“ A Health Care Assistant is a vital member of the nursing team on any ward in any hospital, often undertaking more hands-on care of the patient than the trained nurse „
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I have looked on the search engine for reviews on home care, and found very little. This is a problem with those who are looking into doing community care work, because they do not know what they're getting themselves into. So I've decided to make my own review for you guys (who are just generally reading through dooyoo or employees' who are ready to do the work).
Depending on what company you are with. I won't be naming and shaming, but I have worked as a community care assistant for almost two years, and I thought at first, it would be a fantastic job to have to give me a wide range of skills and experience. It has done just that, with plenty of nasty side effects as well!
INTERVIEW, AVAILABILITY AND FLEXIBLE TIMES
First thing first, the interview was a breeze. I was nervous because I expected them to ask me complicated and awkward questions about clients, and what I must expect of them; in fact, they pretty much answered it all for me! They had the questionnaire paper, and answered all of the questions and they asked me if I was interested, I said yes: immediately they said I had the job. I thought I was in luck! This was going to be the job of my 'dreams'. The recruiter will check what availability would you prefer, and I ticked night times during the week with one day off, and weekend to work all day (because I was at college at the time, so I chose night work).
CRB CHECK AND SHADOWING WITH OTHER CARE WORKERS
I had to pay for my own CRB check which set me back at £41.00, and they said this would be refunded if it came back clear and it never did. I did training for five days, and I was only taught basic skills of how to use the hoist (manual handling), basic first aid, and vulnerability of clients. Bearing in mind that I was doing a BTEC in Health and Social Care at the time, so I pretty much had theoretical knowledge of all of this anyway. After this, when your references and CRB comes back clear, you go out shadowing other carers. When I did my shadowing, I was with a couple of carers who were very rude, and unpolite. They was unprofessional in front of clients' and didn't involve me in any of the work whatsoever. I was getting put off by this, and wanted to get more experience from somebody who is respectable and more professional, and I did.
She showed me the ropes, MADE me get involved (thank goodness) and I was good to go. My Manager kept ringing me, telling me to start working because they was getting desperate and I was only 2 days into shadowing. I didn't feel ready, but I had to because of her demands at the time. The first week I got my rota, it was OK. I only had a few calls at the weekend. I got myself a bicycle as at the time, I did not have a licence. You get given a log-in number which you ring on the clients' phone for your payroll (you must ask the client first), and if they do not have one, you've to carry a timesheet for them to sign that you've been there.
WHAT MY JOB ROLE CONSISTED OF AND DUTIES I HAD TO DO
My job role was to work with people who have Dementia, Physical and Mental disabilities, frailtilty, and also domestic chores. You may also have to go shopping for them. To take them shopping, you do not get paid for the mileage that you do, or to take them. You only get paid by the hour.
I will give a description of my typical working day:
6.45am, I am out of the door and on the way to my first call. I get there for 7.00am, and at this particular call, it is personal care/breakfast/make bed/empty commode/medication. Sometimes, I have to put the washing on, fold any washing that is dry, wash/dry up, clean the commode plus deal with the client by giving them a thorough stripwash/shower, dress and made comfortable. All of this has to be done within 25-30 minutes, and sometimes later (depending if she's having mobility problems or is being difficult in the mornings because she does not want to get out of bed).
7.30am, my next client is about 10 minute bike ride away, so you can imagine if I was walking, I would be extremely late! Anyway, I have at least 45 minutes at this call, and he wants to have his breakfast and cup of tea first before I shower him, so this takes a long time; so I make the bed/or change the bedsheets, empty the commode, open curtains, make his breakfast and tea as well, and because he is constantly dizzy and has headaches, he always wants to sit down every 2 minutes for 5 minutes which is when the time goes. I am in this call for at least 1 hour to 1.5 hours. I've told the office about this situation but it gets unheard.
8.00ish... I am on my way to the next one who is a domestic. Domestic takes one hour, you get £6.19 for it. This obviously consists of cleaning the whole flat/house, hoovering, changing bedsheets, washing, tumbledry, iron, etc.
Around the afternoon; I (used) to do a four hour sit in. During this time, I get help from another carer who comes in half way through and we change her pad by hoisting her onto the bed, and empty her leg bag if required. I have to cook this lady her dinner, and help feed her. Then we basically sit and watch TV, and I ensure that she's OK. Sometimes I will do the cleaning if required.
This isn't it.
There's SO MUCH more involved! Think of lunches and teas and nights. Cooking, cleaning, undressing, washing, putting them to bed. I had to bathe a client at one point which took me an hour, and she only had 30 minute call (they never told me this! They said I will only have to assist to undress and give her a quick wash, but it was actually a BATH call! I had so many clients after this, so they basically tricked me into doing it)
WE NEED MORE TIME - TRAVEL TIME/MONEY/PETROL MILEAGE
Now, what you won't know is that you are only paid for the time you're in the clients home. You are not paid any travel time, and your rota slot will not have a travel gap, so you can be late for every client one after the other. In the company I used to work for, they also do not pay petrol mileage! So you're on minimum (very minimum.. Will get to that in a minute) wage, and having to pay to actually go to work - so you're working for nothing.
If you're out for 8 hours, you are only actually getting paid half of that. For example, a 30 minute call would be around £3, 15 minute call £2.05, and an hour would be minimum, £6.19. Think about those clients you've to rush to, and the clients they squeeze in, and having to put fuel in your vehicle out of those pathetic wages. So, ten 15 minute calls, equal around £20, and about £10 of that will need to go into your car. Is it really worth it? I worked with a woman who constantly topped her car with petrol. Seeing her do that made me realise that this job is nothing but a complete and massive CON!
In my personal experience, I was local. But the wages I got was absurd because of the hours I worked. I travelled from top to bottom, from middle to top, and all of my energy went into going to those clients' for not even the minimum wage. I had rent to pay, driving lessons, and food to live on.
The office would constantly ring me asking me to pick up calls, and once I had to leave college early and make an excuse to my Teacher because my manager rang begging me to do a four hour sit in in the evening, saying they could not find anybody else! That was my day off. Since then, they took my days off me, and started making me work every single day, during the half terms and I was exhausted, I had no time to do my course work and because of this, my attendence was really low and only scraped a pass on my course. I was really gutted, but of course I blamed myself for it. Even when I booked my holidays, they rang me and said ''we need you to do this'' without even asking or saying please, but because of my caring nature, I agreed to do it. I had a night off on my rota for some reason and I was so pleased because I really needed it, but as soon as I started to relax with my cup of tea and the TV, my phone rang... and rang... and rang... and rang. I turned it on silent, and the next morning, I had 25 missed calls! TWENTY FIVE! I also got a voicemail by an angry senior saying I need to go into the office because I was ignoring them! I had THE NIGHT OFF. Why an earth should I be disciplined because I had a night off that they allocated to me? This is complete and pure harrassment.
DAYS OFF? YOU'LL NEED TO FIGHT FOR IT FIRST!
After this, they asked me if I wanted to work full time. I said on one condition that I get my days off again. Did I hell! I was working early morning, throughout the afternoon, tea time and late evening, not finishing until 11pm at the time. I threatened them that I would leave if they did not give me a day off, and after 2 months, they started giving me it. But one day a week was not enough when I was working 45-55 hours per week. I was extremely tired, leaving the house at 6.15am and only getting 1/2 hour break in between and back out until 10-11pm.
