Face to face with community nursing

22 Feb 2017 Amyholgate

“It’s a bit of a disjointed day today,” says Elaine as she ushers me into the Integrated Community Healthcare office. Elaine explains that one of the team’s chronically unwell, long-term patients sadly passed away last week and a couple of the team are going to his funeral today.

Colleagues from the Community Therapy Service are also hoping to attend, as the two teams worked closely together to make sure Fred* could receive a holistic and integrated service in his home. It’s no surprise that our community healthcare teams build genuine relationships with their patients – especially with someone
like Fred,* whom they had known for two years.

I’m spending the day with a community healthcare team based at Amelia Nutt Clinic in south Bristol. The team is made up of community matrons and nurses, healthcare assistants and admin support, working with four GP practices, serving over 32,000 local patients.

Meeting the team

When I arrive, I’m shown around the office by Renuka and Elaine, part of the Community Matron Team. Together with their colleagues, associate community matrons Sarah and Kath, the team has a busy caseload for the day.

Before we leave the quiet early morning office, Renuka shows me the ‘t-card’ system, which manages the working day of the nursing team within the office. The system is a bright pattern of coloured card and dots, all indicating different types of nursing needs for patients and those with long-term conditions, or those in need of injections, syringe drivers, wound dressings or catheter changes.

Matrons on the move

After gathering a bag full of medical equipment and her notes, Renuka is quickly out of the door and 10 minutes later arrives at her first patient’s home. On the way, she explains her role as matron: offering holistic care for patients, many of whom are housebound and have long-term conditions like heart failure or chronic obstructive pulmonary disease (COPD). The ultimate goal, Renuka tells me, is to enable patients to manage and understand their health by working closely with them – hopefully reducing unnecessary hospital admissions in the process.

The first patient of the day is Joyce, who has COPD and lives with her husband, Mylo the dog and a collection of carp. Renuka is well-known here, and they start to talk about how Joyce is feeling and how she is managing her condition. As Renuka makes the necessary medical assessments, she offers advice on the ailments Joyce describes. Joyce sings the praises of Bristol Community Health’s pulmonary rehab exercise course, which helped her improve her overall health. She hopes to re-join the classes when her condition gets a little better.

Before leaving, Renuka makes sure the couple know what to do if Joyce’s condition worsens over the weekend. After a quick peek at the fish, we’re escorted out by Mylo and are back in the car.

Quick pitstop

The office is even quieter during mid-morning as all the nurses and matrons are out on visits. Renuka is attending the funeral with Kath, and I say goodbye.

Community matron Elaine takes me on another visit. It’s just a few minutes before we are with Sue and her husband. Sue has multiple health problems, including COPD, heart failure and a bowel condition. Elaine’s planned visit is to check she is managing her conditions well.

Elaine’s skills and expertise have helped prevent Sue from being admitted into hospital in the past. She reviews Sue’s medication and performs the necessary physical assessments. Sue is full of praise for the community matron service and the amazing job they do, and speaks of them with genuine affection.

Community nursing: on the road

Later on, I spend time with Sarah, who leads a team of 15 highly skilled nurses and healthcare assistants at Amelia Nutt. Together, they serve the community of housebound patients with complex nursing needs such as catheter management, wound care, and palliative care and support. The team provides a nursing support service from 8am until 8pm on weekdays, and 8.30am to 5pm on weekends and bank holidays.

Sarah is quick to point out how important her administrative support team, Lucy and Julie, are to their work. “We wouldn’t cope without them,” she says, and it soon becomes apparent why. The variety of tasks that they both manage is wide-ranging – from setting up all the paperwork for new patients to coordinating the ‘lone working’ mobile.

It isn’t long before Sarah leaves the office, paperwork in hand, to see her first patient. Maureen has leg ulcers and benefits from the expert compression therapy the community nurses perform to help her wounds heal.

Sarah gently assesses and monitors the wounds, taking photographs and carefully documenting them. Then the compression therapy is applied – a complicated but effective regime of bandages which Sarah performs with skill. The team also works with colleagues in the Wound Care Service, where there are dedicated wound care nurses, to ensure optimum healing.

It’s easy to see that the nursing assessments and needs performed
by Sarah and the other clinicians are vital. But what is perhaps most striking are the relationships Sarah, Renuka and Elaine have built up with their patients. It’s the essence of community healthcare.

While Maureen is talking about some tough things she has gone through, she holds Sarah’s hand for comfort. “I couldn’t wish for anyone better,” she says. “I can really talk to her.”

*Name has been changed

About our community nursing teams
Our dedicated community nursing teams provide healthcare and support to housebound patients in the home 24/7, 365 days a year. The teams work in partnership with local healthcare professionals to improve the health and independence of patients. Community nursing is our largest service, with 281 matrons, nurses and administrative staff based in teams around Bristol.

Find out more about community nursing here. Article written by Nadia Tavana.

Sara, community nurse
Sarah, a community nurse