Healthcare Assistant: Practical Work

Duty Diary

Day shift 08.00am-08.00pm

                                         

I normally arrive to work at 7.30am as I like to get organised. I got to the staff room and pick up my assigned duty which has been allocated by the night staff Nurse. I look at the safety I will need to input into the computer later in the morning as this informs me which breakfast trolley I will need to fill and distribute. There are fifteen Residents on each group as there are a total of sixty Residents in Bishopscourt Residential Care.

I go to the kitchen and fill the tea pots, while I am doing this task to maximise time I have the toaster heating. I fill the trolley with porridge, tea and buttered toast. In some instances the residents may not be given Porridge as they may have had Diarrhoea (night staff will inform day staff) and because there is flax seed added to the pot of porridge this will only exacerbate the problem. They will be given an alternative of a different cereal such as cornflakes. I deliver the trays to the residents. I turn on the bedroom light say “Good Morning” to every resident and rise up their bed and carefully place the tray on their bedside table. I pour out their tea to ensure they do not get burnt.

Once all the residents have received their breakfast I go and assist the residents which require support with eating. If my partner has arrived she/he will go to the laundry room and load the trolley with laundry we will require for the morning (face cloths, towels, bed linen and a rubbish bag for the used incontinence pads, gloves and aprons). Meanwhile, I will collect the trays from the residents who have finished eating. I take these into the kitchen and strip the trolley for the Kitchen Assistant. I then split the list of residents I had to feed with my partner and enter these into the Epicare System on the computer. In this system I enter in under Breakfast if they did any of the following (refused, minimal, half, full, independent or assistance).

My partner and I then get the report from the day shift Nurse she tells us who is for a shower, and if there are any issues. We then decide which residents to do first. If there is a resident on the list who likes to get up early we facilitate them by going to them first. Personally speaking, I like to get the people who require the hoist done first as from a practical point of view there is always a queue to use it later in the morning. I also like to get the people who require a shower are done second as it takes a bit longer to get them washed and we also have to change all of their bed clothes which is time consuming.

We begin by going to each room and getting the resident up and washed. If the resident is not on the list for a shower we ensure they are given a body wash. We observe skin conditions and report any abnormalities to the Nurse in charge. If there bedding is dirty we change it. We ensure that they are wearing the correct incontinence pad (if required). We also ensure they are wearing the following if required (dentures, hearing aid and glasses). We give them the option of staying in their room or going to the day room. Some residents require a hoist in order to be moved from their bed to a wheelchair/or the chair in their room, again, this depends on the residents personal choice. We answer bells as they go off throughout the entire shift. These bells are located above the residents’ bed and are adjustable so that they can be attached to the residents chair if they decide to sit there. We chat with the residents and inform them about the different activities which will be taking place throughout the day.

At ten o’ clock we do a safety check, as previously mentioned, the people we do the safety check for are noted on our lists. We break them down into two groups and enter them into the Epicare system. We continue getting the residents up and ready to greet the day.

As soon as we are finished getting the residents ready we split the list down and enter them into the Epicare System. The information provided will depend on the resident. {For example: Resident x – Personal care: hearing aid, dentures and glasses and body wash, choose own clothes, hair brushed. Room hygiene: Room kept tidy, laundry attended to.  Toileting: urine, incontinence urine passed in toilet, bowels opened in toilet (pick most appropriate image and size). I also input fluid output (millilitres) for those that are fitted with a catheter. Psychosocial: happy and continent/aggressive and abusive.

At twenty to twelve we start to move the residents from the day room/their bedroom into the dining room. Some can walk unaided while others need assistance via wheelchairs/walking frames. Again, some of the heavier immobile residents will require a hoist in order to be transferred from their chair to a wheelchair.

