I joined Rand Aid Association as the Nursing Services Manager for the Ron Smith Care Centre on 01st February 2012.
We have 6 Wings all with individual rooms and extremely long passages. We can accommodate 160 residents in the care centre.
In 2012 our bathrooms were fashioned on boarding school showers with 3 cubicles in 1 room and rooms with rows of toilets like in shopping malls. All walls were beige and unappealing and lounges uninspiring places which residents seldom used. Furniture was also against walls or in rows for ease of care.
Our nursing care was based on hospital routines, whereby all residents had to be bathed, showered and dressed as early as possible. Meal times were set with a very early supper and residents being put to bed early. Although we had Occupational therapy this was programme based and not according to individual interests. OT and nursing also functioned as two separate departments with little cooperation across the silos. The Professional Nurses spent many hours doing medication which limited their time spent with our Residents. Although nursing care was good, there was little personal interaction between residents and staff. We often referred to the home as ‘like running a hospice, keeping residents comfortable until they die’.
Following our then OT in July 2012, I attended the three day Eden Associate training with one of our Charge Sisters. We were very fortunate to be given this opportunity to attend the training and to start implementation of the Eden Alternative philosophy at the Ron Smith Care Centre. Our journey has been exciting with many ups and downs but the benefit to our residents and staff has been amazing. We will never go back to the old ways.
To date, the following changes have been implemented:
- We developed an education plan and this includes the need for all enrolled nurses and staff nurses to be Eden Associates in order to lead the team in their area of work.
- We have introduced the Blister packing of medication which is time saving and allowing staff to spend more time with residents.
- Cleaning and nursing routines have been adjusted according to resident preferences. We have early risers and late sleepers who are all accommodated. Residents are welcome to come to breakfast in their dressing gowns or to have a breakfast in bed if they want it so. We have found that the day is long enough to get through all the tasks of cleaning, making beds, nursing and bathing – it is not necessary to have it all done before 8am. This allows more time with residents and less rushing – which helps with bathing too.
- The barriers between housekeeping, nursing and OT are being diffused, with more job sharing and nursing and housekeeping staff on the wings being included in OT activities on wings. We now see domestic staff and care workers engaging with residents in the lounges, playing music, doing hand massages, reading to residents, helping with puzzles. Our nursing staff are also encouraged to arrange surprise happenings for residents – such as ice cream cones over a weekend or a braai instead of the regular meal. These things don’t cost the earth and creates excitement for residents and staff alike.
- I work closely with the OT and together we ensure that residents are informed of activities and events and assisted by nursing staff to participate in their chosen activities. Although there is still an organised activity programme, residents can choose their favourites or just do their own thing, either in the wing or in the activity centre.
- Nursing and housekeeping staff are encouraged to engage with residents to get to know the residents better. The more they know of residents the more the resident becomes a person and not just a patient. This also encourages residents to get to know the staff and so relationships develop that are of value to both parties. Staff see the meaning of their work and residents value staff as people – they are also mothers, wives and have the same dreams and issues as everyone else. We observe warm relationships developing leading to loving care and less complaints and also less petty thieving.
- Nursing care has improved through the use of regular assessments and utilising the inputs of all staff in developing care plans for residents. The care workers share more observations and contribute more to the nursing care. They also know what residents like and dislike and work accordingly, leading to happier residents altogether.
- We were fortunate to be able to upgrade our regimental bathroom and toilet facilities which have created a more homely environment. Residents enjoy using these facilities and the new spaces make it easier for staff to shower residents safely. Both staff and residents look after these facilities and they retain their homely look.
- The lounges and passages have been painted with colourful paint – it does not cost much more to paint a colour than to paint beige! The staff are encouraged to put up photos of residents and themselves and other meaningful decorations, which create a warm and homely atmosphere. The result is that our home looks like a home, not an institution. The same applies to residents’ rooms, where residents are encouraged to bring their own furniture, pictures, chairs etc to create a home, not to feel they live in a hospital. This has not caused any problems with quality nursing care.
- We have accepted pets into the home. At first we were concerned about hygiene and falls. However these fears were unfounded. The cats find the residents who love cats and many residents frequent the areas where the ducks hang out and make trips to feed them. It has also created interest for visiting families and especially children.
We at the Ron Smith care centre all underwent personal changes to embrace a new way of doing old things. We feel that our working lives have improved as a result. We see the purpose in what we do, not just tasks to be done. We don’t feel despondent by the number of residents who inevitably pass away. We don’t feel we are working in a hospice anymore. We see our residents being involved, doing things they enjoy, learning new things, being happy and having a meaningful life. Our staff form friendships with residents and their families. When the residents pass on, we share our memories of them and celebrate their lives. We know who they were – not just a patient who died.
We have changed our Care Centre from an institution to a loving home where warmth is felt. The warmth enhances our nursing care.
Nursing Services Manager 10th August 2018