I never know what a day is going to bring. That's one of the things that is so exciting about nursing, every single day offers something new. I gave up trying to predict the course of a day a long time ago! It's not easy to be a nurse at the moment, you cannot give everything to the people you look after that you would like to. That said, I do like to give it a darn good go!
I have written this blog post inspired by the brilliant +Teresa Chinn who is the force behind @wenurses. I thought, in additon to tweeting, I would write some more about my own nursing day.
Working with people with dementia and those who love and care for them brings a new level of unpredictability - you have to be ready for any situation at any time. Tuesday- international nurses day was no different. My day started with a handover in our Dementia Specialist Care Space, an acute medical ward specifically set up to look after people with dementia who need hospital care. I'm sorry to say that many of my colleagues did not know it was international nurses day. The day on a medical ward is always very busy, and the reality for nurses out on the wards is inescapable and the demands are high. Taking a few minutes to appreciate that was important.
Colleagues in morning handover (Team Emerald)
The discussion was around how to use such a valuable resource as Admiral Nurses and get them to the people most in need. What can they do to help other health professionals? Loads is the answer. As a dementia nurse specialist - the educational aspect of the role has been one of the things that has made the biggest difference. Every single day - I see a person with dementia and family carer who experiences needs that could be met by an Admiral Nurse. The Prime Ministers Challenge on Dementia 2020. does not go far enough to endorse the commissioning of Admiral Nurses or Dementia Specialist Nurses. As long as I am working in this field, I will keep pressing for this.
Back to the main hospital site. A 92 year old who has been living with dementia for 5 years has been referred to me. They have pneumonia, which has occurred several times in the last few months. They aren't able to swallow very well any more, and food and fluid are aspirating into their lungs. They are frail now. They are cared for at home by a family member, who wants very much to keep doing this until the end. I advise the ward team about anticpatory care planning, the use of a pain assessment tool that might help, and I talk to the nurses about communication on a very sensory level.
I spend some time with the person, and arrange to meet with the family carer later that day. They have a lot of questions, and we will need to think about the support they will need too over the coming weeks.
Back to the office. I make bookings for dementia education days running up to the end of the year and design a poster to advertise them. The one day programme is always popular and getting some dates booked has been on my 'to do list' for a while now.
A phone call from a family carer, they were worried by a call from the ward about their parent. I listen to the concerns, and agree I will visit the ward and discuss with the ward manager to help smooth over the worries.
Next, it's off to see another person who has been referred to us. They are in hospital after a collapse at home. They do not have a diagnosis of dementia but there are obvious concerns. It is not always right to make a diagnosis of dementia in hospital, but equally it is wrong to not make a diagnosis if it is appropriate and assessments can take place sensitively. I will support and work with the person now over the coming days. The family carer wishes for their loved one to move into a care home and wants us to 'Get ***** in somewhere'.
I have a conversation with the family carer and social worker about what we can do to help this person return to their own home. It is true that the support and care that's available at home is far from perfect, but a person with dementia should be in the first instance helped to stay at home. In the words of the person themself, 'There's no place like home'
I have to advocate for the people I support. The hardest thing is when a person with dementia and a family carer do not agree about what is needed or they have different wishes. The dynamics of this, the high emotions, the complexity of person and carer needs, the web of different services we might need to think about mean I need many skills. I refer to my earlier point about the absolute need for dementia specialist nurses, but I won't go on any more I promise!
Back to the office - I start to look at the 'Dementia Competencies' for nurses that I have been tasked with drafting - This is a big thing - deciding what nurses should be competent at in terms of dementia care. That's a whole different blog - but I spend an hour on this.
On to meet with the family member who is looking after a loved one as their experience of dementia nears its end. They ask me why the swallow reflex stops working - I carefully explain. They ask me about hospice at home care - We explore how they can help. I explain the decision to stop Aricept and why this was done. They ask me 'How long?' I explain that we think their loved one may be at the last 2 or 3 months of life. I won't lie, I always feel tears in my eyes when I have these conversations - but I think to myself that the day I don't is the day I shouldn't do this anymore. That day hasn't come yet.
Back to the office again - It's 6 30pm now. I update my 'Caseload List' (There are 74 people at present who are having dementia team input) I send this to those who need to see it (My Head of nursing, bed managers, medical colleagues etc)
I leave thinking about the family carer I have just spoken to and how sad they were. It hurts to face losing someone you love, so I feel glad I was able to be there to help in just the smallest way. That was the most important thing about #MyNursingDay.