At noon I input the safety check for the Residents on my list (the same people as before). If I was not down on the list for kitchen duty it means I assist residents who need to be fed. The dining room is divided into two sections the far side is set aside for those who can eat independently and the nearer side to the kitchen are those who require support. Residents are given bibs if they want them. In the interest of food hygiene I wear a green disposable apron and hair net which get disposed of at the end of the dining session. Residents who do not have teeth or dentures/difficulty in swallowing are given purred meals.  When the residents have finished eating they are transferred from the dining room to the day room, their bedroom or sitting room. All employees must enter the eating Lunch option in the Epicare system. We must enter in the residents who were down for our safety check.

The employees left are split into two groups of two as some Care Assistants finish at two o’ clock. The first group to take their break will do “doubles” this is essentially where they pair up to take the heavier immobile residents to the toilet and have their pads changed if required. While they are on their break the other group are “singles” these two people do the residents by themselves because they are manageable. The doubles will have to use the hoist with some residents’ and it is policy at Bishopscourt that the hoist can only be used if there are two employees present. The singles will have to decide amongst themselves who will continue to toilet the residents and who will give out the tea and biscuits to the residents. Communication is paramount for the singles group as they need to touch base often to ensure they do not duplicate bringing any resident to the toilet. The person giving out the teas will go to the kitchen and prepare the trolley with cups, saucers, spoons, beakers, milk, sugar biscuits (wheat free biscuits for one resident) and two large tea pots. They have to be aware of the residents with special dietary requirements i.e. the people with diabetes and or celiac. There is a list available in the kitchen giving details of the residents who cannot receive sugar/wheat and/or need a thickener added to liquids.

The doubles and singles will meet to decide which residents they will cover for the four o’clock safety check. These are divided using the room numbers as follows: 1-15, 16-30, 31-39, and 40-48. Once toileting has been completed this will have to be entered into the Epicare system.

At five o’ clock the residents are again, taken to the dining room where they are given their tea. The person who earlier gave out the tea and biscuits at three o’ clock goes to the kitchen to assist the nurse in giving out the plates of food. Once this task is completed this person will deliver the food to those residents who wish to eat in their rooms. They will assist these residents to eat if they require it.

Once the residents have eaten their tea, those that want to attend the Rosary will be taken to the day room and the others are taken to their room/sitting room or other day room in the Heather wing. We do six o’clock safety check and enter in what these people had for their tea. We also add in what these residents had to eat.

Two employees will go around to all of the bedrooms (take one wing each) and collect the water jugs and wash and refill them and return them to the rooms. One person will brush the dining room floor and put the washed table cloths back on the tables. The other will set up the tea trolley for the night staff just like the tea trolley which was prepared earlier in the day.

Two Care Assistants will go to the Residents who are immobile and turn them to prevent pressure sores. They will answer any bells and assist the Nurses if they are required to do so. They will help some of the residents to brush their teeth (these residents have requested this task to be preformed every evening). They will also change incontinence pads at the residents request and assist residents who wish to use the bathroom. If we get time we all put incontinence pads into the rooms which we have been designated to look after. I have been given the responsibility of ensuring rooms 21-23 have the correct incontinence wear, that their rooms are tidy.

Just before the end of the shift we have to do our final safety check again the same one which we did at four o’ clock.

Night shift 08.00pm-08.00am

There are two Care Assistants on at night. I go to the kitchen and add boiling water to the pre-prepared tea pots and bring the loaded trolley around to each wing first. I then go to the big Day room as the activity which was on will now be finished.

I go to the laundry room to prepare the trolley with more absorbent incontinent pads (purple colour maxi pads). It will also include the same laundry as before. I prepare a second trolley with the normal day pads and again, the laundry. This trolley will be used on the fuschia wing once all residents have been put to bed. These items will be used to change any pads or bedding during the night.

We start by getting the Residents most at risk from falls to bed first or as directed as the Nurses’ deem fit. Some residents are known to like going to bed by a certain time and these residents are also accommodated.

We change the resident’s pads’; take them to use the toilet. We change them into their pyjamas/nightdress take out their hearing aids (we open the hearing aid to preserve the battery and stop the ringing sound), glasses and dentures. We brush their teeth/dentures. We put them into their bed and ensure their bell is fully operational and is at easy reach. In some cases the bed rails are left down. This applies to only a few residents who are mobile and can go to the bathroom unaided.

