2020 is the World Health Organisation (WHO) International Year of the Nurse. We want to celebrate our amazing nurses by publishing articles written by members of the nursing team, showcasing their great skills and diversity!
Integrating Nursing Care and Social Care to provide Holistic Care to Clients accessing the Blood Borne Virus Unit, Treatment Services Ushers Island
By Sebi Ugustin & Lorna Crea, Nurses
Clients admitted to Dublin Simon Community Blood Borne Virus Unit (BBVU) have a blood borne virus, addiction issues and other complex health needs. Homelessness, chaotic life style, extreme weather conditions and addiction can lead to multiple medical conditions (COPD, chest infection, seizure, injuries from fall/assault, unhealed /untreated wounds, high blood pressure, DVT, malnutrition, low BMI, dental problems) and mental health conditions, such as depression or anxiety disorders. Similarly, clients accessing the BBVU will have a range of social care needs: such as access to entitlements (medical card, social welfare, suitable accommodation). Clients may also require support to access services in their community (addiction support, GP care dental care) and/or support to integrate/reintegrate into the community. Working with the aim of addressing their needs holistically requires the multidisciplinary approach of Nursing and Social Care intervention, nurses work with clients to meet health needs while the Project worker and support staff work with clients to meet social care goals. Once a client referral is received, the Liaison Project Worker supports their access to the service by collaborating with their GP prescriber, methadone clinic and accommodation service. While also linking with the client to maintain their motivation to enter the unit.
The team in the BBV unit provide an integrated, systematic, client- centered, drug use reduction approach to client care.
On the day of admission, the nursing team and GP categorize and prioritise the medical care needs, formulate care plans, and review them as required. Many BBVU clients express a desire to reduce their drug use on admission. Nurses observe the client in the first 24-72 hours for signs and symptoms of withdrawal. This observation is supported by PW and Operational staff, who report changes in presentation/behaviour to the Nursing staff. Clients who use drugs like heroin/cocaine often experience intense cravings when admitted. Empathetic support and observation of behaviour by the full team help them engage with the stabilisation process. The PW and support staff with input from the nursing team run a Reduce the Use programme to support clients reduce their drug use. This includes weekly groups, drugs and cravings diaries, and ongoing one to one/group addiction support and relapse prevention.
Nursing staff also prioritise HIV and Hepatitis C/B stabilisation by facilitating initiation, engagement or re-engagement with Infectious Disease clinics like Guide at St James’s hospital/Mater. For many of our clients, adhering to BBV medication while in active addiction can be challenging. PW and support staff support clients to attend appointments. Often the simple act of attending a clinic appointment with a client can remove a huge amount of fear and anxiety that a client may have. Nursing staff confirm the dates for follow-ups with clients and, alongside the PW team, support and encourage them to attend these appointments. Nurses educate clients around their treatment and a plan is put in place by nursing staff and the PW to ensure that the client has systems in place on discharge to continue to take their Hep C medication, which might include DOTS (directly observed therapy) at their pharmacy. The Project worker will ensure that accommodation and addiction support is in place to make this plan more robust.
For many clients who inject drugs DVT (Deep Vain Thrombosis) is common, so symptoms are observed with lower limbs measurements tools. Nurses are trained and proficient in wound care: recognizing the type of wound and which dressing material is the most appropriate. Diet management and monitoring of clients nutritional status is a large part of Nursing care on the BBVU. The Project worker and support staff/ Full-time volunteers support the Nurses to monitor this by filling in diet charts and encouraging clients to make healthy choices when going to the canteen for lunch.
Clients accessing the BBVU can have varying mental health needs, such as depression, anxiety, schizophrenia, drug-related psychosis, and personality disorder. Working with a client experiencing mental ill health is a collaborative team effort in the BBVU; Nursing and Social care staff discuss changes to client presentation and behaviour and handovers and throughout shifts. When deterioration is noted, the multidisciplinary team work to support client safety and promote a safe, calming environment. The nursing staff provide medication as required and liaise with GPs and prescribers, while the Project Worker and support staff liaise with Sure Steps counselling services and carry out safety measures such as room swaps, increased Health and Safety checks and room checks, as required.
The Project Worker and support staff on the BBVU work with clients to move on to further addiction treatment as part of the community integration process. Further treatment options vary based on client wishes and desire for addiction treatment, ranging from day programmes to full residential treatment programmes. Clients are also encouraged by support staff and FTVs to attend social outings (anything from going for a coffee to a cinema or museum trip) during their stay on the BBVU, as part of their holistic, community integration care.
In preparation for discharge the project worker works with the client to seek or ensure appropriate accommodation for move on. This is usually client led; they may request accommodations that are more stable, either in terms of drug use, or duration of stay. In some cases, the PW will work with a client to transition to their own accommodation – which has been secured in conjunction with other agencies such as Housing First. At discharge, the nursing team send discharge letters to GPs, referrers, and methadone clinics to inform them of client progress, follow-on care needs and upcoming appointments. The Project Worker ensures external Key/Case workers are aware of any outstanding items or appointments that need to addressed.
By Sebi Ugustin & Lorna Crea, Nurses Ushers Island