CARE HOME PRACTICE PLACEMENT WORK BASED LEARNING PACK YEAR 1

Transcription

1 CARE HOME PRACTICE PLACEMENT WORK BASED LEARNING PACK YEAR 1 STUDENT S NAME: COHORT: PROGRAMME: CARE HOME PLACEMENT DETAILS: LEARNING TEAM FACILITATOR: MENTOR S NAME Contact Details for Care Home Education Facilitators (CHEFs) Tayside: Vacant contact the School or your mentor for details Fife: Lorraine Malcolm

2 2 Introduction to your Work- Based Learning Pack in Care Homes Please complete this short questionnaire before you start your practice placement in the Care Home. 1. What are your expectations regarding your forthcoming Care Home placement? 2. Have you had connections e.g. work/visiting Care Homes? 3. What do you expect to learn in your Care Home placement? 4. What do you think the Nursing role is in Care Homes? 5. Would you consider Care Homes as a future career choice?

3 3 Introduction to your Work- Based Learning Pack in Care Homes The Organisational Background In March 2009, there were 963 Care Homes for Older People in Scotland. There are a total of 25,202 older people in Scotland living in Care Homes (Scottish Government 2010). People entering Care Homes in Scotland have been assessed as requiring 24 hour residential and nursing care and are likely to have highly complex health and social care needs. This means there is a range of learning opportunities for Nursing Students with staff who have a diverse range of skills. The transition of moving from home into 24 hour residential and nursing care can be a distressing and highly emotive time both for residents and their families. Demonstrating care and compassion is essential in all areas of nursing, but especially so during lifechanging transitions. Residents are reviewed regularly by Social Services whilst living in Care Homes to ensure their ongoing health and social care needs are being met. As there are no longer any legal differences between Nursing and Residential Homes in Scotland, most health care needs should either be met by Care Home staff or accessed as if the person was still living in their own house. This means people continue to receive services as part of the local community. Hospital admission is unusual, but sometimes occurs in cases of medical emergencies or unexpected changes in health needs. As well as the diversity of health and social care needs of people living in Care Homes, the skill mix of Registered Nurses and Social Care Staff with varying qualifications and experience means that the philosophy of care should be quite different to the NHS. It is extremely important to acknowledge that people do not enter care homes with the expectation of requiring hospital based technological intervention. A Care Home environment should be an extension of the person s own home. This means as a learner, you must understand the theoretical principles taught in University and apply them to the environment in which you practice. This is why Care Homes are operated, registered and regulated in a completely different way to the NHS. To find out more about the inspection and regulation of Care Standards in Care Homes please go to The Care Inspectorate is responsible to the Scottish Government for the regulation and inspection of, and supporting improvements in, Care Homes and other services. You should make yourself familiar with the key document - National Care Standards - Care Homes for Older People (Scottish Government 2007).

4 4 There will be a copy in the Care Home but it can also be accessed online at the address above. The standards are underpinned by the underlying principles of dignity, privacy, choice, safety, realising potential and equality and diversity. The care practices you will be involved in will embrace these underlying principles. The Purpose of the Learning Pack This Learning Pack is designed to enhance your learning whilst you are on practice placement in a Care Home. Weekly activities including self-study discussion with team members searching for, reading and documenting evidence reporting to and discussion with your Mentor written reflections. Each activity is linked to your Essential Skills and Competencies which must be achieved during your placements. Your learning e.g. reports and written evidence will contribute to your Portfolio of Practice Your structured learning will enhance the actual practice learning.

5 5 LEARNING OPPORTUNITIES IN CARE HOMES ESSENTIAL SKILLS: CARE, COMPASSION AND COMMUNICATION Nursing Perspectives Consider the Care Home Admission Procedures from the initial enquiry form, the waiting list procedure, prospective resident information packs, terms and conditions, contracts and become involved in pre-admission assessment visits. Familiarise yourself with the Named Nurse/Key Worker system within the Care Home Read and discuss the Philosophy of Care or Statement of Purpose which all Care Homes must develop. Patient-Centred Perspectives Understand the ethical, moral and cultural aspects to making a decision as to whether one should enter a Care Home from the resident and relatives perspectives. Look for best practice and guidance information on ethical care issues such as use of bed rails, PEG feeding, covert medication Spend time with the Activities Organiser and visiting members of staff to understand the social side of care. Discuss Person-Centred Care with your Mentor and how it is achieved in care homes. Discuss Life Story work and Social Histories and how they influence the care residents receive. Become involved in outings and the local community with residents. Organise an activity i.e. reminiscence therapy. Collect relevant items from museums and local groups. Learn about Sensory Impairment and how to improve communication.

