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Profile: Live in nurse

NHS at breaking point, nursing shortages, bed blocking scandals - these are all too common news headlines. However with an increasing elderly population, funding shortfalls and hospital infections, many are now questioning how and where we nurse our elderly population.

Live-in nurses give round-the-clock one-to-one care and expert medical assistance, and ensure patients can be cared for in their own homes. This type of nursing provides a personalised care plan, integration with the medical team and the quality of life that comes from the patient staying where they want to be, in their own home.

The many physical benefits include personalising care that takes into account the client's needs, preferences and choices. Being fully qualified nurses, they are also able to administer medication and conduct nursing procedures as required. They will work closely with a patient's GP, district nurse, physiotherapist, occupational therapist and any other healthcare professional involved in the on-going care to ensure the right nursing support, including post-operative, palliative and re-ablement care. This frees up the time of community nurses and GPs and offers continuity of care.

At an emotional level live-in nurses ensure their client's dignity and self-respect are maintained at all times. They also have the time and opportunity to support the family as they learn to cope throughout their relative's often progressing illness.  

The option of live-in nursing care is one preferred by many patients. A recent report1 revealed that despite most people aged over 75 years wanting to be cared for in their own homes, only 54% think this could be a reality and 23% said they didn't know what would happen to them in their old age. The Choice Gap report1 also revealed that just 3% surveyed said they would like to be cared for in a residential home. Catering for an elderly person's medical needs in their own home and providing vital support to cope at home, a live-in nurse allows individuals to regain a measure of control over their treatment. It also means their families can visit at any time of the day, and patients are able to stay in their community and benefit from the support of people who are familiar to them. This often means patients recover quicker and enjoy getting back into community life sooner.

Live-in nursing care has particular benefits in chronic, post-operative and palliative care. For people with chronic illness and those recovering from an operation, live-in nurses can be invaluable, allowing people to go home from hospital earlier, which in turn reduces pressure on hospital beds and allows patients to return home to a familiar environment with tailored one-to-one care. 

Many patients who have been in hospital for an operation would prefer to recover at home; a familiar environment has shown significant benefits to an individual's sense of wellbeing and improved rates of recuperation. However, a fear of being alone and having to wait for nurses and physiotherapists to visit can often cause anxiety about being able to cope. For some this situation is new to them, having been mobile and independent until perhaps a fall or sudden illness has resulted in temporary disablement.

Live-in nurses can assist with wound care, stoma care, medication, nutrition, personal care, promoting continence, mobility, physiotherapy exercises, procuring specialist equipment, rehabilitation, prevention of post-operative complications, promoting independence, reassurance and encouragement. 

In terms of palliative care, a National Audit Office report in November 2008 stated that given the choice, 78% of people would prefer to stay at home to die. With live-in nursing services, individuals can retain a sense of control over their last wishes which can mean those precious last few weeks and months can be spent among their family and loved ones.

Live-in nurses will integrate the social and psychological aspects of their client's care and liaise closely with other healthcare professionals to ensure the best support systems are put in place. They will also support the family as they learn to cope throughout their relative's illness and during the subsequent bereavement period.


Case study: Sigrun Hoppmann, live-in nurse at Consultus Care and Nursing

I got my first taste of the caring professions when, as a schoolgirl of 16. I joined the Red Cross and completed their first aid course. I then went on to help out at the local GP surgery, where I assisted their team by working as a receptionist over the weekends. This gave me a real sense of teamwork and also an understanding of people in need of medical care. There is a realness to people who are in pain or ill, and you feel compelled to help them.

During my final A Level-equivalent exams I was feeling the pressure and was worried that I hadn't done very well, but this training and experience gave me confidence and a sense that I could go into nursing should I want to. 

After leaving school I did my nursing training in Cape Town, South Africa, and the nursing department was part of the prestigious Groote Schuur hospital.

Once I graduated however, because I was a foreign student from Germany, I didn't have the option to start work straight away in South Africa because work visas were required. It was far too complex to apply from South Africa, so instead I came straight to the UK in 2000, and was given auxiliary work first. I then worked for a hospice in Hove, near Brighton. The team here were very kind and, once I hadproved myself and also had gone through all the correct procedures, they helped me gain my nursing registration.

While working for the hospice I trained as a helicopter pilot, and when I am off duty I like to fly. Just like nursing, I need to keep up my flying qualifications, and I partly do this with regular flights around the beautiful South Downs and South Coast areas.In addition to the hospice, I went on to find work through nursing agencies, giving me variety and flexibility in my experience across different departments and nursing skills including medical and surgical wards, A&E and orthopaedics.

Eighteen months ago I was introduced to Consultus Care and Nursing by a friend who already worked for them. It was pure curiosity that encouraged me to try this type of work, and I currently work for them as a live-in nurse.

Being a live-in nurse is very fulfilling, although it does come with challenges. It is the right fit for me though because I don't have a family and live with my friend in Hove on my weeks off. I know that I don't have an ordinary social life, and if someone is very integrated in their neighbourhood and environment, they might find it difficult.

I feel great pride in making such a difference to the lives of others, and get enormous job satisfaction from providing a high standard of one-to-one nursing care. The benefits of being a live-in nurse far outweigh the demands of this 24/7 role.

My work has had a real impact on the lady I care for. She suffered a stroke many years ago, and was experiencing recurring urinary tract infections (UTIs) which made her very ill. With our constant nursing care she has improved immensely to the extent where, whenever possible, she can now enjoy outings, and she absolutely lights up when her daughters come to visit. We have also worked to improve her speech and it's lovely to see how her life has become enriched.

Even though her speech is limited, because we spend a great deal of time together, I have learned to read and understand her facial expressions and body language, and I know what she wants and what she is thinking most of the time. If this lovely lady was in residential care, no-one would have the time to study her to such an extent. This consistency of care, because I look after her for two weeks at a time, also places me in an ideal position to adapt her care quickly, as I can pick up on when she is uncomfortable or has a particular need. A familiar routine, having the same cleaning lady and gardener, for example, also helps her by keeping her environment familiar and calm, I find. I am also most careful to keep give a detailed brief when I hand over to her other live-in nurse, to help ensure this consistency - as I tend to share her care with one other nurse, and we both do two weeks on, and then two weeks off.

I love this career and am still able to provide hospice care on my weeks off. It means that during my two week break, I'm able to continue to do something else in my life about which I'm passionate, as well as find time to see my friends. It's a busy but fulfilling life.