On duty with…

Health Professionals Homecare Nurse, Elizabeth Prentice (RGN, BsC Hons, SCPHN (OH), talks to us about her current assignment caring for a post-operative back client, in their own home.

It’s 07:45am on a Saturday morning, and Elizabeth is preparing to go on duty, taking over from the patient’s Health Professionals Homecare night nurse. Her shift is part of Homecare’s 24/7 patient cover, and will run until the next day, Sunday, 20.00 hours.

What is the nature of this particular back condition which was treated by surgery?

An injury caused damage to one of the patient’s discs.

So what are the main considerations in looking after your post-operative patient?

Following any type of surgery, there are, of course, certain issues to be aware of.

There’s a fairly high risk of infection, where bacteria may enter the operation ‘site’. So performing aseptic wound dressing and inspecting the area for signs of infection such as redness, offensive discharge, swelling or pain is absolutely essential. Bladder infection can also arise due to a catheter being in use.

In particular, post-operative back surgery patients can suffer from loss of sensation in their limbs. So it’s therefore vital to check circulation and sensation levels, to determine any abnormalities.

Equally, they may experience a loss of balance when they first get out of bed. This is due to the patient being nursed on their back for so long. They need support to mobilise and help getting into, and out of bed.

But psychological care is just as important as medical care. It can be very difficult for a patient to adjust to losing some of their independence, even for a few weeks. The patient’s emotional wellbeing is a key factor to their overall recovery.

Tell us how you administer that...

By building a trusting relationship with the patient, and demonstrating kindness and practical help as well as medical expertise; asking them how they are feeling personally as well as physically.
 

What do you believe are the challenges a Health Professionals Homecare patient – and their relatives – may face?

The patient may initially be apprehensive as to whether a nurse has the correct qualifications and expertise to look after them at home, rather than in hospital.

But before any Homecare nurse is engaged with a client, our Registered Manager Michele undertakes a comprehensive healthcare assessment, and home environment review. This means that a patient receives the right person to administer holistic care, spanning psychological and emotional, as well as physical. It has to be a good fit, on both sides.

Where possible a Homecare nurse or carer will meet the patient and perhaps their main relative, before an engagement begins.

And what are the challenges for you, as the patient’s Health Professionals Homecare nurse?

Nothing that immediately springs to mind. I certainly don't find being in a client's home challenging, as I’m competent, experienced and confident dealing with most situations.

How do patients benefit from being cared for at home by Health Professionals Homecare?

It’s much better for them to be nursed in their home surroundings as they are familiar with everything, and it helps prevent the client getting confused.

They can eat and drink what they want, when they want to. Being at home is generally much more comfortable for patients because they are in their own environment.

So can you please give us a ‘snapshot’ of what a typical shift might involve?

♦ Arrive at the client’s home 07.45
♦ Have handover from the night nurse
♦ Check on client and ask how they are feeling
♦ Begin visit report for completion throughout the shift duration
♦ Check for signs of any post-operative complications which may be developing
♦ Prepare some breakfast for the client
♦ Prepare and administer medication
♦ Assist client to kitchen to have breakfast
♦ Organise and assist the client to have a shower
♦ Inspect and dress wound
♦ Tidy room and make bed
♦ Discuss what's been happening in current events. This is an essential part of client relationship building
♦ Assist client to walk around house for exercise
♦ Make some lunch
♦ Act as a confidant. Give psychological support, by determining and discussing any anxieties
♦ Reassure the client that they are making good progress, or
♦ Reflect on any part of their care that the patient felt should have been different and implement the changes via our Registered Manager, Michele
♦ Ensure the client has a rest period in bed, to help their spine relax
♦ Discuss diet and the importance of fluid intake
♦ Prepare dinner
♦ Talk to patient’s main relative about any concerns they may have, and relay their anxieties to our Registered Manager
♦ Say goodbye to client and hand over to the night nurse

What are the most fulfilling parts of your home nursing role?

Looking at the client in a holistic way providing then support and encouragement to get well and get back to a normal life as soon as they can. Providing holistic support, care and encouragement to enable the client to recover at home, where they will recover more quickly and reduce the risk of hospital acquired infections, is certainly very fulfilling.

Overall, would you say are the values of home nursing?

To have all the support and treatment in their own home this will prevent a patient from going back into hospital, where it is essentially an alien environment, where they can feel isolated and insecure. And the smell of a hospital can make some clients extremely anxious.

The crux is for any nurse to treat a client with dignity and respect, while being sensitive and sympathetic to their situation. This will build the mutual respect which is required for this type of nursing.

And so, with Elizabeth’s patient progressing well, she ends her shift by handing back over to Health Professionals Homecare’s night nurse and ensuring that all her observational notes are in order, before heading off to her own home.

More information on our private nursing at home service can be found at www.hphomecare.co.uk

Nurses - Please contribute…

This nursing case study is open to comments from Registered Nurses and anyone with an interest in home nursing. Does it resonate with your experience in homecare? How does it compare with your experience of treating patients in hospital? Would you like to take the transition from caring on a ward to caring for someone in their own home?

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