A typical day and the duties of a ward based

Health Care Support Worker (HCSW)

Firstly, thank you for taking on this reallyimportantrole.In order to help you settle into the role wehavelistedbelowsomeimportantpointsandkey duties that you will most likely beinvolvedinasawardbasedHCSW.We hope you find this both informative anduseful.

Arriving for your shift

Arriving at the hospital before your shift begins isimportant. Youmust leaveenough time to changeoutofyoureverydayclothes,putonyouruniformandleavebothyour belongings and food in a safe place before the shiftstarts.Theremaybelimitedspacetokeepyourbelongingsso try and keepwhat you bring to aminimum and don’tbringvaluables.

Youshouldlookprofessional,checkingthatyouruniformisasitshouldbe,you have no jewellery on (apart from a plain wedding band), you haveyour ID badge visible and your hair is neat, tidy and not touching youruniform.Washyourhandsusingthesix-steptechnique–handhygieneissuchanimportantpartofeveryhealthcareworker’sday.

Getting a Handover

patient’scaretohelpyoulookafterthepatientssafelyonyourshift.Mostwardsalsohavea‘safetybrief’whichhighlightsthepatientsonthewardwhomaybemoreat riskofpressuredamage, fallsor requireassistancewitheatinganddrinkingatmealtimes.

The nurse in charge of your shift will allocate youintoateamfortheshift.Staffonthepreviousshiftwillgiveanupdate includingnewpatients,changestopatients’ condition and specific things that needtobedoneontheshift.Youarelikelytobegivenatypedhandoversheet,detailingkeyaspectsofeach

First duties of the shift

It’simportanttohaveacaringandpositiveapproachwithyourpatients. Asyouattendtothem, introduceyourself.Aneasywaytostartis“Hellomynameis[yourname]andalongwithyournurse Iwillbe lookingafteryoutoday”.Youmaybethefirstpersonthatpatientseesinthemorningsomakesureyoustart thedaywitha smileJ. In themorning,oneof the firsttasks is getting patients ready for breakfast, helping them togetwashedanddressedorassistingthemtothetoilet.

At this point the care rounding chart for each patient should be checked so that youknow how often care is required for that patient throughout your shift. This chart isupdated at regular intervals throughout the shift and it’s important to let the nurseknow if you areworried about anything. Formore information on the care roundingprocesspleaseclickhere.

First duties of the shift

When starting a nightshift, the tasks can be quite differentand may involve giving out drinks and snacks and gettingpatientssettled inbedforthenight.Againtakethistimetointroduce yourself and check andupdate the care roundingcharts.Involvingpatients indecisionsabouttheircare,askingthemwhatmatters to themandupdating their ‘WhatMatters toMe’ board are ways we can ensure that we are deliveringcare that is right for the patient. A patient may say ‘Ifpossible,couldIhavehelptohaveashower’andit’sourjobasateamtotryandmakesurethishappens.

Assisting a patient to wash

Respecting thepatient’sprivacyanddignityatall times isakeypartofyourrole.Itisespeciallyimportantwhencarryingoutpersonalhygieneorassistingpatients with a wash. When getting ready to assist a patient with a wash,shower, or bath put on appropriate personal protective equipment (PPE).Always find out what they need help with and encourage them to be asindependentaspossible.

Checkiftheyhaveahearingaidorglassesandensurethattheseareavailabletouse.Patientscanfeelbetterwearingtheirownclothesandencouragethemto change from nightwear to daywear if they have these clothes available.Don’t forgettoassistwithmouthcare,thiscanbeofferingtheirtoothbrush,cleaningtheirdenturesorprovidingmoistoralspongestocleantheirmouth.

Usethistimewiselyandfill itwithconversation.Thepatientshouldhaveyourundividedattention.Askthem‘Whatmatterstoday’andusethecuesyouaregiventoleadtoconversation.Thereisawell-knownsaying‘peoplewillforgetwhatyousaid,peoplewillforgetwhatyoudid,buttheywon’tforgethowyoumadethemfeel’.

At this point the patient’s bed linen is usually changed. Place it straightinto the laundry receptacle as near to the bed as possible. Before youleave,checkthebedspaceiscleanandtidy,thatthepatienthastheircallbellandanythingelse theyneedtohand.Remember toupdate thecareroundingchartattheendofthisprocess.

Assisting with other personal care Patientsmayormaynotbeabletotellyouwhentheyneedtogotothetoilet,anditcanbequiteembarrassing for them if theydon’t get to the toilet in time. Findoutwhat’snormal for thatpatient;are theyassisted to thebathroom,do theyneed touse a commode at the bedside or do they wear pads due to incontinence. WhenassistingsomeonealwayshaveonappropriatePPEtoensureyouareprotectingbothyourselfandthepatientfrominfection.

Ifyourpatient is incontinent it is importantthattheirskin isattendedtoassoonaspossibletoremovetheurineorstoolfromtheirskinasitcancauseskindamage.Theskinmustbecleansedusingwarmwaterandaskincleanser,driedandaskinbarriercreamappliedbeforenewincontinenceproductsareplacedonthepatient.Patientsmayhavea fluidbalancechartoraBristolstoolchart inuse, remembertocompletethesewiththevolumeofurineortheamountandtypeofstoolpassedastheseareimportantintheircare.