At midnight we do our safety checks one of us does the Heather wing and the other does Fuschia. We continue getting the last residents into bed. These residents are entered into the Epicare System.  We put in that they are “settled to bed and appear to be sleeping”. Like during the day we enter in if we have laundered their clothes. We enter in if we have taken out their hearing aids/dentures or glasses. The only thing different to note is that residents, who are immobile, have which side they are lying on entered. Their position will be changed during the night to reduce the risk of developing pressure sores.

We go to the kitchen and complete the following duties: wash the delph which was used earlier. Wash down and disinfect all surfaces. Fill the gurney with water. Get the porridge prepared and soak in milk. Prepare the breakfast trolleys, with sugar (canderell for diabetics); we do not put marmalade on the diabetics’ trays. We provide beakers for those who require them and bowls of cereal for seven residents who do not like porridge and gluten free cornflakes for a resident who is wheat intolerant. I put the dirty tea towels and clothes in the washing machine. Meanwhile, I will answer any calls which occur on my designated wing. I will change any bedding and pads as required. I load the original trolley with the lighter absorbency incontinence pads. At 4 o’ clock we do the safety checks on both wings and then enter in our designated wing into the computer. I turn on the gurney and put the porridge on the heat. At half five we complete a safety check and enter this into the computer. We then split up I go to my designated wing along with a nurse and change any pads which need changing. We also move residents which need to be turned. We put the black rubbish bags with soiled pads, gloves and aprons into the big bin outside which has be designated for pads and is denoted with a large sign. This is critical for infection control.

We go to each wing and collect the jugs and glasses and bring them to the kitchen to be washed and to be replenished. At seven o’clock we go to the residents that require extra assistance with eating their breakfast. We answer any bells and put the meat on as per the instructions given by the chef. We help the day staff coming on in the morning to fill their trolley. We help the night nurse with any requests. I enter in the residents I fed to the Epicare system.

Conclusions

Upon reflection, I feel I am really lucky to have secured employment in a highly regarded Nursing Home. I also feel like I created opportunities for myself to advance within the Nursing Home to become a Safety Representative because I completed a Higher Diploma in Health and Safety in the Workplace. This will enhance the credentials’ on my Curriculum Vitae. My experience with the Cork Centre for Independent Living and the Irish Wheelchair Association helped me to skip the work experience element and go full throttle into paid employment. My career progression looks promising and my future looks bright.

Healthcare Assistant: Work Experience

Job description and qualifications:

A candidate for and any person holding the office must be of good character. Confidentiality is a key requirement.

The Care Assistant is responsible for assisting with the provision of individualised patient care while under the supervision, direction and guidance of a Registered Nurse and as part of a multi-disciplinary team.  The Care Assistant will ensure that he/she understands the core values of where he/she is placed.    

Duties

·         Assists patients/residents with hygiene needs at the bedside or in the bathroom;

·         Observe Skin condition and report any abnormalities to the nurse in charge;

·         Assists patients/residents with dressing and grooming in accordance with individual preference;

·         Assists patients/residents with the use of commodes, bedpans urinals and toilets;

·         Empties urine drainage bags and records urine and bowel output;

·         Assists in the promotion of continence;

·         Assists patients/residents at meal times and ensure patients/residents individual needs are met e.g. by collecting menus;

·         Assists with distribution and collection of meal trays;

·         Assists with preparation and serving of light snacks and nutritious drinks;

·         Helps to ensure that individual dietary needs are adhered to;

·         Assists with lifting, turning, moving and re-positioning of patients/residents using appropriate equipment; (Manual handling and Patient Handling and Moving courses needs to be completed)

·         Assists patients/residents with walking and limb exercises;

·         Assists with safe transfer of patients/residents from bed to chair in accordance with Manual Handling Policy;

·         Assists with pressure sore prevention;

·         Assists with and accompanies patients/residents to other departments and/or Hospitals;

·         Assists patients/residents with achieving or maximising independence where applicable;

·         Helps promote interpersonal relationships with patients/residents, their families, peers and colleagues;

·         Helps to provide recreational and conversational support for patients/residents;

·         Ensures patient/resident confidentiality at all times;

Maintaining a Safe Environment:    

·         Make occupied and unoccupied beds;

·         Move and clean beds as required;

·         Read and sign applicable chapters in the Safety Statement;

Communication:

·         Reports any unusual occurrence to the manager/nurse in charge e.g. pain, distress;

·         Participates in internal rotation including day, evening, night-duty.

