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About You
Jane Crowther is Senior Support Nurse at the Hartrigg Oak Care
Community in Yorkshire. She has worked extensively with MDS forms in order to
assess older people with a widely differing range of needs.
She spoke to us about her role and the way the assessment forms actively
help her in her work.
Can you tell me first of all about Hartrigg Oak, the care community where you work?
Hartrigg Oak is the first Continuing Care Community in the United Kingdom -
it’s been open for around 5 years. The community consists of a Care Centre in the
middle of the complex that takes over 40 nursing and residential older people.
In addition, around the Centre there are about 152 bungalows for residents who
are more independent. We’re located in a village but we’re also a 200 strong
community – with hairdressers, café, shops and a restaurant.
The idea behind communities like this was pioneered first in North America and then
taken up here by the Joseph Rountree Foundation. Now we’re seen as a pioneer in the
UK and have regular visitors to see how we were established and how the system works.
And what’s your role?
I’m Senior Support Nurse providing care to residents within the Care Centre
primarily, although we offer an advisory service to our residents in the bungalows.
It’s a management role – at times we are responsible for the whole community.
As well as all that, I’m MDS Nurse Specialist, in charge of the assessments as
older people join the community or as their needs change.
How does the assessment process work?
The form itself is 16 pages long. While that sounds like a lot, it’s so easy to use that
it becomes a way of getting to know someone, finding out about their needs and
gaining a deep understanding of their concerns.
It relies on a mixture of tick boxes and interviews, so you get the best of both worlds.
It reviews the clients’ needs thoroughly and objectively, then backs up the
information with the patient’s own input. That’s really important.
For someone with extensive needs, I put aside an hour for the interviews and by the end the
time, you have a full picture not just of someone’s needs but of who they are.
After I’ve done a thorough assessment, I find it forms a real bond.
But that’s only the beginning. A supporting software package automatically generates a Highlight
Sheet that flags up particular problems. That then forms the basis of the care plan.
At the same, the information can be analysed to help with the management of the centre.
From a nursing point of view, the great advantage of these MDS forms is that everyone’s care
needs are recorded on a single document. They’re flexible too: if someone is
independent, the form reflects that and you would have them fill out their personal
details and not much more. But as their needs change, you can go back and investigate
what level of care they might need.
So the forms are structured, yet flexible. But can you give an example of how
they work?
Well, as a nurse, I don’t always have access to a client’s doctor’s notes so the assessment
is my chance to find out about underlying health conditions. One patient came in was
diabetic – it was under control and they were treating themselves. Now, because they
were doing so well, they might have felt no need to mention it to me and I might not
have picked up on it. But because the assessment form asked the right question, it was
noted and is now on the record.
Finally, what tips do you have to help ensure that this kind of assessment stays
focused on the older person?
I’d like to stress that in the most general sense, giving older people the opportunity to
describe and enumerate their concerns is valuable in itself. I’ve found they enjoy it
and engage in the process. The form is rigorous but the fact that it provides places to
record personal feelings means that the interviewer stays focused and the client is
fully engaged.
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