My Journey Qualified as an Enrolled Nurse Birmingham England ENB 153 Neurological and Neurosurgical Nursing Moved to London and worked at Northwick Park Hospital when a new rehabilitation Unit opened in 1993 ID: 1044040
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1. CNS NeurorehabilitationBurwood Hospital
2. My JourneyQualified as an Enrolled Nurse Birmingham EnglandENB 153 Neurological and Neurosurgical NursingMoved to London and worked at Northwick Park Hospital when a new rehabilitation Unit opened in 1993Transitioned to Registered NursePost grad Diploma in Health Services ManagementMoved to New Zealand November 2007 – Burwood HospitalMay 2008 Became CNS Brain Injury Rehab ServiceCompleted Post graduate Diploma In RehabilitationFeb 2018 CNS Neuro Rehabilitation
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8. Ward CG14 Beds – 13 Rehabilitation 1 RespitePatients aged 16 – 6570% StrokeSubarachnoid HaemorrhageRemoval/Debulking TumoursEncephalitisNeurological conditionsDeconditionedTraumatic Brain InjurySpinal
9. Interdisciplinary TeamNursesMedicalPhysiotherapistsOccupational therapists – outpatient VOC, Driving assessmentsSpeech and Language TherapistDietitianClinical PsychologistSocial WorkerRanga HaouraMusic Therapist – Trial in 2018Pharmacist
10. Length of Stay Calculated by FIM score Use the AROC calculator for LOS
11. My RoleStart at 06.45 – Can liaise with night staff re any concernsAssist morning staff to practice sitting balance with patients prior to hoisting, walking patients to breakfast club etc. Medications – assisting nurses, Attend board roundWorking with individual patients / family – discussing concerns they may have with their health or rehabilitation.Support for the team – reflecting on approaches suggesting alternatives.Working with the nurses to support patients achieving goals, discharge planning.Attending family meetings and IDT meeting
12. Bladder BundleCompleting AROC Data formsOrganising education for nurses and the Interdisciplinary team.Outreach home visits / phone callsProviding education to Nursing students on the Role of the Rehabilitation Nurse.Member of the CG Quality team
13. February 2018CNS NeurorehabilitationCG/DG and other Burwood Rehabilitation Wards
14. Case Study40 year old femaleLives with partner and their 8 year old son in ChristchurchMother sister and other family members live in InvercargillEmployed
15. Admission to CPH27/08/18 Presented following 30 minute history of headache left side weakness and inattention complaining of neck painBP 188/88, Temp 36, RR 18, hr 62, 96%RACT scan on admission :Right Basal ganglia haemorrhage with extensive intraventricular haemorrhageVentricular dilatation in keeping with hydrocephalusNo cause for haemorrhage evident on CTA
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17. Past medical HistoryMigrainesRight Ovarian dermoid cyst removed 2011Menorrhagia
18. ICU and Ward 28Admitted to ICUStarted on vasopressors for hypotension then became hypertensive started on labetalol and hydralazineTaken to surgery for urgent EVD placement on 27/08/18 – difficult placement, large bore EVD placed draining blood stained CSF.EVD blocking due to blood clots – 3 further EVD’s inserted on 7/9/18, 9/9/18 and 1/10/18.Started on Kepra for seizure prophylaxisEVD removedProgress fluctuated for a significant period – 2 months
19. October 2018Mobilising with assistanceSpeech improved now able to read sentences from magazinesUTI treated with ecoliVentriculitis – long term fluclox via PICCEcho when investigating fevers – no endocarditis?Bleeding disorder- Referred to haematology due to spontaneous basal ganglia bleed with ongoing bleeding from EVDsDischarge to BIRS
20. BIRS (Ward CG)Reviewed on Ward 28 by rehabilitation specialist.Ready for rehabilitation 25/10/18Doubly incontinentDisorientated to age, month, time of day, day of the week, yearMemory issues Supervision at meal timesRequiring hospital aid special
21. Sara steady transfer with 2 assistNo EPOA lacks capacity – Family issuesPoor insight and judgementAssistance with ADLsFatigueImpulsive Recurrent fallsFamily meeting held will refer for transitional rehabilitation
22. 20/11/19Transferred back to neurosurgeryDue to unsteady gaitDifficulty engaging in therapyOngoing incontinence23/11/19 Required a left occipital VP shunt27/11/19 Re admitted to BIRS for rehabilitation
23. Arrival back to BIRSCould not remember the ward or staffOrientated – appears clearer cognitively – Thought she had been in AustraliaImproved gait and balance – Independent lie – sit, independent sit – stand, gait pattern smooth and symmetrical, constant speed.ContinentAble to engage in formal testing in therapy sessionsHospital aid special in situ as not ringing the bellRequiring prompts to complete ADLs
24. Where do I want to be ???Able to report family history accuratelyAble to state she would prefer to stay in Christchurch but to ease the burden would go to Invercargill
25. 4/12/19HA special discontinuedHome visit?some day leave at the weekendStarting to initiate strategiesTo check capacity
26. GoalsTo walk independently to and from the toiletTo be able to get up off the flor independentlyTo initiate and complete personal care tasks independentlyTo ring the bell to ask for my medicationsTo keep a written log in notebook of activities each day so I can refer back to this when talking with friends and family To plan and prepare a simple meal with supervision onlyTo initiate following my daily timetable To have successful day leave at the weekend.
27. 11/12/18Aiming for discharge on 21/12/18Refer to CREST and CSRSReferred to Stroke FoundationTo have overnight leave prior to dischargeTo have neuropsych testing in the communityFamily do not want medication oversight they will support her to use a Dossett box which the partner will help her with.
28. 21/12/18Ready for dischargeNot able to drive for a year – she has been advised not to use any vehicles including scooters, quad bikes, biking etcNot to return to work until next neurorehab review in 6 weeks then will require a gradual return to work programme
29. Return To HomeHome in time for ChristmasPartner had leave to support her over holiday periodContinuing to improve – however some difficulties with cognitionConcerns how to get son to school as unable to driveFinancial concernsCould she ride a bike to take son to school?