·         Performs any other appropriate duties appropriate to the post as may be assigned to him/her from time to time by the DON;

Health and Safety:

·         Be familiar with all policies, practices and procedures;

·         To adhere to the policies and procedures laid down in the Safety, Health and Welfare at Work Act, 2005;

·         To maintain a safe work environment in co-operation with the Management Team and with reference to the Safety, Health and Welfare at Work Act, 2005;

·         To work in a safe manner with due care and attention to safety of self and other authorised persons in the workplace;

·         To report immediately to the DON/Nurse any accidents or incidents involving patients/residents, staff or members of the public.

·         Attend to spillages immediately to reduce the risk of accidents/cross contamination;

·         To practice high standards of personal hygiene including the wearing of proper attire, grooming, etc;

Infection Control:

• Comply with the Infection Control Policy e.g. Hand washing, isolation room procedures, use of personal protective equipment (gloves, aprons, visors);
• Maintain a clean environment with due consideration to Health and Safety issues;
• Assist with the disposal of clinical waste as per hospital guidelines (yellow bins);
• Ensure that used linen is placed into correct laundry bags and securely tied;
• Assist in the maintenance of room cleanliness;

General:

·         To adhere to  policies at all times;

• To work under the direction of a qualified member of staff at all times;
• To report back to a qualified member of staff following attending resident’s care;
• To Act in such a manner as to safeguard the interests and well being of residents;

·         To perform such other duties appropriate to the post as may be assigned from time to time by the DON;

·         To ensure confidentiality in all matters of information obtained during the course of employment

Self Development:

·         To be aware of current developments and issues in health care by reading current literature and keeping abreast of new developments, attending ‘in-house’ seminars, lectures and courses when possible and as appropriate in consultation with the DON;

·         To assume responsibility for his/her own professional development and safe work practice;

·         To ensure a safe environment for himself/herself, colleagues and visitors;

Garda Clearance:

Arrangements have been introduced, on a national level, for the provision of Garda Clearance in respect of candidates for employment in areas of the Health Services, where it is envisaged that potential employees would have substantial access to children or vulnerable individuals.  Each candidate will be required to complete a Garda Clearance form.

Career opportunities:

In order to secure employment it is important to establish a profile on a job hunting website. Personally, I have chosen LinkedIn to highlight my particular skills set - 

http://www.linkedin.com/profile/edit?trk=hb_tab_pro_top

The following websites are an excellent resource as they specifically look for a Healthcare Assistants:

http://www.nurseoncall.ie/

http://www.cplhealthcare.com/

There are also positions advertised on Fas.ie, jobs.ie, to name but a few.

http://cork.gumtree.ie/f-Jobs-healthcare-nursing-W0QQCatIdZ8098 (personal advertisements can be created and posted on Gumtree)

Healthcare Assistants can gain employment in the following settings:

Day centres, community centres, hospitals, nursing homes, hospice, respite care services, mental health services and nursing agencies.

There are opportunities to progress to senior positions in the Health Care sector through your experience and further education or training which you may undertake in areas such as the Social Sciences, Nursing Studies, Occupational Therapy, Speech and Language Therapy, the list is endless.

Healthcare Assistant: A Planned Activity - Quiz

Planning and Design:

I assigned a time with the aid of the Activities Coordinator which would be suitable to hold the quiz. I put the notice of the quiz on the notice board and on the activity sheets, which informed the residents when the quiz would take place. The quiz needed to be planned out and designed. I looked at the resident’s life stories and work experiences’ to gauge their interests. Consequently, the questions were taken from reputable internet sites. The quiz was set at medium difficulty. I asked the Nurses’ on duty to identify suitable residents; this was also partly driven because the questions were guided by the resident’s cognitive ability. It was decided that the quiz would run from 3pm-4pm on Wednesday the 29^th of August.

