Edna at the Palace! - Unique - The Rare Chromosome Disorder ...

A day in the life of…
A Residential Respite Service
I have known sick children’s nurse Geraldine Sharpe since Jenny was a baby. Geraldine is manager of
Mulberry House, where Jen spent many happy times for short breaks until she was 18. Bev
Geraldine writes:
My background is as a Sick Children’s Nurse but
I have been working outside the acute sector
for over 20 years now. I work at The Children’s
Trust at Tadworth Court and have had various
titles to my job description over the years but, in
effect, my role is to lead a team of nurses and
carers in one of the residential houses –
Mulberry House.
It is a purpose-built, one storey house
accommodating up to 8 children at a time in
one of four single or two double bedrooms.
Most of the children are aged up to 12 years
with profound and multiple learning disabilities
and/or complex health care needs. Up to five
of the beds are allocated for children coming
for residential short breaks, more commonly
referred to as “respite care”. Other houses on
site can also offer the same service for 1–3
children or young people (one house
particularly for older youngsters) but in
Mulberry House it is the primary service and
up to 30 families are supported in this way.
Children are referred for assessment by
parents/social worker/health care professionals.
This assessment is to establish whether the
child’s needs can be met – not only their
health/physical needs but also their social and
emotional needs. In offering short breaks the
hope is that a child will have a healthy, safe,
happy experience, accessing a new environment
and experiences and gaining an increased sense
of independence. At the same time families get
a break to recharge their batteries or to just
have a change of routine themselves.
I work shifts to help cover the 24/7 service with
internal rotation to night duty. Because of the
way the shift system works I do not have a
typical day – In one week I may work an early
shift starting at 07.00 and finishing at 14.50, a
late shift starting at 13.10 and finishing at 21.00
or a night shift starting at 20.30 and finishing
at 07.30. It includes working weekends (usually
alternate) when there are more children coming
to stay in the house. It may seem a tough
working pattern but the great thing is getting
to know children through the 24 hour period.
I do work some “office days” to catch up with
paperwork but the days/nights when I am
involved in direct care are more challenging
and rewarding for me.
All of the shifts start with a handover between
staff including checking that all medicines, feeds,
programmes and so on are “up-to-date”. If I am
leading the shift I will allocate children to staff
(including myself), linking the staff with the skills
and personality to meet the needs of one or
two children. Each child has a care plan which
details all their needs and how to meet them.
Three of the Mulberry Team.
This is based on information gathered from
parents/foster carers and other professionals at
the initial assessment and then updated at the
beginning of each child’s stay. Some children
need one nurse or carer supervising them all
the time – for example some children have
a tracheostomy (artificial airway) or are
dependent on oxygen or have intensive
medicine regime whilst others may need more
than one person to safely move them and
others a particular “nursing” procedure/s that
needs to be carried out in a set timeframe.
Coming out of handover all the children are
checked and greeted if they are awake. Personal
care, mealtimes, gastrostomy feeding and
medicines punctuate the day – a child’s usual
home routine is followed as much as possible
to provide some continuity with home life. Most
of the children need hoisting in and out of
equipment so the getting up routines can take
1–2 hours. Children unable to move themselves
also need to have their position changed during
the day and night using standing frames or a
wedge/comfy chair. As nurses and carers we
get our breaks to fit in with the children (20
minutes on the day shifts and an hour on the
night shift) and take them in the house.
On Monday to Friday in term time some
children will continue to access their own
school. Making sure that a child is ready for the
transport is part of meeting their needs. For
children who are staying on site (children whose
schools are too far for them to travel to or who
are not able to tolerate the journey) access to
the Surrey County School Teaching Service on
site is possible for an hour in the morning and
about an hour and a half in the afternoon in the
New Cheyne Centre on site – its just down a
short path from Mulberry House and the staff
take the children over and ensure that they are
supported in the class.
The period between the late staff arriving and
the early staff leaving is known as the “overlap”.
This time is used for staff supervision and
training, assessments, report writing, meetings
and reviews. A lot of the liaison work takes
place in the afternoons as well as following
up health and safety checks or maintenance
requirements or other orders. In the afternoons
meeting and greeting parents/carers bringing
or collecting children also happens. If a child is
going home he/she will leave the house by
14.00 so all their clothing and equipment is
ready by then (the night staff do the bulk of
the packing). New children arrive after 15.00
(rooms quickly cleaned and prepared!). A
number of children may have had hospital stays,
changes in feed or medicine regimes or changes
in their daily routines since their previous stay.
Outside the school hours and also at weekends
during the day there a lot of different activities
that the children can be supported by nurses
and carers to access in between meeting their
personal care needs, nutritional needs, medicines
and so on. A play specialist works in the house
with the nurses and carers to plan 1:1 and
group playtimes, reading stories, listening to
music, playing games, watching TV/DVDs,
cooking, coordinating parties or outings in the
holidays. The children can also go into a shared
multi-sensory room, a soft play room or go for
walks around the site maybe incorporating a
scavenger hunt and creating some art work
from the items collected. Fulham Football Club
come each Tuesday evening as part of their
Community commitment whilst hydrotherapy
can be available for children who come for a
short stay and are remaining on site on a Friday
morning in our pool – a new one is due to
open in April in the new Rehabilitation Centre
which will be even better resourced to offer a
multi-sensory experience for the children.
The night shift is very different from the day…
Keeping a child comfortable, sleeping well,
changing their position, giving overnight feeds
and medicines as well as ordering, stocking up,
packing for children going home the next day,
as well as cleaning wheelchairs and equipment
is all part of the night time routine.
Amidst all the caring for the children the
nurses and carers also have a huge amount of
communication going on to keep our house
ticking over and meeting statutory requirements.
We are particularly supported by our
administrative assistant who works 4 days a
week and filters a lot of the phone calls that
we get.
Overall I have a very varied role working with
children and families. The most rewarding part
is caring for the children and knowing that their
stays can enhance their quality of life and that
of their families. At the same time it is a team
effort and my “day in the life” hopefully reflects
that.
For more information on The Children’s Trust,
please see www.thechildrenstrust.org.uk.
www.rarechromo.org
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