Background of change and intervention
COVID-19 has presented many challenges in continuing to provide care to people in the community; especially those considered to be amongst the most vulnerable, such as the elderly or frail or citizens living in care facilities. The pandemic has presented opportunities to develop a more collaborative approach supporting the upskilling of staff across health and care to ensure those who need care can continue to receive this without having to go to hospital. In residential homes, where district nurses often provide an in-reach service, new ways of working have been developed to support the reduction in COVID-19 spread.
Learning and advice to be shared
At the onset of the pandemic, University Hospitals of Morecambe Bay NHS Foundation Trust offered care home staff a swift ‘wrap-around’ programme of education, training and development supported by the Trust. This included areas of care such as management of indwelling catheters and drains, basic wound care and delegated administrations of some medications where appropriate for example insulin and heparin.
This education, training and support offer enabled care home staff to continue to meet the needs of their residents throughout the pandemic, facilitating a flexible and personalised approach to care.
District nurses provided oversight of delegated duties and supported care staff in developing new skills, bolstering confidence and safety through clear escalation plans and remote video consulting. Where face-to-face training was required, district nurses provided this in the appropriate Personal Protective Equipment (PPE) and where training could be delivered remotely, digital technology was embraced to reduce the risk of the virus spreading further.
This approach has had positive responses for residents, residential staff and district nursing teams as it continues to support a focus on the residents needs with services ‘wrapped-around’ them where they need it most. District Nursing teams overseeing this approach have also noted the positive impact upon their capacity, being able to focus upon care for people at the end of life in their own homes and those with more complex needs.
Due to this new way of working the District Nursing Team was also able to align to the local General Practice ‘red hubs’ who provide support for people confirmed or suspected to have COVID-19 to ensure any nursing care required was responsive.
Would it be beneficial to retain these changes?
This new way of working has supported staff to deliver care throughout a challenging time as well as supporting new improved ways of working across different settings. Many see the value of continuing this delivery of care. Residents enjoyed a qualitative person-centred approach from their residential care staff, while decreasing reliance on ‘in-reach’ from district nurses to support shielding from the virus. Additionally, the relationships between the care staff and District Nurses have positively developed, with carers embracing new skills and enhancing the quality of the care offered to their residents and District nursing teams able to offer more support to complex individuals.
Education and training to support delegation of care skills may help retention of staff and care staff have certainly agreed that these new ways of working are enhancing job satisfaction within challenging times. Staff engagement across systems has manifested in a different way, together creating a new culture of multi-professional team working built on mutual respect and a desire to improve care.
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