MY ILLNESS THAT WAS CAUSED BY STRESS FROM WORK
As time continued, I was sent further away from where I live, at least 40 minutes walk (my bicycle got stolen at this time, I explained this but again, they never listened). Funny, because I had a client up the road who was the same time as the client who lived 40 minutes away, but I still got sent up there. After a while, I was hospitalised with a chest infection because my immunity was low from working, my diet was poor (lost 2-3 stone) and doctors orders was to have a few days off. So I did just that - they still kept calling me to go in. I did, and carried on. I got ill again and again, and still put up with it and was put on antibiotics for infections.
CHANGED MY AVAILABILITY, GOT MOANED AT, AND NOW ONLY GET VERY LITTLE
This year, I had enough and changed my hours and told them to do it as soon as possible. I had to wait three months, but I was waiting for four-five months. I threatened them and said I was not going to turn up to these clients' homes. So they took them off, and the coordinator got extremely rude and told me to stop moaning, and that she doesn't go by the timesheets. I only changed my hours to finish at 5pm, and work weekend night times. From then on, they took clients off me and my pay were reduced. I had less income, so struggled even more to cope to pay the bills. I passed my driving test by then, and I refused to drive for them without mileage allowance.
DONE MY NVQ OFF MY OWN BACK, AND GOT MY NEW JOB
During the time I was there, I realised I shouldn't be working forever and not getting anything from it, so I went and did my NVQ with my OWN assessor. Theirs was going to make me wait for approximately 1-2 years, and I was planning on leaving before that, so I took matters into my own hands. I have now passed, and I have found a new job at a care home. I am looking forward to having regular hours, more pay and staying in one place without exhausting myself to the point where I am so poorly, and getting my hours reduced even MORE that I'm struggling to pay bills. Basically, you either work SO much or VERY little, which is exactly what the management want.
MY FUTURE IS IN MY OWN HANDS
I am studying a Nursing course, which they cannot acknowledge and despite the fact my availability will still enable me to do lunches instead of evenings, they've completely took that away from me, unless I work on a completely zero hour contract where they'll give me whatever work they want, regardless of whether its at 6am or 11pm. I have done everything for them, from shuffling in the snow, thunder, rain and all sorts of weather just to do these clients for minimum wage while they sit on their backside all day on senior pay, and I got nothing but bad treatment from the lot of them. You'd be surprised that the manager is OK with us, but the coordinators and seniors are terrible. They walk all over me/the carers, they think that we can carry a heavy weight on our shoulders. Well not anymore!
FINAL STATEMENT ABOUT THIS REVIEW
So here are the completely disadvange of this whole sham of a company:
- no petrol allowance whateover, even if you go shopping for someone or take them with you
- yiu don't get paid by the hour or the travel times, there are no slots or gaps in your rota to give you time to travel from a to b
- flexible/zero hours: they don't go by your agreed hours that you'd like to work, and misuse this and make you work your backside off
- wear and tear on your car, you've got to foot the bill on minimum wage
- fitting clients in between other calls that you've to rush everywhere, and it makes you very late and your pay is reduced because you logged out too soon or too late
- carers sometime gossip, have got attitude, and don't give new carers a chance
- clients suffer because of this, and it is not fair on either of them to get such treatment from the company
DO YOUR RESEARCH BEFORE YOU CONTINUE INTO DOING COMMUNITY WORK
If you are planning on doing community care work, please do your research first and always ask the manager questions about petrol, rota, and allowances/benefits.
In March I applied to be a healthcare assistant (hca), with the nearby nhs hospital trust, after waiting for all the health assessments, crb checks, references, compulsory courses to be completed, last weekend I finally undertook my two compulsory shadow shifts at the hospital.
I was fairly nervous about doing these, as I have not worked for a while, and the hospital seemed extremely daunting as it is a very large place. I was not really sure what a shadow shift meant, don't get me wrong I knew that it meant I needed to shadow another hca, but I didn't know what I personally would have to undertake, what I was expected to know and do.
I searched on the internet via google, I went on numerous nursing forums, hospital websites, etc, but I never found anything that was of any help to me. I wanted to be able to find a review, a statement, a poost on a forum, a case study.........of someone that had been in my position, but I couldn't find anything of any relevance. So this is why I am writing this review, I am writing it to inform people of what is expected on a shadow shift at a hospital for a hca, and also to let people know of my experience on the shadow shifts and how I felt.
I undertook two shadow shifts, one on Saturday working from 2.30pm-9.30pm and one on Sunday, working from 7am-3pm, I will now let you know how I got on.
****My First Day****
To begin with, I got given a list of all the wards and where they were situated in the hospital grounds, I am a bank hca, which means that I can be put on any ward, so the list is very valuable to me, or it should of been. I was placed on an elderly ward for my shadow shift, the list told me that it was in south wing, when in fact it was in west wing, after much walking around corridor after corridor and not finding the ward I asked someone, who pointing me in the right direction, luckily I got to the hospital early for this exact reason, so that I could find my way without having to rush. This is the first piece of advice I would give to someone in the same position, I would tell you to arrive with time to spare, so that you can find your way and not be late, as being late does not look good on your first day.
Once I finally arrived at the ward, I was greeted by a health care support worker, who was extremely friendly and who showed me to the staff area, where I could get changed into my uniform. This first point of interaction was extremely important to me, and it set me up for a nice afternoon and evening ahead, to have someone greet you who is so cheerful, who is working on a ward that can be extremely demanding, really made me feel at ease and made me realise that you need to have a sense of humour and a good balance of when it is essential to be serious, and when it is necessary to smile and laugh. As this job can often be a struggle and a challenge, everybody needs to have a sense of humour to lighten the mood.
Once the shift began, it was time for what they call a handover, this is where the staff nurse from the previous shift hands you out a chart, this chart has all the relevant patients names on, why they are in hospital, what care they need, how often they need there observations done, and when they are estimated to go home, I cannot elaborate on this just yet, as I need to be there a lot longer to work out exactly what everything means.
The staff nurse then gives a run down on how the patients have been on the previous shift, what still need to be done and when etc, others were making notes on there charts, but as it was my first shift, I was unsure of what to write, but now I have figure that I will write anything that I feel is of relevance to the job that I need to undertake. They often use abbreviations for many terms relating to the patients condition, so I would advise that you find out what these mean, I was given a handout with some of these on, but not all, so this is something that I have to undertake also.
It is advisable to also ask if you are unsure of what things mean, maybe not while they are in the middle of talking about a patient, but make a mental note to yourself and ask afterwards.
After handover I was assigned to a health care support work level 3 (hcsw3), I had to as the shift suggests, shadow her, watch and observe what she was doing but where a shadow just stays by your side and does nothing, you have to physically undertake the relevant tasks that you are told to do, from making beds, helping take obs, help with feeding (for those patients who are unable to do this themselves), help assist them to the toilet, help with personal care, help get them comfortable in there beds etc, for most of these you are often in two's, so you are not left to do all the above on your own.
For a couple of hours on my first shift it was a little bit manic as an event occurred whereby social workers occurred, so the hcsw3 that I was shadowing as busy dealing with that, so basically I was floating around helping whoever needed help, there was another hca working, another hcsw3, a staff nurse, a more senior nurse (unsure of exact title - it was too long to read on her badge) and there was a doctor, so I was following them all around and learning as I went.