At 2.20pm I set up the room for health and safety reasons to ensure the floor was clear and I ensured the microphone was working. I put two lines of chairs on either side of the room. At the centre of the room I placed a table to hold the quiz questions which had been printed off.

 At 2.30pm residents in their bedrooms were invited to participate. This was to allow them time to get to the day room. It also allowed me to assist those who have limited mobility. I was located at the centre of the room so that I was able to fully interact with the residents and be able to have full view of the room for the duration of the quiz and also due to the fact that they are adult participants.

Running the Quiz:

At 3pm I comprehensively informed residents of the rules. I told them that the quiz contains verses of songs which test their memory to see if they can identify the era in which the songs came from. The group which guesses the song and sings it gets allocated two points. By including songs, the quiz became more engaging.  The first half of the quiz contained twenty questions. The second half of the quiz contained thirty questions. The left hand side was designated group A and the right hand side, group B. There was a break for refreshments/toilet for fifteen minutes between 3.20pm-3.35pm. I will use this time to tally the scores and inform the participants which group is in the lead. I ensured everyone was settled in their seats before recommencing.

The quiz stopped promptly at 3.55pm I gave myself five minutes to add up the scores. Whilst I added up the scores I ensured the radio was turned on.  I give a brief presentation and I announced the winning group.

 Analysis of Quiz:

I asked the residents for verbal feedback. The quiz ran very well and the participants were entered into the Epicare system. It was well organised and methodical though out. The break in the middle of the quiz was essential to the smooth running of the quiz. It meant that there were minimal interruptions.

Modifications:

 If I were to do the quiz again I would give myself more time to set up the room. I would also organise a volunteer to assist me during the running of the quiz.

Healthcare Assistant: Depression

Table of Contents                                                                Page

1.0 Background and causation factors                                         03

2.0 Treatment

                   2.1 Anti-depressant medications

                   2.2 Cognitive Behavioural Therapy (CBT)

                   2.3 Counselling and problem solving techniques                               04

3.0 Other factors to consider

                   3.1 Healthy diet

                   3.2 Exercise regularly

                   3.3 Mentally active

                   3.4 Express your feelings to others

                   3.5 Think positive thoughts

4.0 Healthcare Assistant’s role                                                       05

5.0 Summary:

Depression

1.0 Background and causation factors:

Depression is a psychological condition that changes how you think and feel, and also affects social behaviour and sense of physical well-being. Depression does not distinguish between age and social background. Depression can manifest itself in the following ways, please be aware that many people who suffer depression may display variations of these side effects: dark moods and aggressive words, going through a difficult transition – moved into residential setting, stigma, not sleeping – insomnia, feeling anxious and sad, poor health combined with weight gain, loss of energy, uncontrollable crying, irritability.  Please note the above list is not exhaustive. It is important to bear in mind that depression is treatable.

2.0 Treatment:

Treatment often involves a combination of different therapies such as medications, psychological thraperies, social support, and self-help relaxation techniques. This combined approach treats the person as a whole, and marks the beginning of the journey back to wellness and a normal life. I will discuss a number of these treatments in detail.

2.1 Anti-depressant medications:

There are many different types of antidepressant medications, which appear to work in slightly different ways, but which all have the same aim – altering the levels of one or more of the chemicals in the brain that are thought to cause depression. Referrals to the following service are by the person’s General Practitioner (GP) such as Psychiatrist and Community Mental Health Nurse to name but a few.

2.2 Cognitive Behavioural Therapy (CBT):

Seeking advice and support from a Psychologist could result in using CBT which involves teaching the person with depression how to recognise their negative thoughts and beliefs and replace them with constructive positive ways of thinking.

