My job

COVID-19: ‘Infection prevention and control is as vital in care homes as it is in the NHS’

Lindsay Dingwall on the challenges and opportunities of caring for some of society's most vulnerable people

Lindsay Dingwall

What is your job?

I am the clinical care quality manager for Balhousie Care Group, supporting staff and managers across its 26 care homes in Scotland. I provide assurance relating to care governance, advising on and contributing to the delivery of evidence-based care that is safe, effective and individualised to each of our residents.

Why did you become a nurse?

I started a BSc course in 1976 that had a hard science and computer programming basis and found it difficult to imagine what I would do as a career that would excite me. I wanted to work with people and so I pursued nursing. No one among my family or friends was a nurse and I had no idea what to expect.

How can nurses in social care respond to the COVID-19 outbreak? What are the most significant challenges for the sector? What are the opportunities? 

Nurses in social care are already looking after the most vulnerable people in our society who are living with multiple, complex long-term conditions. Because of this, infection prevention and control is as vital in care homes as it is in the NHS.

Similar to the NHS, non-essential visiting has stopped and some people displaying symptoms are being cared for in isolation.

'The unique therapeutic relationships that nurses working in social care can develop will bring comfort in these most trying of times'

The challenges in care homes are linked to the physical consequences of inactivity and the mental health consequences of isolation. Care staff are finding novel ways of keeping residents active in a confined space to reduce falls, delirium and respiratory infections. They also need to keep residents connected with the outside world. Balhousie Care Group, for example, has issued two additional iPads to each of its 26 homes, and is also using traditional means – the telephone, letter writing, pen pal groups – to ensure that communication with families and communities is maintained.

Possibly the biggest challenge for care home staff, again like the NHS, is that sadly some carers and care home managers will have to have difficult conversations with families if their loved one is ill and deteriorating, and reassure them that they are receiving the best care possible. More than ever, the unique therapeutic relationships that nurses working in social care can develop will bring comfort in these most trying of times.

What or who inspires you, and why?

The heroes who provide nursing care every day, not for glory or recognition but because it’s what they do. My friend has worked in acute medicine for 20 years. He treats everyone, irrespective of life choice or health condition, with respect, humour and compassion. He often runs on empty but is always present in body and spirit. It is nurses like him – who are found everywhere – who make me feel humble.

Outside work, what do you enjoy doing?

I read a lot and have just discovered yoga and wish I had begun 20 years ago. I love the smaller music festivals found across Scotland, especially on the islands like Mull and Tiree.

What advice would you give a newly qualified older person’s nurse?

Be prepared to be a specialist and a generalist. The ageing process means that older people have a different physiology to those aged under 65: their organs have reduced capacity to respond to stressors like heat, cold, infections and trauma. The specialty of nursing older people recognises that what may be a minor health event for younger people can be catastrophic for older people. Much of a nurse’s work in the specialty focuses on maintaining their homeostasis while treating and managing their existing health conditions. Although it is incorrect to associate older age with ill health, older people are more likely to be living with multiple, long-term conditions and older people’s nurses need a broad general knowledge base to be able to respond and to promote optimum physical, mental and social health and well-being.

At this exceptional time in health and social care, newly qualified older people’s nurses may finally get the recognition all older people’s nurses deserve. Historically, nursing older people was seen as ‘basic care’ and lacked the kudos of more technically focused clinical specialties. Over the past decade, however, frailty syndrome and dementia have become prevalent. Integrating health and social care designed for older people to live at home or in a homely environment increasingly requires nurses with specialist knowledge.

Nursing older people provides opportunities for career development across all sectors, primary or secondary care and in the private sector. Any newly qualified nurse caring for older people should be prepared for a rapid learning curve and to never stop learning.

@LindsayD_BCG

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