On this shift I was shown how to fill out an observation chart, I am still not 100% on this, but I am about 90% sure of what to do. These charts can be extremely daunting, and there is a certain way that they have to be filled in, this will be explained to you on the nursing induction course before you start, and the person who you are shadowing will help you with this, also once again just ask, maybe not when they are busy, as hospital workers can get extremely stressed very quickly, but when there is a quiet time, test the water and ask.
I received a 30 minute break on this shift, which was actually quite sufficient, I didn't feel like I needed any more. I was on my feet for the entire shift, walking from each bay, from one end of the ward to the other and then back again, this was constant throughout the shift, I look at this as a positive, I was busy, and although it could ache your feet after a while, it is exercise, which can only be a good thing.
I came away from this first day feeling really happy, I enjoyed it, I had many stories to tell my husband as the shift was quite eventful, and there are a lot of little quirky things that tend to happen, I managed to get home at about 9.50pm, so it was time for tea or more like supper, then bed.....as I have another shadow shift on Sunday morning..................
****My Second Shift****
This shift began at 7am, it was on the same ward so I knew where to go, a couple of new patients had appeared over night, which is generally what happens in a hospital setting, I didn't get to see them as they were male and I was mainly based on the female part of the ward on this occasion.
Being given my own section of the ward was actually quite nice, as it gave you a chance to get to know the patients a bit more, as you were in and out of the rooms and bays constantly for 8 hours, so you became familiar to them and them to you.
Once again we had the handover at the beginning of the shift, then I was assigned to shadow a hca, although once again I ended up shadowing two hcas and a hcsw on different occasions. It is not realistically possible to just shadow one person for 8 hours in a hospital setting, as that person will no doubt get called off to do something else. When this happens you just need to use your initiative, have a look around, see if there is anyone who needs help, see if you can assist someone, ask if anything needs doing etc.
Luckily on this shift there was a nurse and a hcsw that I was familiar with and who I had met the day before, so it was nice to have someone who was familiar, this helps to make you feel sttled in your surroundings, because at the start of being a bank hca this wont be the case, as you can be put on a variety of different wards where you will not have worked with any of the staff before, I feel that this wont always be the case as I guess you will often overlap with other bank staff and you can also request to go on wards that you have been on before.
Anyway, back to the shift. This shift was an hour longer than the evening one, this shift by the way is called an early and the evening one is called a late. This shift was slightly more demanding than the late shift and you have to undertake more personal care of the patients, by this I mean that they needed washing, changing etc. You also had to aid with breakfast and lunch, so you had to make sure that they were all fed and had eaten enough. You also had to make sure that they were given drinks and drinking enough in between, a few of the patients were unable to drink by themselves so it was up to us to assist with this. It was also necessary to do observations, for the first time I was left on my own to do 5 of these, to start with I was unsure, but I got the hang of it in the end. By observations I mean blood pressure, temperature, heart rate, oxygen, whether they are alert, respirations, and there par score, to work the par score out you will find that there is normally a laminated card attached to the trolley that you use, so if you just take a few seconds to look at it then you can work this out, I managed to get a par score sheet which I will now carry around with me, I am not going to go into what a par score is as I am not 100% sure about it myself yet, but I do know that if you work it out to be 3 or above then you have to inform the nurse. I will find out about this, and there is a course that you can do so you understand this further, which I feel is a good thing to do.
I received two 30 minute breaks on this shift, which again were enough for me, by the end of this one I was a little more tired, but I still enjoyed it, however daunting it was being left alone to do obs, I really appreciated it at the end, as it made me become more independent and a lot more confident in attempting it next time.
To anyone who is due to undertake there shadow shifts soon, don't be nervous, there are people who are there to help you, and they never seem to mind when you have a question, as long as you ask it when they are not extremely busy or when they are doing obs (for this you need to be quiet). Go in there confident, and if you are not usually confident like I am not, then go in there and make out you are, by the end I guarantee that you will be, it really helped me feel good about myself, it has given me the belief that I am not useless, that I can do more than be a full time mum and housewife, and eventually I can either decide to do nurse training or do nvqs which will allow me to do more clinical things, such as dressings etc.
I would have loved to find a write up about this before I started, I hope that this helps someone, I must just say though, that all wards are going to be different, mine was an elderly ward, but you can be placed anywhere if you are on the bank, for instance my first two proper shifts this coming weekend are on orthapeadics on Saturday and renal on Sunday, maybe I will write another review in a few months, once I get settled in. I have only given it a four star, as it was only my shadow shifts, i am waiting to start properly before i increase it to 5.
Health Care Assistant is the job title given to individuals who take care of our sick and elderly in Britain. Over the years the job title has changed many times. Auxilliary Nurse, Care Assistant, Home Help, Care Attendant and Carer are naming a few.
For more years than I care to remember, I have worked as a Health Care Assistant. I have worked in a Hospital, in a Care Home, in a Nursing Home and also in people's own homes.
I don't think it matters where I work as the basics, of what my job description is, are the same. My job is to take care of, and look after those who cannot, for whatever reason, look after themselves.
A number of years ago, when I worked in a hospital, my job was to look after elderly people. Most of those people were suffering with different stages of, either Dementia or old age. As a Health Care assistant, it was my role to ensure that each individual was assisted in all aspects of their personal care. This could range from something as simple as running a bath for someone, to having to wash, dress, comb hair, shave and assist with toileting for another. None of this was ever a problem to me. I loved my job and I wanted to help people.
In the Care Home and Nursing Home my duties were much the same. Each person had to be treated as a individual and their needs dealt with in a kind and helpful way. If one lady wanted her hair set in rollers, then that is what I did. If another lady did not want her hair set, then I didn't do it.
Probably the most enjoyable part of my job was when I was working in the community. Here, I went to people's own homes to assist them. Obviously each person has their own individual needs, and my duties changed from house to house. I could visit a old gentleman who needed assistance to shave and I could then visit another gentleman who needed assistance to shower and dress and I would then make his breakfast.
One occassion in particular sticks in my mind. I went to a certain house and found that an elderly lady, who was quite frail, had been up very early and struggled to get herself washed and dressed before I arrived. When I explained to her, that I was there to help her, she told me that she didn't want to put me to any trouble. I can remember putting the kettle on and then spending time, just chatting with her and drinking tea. It took two weeks of drinking tea,before she would allow me to help her. When this happened I felt that I had 'job satisfaction'.
On the other hand there are the people who, no matter what you do for them, it is never enough. I can remember visiting one person, who was quite mobile, but wanted me to do everything for them. My job there was to try to encourage them to be a bit more independant. This was a very slow process, as this person thought that, because I was visiting, that it was 'my job' to do everything and that I was 'getting paid for it'. This is a sad part of the job.
Another aspect of this job, is that, you become very attached to the people you visit. Close bonds can be formed and if their is a death, it can be like losing one of your family. I always try to look at this in a positive way. I tell myself that I was fortunate enough to have been able to make their last days, just that tiny bit easier for them.
Being a Health Care Assistant plays with lots of emotions. Some good and some bad. I don't think everyone could do this job. But then, I would hate to work in an office.
In my time doing this job, I have occassionally come across a few people who do not do their duties properly. I have never had any hesitaion in reporting them to the relevant authority.
It is my opinion that, if you cannot treat these vulnerable people, in the same way as you would treat one of your own family, then this is not the job for you.
