Clare Cable, Chief Exec and Nurse Director of the Queen’s Nursing Institute Scotland shadows Community Staff Nurse Karen Macleod on the Isle of Lewis.
Karen knew she wanted to be a nurse when she was 14; at that age I wanted to join the BBC as an engineer and be on the technical side of broadcasting! But it was not until after Karen had married and had children that the timing was right for her to fulfil her dream, as it became possible for her to train in the Western Isles without having to move to the mainland. The one year job guarantee enabled her to gain post-registration experience in the community before a permanent position came up with the Westside District Nursing Team. So, like so many of us, Karen is a working parent of three teenagers, whose morning starts long before arriving at work, making sure the needs of the family are sorted before she steps out to meet the needs of those she cares for professionally.
Karen and I have met before as she is an activist, keen to get involved in developing practice and was part of a team working on a Delivering Dignity project through QNIS to explore how best to support people with sensory impairment.
It’s 8 am and Karen meets me in the car park of the Western Isles Hospital in Stornoway. It’s Karen’s first morning back from holiday and the last thing she needs is a visitor, but she greets me cheerily and briefs me on what the day has in store. She has already been in touch with colleagues last night by mobile phone to take a handover and check out what her priorities are. She tells me that one of her staff nurse colleagues is calling in on her usual early morning visit (unsurprisingly, a gentleman who needs insulin) and that we are going to the health centre, which is her base, to log on to the system and check the team diary and messages from the out of hours team.
Karen’s particular concern is for David’s family. David was diagnosed with cancer last year and, following surgery, has deteriorated rapidly and is now being cared for at home at the end of his life. He had become more uncomfortable whilst being moved and handled over the weekend, this was dealt with and passed on by the nurse on duty. Karen nips through to see the duty GP to ask her view on increasing the dose of morphine in David’s syringe driver and comes back to phone his daughter. She is kind and supportive on the phone, asks about how things have been over the weekend, and agrees that she will come straight over. We are at the house within ten minutes. It feels a real privilege to be welcomed in and the family are quick to tell me how much they value the care and expertise given by the team. Karen washes her hands and makes a careful assessment of David’s condition.
He looks very peaceful and comfortable; he is breathing deeply and after talking to David’s wife and daughter, Karen suggests that she gives David a sub-cutaneous injection of diamorphine to see him through his wash and turn. She says she will return in two hours when the syringe driver needs changing and they can talk about how things have gone with his care this morning. Her manner is gentle, professional and caring. Karen gives the injection, talking to David all the while, then records her actions and conversations with the family in the nursing record kept in the home.
Karen uses a digital pen, which uploads what she has written via her mobile phone to the nursing record held on the central system, so that all Karen’s healthcare colleagues have real time updates on David’s care and condition.
We return to the office to catch up with the rest of the team. Karen’s health care support worker colleague is there and the two staff review the diary and requests for visits together. Karen allocates the visits, being clear about what is required by each person.
Karen was keen to touch base with the other staff nurse working with the team, but she has been waylaid at the home of a gentleman with palliative needs, who was requiring significant support with personal care. This illustrates well the dilemmas faced by the service. Nurses do not walk away from those who require help and support yet, strictly speaking, this support should be being provided by social care staff, but in this instance there were none available. At this stage the team will endeavour to meet these needs to ensure the patient remains at home as the family wish.
Karen’s colleague arrives and so they plan their day together. Karen’s colleague worked part-time in the hospice on the island and was able to reflect with Karen on the care issues faced by David, who we had seen earlier. David had a pressure area on his ear and the two nurses discussed how best to prevent further damage.
So we were back in the car and off to see Mark. Mark is in his thirties and lives with MS. He co-ordinates his care needs with self-directed support and Karen was going to help him with regular bowel care. He greets Karen like a friend, they catch up on how he’s been since they last met. Things are going well for Mark, he had found it difficult to find carers he could relate to, but now he has the kind of care he has been looking for through self-directed support. They head off to the bathroom and keep up a cheery conversation as Karen helps Mark with the bits of the process he cannot manage himself.
Karen updates Mark’s notes using the digital pen, we bid our goodbyes and step back out into the winds and the rain which is all too familiar weather in this part of Scotland!
Karen and I made two more visits significant distances apart. One of the challenges of home nursing in a rural area is ensuring that travel time is factored in to the day. Karen’s boot is well stocked with equipment as nipping back to the office is not an option when you’re 15 miles away. Karen tells me that despite their rurality, there is an excellent system for getting care equipment to people’s homes in a timely way. The team deliver to each area of the island weekly, but if a bed or a hoist is needed urgently, someone will normally come within a day.
Karen exemplifies a compassionate and competent community staff nurse. As a registered nurse working in the community; she assesses, delivers and evaluates care with kindness and skill, supported by the wider DN team, the local GPs and allied health professionals. At some point, she hopes to have an opportunity to do her DN training. Enabling staff nurses to undertake further training and develop into the District Nursing team leader role is a particular challenge in remote and rural health board areas.
Karen was really interested to hear about the work which QNIS is undertaking with our sister organisation the Queen’s Nursing Institute on District Nursing Standards for Practice and Education [hyperlink]. This is a hot topic across Scotland and one which the planned Scottish Government work reviewing the DN role will help address.
I am very grateful to Karen for sharing her morning, and to the people we visited for their hospitality. Queen’s Nursing Institute Scotland wishes Karen and the team the very best as they continue to provide high quality care to the people of the Westside of Lewis.