A recently-qualified nurse who embarked on an ambitious programme to improve care in her nursing home is hoping it will earn her a prestigious Nursing Standard Nurse Award.

Shauna Rooney

Shauna Rooney. Picture credit: Harrison Photography

Shauna Rooney had only been in her first staff nurse job for four months when she decided to revolutionise infection control at Rush Hall Care Home in County Londonderry, Northern Ireland.

Her work has led to a 100% reduction in outbreaks of infection at the 66-bed Four Seasons Healthcare home for people with dementia in Limavady: from three in 2013 to zero in 2014.

She has been announced a finalist in the infection prevention and control category of the Nurse Awards. The winner will be announced on May 1 at the Savoy Hotel in London.

Shauna says: ‘Our residents were often unaware of potential risks because of their dementia. We have a duty to protect them from preventable infections and maintain a homely environment.’

The home relied on hospital staff for infection prevention and control training until Shauna became infection prevention and control link nurse.

‘The programme allowed me to develop my knowledge of healthcare acquired infections and see that prevention was key rather than control,’ she says.

‘There was no point me having knowledge and not sharing it - I wanted to use my knowledge to reduce infections by providing local expertise and support, to raise awareness at the home and encourage staff to improve their practice. And from a personal perspective I wanted to develop my leadership skills.’

To understand how to move forward, says Shauna, she had to understand what was happening at the home. So she began a programme of audits, starting with standard precautions such as handwashing and appropriate use of gloves, supported by clinical supervision with staff to find any gaps in knowledge.

She fed back her results to the home manager, who helped her develop an action plan. She began holding supervision sessions in small groups and worked alongside staff to support the training. ‘This meant I could address the practicalities and answer questions as they came up,’ says Shauna. ‘I could never have done this without being given supernumerary time by the home manager.'

Culture change

At first she felt limited in how she could challenge practices. ‘I thought I would look like a newly-qualified know-it-all,’ she says. ‘And it was difficult getting staff to attend training on days off. This was why supernumerary time was crucial. But as my skills increased, so did my confidence and soon I was able to take on resistant staff who preferred "the way they were shown".

She credits support from Four Seasons and her home manager. ‘I got it from the top. I also had the head housekeeper as my wing woman so it was not just me pointing the finger.'

The change required teamwork at every level, but initially the biggest problem was communication between care and domestic staff. ‘It was important to get everyone together - everybody had to collaborate,’ says Shauna.

By provided continuous feedback to the manager and staff and showing how things were improving through monthly audits, the culture and practice at the home moved its focus to infection prevention rather than control.

‘I wanted to show them there were results after they did the training and that it was not just about telling them off,’ Shauna explains.

Staff reported increased confidence and satisfaction as they saw the consistent improvement for their residents.

Shauna Rooney

Shauna Rooney at work. Picture credit: Harrison Photography

‘The most important thing was the positive effect on the residents’ wellbeing,’ says Shauna. ‘Reduced rates of infection meant fewer hospital admissions. Also, infections often led to residents being isolated in their bedrooms which meant they could not take part in activities, had less engagement with people and reduced cognitive stimulation which is so important for people with dementia.’

Infection prevention was raised at meetings with relatives and carers to explain its importance, especially handwashing. ‘They often take people to the toilet so it was important to help them understand how infections transmit and that they have to think of the other residents as well as themselves.’

She also drove a reduction in the use of catheters and antibiotic prescribing.

‘Before working at the home I had worked on a urology ward. At the home I saw a lot of urinary tract and catheter infections, gloves not being washed and a lack of aseptic technique.

‘When a new resident arrives from hospital catheterised, I ring the doctor to find out why. Often it is because of urinary retention and there has been no trial removal and so we do that. Catheters are often the root cause of infection so we challenge their use when we suspect it is unnecessary.

She also looked at the use of prophylactic antibiotics at the home. ‘Four or five of our residents were taking them for 18 months and nobody was reviewing this so I have been challenging their GPs,’ she says. ‘I’m not very popular with them.’

Tremendous impact

Nurse Jane Bell, who manages the care home, says the team is proud that Shauna has made the final of the awards.

‘Her work has had a tremendous impact on our residents as it continues to ensure no-one suffers from an infection that can be prevented,’ she adds. ‘By imparting knowledge to her colleagues on a daily basis Shauna continues to help enhance the quality of vulnerable people’s lives.

‘She has also proved that the care home sector provides quality life enhancing care. Its nurses often feel undervalued so we are delighted that this nomination recognises their quality.’

The judges praised her bravery in launching such an ambitious programme in such a challenging environment just months after she had qualified, and were impressed at her skill at implementing it. North Hampshire clinical Commissioning Group chief nurse Jan Baptiste Grant says: ‘Shauna embodies courage, commitment and care - the very essence of what we want to see in nursing’.

She adds: 'I am overwhelmed by her courage just four months into her career and her ability to utilise her leadership skills to get nurses and domestic staff to follow her to such great effect.’

Gary Cousins, Four Seasons infection control and clinical development nurse for Northern Ireland, Wales and the Isle of Man, is currently creating a plan to roll out Shauna’s programme. He says: ‘I don’t think there are many nurses who could achieve what Shauna has done at such an early stage of her career.’

As well as maintaining the high standards the team has achieved at Rush Hall, Shauna wants to be part of the roll out and visit other homes to showcase her work. ‘I want other nurses see the positive results,’ she says.

‘I also want to pursue further education around infection prevention and control. It is lacking in care homes and there is work to do.

‘People forget that elderly people are so vulnerable, especially those with dementia, and infection has a really negative effect on them. Making their lives better is my motivation.’

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