Along the way I have made, lots and lots of friends and probably a few enemies too.
I would not swap my work for anything else.
Certain qualifications are needed to do the type of work and employers usually run the relevant courses. To do the work you need to have the following:
Moving and Assisting Certificate
Basic First Aid Certificate
Basic Fire Safety Certificate
Food and Hygeine Certificate
Many employers are now looking for employees to have an SVQ level 2 or 3 in Healthcare. This is the certificate in Scotland, I am unsure what the English Equivalent is. I have been told that a lot of employers now provide the funding for this certificate.
The pay for Healthcare Assistants varies qute a lot. If you work in a Care Home or Nursing Home you are usually paid just over the minimum wage. If you work in the Community for a private company it is about the same as a Care or Nursing Home. If you work for the NHS or your local Authority you can expect to get a bit more.
At around the age of sixteen I left school, due to the fact that they were only offering an NVQ in Leisure and Tourism, this was`nt for me so I left in November 1996.
My mum was`nt an easy person, she did`nt allow me to join the YTP as it was known then, by joining this I would be payed £32 a week for working in a work placement job and she was`nt having this.
Before leaving school, I had already decided that I wanted to look after the elderly, so I searched the local papers and aranged several interviews, shortly after Christmas I went for an interview and a few days later, the Nursing Home informed me that I got the job.
First few weeks
Well I was basically thrown in at the deep end, I had no training, only other members of staff teaching me the basics, like how to lift properly etc, we done 12 hour shifts back then and got £2.80 per hour, however although the shifts were long and the money low, I knew this was the job for me, eventually I did do inhouse training and my job became a bit easier.
We had to get the residents dressed or bathed in the morning, serve breakfast, feeding some residents if neccassary, By this stage the staff could enjoy activities with the residents like games, music, talking, listening to the wonderful stories they had to tell and sometimes taking them for walks.
We were also responsible for laundry, making of beds and the cleaning of commodes in some the residents bedrooms. Another duty was to aid the residents to the bathroom at certain intervals of the day or when required.
In the afternoon lunch was served, again some residents required assistance, same with dinner time, then we could enjoy the rest of our shifts by doing activities with the residents, then at nights the night staff would serve tea/coffee and biscuits, and put the residents to bed.
Staff on duty
There was always a staff nurse on duty during the day, to make sure everything would run smoothly and to administer medications needed, most of the Nurses also done there fair share of work during the day. So with a staff nurse and three care assistants on, looking after 18 residents was`nt to hard.
A rewarding job
This is a really rewarding and worth while job, I really did enjoy working in the nursing home, The reason I left was because I had my kids and the shifts were very long then, but I do plan to go back to this sort of work when my kids are older (hopefully)
The down side
Well the only down side for me was that I got to close to the residents and it broke my heart when they died.
If anyone out there is considering this sort of work I would highly recommend it,
Thanks for reading
I have done this review on Ciao
i currently work as an health care assistant in my local hospital on a critical care unit.(west midlands) I find it extremly rewarding. I have been working here for 5 years now. I work 12.5 hour shifts and because of the long days i only have to work 3 a week and make up a shift at the end of the month. Before this i spent the previous 8 years working as a care assistant and community assistant in nursing homes and resource centres. I work along trained nurses on the ward and help manage 10 level 3 beds(intensive care) where patients need respiratory support from machanical ventilators and major organ support and are "critically ill". I also help manage 6 level 2 beds (high dependancy)where patients are not so critical but still need a high level of dependant care and support, a kind of step down. I am trained in basic life support but my unit consists of one - one nursing care i very rarely have to get involed. I leave it up to the proffesionals. I have to keep updated with this so the trust sends everyone on a inservice study day once a year. I help with all aspects of nursing care, hygine needs and nutrition support. etc. As you can expect the nature of the unit we do regularly have patients who are so seriously ill that they often pass away. This can be tough, especially when they are young. It all comes naturally when i am in that situation especially when i am spending time with families and loved ones of someone they have lost. This is the down side of my job i must admitt. We have a range of patients ranging from very small children, teenagers, adults, prisoners etc. We also have attempted suicides and people who have actually succeded so you are exposed to alot of unpleasent sights but the support there for you is wonderfull.
I also take regular observations from patients and chart them on our observation charts, explain to families and friends what has been going on in the day with their family member/friend etc. I act as an extra pair of hands to staff nurses and sisters so i also do a lot of walking to labs with bloods and collecting blood producs when requested. I enjoy talking to the patients as we do often get long tearm patients who have been so poorly and have been able to recover and it is great to see how much some one can prove you wrong when they are so ill!!!. We have some fantastic parties and summer balls, it helps to let your hair down socialise with your work mates. We all have a great sence of humor and have a great laugh and joke with the doctors!!!. Being a health care assistant has helped to give me an insight to what being a nurse is all about. I do feel that health care assistants are not always appreciated in what they do. You find that some staff will try and make you there personal run aroud but i soon put them in their place!!. Working here has enabled me to gain a lot of experience and knowledge and i have decided to apply for my nurse training in 2008. I know i have got alot of support from my collegues of the unit and i am really appreciative of what they have taught me. I am so glad i was given the opportunity to work as an health care assistant but i must admit it is not for everyone. If you love working with people, have a caring nature and the abbility to learn new things this is a great rewarding job. You never know, you may even be able to teach the qualified staff a thing or two!!!!! You generally need some care experience to apply but the trust will always be willing to put you through your nvq 2 and 3 and gain this while you learn. Believe me your daily work as a hca covers all your units on the nvq. You will be supprised by how much you actually do and know when it comes to writing it down.