6 6 Multi-agency Perspectives Contact Social Services to learn about the Financial assessment process for entering Care Homes Contact Social Services regarding Single Shared Assessment process involved in entering Care Homes Become involved in Social Work reviews of Residents. Become involved in developing a Care Plan for new residents or reviews of existing residents. Visit a Carer s Association Centre Organisational perspectives Be aware of the National Care Standards for Older People. Read the last Care Inspectorate Inspection Report for the Care Home. Understand the quality grading system. Learn how care homes actively involve service users and their families in the running of the Care Home take part in a resident and relative meeting. Observe how this is evidenced for the Care Inspectorate Are there any volunteers connected to the care home spend some time with them.

7 7 ESSENTIAL SKILLS - ORGANISATIONAL ASPECTS OF CARE Revise the Nursing Process/Systematic Approach from theory Discuss the assessment tools used in the Care Home. Become involved in using the tools and developing care plans. Learn about recording and write in care plans under supervision. Discuss issues surrounding risk assessment, policies and individuals rights. Learn how Care Homes help residents feel safe and secure. How is this linked to National Care Standards 8 and 9 Manage a group of residents under supervision Learn about Health and Safety refer to a book called Health and Safety in Care Homes. Assist and take part in various audits required to carried out in the Care Home. Look at SSSC Codes of Practice and the NMC Code. Think about their similarities and differences. Attend in-service education if appropriate. Read relevant legislation and publications Eating Well in Care Homes for Older People, Remember I m still me, Living and Dying Well, Care and Respect Every Time, Scottish Dementia Strategy. Discuss these with your Mentor. Attend Staff meetings, Resident and Relative Meetings. ESSENTIAL SKILLS - NUTRITION AND FLUID MANAGEMENT Identify the nutritional initiatives in the Care Home and the challenges in promoting a nutritious diet within the Care Home. If the opportunity arises, observe the cook s interviews with Residents regarding developing menus. Look at the guidance available from the Care Inspectorate and other available documentation. Learn how to monitor residents dietary and fluid intake in the Care Home.

8 8 Observe and participate in patient assessment and development of nutritional plans for Residents under your Mentor s supervision. Become involved in providing nutrition through alternative methods i.e. PEG, NG, strategic placing of finger foods for people with dementia. Observe and if able, interact with visiting professionals i.e. Community Dietician, Speech and Language. ESSENTIAL SKILLS - MEDICINES MANAGEMENT Observe (and participate depending on stage of learning), in dispensing and administering medication. Learn about the Care Home process for management of medication and compare this to the NHS. Learn about counter-interactions and side effects of medication. Learn about the complexities of medication in older people Observe medicines management of a variety of conditions e.g. Diabetes Observe non-oral medication administration. ESSENTIAL SKILLS - INFECTION CONTROL/CLEANLINESS CHAMPION Review the Infection Control Policies in the home use the NES (2011) Preventing Infection in Care Infection Prevention and Control: Older Person Care Homes and Home Environment pack. Consider what you learn from this pack in terms of the vulnerability of the residents in the Care Home There may be a Cleanliness Champion within your Care Home. These are just some ideas and areas in which you may become involved. As a Nursing Student you have a responsibility to identify learning opportunities and be proactive in pursuing opportunities through agreement with your Mentor.

