise will be left to enjoy a small amount of independence.
There will be care home nurses on call 24 hours a day, so there may be a handover to complete with the night shift nurses. Some residents in a care home specialising in palliative care may be placed on the Liverpool Care Pathway (LCP), which is a recognised care plan to ensure the quality of care in those final days and hours of life is as high as possible. The LCP requires care home nurses to monitor and continually reassess the condition of the individual in order ensure death is neither hastened nor postponed. A multidisciplinary team should be involved at the key decision making points, and in conjunction with the observations of the care home nurses, should ensure the appropriate steps are taken maintain the care pathway in a way that is suitable for the individual.
Working in a care home nurse job can be extremely rewarding, but also emotionally involving. You will need stamina, and the ability to be a good liaison between family, relatives, other healthcare professionals and the residents.
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