2.3 Counselling and problem solving techniques:

Psychotherapy – also known as talking therapy can assist a person with depression learning new coping skills and approaches to problem-solving during counselling sessions can be valuable for someone affected by depression.

3.0 Other factors to consider:

3.1 Healthy diet:

Eating a healthy diet with the correct balance of the various food groups is important for good mental health. Avoid excessive amounts of fats, red meats, sugar, salts and alcohol. The food pyramid should be used as a guide.

3.2 Exercise regularly:

Exercise helps to release endorphins which aid in eliminating stress, relaxes the body and helps promote healthy sleeping patterns

3.3 Mentally active:

Due to the complexity of the human mind it is vital to be mentally active so that the person with depression takes their negative thoughts and refocuses them on a productive activity such as volunteering. An activity such as this helps a person who may be isolated to meet new people thereby enhancing their quality of life simply by the virtue of helping others.

3.4 Express your feelings to others:

It goes without saying that bottling up your emotions and feelings is very harmful to everybody’s mental health. Confide in a friend or someone you feel comfortable talking over your problems with.

3.5 Think positive thoughts:

Remember that nobody is perfect and everybody makes mistakes. Learn to make the best of whatever the situation that you find yourself in at any given time. Strive to see the silver lining in every cloud and focus on that.

4.0 Healthcare Assistant’s role:

As a Healthcare Assistant, I provide a high level of person centred care to the residents in the Nursing Home and contribute to the provision of a comfortable yet stimulating environment. I attend to the needs of the residents while ensuring their well-being and safety. My particular experience ranges from low dependency (compos mentis) to high dependency residents who may suffer from the following  or a combination of health ailments: Parkinson’s, MS, Stroke, Alzheimer’s, Depression and Dementia.

I am sensitive to and respectful of the person’s culture, lifestyle and beliefs not to intrude inappropriately on a person’s privacy. I treat as confidential all information obtained in the cause of my work. Supporting someone who has depression can be difficult and challenging. For example, someone affected by depression may feel so worthless and trapped that they feel suicide is the only way to end their pain. This behaviour should never be ignored.  Where I feel I need additional assistance I will seek professional assistance from the Director of Nursing. I will endeavour to share information and ideas, therefore enhancing services within the Nursing Home.

5.0 Summary:

Advocating for positive changes in society is paramount to ensure people affected by depression receive appropriate treatment and are not ostracised from the community at large. The non-judgemental, person-centred approach, which is central to the way Healthcare Assistant work, is critical to every aspect of providing care. I will continue to strive for the highest possible standards in all aspects of my work. Depression often leads to social isolation and can make it difficult for those affected to keep up friendships. This is when it is most important to be a friend to lean on, and reinforce that treatment and support are available are recovery is possible. Partnerships and links between different healthcare providers are important as each can be a useful resource in terms of sharing information and also troubleshooting to ensure quality service for people with depression. The nuts and bolts of depression are to treat the person suffering from depression as an individual and assist them to maintain a sense of identity.

Healthcare Assistant: Managing Incontinence

Table of Contents                                                                                                             Pages

Overview                                                                                                                                03

     Stress Incontinence

     Urge Incontinence

     Overflow Incontinence

     Functional Incontinence

     Faecal Incontinence

My role as Healthcare Assistant is assisting a resident with their incontinence               04

Diet                                                                                                                                         05

Going out with Family members

Overview

Incontinence is the loss of control of bladder and/or bowel function. There are four different types of urine incontinence and they are as follows:

Stress Incontinence: Any movement that puts pressure on the bladder causes stress incontinence. In females, the pelvic walls that hold the bladder in place become weakened, so the bladder slips toward the vagina, weakening the sphincter. The sphincter is a muscle that holds the bladder closed. Laughing or sneezing can trigger your bladder if there is already a weakness. The pressure of an unborn baby also can cause stress incontinence when the uterus leans into the bladder from the weight of the baby. That pressure causes the bladder to leak or empty completely. In males, stress incontinence is caused when the prostate enlarges, thereby placing pressure on the urethra

Urge Incontinence: Patients who have urge incontinence usually have a neurogenic (nervous) bladder: Sphincter muscles become overactive, causing leaks or emptying. A neurogenic bladder is caused by anything from nervousness to a stroke, to Parkinson's disease, multiple sclerosis or a spinal cord injury

Overflow Incontinence: When someone is unable to completely empty the bladder because of a weakened sphincter, the bladder overfills, causing leaks. It's common to have both urge and overflow incontinence.