This piece is about working as a care assisstant in a nursing home, but most of the skills are tranferrable to hospital settings or home care services. "Nursing Homes are care giving facilities developed to provide long term care to chronically ill or dependent individuals" (Carnevali & Patrick 1993 p163). As a care assistant in a nursing home my job involved caring for the residents giving them the assistance required to fulfil their daily activities. To show how I felt I contributed to the needs of the resident I aim to discuss what I did under the headings of Roper, Logan and Tierney's Activities of Daily Living. The Activities of Daily Living were devised by Roper et al in the late 1970's to enable nurses to get a broad view of a patients every day life, therefore gaining a full assessment enabling them to provide individualised care. There are 12 Activities of Daily Living; ~ Maintaining a safe environment ~ Communicating ~ Breathing ~ Eating and drinking ~ Eliminating ~ Personal cleansing and dressing ~ Controlling body temperature ~ Mobilising ~ Working and playing ~ Expressing sexuality ~ Sleeping ~ Dying It is a well known fact that people are now living much longer. It was estimated that in the year 2000 there were a million people aged 85 or over. As the majority of Nursing Home residents are in this age bracket and are also more likely to have problems with many of the Activities of Daily Living, it is very important that care staff can meet their needs, making the residents life as comfortable and happy as possible. It has to be remembered that although the model is being followed, that each resident is an individual and care should meet his/her individual needs and not be generalised. Many of the activities overlap, so many problems fit into more than one area, in an effort to avoid repetition they will be discussed in only one area. ~M
aintaining a Safe Environment~ "In order to stay alive and carry out the other activities of daily living, it is imperative that actions are taken to maintain a safe environment" (Roper et al 1990). As people get older their ability to maintain a safe environment is reduced, due to failing sight, hearing and mobility, confusion and ill health. In fact inability to maintain a safe environment is probably one of the most common reasons for admission to a Nursing Home. Care Assistants should ensure that the environment is as safe as possible for the resident, this can be done by paying attention to simple things that most of us probably take for granted; ~ ensuring that nothing is left on the floor for anyone to fall over, ie clothes, bedding, cups. ~ making sure that things are within reach so that the resident is not tempted to stretch to reach what they want. ~ checking that footwear is safe eg. fits properly, shoe laces fastenend. ~ cleaning up any wet floors straight away to avoid anyone slipping. ~ ensuring that resident is wearing glasses and hearing aids if they have them and that any walking aids are within reach. ~ see that the residents call buzzer is within reach and that they know how to operate it. Confusion and disturbed behaviour are common problems for residents in nursing homes and this can pose great difficulties in maintaining a safe environment. "Wandering, incontinence, angry outbursts, stubborn denial that there is a problem and sleep reversal, being drowsy by day and restless at night are among the most troublesome forms of disturbed behaviour" (Shukla & Brooks 1996). People who are confused are rarely aware of their confusion, they might admit to being a bit forgetful, but usually think it is other people who are confused, not them. It is important for the safety of all the residents that any confusion is kept to a minimum,
this can be done by keeping the resident orientated to the time, day and place, ensuring that routines are maintained and the environment kept as constant as possible. It is also important to try and reduce any anxiety as this can exacerbate the confusion. "A gentle reassuring touch can calm a patient better than words or drugs" (Shott & Finlay 1984). This will not work for everyone as some people do not like being touched. Confusion is not a illness, but a symptom and a sign something else is happening. ~Communication~ "Communication is the process by which we transmit information to, and receive information from other individuals or groups" (Cormack 1985). Communication can be verbal or nonverbal (body language). "Nonverbal behaviour provides us with clues to, not conclusive proof of underlying feelings. However research has proven that nonverbal clues to be more reliable than verbal clues" (Okun 1991). It is important to be able to recognise nonverbal communication and act upon it, for example if someone is uncomfortable, in pain or worried about something, these are all things that people want help with, but may not verbally request it. People who are worried or unhappy often want to talk, but do not ask as they feel they are wasting your time, but if you can recognise that there is something wrong and approach them about it they may feel happier about telling you. Inskipp stresses the importance of "accepting peoples feelings without trying to cheer them up, or deny or play down their feelings" (Inskipp 1988). "For many an elderly person pain is a constant companion" (Cormack 1985). Often they will not complain and suffer unnecessarily unless the carer recognises the resident is in pain. There are many barriers to communication, including hearing loss, visual problems and speech disorders. "Some deafness is inevitable as we grow older and in som
e cases complete hearing loss may result from degenerative changes in the ear" (Wright 1984). To make sure the resident who is deaf or hard of hearing understands as much as possible the carer should face the person, speak clearly, find out if they hear better on one side than the other, make sure that they the resident has understood what was said. Hearing aids should be used correctly if the resident has one. "All professionals who provide care to hearing aid users should know how to assist them in inserting their ear moulds and adjusting the volume control to a comfortable level" (Carnevali & Patrick 1993). Vision is used a great deal in communication, watching the person speaking to us gives us a lot of information about what they are saying and we also use many visual forms of communication, letters, newspapers, television, books etc. A person who has visual problems can feel very isolated. They can be helped by the carers talking to them clearly, keeping them informed about what is happening around them, reading their letters to them and helping to write replies and if their is any spare time carers could read to the resident if they are interested either in the news or a book. For residents who wear glasses it is important to make sure that their glasses are kept clean and worn at all times, except in bed. Speech is often affected by strokes or Parkinsons disease, this can be very frustrating for everyone as the resident has difficulty communicating their needs. The carer needs to be very patient and encourage the resident to take their time when trying to speak, reassurance is important, if the person gets upset it makes speech even more difficult. Observation of nonverbal communication can be very useful in interpreting what the resident wants. Writing down what they want can be encouraged for some residents, but this ability is often affected by strokes, Parkinsons, arthritis and visual problems. ~Breath
ing~ This is something that most of us do without thought or effort, but as we get older the lungs become less elastic, so breathing becomes more of an effort. Many people also suffer damage to their lungs and suffer from respiratory diseases. "Pneumonia is the fourth leading cause of death in the elderly" (Carnevali & Patrick 1993). Being breathless is very distressing and tiring for the resident. The carer can help in many ways, firstly by providing reassurance, helping them to find a comfortable position which makes breathing easier (usually upright and supported), allowing them to move around in a wheelchair if they find walking to much of an effort (it is important to keep as mobile as possible to prevent secretions settling on the chest and exacerbating the problem). It is also important that carers know how to use oxygen, inhalers and nebulisers if the resident should need them. "A good nurse can help someone to get his breathe freely and get his breath in more ways than one, not least by caring for him in such a way that it restores or reinforces the way he sees himself as a worthwhile individual who is respected and valued by others" (Ashworth 1976). The carer should observe residents for signs of breathlessness and distress and report them immediately so that the problem can be acted on to prevent unnecessary distress, ill effects or further complications. ~Eating and Drinking~ We all need to eat and drink in order to survive, but many older people lose interest in food, this maybe because they are ill, depressed, attention seeking, afraid of poisoning or put off by a bad experience eg. choking. "The elderly person often has less appetite for food; there is usually less physical activity so there is not the same requirement for the energy foodstuffs" (Roper et al 1990). Problems with senses often make food unappealing. "Many older people experience a diminution in the