9 9 WEEK ONE GETTING TO KNOW THE CARE HOME Week One Work Based Learning Activity: Begin the process of building a picture of the infection control needs of the people living in the Care Home. This week, your task is to prepare a folder of information that illustrates the key documents (both national and local), which underpin the philosophy of care delivered in the care home when considering Infection Control issues. 1. Consider the information upon which the practise is underpinned, such as best practise guidelines, documents and policies which pertain to care homes. List the main documents and any current initiatives within the care home. Present your compiled information to your mentor. 2. Choose, with your mentor s help, a resident* or group of residents* who have particular needs which require consideration of infection control policies. Identify these needs and discuss with your mentor how these needs can be met. Record your findings. 3. Complete a record of this week s learning. * Change family names and details within your work to preserve confidentiality. Helpful Hints :- You will find it useful to work your way through the Preventing Infection in Care Infection Prevention and Control: Older Person Care Homes & Home Environment Learning Programme Workbook (see appendix 1). It can also be accessed online at Consider the level of assistance the resident requires e.g. going to the toilet, eating meal or meeting own hygiene needs Reflect on the following points:- How are PPE accessed? Where are the PPE kept? How much do PPE cost?

10 10 How do staff decide whether they need to use PPE? Discuss with members of the staff team the overall philosophy of care. How does it differ to an acute hospital setting? What are the local arrangements for disposal of hazardous/infectious substances? Imagine you are a resident who needs assistance i.e. to use cutlery. How do you think the resident might feel being assisted to eat by someone with an apron and gloves on? Would you wear an apron and gloves if you were carrying out this assistance in your own home; in an acute hospital environment? Would you wear PPE to change a dry dressing? Available Resources:- Policies and Procedures Care Inspectorate guidance Electronic Resources (see back of pack) Staff Residents Related Essential Skills:- Cleanliness Champions Organisational Aspects of Care Related NMC Domains:- Domain 1 : Professional Values Domain 3 : Nursing Practice and Decision Making Domain 4 : Leadership Management and Team Working

11 11 WEEK ONE - REFLECTION ON PRACTICE THIS WEEK

12 12 WEEK TWO MOVING & HANDLING AND CONTINENCE 1. During the week you will investigate the application of moving and handling techniques or continence management support, based on a resident chosen through discussion with your Mentor or associate, with whom you have supported in terms of Moving and Handling OR with Continence needs. 2. For the end of the week, you should compile a report focusing on the assessment tools utilised in the care home, the clinical skills as observed and practised, the equipment/aids used and the involvement of the multi-disciplinary team where applicable. You should include examples of how the principles of moving and handling/continence management may be required to be adapted within a care home environment. 3. You should try to provide a rationale for particular observed nursing actions, using webbased and literature-based sources as well as discussions with care staff to form this rationale. Your report will form the basis for a discussion with your mentor at the end of the week. 4. Complete a reflection of this week s learning. This can be used as evidence in your portfolio. * Change family names and details within your report to preserve confidentiality. Helpful Hints: You may wish to consider: Which assessment tools have been used in the resident s care plan? How often are reviews of the care plan carried out? How often may the resident s needs vary? Can you think of why the resident s needs might vary? Is the care home purpose built or are there restrictions to the space available? Where do continence aids come from? What happens if you have too many/too few? Is there a Continence Advisory Service? Do residents have their often moving and handling equipment? How much do hoists and stand-aids cost? What training is available and accessed by staff? Are there statutory training requirements?

13 13 Available resources (see end of package) Local Continence Advisors Link Nurses Moving and Handling Training resources DVDs, information in care home Library resources such as relevant journal articles, books. Local and National policies and procedures Referral pathways Related Essential Skills:- Care, Compassion and Communication Organisational Aspects of Care

