Post No29...What type of care needs are considered nursing care?

Introduction

When they are seeking a care placement, families are often left unsure what constitutes nursing care, although they may have been advised to look for nursing care by a Social Worker or by a hospital.

Nursing care is subjective and will vary from one care provider to another, but it is often either a selection of higher needs, or one particular need that a nurse has to monitor.

This post is going to look at some examples that care homes may view as a nursing, either as a collective, or as an individual nursing need.

Restricted Mobility

Restricted mobility, or no mobility, is one of the main reasons a person is assessed as requiring nursing care. The reason for this is actually not so much to do with a nurse, but more the care assistant to resident ratios, which are higher in nursing homes. If a person requires hoisting, this can take time and often two members of staff, so the home must have more care assistants to ensure other residents are also being attended to.

Full support with personal care (and restricted mobility)

If a person has limited mobility, they may also require full assistance with personal care. This can include washing, dressing, eating, drinking, and oral health care. In many cases, this can be achieved with the assistance of one care assistant, but will take longer than someone who is more independent.

In other cases, it may take two care assistants to provide personal care, which again requires more staff to ensure the rest of the floor is managed safely.

The combination of restricted mobility and full support with personal care is a good example of a collection of needs being the reason nursing care is required.

Pressure areas, leg ulcers and sores (nurse only)

Pressure areas and leg ulcers are often considered a nursing need, although they can be managed in a residential only home via the support of the community nurse team. However, in a nursing home the nurse will be able to manage in house, and will also be available in the evenings, weekends, and overnight, which the community team will not be.

Pressure areas and leg ulcers are an example of a care need that a nurse must do, and are seldom dressed by care assistants.

If a person has pressure areas they will likely need an air flow mattress, and will certainly need one if their mobility is restricted and they spend a lot of time in bed.

Pressure areas also need to be monitored, to check for signs of improvement or of infection, which again makes them, in themselves, a nursing need.

Insulin dependent diabetes management (nurse only)

If a person has diabetes and requires an injection of insulin, this must be done by a nurse. Like pressure areas, this can be done in a residential home through the support of the community team, although this can be tricky if the person needs clinical support (due to their diabetes) at night when the community teams are off shift.

Other forms of diabetes management, such as diet controlled, may not be classed as a need that a nurse must attend, but by injection certainly is, and like pressure sores it is another example of an individual nursing need.

Eating, drinking and risk of choke

If a person requires assisted feed because they are on a modified diet, this could be deemed as a nursing need. Although this can be managed by the care team and not always a nurse, the home would need more staff to support this.

If a resident is a high risk of choke, or has a condition that prevents them from easily swallowing their food or fluid, having a qualified nurse onsite can help with the prevention but also the intervention if they were to start choking.

Although assistance with eating and drinking is not in itself a specific nursing need, risk of choke can certainly tip someone into the nursing care category.

Cognitive concerns and dementia

In itself, dementia is not a nursing need, however if a person has some of the other care needs listed above, and also has dementia, then they maybe assessed as needing nursing dementia care. This means that the primary care needs are both physical nursing needs, and dementia needs.

If a person has dementia but no other nursing needs, they will be assessed as requiring residential dementia care. However, if the person has a bad fall which leads to time in hospital, restricted mobility and increased confusion, then the physical change in their care needs might tip them into nursing.

Conclusion

Although the term nursing suggests a nurse must be involved in the care provision, sometimes it is the collection of higher care needs that makes a person nursing. In these cases, having more care assistants who help support the nurse is important in the daily management of the care needs.

If the need can only be attended to by a nurse, such as an insulin injection, then this can be managed either via the community nurse team or by a nurse employed by a nursing home. However, community teams mostly work day shifts, so it is worth considering a care home with nursing to benefit from the 24-hour clinical support.

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