sense of smell and taste, which of course makes food insipid" (Cormack 1985). Also if you cannot see what you are eating it is not as appetising. Some medication reduces the appetite or can make you nauseous. Many residents may need help with eating and drinking, due to arthritis, strokes or visual problems. Help needed can range from cutting up tough foods to spoon feeding. It is important to find out the resident likes and dislikes, there is nothing worse than being made to eat something you dislike, especially if your appetite poor anyway. Some residents may need plate guards to prevent food being pushed off the plate, carers should ensure these are provided. If a resident has suffered a stroke or has problems with their hands, it may be possible to get adapted cutlery, so they can still be independent, it is quite degrading being dependent on someone feeding you, and it may mean that they will eat better. Carers need to be aware of anyone who is diabetic and know what they can eat, as often they will ask for things they cannot have. Awareness of religious beliefs is important eg. Muslims do not eat pork, Hindus are vegetarian and Jews prepare food in a certain way. To ensure that residents can eat properly carers should check that any dentures are clean and that the resident is wearing them. Dentures can often become uncomfortable, making chewing difficult, discomfort should be noted and efforts made to get the dentures altered. Fluid intake is more important than food "one suffers more acutely, more quickly from lack of fluid than food" (Cormack 1985). Often it is difficult to get the elderly to drink adequate amounts as they worry about being able to get to the toilet, or being incontinent, confused residents can forget when they last had anything to drink, so carers can have a difficult job to persuade them to drink. Offering drinks at regular intervals and being available to help with toileting can help
to encourage fluid intake. Difficulty swallowing (Dysphagia) is often the result of a stroke and can make eating and drinking difficult if not impossible. Residents with this condition may need liquidised diets and careful observation to ensure that they do not choke. Others may need to be artificially fed through Nasogastric or Gastrostomy tubes, although care assistants cannot administer the feeds they need to be able to recognise any problems with the machinery or reactions in the resident so that they can be quickly rectified by the qualified staff. ~Eliminating~ This is an activity that everyone has to do, but for elderly people it can cause many problems. There are two sorts of elimination, urinary and faecal. Some of the difficulties experienced by the elderly are frequent urination, incontinence, constipation and retention of urine. Urinary incontinence is "any uncontrolled leakage of urine at any time" (Ouslander 1981). "Constipation is one of the most common complaints of older people" (Carnevali & Patrick 1993). In order to prevent the distress and complications that can be caused by incontinence carers need to encourage frequent toileting, 2 hourly for those most at risk. Carers should encourage the residents to ask if they need assistance getting to the toilet and, or help with clothing and must not ask people to wait if they ask for the toilet as this leads to upsetting accidents and discourages the resident from asking for help and causes anxiety. Residents who are incontinent should be helped to clean themselves and get into dry clothes, some may use pads to prevent soiling of clothes, these should be checked regularly to prevent sores. Many residents will be upset if they are incontinent so need reassurance and help to prevent it happening again. Incontinence is caused by weakening of the bladder muscles or failure of the brain to recognise the signals that the bladder is full
, regular toileting can help to retrain the bladder in some cases. Some residents may be catheterised to avoid incontinence or to relieve urine retention, carers need to know how to care for the catheter in order that they can teach the resident or carry out the care themselves, this must be done daily to prevent infection. Constipation can be uncomfortable, painful and distressing, it is often caused by reduction in mobility and changes in eating habits. Carers can help by encouraging mobility and a high fibre diet. Medication is often the only way of easing the constipation, so checking that the person takes their medication can also be helpful. Some elderly people get very concerned about bowel habits, reassurance that a daily bowel movement is not essential can be useful. ~Personal Cleansing and Dressing~ "Elderly people may have increasing difficulty in managing some of the physical activities involved in cleansing and dressing" (Roper et al 1990). Some residents need help with all aspects of cleansing and dressing others will need little help, perhaps just washing their back or unfastening fiddley buttons. Again some residents are reluctant to ask for help and will neglect hygiene rather than ask, on the other hand others will allow carers to do everything for them when they can manage themselves. It is important for carers to assess what people can do for themselves in order to maintain some independence or avoid neglect of hygiene needs. There are aids to help with bathing and showering, eg. hoists and chairs, but carers must be instructed in their use before using them for a resident. When using the equipment residents should be told what is happening, it is quite frightening being lifted up in the air and swung round even if you are expecting it, so reassurance is also important. Water temperature must be checked, many elderly people cannot tolerate hot water. If the resident has a regular r
outine it is useful to try and stick to it, ie if they like a bath at night rather than in a morning, or if they have their hair washed on Sundays and Wednesdays, it gives them a sense of control and security. At all times privacy must be maintained eg. bathroom doors closed, body kept covered as much as possible, knocking before entering a room. Attention must be given to cleaning of the perineal areas, although this can be embarrasing for the resident, if they can do it themselves it is less distressing. Nails are often over looked and can become very dirty, they need to be cleaned and cut regularly. According to Roper et al (1990) 74% of people over 65 and 87% of people over 75 are toothless, the majority of others have gum disease and caries. Mouth care is very important and so often neglected. dentures need to be removed at night and soaked, then cleaned before they are put back in the mouth. Residents with their own teeth need to be reminded or helped to clean their teeth. For resident who are being artificially fed regular mouth care is needed as the mouth becomes very dry and sore. ~Controlling Body Temperature~ "Elderly and immobile patients feel the cold more readily" (Roper et al 1990). This can be helped by providing blankets and wearing layers of clothing. Making sure windows and doors are closed prevent draughts. "Body temperature falls at night" (Roper et al 1990) so carers need to make sure the resident has enough bedding to keep them warm. A raised body temperature is a sign of illness and should be reported. Residents can be cooled using fans, wiping the face with a wet cloth and removing extra bedding. Care must be taken that they do not get too cold. ~Mobility~ As people age mobility is often reduced, due to pain, stiffness, limb weakness, respiratory difficulties, lethargy etc. "Falls are common in the elderly; 1 in 4 over 65 years will fall in the subseq
uent year and 5% will result in a fracture" (Shukla & Brooks 1996). Carers need to accompany residents who are unsteady on their feet or lack confidence when walking. It has to be ensured that any walking aids eg. zimmer frames or walking sticks are used. Confused residents often forget that they are unsteady, unable to walk, or use a walking aid therefore need extra observation and reminders. In conditions such as Multiple Sclerosis or Parkinsons disease the residents ability to walk varies from day to day, from being fully mobile to dependent on a wheelchair. Rheumatic problems such as Arthritis are common in knees and hips, making walking very painful if not impossible. "Rheumatic disorders are very common - up to 40% of elderly people have this disorder" (Shukla & Brooks 1996). Other residents may be fully mobile, but spend long periods sitting as there is nowhere to walk to, carers should encourage them to walk around for short periods, to prevent the consequences of immobility eg. pressure sores, chest infections and thrombosis. Despite careful observation falls do happen, on finding a resident that has fallen the carer should not attempt to move the person until they have been checked by a qualified member of staff, who may decide to call a doctor or ambulance if they suspect fractures, head injuries or internal injuries may have occured. Following a fall the resident will need close observation for signs of pain, level of consciousness, vomiting and anxiety. Reassurance is very important, as is keeping them informed of events and making them as comfortable as possible without causing further trauma. Accident forms should be completed. All carers should be taught how to lift and transfer residents to prevent unnecessary falls or damage to the carers themselves. Pressure sores are the main result of immobility in the elderly. "Pressure sores may be of the superficial or deep skin type and are associated
with immobility and a general deterioration in the physical / mental condition of the elderly person" (Cormack 1985). "Nearly all pressure sores are due to unrelieved pressure, usually in relatively or totally immobile patients" (Garrett 1991). Pressure sores can be prevented by regular relief of the pressure eg. walking, standing, changing position. Residents who are bedbound or unable to turn themselves in bed need regular changes of position, the most at risk need to be turned 2 hourly. "At risk patients can be managed with regular turning" (Shukla & Brooks 1996). Residents should be regularly assessed for their risk of getting a pressure sore, using either the Norton or Waterlow scoring scale. Areas of the body at risk of sores, eg the bottom, hips, knees should be checked daily for any signs of redness or breakdown of the skin. Changes in the state of existing sores should be reported. Areas prone to pressure areas should be kept clean and dry at all times. ~Working and Playing~ Most people would probably say that the elderly do not work or play, but they need to kept occupied as much as anyone else. "We should not underestimate the problems that boredom and the lack of mental and social stimulation can have on the health and wellbeing of any person young or old" (Garrett 1991). Residents should be encouraged, but not pressured, to take part in organised activities and outings. Many like to watch particular programmes on television, so carers should ensure that the residents television is on and that they can change channels. Others enjoy sitting and talking with other residents or to staff and relatives, often talking about the '?old days'. "In the last few years an ever increasing interest has been shown in the uses of reminiscence therapy" (Garrett 1991). Any activity is a relief for boredom or a distraction from the present. "Whilst people are enjoyin
