Caring for the Elderly can be one of the most challenging roles for a healthcare professional. Aside from addressing patient’s complex health needs, their quality of life must be at the forefront of their care plans.
I am Melissa and I work in one of the NHS Trusts in the East of England. I work in a DME (Department of Medicine for the Elderly) ward ever since I moved in the UK. In this ward, we usually handle patients with dementia, Parkinson’s and patients who need palliative treatment/care. It was not something I chose before coming here, but I would definitely say that it is an experience worth going through.
My Typical Day as a DME Nurse
Like any other wards, my typical day starts with the handover and patient allocation. Once allocated to a group of patients (usually 6-7 patients during the day, and 9-10 patients during night shift), our routine juggles in between medication rounds, reading notes of doctors, and hands-on patient care. In this field, hygiene care and turning patients are big parts of my role as a DME nurse because this is when my cephalocaudal assessment happens. I see hygiene care as a critical task in my day to day job as I am able to properly assess my patients and plan ahead what their needs are during my 12-hour shift. This includes assessing my patient’s cognition including the use of their senses. Questions like - Are they confused? Do they need glasses? Do they need hearing aids? Would they need feeding? Would they need extra help turning or walking to the toilet? All these go through my head as I assess them. I would also check for pressure sores and wounds as they are more fragile than younger patients. By mid-day, families come in the ward to visit, so we make sure that everyone has been washed and dressed before that time. This is also the time to answer queries from families when you do your mid-day medication rounds.
The Department of Medicine for the Elderly (DME) is a ward full of vulnerable patients. We admit 70 years old and above with various comorbidities. Usual reasons for being admitted in a DME ward are sepsis, falls, delirium, cognitive/health decline and increase in health care needs which fall under complex discharges. We need to make sure that these patients can go home safely back to their communities, otherwise, we need to search for placement (i.e. residential home or nursing home). We also need to involve social workers, occupational health therapists, physiotherapists, and discharge planning specialist team to discuss whether they need increased care or they can go home without help or the same amount of help they have been getting in the community.
Even when I was completing my Nursing degree, I was always drawn to the emotional and psychological support that this profession offers rather than the medical side of it. I used to be very keen on practicing therapeutic communication and empathy towards the people I encounter. This was why I avoided places like theatres or ICU because I always had that perception that I will not be able to make conversations with my patients in those areas as they are mostly in coma or under anaesthesia. In my current role, I could sharpen my communication skills better and practice empathy towards my patients and family. I could easily have gone to another unit but I chose to stay in the DME ward because I enjoy actively listening to my patients concerns’ and giving them answers. It gives me a great sense of purpose.
As a DME nurse, one should be patient and can communicate well as there will be challenging patients with complex needs. We also cater for patients who need end of life care. We need to practice resilience, sensitivity & professionalism all at the same time. Mastering the art of letting go should be on your list of skills to learn when working in this ward. There will be times when you get attached to your patients as they mostly stay in the ward for a long time whilst we look for the best possible care or placement for them. We need to be tough enough to deal with death as there would be patients for palliative care/treatment. You need to be strong enough to move on and easily detach yourself from anyone you will take care of in the ward. If not, your emotions will get the better of you and it can affect your care towards other patients.
It is also important to be a good team player in this role as these patients have complex needs, so we need to closely coordinate with other groups and specialities like dieticians, speech and language therapists, occupational therapists, physiotherapists, district nurses, discharge planning team, etc. We need to know how to harmoniously work with them. Respect and understanding within the team are a must.
My daily life as a DME nurse requires a lot of role-playing. Elderlies with dementia feel reassured when you acknowledge their reality. Patients with dementia mostly live in the past and every day, I can be a different person to them. Sometimes I am their child, their mother, their friend and it is amazing how I find out a lot about them just by being that person they want me to be in the moment. My role as a DME Nurse is challenging, but with the right mindset, it can be very rewarding. Keeping these vulnerable adults safe makes me feel that I make a difference in their lives and their families. In this area of nursing, I have also realised that enhancing the quality of life for the elders is highly essential, especially to those who have reached their final stages. This is where our nurturing role takes place as we help the patients and their families cope with the drastic changes happening to them or to their loved ones.
Career Pathways Available
There are various career pathways for a DME Nurse like me. You can become a nurse in charge or a junior sister in the same department or acute ward. You can also go to various specialisms. As we are dealing with complex cases, there are various areas where you can be an expert of. You can become a palliative specialist or those who specialise on end of life care, discharge planning specialists or those who focus mostly with complex discharges. Other career pathways are tissue viability nurse specialist, Development nurse for dementia and Parkinson’s specialist as we get a lot of these cases too.
If you are a newly qualified nurse from the Philippines, DME ward can be a good starting point for your UK nursing career. Working in this unit will train and expose you to diverse medical cases, some of which are highly-complex and challenging. You will learn more about dementia patient care, which is not practiced in some hospitals in the Philippines. You will not only upskill your technical knowledge, but your soft skills too such as empathy, communication & organisation skills.
“People might forget what you said, but they will never forget how you make them feel.”—this has been one of my key learnings in my role as a DME Nurse. Certainly, nursing for the elderly has made me become more sensitive and understanding towards everyone I encounter in my daily life. I learned to connect with my patients and feel empathy towards them. I can be their parent, child, or friend any given day. I have the privilege of holding their trust during their most vulnerable time. It also made me appreciate life more & the people around me. Working in DME does not only help me grow as a Nurse but it has also made me a better person.
About the Writer:
Melissa, also known as Manileñang Nurse sa UK, is a nurse from Manila who came to England 4 years ago who, like a lot of us, shares the same struggles and joy of working in the UK. Her vision is to empower nurses, especially the younger ones, by reflecting and sharing her perspectives in living abroad.
Follow her facebook/ instagram/youtube: @mnursesauk and her blog theadventurouspinaynurse.com to know more.