14 14 WEEK TWO - REFLECTION ON PRACTICE THIS WEEK

15 15 WEEK THREE NATIONAL CARE STANDARDS FOR OLDER PEOPLE 1. This week you will be required to familiarise yourself with the National Care Standards for Older People (2007). A copy can be found in the Care home or accessed via the Care Inspectorate website. Pay particular attention to the underlying principles of dignity, privacy, choice, safety, realising potential and equality and diversity. 2. Concentrate on Standards 14, 16 and 17. These relate to Keeping well Health Care, Private life and Daily life. Through discussion with your mentor, select a resident/s to compile a case study based on these standards. Consider each bullet point and provide written examples of how you have observed staff empower residents according to these standards. Include examples of how caring for residents using these underlying principles link with person-centred care and caring for people as valued individuals. 3. Complete a reflection of this week s learning. This can be included used as evidence in your portfolio. * Change family names and details within your reflection to preserve confidentiality. Helpful Hints:- Take each bullet point within the National Care Standards for Older People and provide specific examples of how the staff team (and yourself) have provided person-centred care i.e. Standard 17.4 Mr S was a professional footballer when younger. He is supported in a person-centred way to maintain his interest in football by being accompanied by care home staff each week to the local football match. Look at the care plans for residents. Do they include a personal history/social story/personal history which is reflected in their activities and choices about how they are supported by staff? Observe the interaction between staff and visitors. Is privacy provided by families/groups that require privacy? Do any residents access NHS services i.e. Speech and Language, Dieticians, Mental Health support? What are the links and integration with the local community? Do residents go on outings or holidays? Are resident s individual likes/dislikes regarding food taken into consideration? Available Resources:- National Care Standards for Older People Other national policies Activities Organiser Staff group Admission procedure Assessment tools/ Training materials

16 16 Life histories Visiting professionals Journals/Books Internet access Care plans Related Essential Skills:- Care, Compassion and Communication Organisational Aspects of Care

17 17 WEEK 3 - REFLECTION ON PRACTICE THIS WEEK

18 18 WEEK FOUR: A TEAM APPROACH TO CARING 1. Identify the managerial and staffing structure within the care home environment. In particular, the role of the Care Home Manager, Mentor/Registered Nurse and Senior Care Assistant. 2. Arrange time to briefly discuss the main roles and responsibilities with the Care Home manager, Mentor/Registered Nurse and Senior Care Assistant. You need to plan some time with each professional with guidance and agreement from your Mentor. You should be able to identify the main responsibilities and issues facing the Care Home Manager, Registered Nurses and Senior Care Assistants or Care Assistants (if no seniors available), in fulfilling their roles. 3. Following these discussions, produce a short summary denoting the main roles and responsibilities of these staff. Helpful Hints (questions to ask):- What are your main duties and responsibilities? When and how do you decide to involve other health professionals in aspects of residents health and well-being? What do you believe are the most important learning opportunities which you are directly involved in for Nursing Students in the Care Home? What do you believe are the most positive aspects of working in a Care Home environment? Do you think there are any challenges in working in Care Homes? How do you keep up to date with current practice? What do you believe are the differences in your role as compared to NHS hospitalbased staff? Available Resources:- Staff Journal articles Care Inspectorate website Staff Induction Packs Nursing Student welcome packs SSSC website Related Essential Skills:- Care, Compassion and Communication Organisational Aspects of Care

19 19 WEEK 4 - REFLECTION ON PRACTICE THIS WEEK

20 20 Please complete this short questionnaire on your last week of your placement in the Care Home. 1. How have you felt about your Care Home placement? 2. Is the Care Home as you expected? What was different to your expectations? 3. What have you learnt in your Care Home placement? 4. What do you think the Nurses role is in Care Homes? 5. Would you consider Care Homes as a future career choice? NOW, compare your responses to the questionnaire you completed before your Care Home placement. Write a short reflective piece comparing your responses to the two questionnaires. This learning pack could form part of your portfolio.

21 21 REFERENCES NES (2011) Preventing Infection in Care Infection Prevention and Control: Older Person Care Homes and Home Environment pack. Available from Scottish Government (2007) National Care Standards - Care Homes for Older People, Available from Care Home Census: Community-Care/Care-Homes/Previous-Publications/index.asp USEFUL RESOURCES Searchable databases for literature sources and evidence are:- Local Information Sites are :- Angus Council: Perth and Kinross: Dundee City: Fife: Sites pertaining to Care Homes are:- Care Inspectorate Scottish Social Services Council (SSSC) Eating Well in Care Homes for Older People (Care Commission 2009) Available from Remember I m still me Living and Dying Well (Scottish Government 2008) Available from Scottish National Dementia Strategy (Scottish Government 2010) Available from NMC Code