g themselves they often forget about their current aches, pains and symptoms" (Garrett 1991). ~Expressing Sexuality~ Sexuality is "those aspects of the human being that relate to being , boy or girl, man or woman. An entity subject to lifelong dynamic change. It reflects our human character, not solely our genital nature" (Garrett 1991). For most residents expression of sexuality is shown in the way they dress and present themselves. Ladies may like to have their hair done and wear makeup and jewellery, whilst men may want to wear a shirt and tie and have a splash of after shave. It is important that residents are allowed to wear what they choose and are helped to apply makeup or set their hair, as well as expressing sexuality it make them feel good. Maintaining dignity is also important some residents would be very embarrased at anyone seeing, them bathing or not fully clothed. On the other hand there are residents who may not keep their bodies covered or wander around without clothes in their confusion, this should be discouraged and the person made decent to maintain their dignity and to avoid upsetting other residents or visitors. ~Sleeping~ Everyone requires sleep, but not every one needs the same amount. Many elderly people have problems sleeping, they seem to wake often or have difficulty getting to sleep. "The older person sleeps for a shorter period than the young and it is more broken by periods of wakefulness" (Roper et al 1990). Shott and Finlay (1984) say that insomnia results from being separated from one or more of six facets; ~ Warmth ~ Loving contact ~ Physical comfort ~ Regular exercise ~ Peace of mind ~ Security. Carers can try and ensure that residents are not separated from these facets as much as possible, for example making sure they are comfortable, that they are warm enough, listening to any worries they have and gi
ving reassurance. Other factors that prevent sleep and can be controlled by carers to a certain extent are noise, light, routines and toileting. Carers need to know what the residents usual bedtime routine is eg. what time they like to go to bed, if they have a drink, if they like the light leaving on or have the door open or closed. These may all sound simple, but it helps the resident to be settled and to sleep better. Residents should be checked regularly during the night, taking care not to disturb them if they are asleep or try to resolve any problems of those that are awake. Ensuring that the resident can reach their call buzzer will give great peace of mind and help promote sleep. Provision of commodes next to beds is another way of relieving anxiety for the resident who is worried about getting to the toilet during the night. Night time is often when people with problems and worries like to talk, carers may also have more time to listen during the night and should be understanding and allow the person to express their fears and worries. "A sympathetic listener last thing at night is invaluable" (Shott & Finlay 1984). Having a nap during the day should be encouraged to prevent residents becoming over tired, it also helps to pass time, but if someone seems unusually drowsy it may be cause for concern and should be reported. ~Dying~ Death affects the daily lives of the elderly more than any other age group, be it the nearing of their own death or death of those close to them. "For the elderly there is the realisation that they are approaching the end of the lifespan and they are made aware of this by an increasing number of deaths in their peer group" (Roper et al 1990). Many residents are admitted to nursing homes as a result of their partners death. "The death of an elderly spouse often means the loss of a previously coping partnership the two having compensated for each others
difficulties and disabilities" (Garrett 1991). In this situation their grief may be aggrevated by having to leave their homes and possessions. Everyone copes with bereavement in different ways, some see death as inevitable and often a relief of suffering, therefore cope well, whilst others are devastated and lose their own will to live, deny the death has occured or become confused, some may never recover from a bereavement. Bereavement means "to be robbed of something valued" (Garrett 1991). Carers need to be sensitive to the persons needs and willing to listen, if they wish to talk about the deceased person it should be encouraged as often it helps the healing process, memories of the good times often ease the misery. There are thought to be four stages to grief. "An initial stage of numbness is followed by a period of restlessness and pining, a time of anger comes next often directed at helping professionals" (Waltis & Martin 1994). Carers need to understand that grieving is a long process and should not expect the person to recover after a week, it can take months or years. "Helping people cope with grieving is part of preventative health care" (Copperman 1985). For some residents their own death is frightening, others may feel it is inevitable and do not worry about it. Death can be painful, distressing, drawn out, sudden or peaceful. Terminal illness can be very distructive and bring out a lot of emotions in the resident and their family. Emotions include anger, depression, denial and fear. During a terminal illness the resident may suffer a lot of pain, lose weight, lose control of bodily functions, even lose consciousness. The carer should ensure that the person is kept as comfortable as possible and has their hygiene and nutritional needs met as well as emotional needs. The care given must show that "you matter because you are you; you matter to the last moment of your life, and we will do all
we can to help you die peacefully but also to live until you die" (Saunders 1976). At times of bereavement the carer may be of great support to the residents family and should offer help if needed whilst respecting the privacy of the family. ~Conclusion~ The job of a care assistant is very important. They usually have the most contact with the residents and are involved in all activities of daily living. Often care assistants will be the first to notice changes in a resident, which need to be reported to qualified staff. Also care assistants are usually the ones who residents approach with worries as they do not like to bother the qualified staff, all worries should be taken seriously and acted on if necessary.
1.She has had no rigors or shaking chills, but her husband states that she was very hot in bed last night. 2.Between you and me we ought to be able to get this lady pregnant. 3.She is numb from the toes down! These are just a few of the ‘funnies’ doing the rounds at our hospital at the moment. Apparently they supposedly are extractions from actual patients notes! I can’t corroborate that but I have seen a few funny extracts in my time as a nurse. Not as obvious as those above but mildly amusing nevertheless and not of the kind to cause any offence to anyone affected. It is little things like the extracts from the list above, (stay tuned I will sprinkle a few more throughout this op!) which go a long way to lifting the spirits of the nursing staff at times of considerable pressure and stress in an often highly volatile environment. I don’t quite remember the exact time of my life when I decided I wanted to become a nurse, like lots of little girls, but I am sure it had something to do with the fact that my Mum was an Orderly (as they were called then) back in the late 60’s and early 70’s and it always seemed such a glamorous and worthy job to go for. Ho ho ho!! (4. Patient has chest pain if she lays on her side for over a year!) I kind of fell into it eventually, having been ‘forced’ to go out to work following a nasty biking accident my partner had in 1989. I started off by joining the domestic/housekeeping service at our local hospital. I had the idea that I would see if I could hack working in this kind of environment and just see where it might take me. After cleaning and buffing and dusting and being a scrubber ;o) for a few years I decided to take the plunge and apply for the job as a temporary Health Care Assistant on a Care Of The Elderly Ward at one of the local hospitals. It was a 3-month contract and I decided that while I w
as doing this I would gain some experience and join the nurse ‘bank’. So that when it did end if I had not secured a more permanent position in the Trust by then I would be able to work as and when I could get shifts with the ‘bank’. This was April 4th 1994!! By August of the same year I was a permanent part-time member of staff of another CoTE ward and loving it. (5. On the second day the knee was better and on the third day it had disappeared completely.;o)) Sadly the hospital I was working in was due for closure later the following year but fortunately the ward and its whole compliment of staff were transferred to the newer hospital across town. By the time this happened I had changed from working part time in the evenings to full time during the day. What a change that was, not the hours but the hospital environment. We were used to a small ‘cottagey’ type set up when if someone took poorly or who had a cardiac arrest, was usually attended to by just the ward staff and the on-call ward manager and a couple of doctors. My eyes nearly flew out of my head the first time I witnessed such an event at the other place, the world and his wife appeared from nowhere as soon as the crash call was put out and took over, there was little then for the majority of the ward nursing staff to do, we had to let them get on with it. No nurse wishes to be involved in such an event but I am peculiarly grateful that I was party to such whilst still at the old place. I was a main attendee to it and was able to perform CPR myself with the supervision and assistance of senior nursing staff. I would like to think that should I encounter such a critical incident in the future that I will be able to call upon my past experience and be of some use. All nursing staff are trained to be able to carry out some form of basic life support, as well as attending regular
