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.
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