Functional Incontinence: The physical inability to get to the bathroom on time, either because of limited mobility or mental impairment causes functional incontinence. It is not caused by a dysfunction in the urinary tract.

Faecal incontinence: Faecal incontinence is the inability to control your bowel movements, causing stool (faeces) to leak unexpectedly from the rectum. Also called bowel incontinence, faecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Common causes of faecal incontinence include constipation, diarrhoea, and muscle or nerve damage. Faecal incontinence may be due to a weakened anal sphincter associated with aging or to damage to the nerves and muscles of the rectum and anus from giving birth

My role as Healthcare Assistant is assisting a resident with their incontinence

The resident I have chosen to study for this assignment suffers from Dementia. She has Urge Incontinence (nervous bladder) which may occur in people with dementia for many reasons. Our brains send messages to our bladder and bowel telling them when it is necessary to empty them. Being in control of these functions depends on an awareness of bodily sensations – such as the feeling of having a full bladder – and the memory of how, when and where to respond. When there is a decline of intellect and memory as a result of dementia, incontinence may occur.

The changes in a person’s brain that occur with dementia can interfere with a person’s ability to:

• Recognise the need to go to the toilet
• Be able to wait until it is appropriate to go to the toilet
• Find the toilet
• Recognise the toilet

The above is not yet applicable to the Resident I have chosen, however it is inevitable as the Dementia progresses that this confusion will ultimately effect her recognising the toilet.

Incontinence can be very distressing for the person with dementia. It helps if the carer remains calm, gentle, firm and patient. It is important that the carer tries to accept and get over their own embarrassment in having to help the person in such an intimate way.

During my time as a Healthcare Assistant I attended a lecture given by the Nurse who specialises in incontinence wear and is employed by the company who supply the pads. She assesses each Resident using the information given to her by the staff. As a direct result of this activity an incontinence wear prescription is attached to the inside of the wardrobe so that all staff is aware of what pads each resident needs during the day and night. When it comes to toileting her I always explain what I am going to do, and whilst carrying out the work. During the day she wears what’s known as a comfort pad during day. This pad has a small amount of absorbency because this particular resident is mobile and still knows how to use the bathroom facilities. She tends to be nightly diuretic, meaning she passes a lot of urine during the night and the end result is bed wetting. As a result, she uses a heavy duty pad at night and also because bed rail is up at night which is a feature of her individual care plan assigned to her by her primary Nurse. Infection control is paramount consequently; I wear disposable gloves and aprons which I change between residents. The resident’s pads are checked and changed if needs be at 6am every morning. The pads are checked using the indicator line on pad to show when it is fully used. There is gel on the pad which soaks up the urine and takes it away from the body, reducing infections and also so the skin remains intact. Skin care is very important. Wash the skin after an accident to keep it clean and dry, and to prevent rashes. Make sure the person’s skin does not come into contact with protective plastics as this will cause soreness. I record bowel and urine output on the Epicare System. If there is anything sinister such as blood in her urine or faeces I tell the Nurse on duty. It is important to respect privacy and dignity. Losing control can be humiliating and embarrassing, and I need to be sensitive to these feelings.

Diet

Diuretic foods and drinks: tea, cucumbers and wine should be limited to avoid dehydration. It may seem counterintuitive to advise someone with urinary incontinence to drink more, but being dehydrated can make urine more concentrated and irritating to the bladder.

Going out with family members

Even if the person is wearing an incontinent pad, their clothing may still get wet. If the family is planning on venturing out in public with her who is I make sure that they bring a change of clothes for her often just a fresh pair of pants and underwear will suffice.