In the NHS, nurses are often faced with the overwhelming task of looking after the physical needs of a large number of patients at once. Unfortunately, this means they sometimes are not gifted the time to be able to provide the same level of individualised care that meets their emotional needs. This can lead to sedation being used to manage difficult situations, however, in social care, nurses are encouraged to take a more holistic approach in a more natural environment.
Today is International Nurses Day and we spoke with Lucy Hernaman, one of our Social Care Nurses at Heanton Nursing Home in Devon which is a part of Evolve Care Group. Lucy speaks from experience and teaches us how a nursing career in the care sector gives nurses the time and opportunity to deliver care steeped in compassion.
Putting an End to Institutionalised Care
I would love to see Nurses that have only worked within the NHS having placements in care homes like Heanton. What an education it would be, that they could take forwards into their careers with them. I know I wish I had been offered a placement like Heanton when I trained 15 years ago. I did have a caring background, but it was in a home located locally to me that was very institutionalised. Heanton is about as far from institutionalised as it could possibly be.
This is because Evolve Care Group have created their own model of care, which is probably the most holistic approach I have seen in my 20 years working in the care sector. Sadly, I feel that the NHS is behind the times with how we look after “at risk” people. The NHS are good at fixing a physical condition, but they have stayed with the same principles for decades and people just aren’t trained in how to look after someone with a Dementia. Evolve wants to change this and are challenging the status quo.
The Importance of Meeting Emotional and Social Needs in Dementia Care
When I first started at Heanton I had very little Dementia knowledge. I had worked in a home which had Dementia floors but I had not been taught to really stop and consider the person. I can think of so many incidents that involved people I have looked after before I came to Heanton where we never stopped to look at their behaviour and consider why they were behaving that way, it makes me quite sad. This is why the right education is so important in social care.
As a nurse at Heanton, I have been given so much more time to observe people and their behaviours. I soon found here that a person behaved a certain way for so many reasons, and that it was important to identify those reasons as people often don’t have the capacity to tell us themselves. This in turn has led to our residents, who we call family members, being able to live fulfilling lives without judgement or ridicule, and sometimes people have been turned away from other care settings due to being “too complex”, however will go on to lead fulfilling lives here with us.
Breaking the Mould of Social Care
In some homes I have worked in, people have been expected to fall into the homes schedule. For example, be up by a certain time, have breakfast, lunch, dinner and be in bed by a certain time. Heanton works the way it does because we allow our family members to live their lives as they wish. There is no strict routine here and they aren’t made to fit into a mould like many other homes I have worked in.
The fact that Evolve are prepared to break the normal mould of care is a big plus for me. Not everyone fits into the normal care home narrative. I know I certainly wouldn’t if it were me coming to live in a care home. If the team have a reason for going against the grain and can show why and how, then with risk assessments Evolve will support it.
Care without Sedation
I love Evolve’s stance towards medications and that it is always used as a last resort only. I also love that we NEVER restrain or “safe hold” a person as I have seen in previous jobs which created such a negative perception towards the team. Some of our family members have had hospital admissions and have been deemed difficult, physically aggressive and verbally aggressive. As a result, they are given sedation and are watched 24/7 by security services who are neither appropriate for this role or trained in mental health conditions. They will often make the situation worse and so it goes on.
I know there are perhaps times when restraint techniques might need to be used in order to keep someone safe, but in my two years at Heanton I have never once seen restraint used on a family member. It is very much our ethos to find out why an expression of behaviour occurred and to minimise the chances of them escalating rather than act once it has already happened. That isn’t to say that accidents and incidents don’t happen, they do, but our team are trained to understand why they happen so that in the future we can prevent them.
We have a team that have been given time to learn about each person, who can recognise risks so that these can be avoided in such a way that the family member isn’t even aware that they are being distracted from a situation. Sadly, this often creates a rod for our own backs, because in other homes and in funding worlds it is often called ‘a met need’. But what funders don’t realise is that far more work and skill goes into meeting that persons need than simply mopping up the after effects of an incident.
A Human Approach to Care
Overall, the thing I most love about my job is that I am allowed to love the family members as if they were my own family. Every job I have ever had has always called those we look after ‘residents’, ‘service users’, ‘patients’, such horrible titles, so impersonal and uncared for. It’s also so taboo to hug and kiss those we look after, “keep it professional”, but that is so old fashioned and is often what makes a person’s day. The people we look after are our equals and this is how we should care for them.
Evolve want to change the whole future of care, make it better and allow people to be better understood on a basic level. Every day I go home feeling as though my job and my life has been worth it because I have made someone feel loved and cared for and not just on a ‘social care’ level but on a psychological and emotional level.