updates though their employment. I thoroughly enjoyed my placement as an HCA on the CoTE ward but jumped at the chance to become part of the Medical Assessment Unit, which was a newly formed team later on in 1997. Care Of The Elderly nursing is special, I think you have to be a particular kind of person to be able to work with the elderly and all the age related illnesses that come with it. The MAU was a real eye opener! Here we began to get used to dealing with a very different clientele. We dealt with any medical admission patient ranging from a suspected heart attack to would-be suicides. This is where you really do have to learn on the job, both trained and untrained staff. Lots of support is offered to all members of the nursing team be it through formal tutorials and lectures to the more informal support from the varying hierarchy. However nothing prepared me for the first time I had to sit with an elderly gentleman who had survived a suicide pact between him and his wife, he survived she didn’t. To say that he was bereft is more of an understatement that you will ever get. I sat for three hours with that man while he pleaded with me not to judge him, and asking me if I thought God would forgive him. Interspersed with being heartbroken that he was alive, and his beloved wife wasn’t. Even I, who can usually cope with most things that life throws at me had to have a bit of informal ‘counselling’ after that. I loved my time on the MAU, I can truly say that. We were a great team and all supported each other, in work and out. Boy did we have some wonderful and wild Christmas parties. I would have said that Medical People know how to party best but since I have been on the Surgical side I think I would have a hard job differentiating! (6. The patient is depressed ever since she has begun seeing me in 1993.) (7. The patient is tearful and crying constantl
y. She also appears to be depressed.) I was given more and more responsibility as my experience and knowledge progressed, eventually leading to me doing an NVQ Level 2 in Care. This didn’t give me a higher grade but it was a pleasure to be able to gain further knowledge in a field I was very interested in. As well as the theory side of things HCA’s on our unit were encouraged to develop professionally further, as far as their grading limitations would allow. I can’t comment on wages here as they will differ between areas but I can divulge that when I started I was on just over 9k a year and this was incremented each year until year 5. I left at earning about 10 and a halfK, supplemented with unsociable hours payments as well as night work enhancements. It is fair to say that the role of the Health Care Assistant, or whatever name they go under in other hospital trusts, can differ from ward to ward. Our unit ‘trained’ their HCA’s up to do the basic admission paperwork for new patients. We were also shown how to do BM’s (the measure of blood sugar levels in diabetic patients), remove Venflons (the plastic catheter tube that is sometimes inserted into a patients vein so that the trained nurse and doctors can administer medication) as well as remove urinary catheters. We are not trained nor indeed permitted to put in a Venflon or catheterise a patient. These are among the many things the trained nurses train very hard to do. The catalyst that brought me to the decision to become a HCA was seeing things that HCA’s were doing on the Ward where I was a domestic and knowing that I was more than capable of doing the same things. Coupled with the desire to have more ‘patient contact’. (8. Discharge status: Alive but without permission.) It is the ‘more patient’ contact that keep HCA’s in that position, I think, rathe
r than going on to do their training. Patient contact is sadly lacking for the most part with the trained staff due to the ever increasing and overwhelming amount of paper work that they are now required to complete. Our Trust encourages HCA’s to undertake their qualified nurse training by supporting them with further education and seconding some HCA’s to do their training whilst still on an HCA salary and with the added option of returning to their own ward once they have qualified. Hence HCA’ing is an ideal step up to the heady height of RGN. To briefly summarise the ‘average’ duties of a Health Care Assistant I will give you an outline of the jobs that I undertook whilst I was one. Assisting the patients with their ADL’s (Activities of Daily Living) as the name suggests this is the usual thing of washing, dressing, feeding etc. The extent to what you will do this obviously will depend on the particular speciality of nursing you go into. For apparent reasons the critical ill patient on an Intensive Care Unit will not need much of the above help and duties within this department will vary, as in A&E. Colleagues I know who work there tend to do a lot more cleaning up and running around and more closely assisting the trained staff. On our ward, elective orthopaedics, (mostly hip and knee replacements) the HCA’s are extremely well valued and are competent in wound dressing changes and the like. Surgical wards need a lot of observations done on the patient, i.e. blood pressure, temperature and respirations following surgery, sometimes as often as every 15 minutes post-op. Medical wards tend to keep patients for longer while investigations continue. This is nice for the staff as they can get to ‘know’ various patients and a good deal of trust can be built up between both patient and nurse. Departments also employ HCA’s such as O
utpatients and Day Care Units. Our HCA’s in out-patients are quite prominent in assisting the clinicians in getting outpatients ready to be seen. This can in itself be a highly charged atmosphere due to the sheer size of some of the clinics, in patient volume. (9. Patient has left his white blood cells at another hospital!) Most larger hospitals will have an assortment of specialties and if you are interested in becoming an HCA it might be well worth checking them out to see which would, or in some cases would not, appeal to you. For instance you might not be able to work on an Oncology (cancer) ward had you lost someone to this condition. From personal experience I can tell you that I found it very hard to deal with patients that we sometimes had come onto the MAU who had suspected brain tumours after I lost my Mum to one in 1996. I also knew that I would never be able to work in the SCBU or maternity. Not because I don’t like babies or because I have had a sad experience with them. More like because I was very broody at the time and I would have gone all gooey over the babies, came home and jumped my husband! Either that or been tempted to walk out with one! *Tongue in cheek*!! I can highly recommend a spot of agency HCA’ing with your local nurse bank. It is a superb way to get to work on an assortment of wards and discover first hand which speciality you prefer, on top of that you will get a whole load more experiences and confidence. (10. Patient’s past medical history has been remarkable insignificant with only a 40 pound weight gain in the past three days!) As you might have gathered by now, (unless of course you have scrolled down to here without reading the rest..tsk tsk! as if!) this op is mainly concerned with Health Care Assistants within the hospital environment. HCA’s or Care Assistants as I believe they are more co
mmonly known do work in nursing homes and the like. That is something I am not going to elaborate on here, as although I have done that work myself it is something that I choose not to remember. One day I might do an op about my ghastly experiences, but not here. HCA’ing within a hospital is a brilliant job. You will be a close and valuable part of the nursing team and assisting them, as well as the doctors, I have seen some very interesting things done to patients by the latter. Yes you will see sad things, yes you will be expected to administer the last care to a dying/dead patient but you will learn to deal with this. At the end of the day you will go home knowing that you have a made a world of a difference to any patient that you have ‘touched’ that day, be it by hands on care or simply by just being there to listen and comfort. Gosh…2077 words, best I bring this to a close pretty sharpish then! I do hope that I have given you a bit of an insight into some of the ‘qualifications’ of which I had none when I enrolled up as an HCA, and whetted your appetite had you been thinking of pursuing this career pathway. I can highly recommend it and most definitely would have gone on to do my nurse training if I hadn’t been given the chance of doing a spot of Ward Clerk work. But that is another op for another day!!..watch this space!! I will leave you with a final couple of ‘funnies’ and urge you not to take them too seriously. No offence whatsoever was, or is intended. (11. Healthy appearing decrepit 69 year-old male, mentally alert but forgetful.) (12. Since she can’t get pregnant with her husband, I thought you might like to have a go) (13. The patient refused an autopsy.) The End.......quite appropriately!! Have a nice Sunday! Kazz x