Is the stay to provide respite care, rehabilitation following a hospital admission/illness or for end of life care?

Regardless of the reason for the care home stay it is likely that the nurse will be leading/working as part of a multi-disciplinary team and will contribute to assessment, goal setting and measurement of progress as well as co co-ordinating care.

Seema has recently moved into a care home that is covered by the integrated healthcare team. The home manager has contacted the team coordinator with concerns regarding Seema as her decreased mobility has led to a high risk to her pressure ulcers, and her recent falls have also led to wounds to Seema's arms and a wound to her right leg. The care home manager points out that Seema speaks only a small amount of English. 

The community physiotherapist visited to assess Seema's needs with Seema's daughter present to enable translation. An attempt to access the local translation service did not help as they did not have anyone who spoke Seema's particular dialect.

Staff nurse Danilo provides an initial assessment which also includes establishing if others involved are covering key areas of Seema's healthcare needs. Danilo establishes that a mental health nurse is monitoring Seema's acute mental health and in particular how the new medication is helping Seema with her distress.

The following issues are listed as needing investigation or intervention:

• wound care
• risk of pressure ulcers
• urinary incontinence
• falls
• mobility problems
• social situation.

Danilo prioritises Seema's healthcare needs with concerns for pressure ulcers being highest. Pressure area equipment is provided and advice given to Seema and the care staff on how to prevent pressure ulcers, including a helpful leaflet written in Seema's own language.

The wounds are superficial but the nurse ensures that a suitable wound dressing is applied to promote wound healing in a warm moist environment. Cleaning of the wounds was not necessary as they were visibly clean and she knows that unnecessary washing of wounds can damage the healing process. Once the wound has improved and requires less frequent reassessment, Danilo delegates this dressing to Rachel the care assistant. Danilo makes this decision in line with the home's policy, his professional code and guidance from the RCN about accountability and delegation.

A continence assessment is started with thought towards reversible conditions such as infections and pelvic floor weakness. Danilo uses a continence pathway tool which enables him to methodically consider all the potential causes of urinary incontinence and assures Seema that urinary incontinence is not a normal part of ageing.

Danilo also considers if any of Seema's medication may be affecting the urinary incontinence or her falls. Although he is not a nurse prescriber, Danilo has ensured he understands the side effects of medication which is essential for all nurses that administer medication. He also starts a falls assessment although this will take a few days and includes a multi-professional assessment looking at physical, environmental and medical reasons for Seema's falls. Danilo will ensure that the falls assessment is co-ordinated and any possible causes for Seema's falls are removed to make Seema safe and improve her mobility.

Danilo has completed additional training on assessing for the use of walking aids and he has brought a walking frame to the care home: he adjusts this to the correct height for Seema and demonstrates safe use of the frame. The walking frame will help to keep Seema safe while the falls investigation is being competed.

When Danilo returns to the team office, a call is made to the social worker involved to discuss Seema's ongoing needs and to start to consider what will happen when she returns to her usual home address. A review is planned for Seema for the following week.

The nurse’s role in supporting family/friends during a short stay might be to offer suggestions for maximising their own wellbeing and to maintain a dialogue with them – providing reassurance and communicating with them as per their wishes.

Sue was keen to understand what the experience of respite care had been like for Seema and her family and sought direct feedback. As the senior nurse, evaluation of the stay and the clinical outcomes were part of Sue's role.

Feedback can be sought in a variety of ways:

- direct conversations
- follow-up questionnaires
- follow-up phone calls
- feedback via other professionals
- feedback through independent agencies

As part of our professional revalidation requirements, feedback from residents and families is essential.

As nurses our focus is on getting it right for all of our residents, all of the time. In being professional we must be willing and able to hear the developmental comments as well as the positive detail. It means being able to take feedback, good or bad, to improve the way you and your team works. The aim is to ensure that the care you provide really does meet the needs of your residents, their families and loved ones.

Actively seeking feedback is really important particularly for residents who might find it hard to communicate or have their voice heard. Often this will involve a number of different ways of engagement so that the messages can be got across clearly. Examples might include residents groups, regular meetings or quiet enquiries when providing care. For families there may be drop in "surgeries", support groups and email discussions.

In addition to this, your home might also look at other measures that indicate high quality care; staffing levels, adverse events, drug errors, measure of distress or contentment. As a nurse you will be mindful of non-verbal clues that indicate both pleasure and discomfort. It is important to discuss both the positive and negative feedback to establish if there are patterns within the home, then action to improve care and share good practice.

The way you have handled feedback is important for your revalidation and you may wish to complete a reflective account.

Further resources

• NMC. Revalidation

The nurse’s role will be to support colleagues and encourage the sharing of learning from working in a multi-disciplinary team. The nurse’s role will include using evidence based practice, evaluation and resident feedback. Using resources such as specialist nurses is part of the leadership and coordination required of senior care home nurses.

In the video below, which focuses on a specialist dementia nurse role, we see how these roles can support both care and colleagues.

Further resources

• RCN. Mental health in later life
• RCN. Understanding mental health
• RCN. Falls

Below you will find some further links to resources.

• Alzheimer's Society. Respite care in England
• Belong Villages
• Carers Trust.