Assisting with eating and drinking

Food, fluid and nutrition is essential to help patientsrecoverfromillnesswhilsttheyareinhospital.Youwillbe involved throughout your shift in supportingpatientstoeatanddrink,whetherit'sjustmakingsurethey have access to it when they need it or sittingdowntoassistthemwithit.Athandover,thenurseincharge will highlight those who need assistance witheatinganddrinking.

The usual day shift routine includes breakfast, hot drink and snack mid-morning, lunch, hot drink and snack mid-afternoon and evening meal. Thenightshiftstaffwillofferahotdrinkandsnackbeforebed-timeandpatientscan ask for a hot drink during the night if they are awake. The moreopportunities a patient gets to eat and drink ‘what is normal for them’ themorelikelytheyaretohaveenoughenergytogetbetter.

Assisting with eating and drinking

Havingaccesstofoodanddrinkcanbethehighlightofthedayformanypatientsandyoucanbekeytomakingsure thepatientshaveagoodmealtimeexperience.Atthestartofashiftamealtimecoordinator is identified,theirroleistocoordinatethemealtimeandensurethepatients have all that they need; choice of drink;condiments; assistance and the mealtime runssmoothly.

Cateringstaffareresponsibleforthefoodbeingatthecorrecttemperatureforserviceand will plate the food for you to take to the patient. As part of their care, somepatientsmayhavetheirfoodanddrinkintakerecordedonaFoodandDrinkrecordingchartorfluidintakeonlyonaFluidBalanceChart.Itisimportantforyoutoknowwhichpatientsareonthesechartsandforyoutodocumentaccuratelytheamountof foodanddrinktheyhaveeatenordrunkbeforeremovingtheirplatesandcups.

Using specialist equipment

Keeping patients as mobile as possible andrehabilitatingthemtobeingasindependentaspossibleis a teameffort. To ensurepatient and staff safety, arange of specialist equipment may be used such ashoists,mobilityequipment,slidingsheetsorstandaids.Itisimportantthatyouknowhowtouseeachofthesepiecesofequipmentbeforeusingthemwithapatient.Physiotherapists offer specialist input to aid mobilityand are important members of the team. Theequipment necessary foreachpatientwillbepartoftheinformationavailabletoyou:atthestaffhandover;itwillbewrittenabovetheirbed;and inthepatient’scareplan.

Clean and tidy environment Keepingtheenvironmentcleanandtidy is theresponsibilityof the whole team. All wards have access to a domesticassistantwhowillhaveaseriesoftaskstheymustcompleteeveryday,forexampledampdustingandwashingthefloor.Thepatient’slocker,bedsidetableandbedarekeptcleanbythewardstaffandit’simportanttokeepitasclutterfreeaspossible.

Cleanlinenisdeliveredtothewardfrequentlyandyoumaybeaskedtoputthisawayin the linen cupboard or asked to restock the linen trolley. Once finishedwith usedlinen it shouldbeplaceddirectly intoa laundry receptacle close to thepointofuse.Contaminated linen should be placed directly into awater-soluble/ alginate bag andsecuredwiththetieandthenplacedintoaclearplasticbagbeforeputtingitintothelaundry receptacle.The laundry receptacles shouldnotbeoverfilledandyoumaybeaskedtotieupthelaundryandtakeitoutsidethewardtothedirtylinendepositbinorchute.

Clean and tidy environment The way we get rid of waste in the hospital is important,most clinical areas will have two different types of wastebins, one with a black lid (containing a black bag) fordomestic waste and onewith an orange lid containing anorangebagforclinicalwaste. Theseareemptiedwhen2/3rdfull, tied and secured with a cable tie using a ‘swan neck’closureand the tracer labelwith thewardon it isadded tothebag.Stores are also deliveredby theporters to eachward area.PuttingstockawayistheroleofthewardHCSWandhelpingwiththisisagoodwayforyoutofindoutwhereeverythingiskept.

Going off the ward with a patient

The nurse may ask you to escort a patient toanotherdepartment,e.g. foranX ray.Your role isto keep the patient safe and reassure them bykeeping them informed about what is happening.Youmaybeaskedtolookafterpatientrecordsuntilyougetbacktotheward.Patientswillnormallybemovedinawheelchairorintheirbed.Portersalsohelptomovepatientsfromoneareatoanother.

Special Observations Somepatientscanbeatincreasedriskofcomingtoharmwhilstinhospitalduetoa new confusion, or changes in their behaviour. These patients may need anenhanced level of observation toprevent them from coming toharm. For thesepatientsitisimportanttoknowinformationaboutthemasaperson.The‘GettingtoKnowMe’documentwhichcanbefilledoutbyafamilymemberandkeptatthebedside.The‘WhatMatterstoMe’boardcangiveyouinformationwhichcanhelpyoutointeractwiththepatientandreducetheirlevelsofstressanddistress.

Forthesepatientsyoumaybeaskedtocompleteapatientbehaviourchartwhichwillindicatethetypesofbehaviourthepatientisdisplayingandallowsyouandtheteam to look for patterns in their behaviour. For example ‘I’ve noticed that mypatient’sbehaviourchangesjustbeforetheyneedtomovetheirbowels’.Ifyoucanhelp themto the toiletwhenyousee thisbehaviour starting, thepatient’s stressmaybereduced.

Ending the shift Caring forpatientsonawardcanbereally rewardingbut itcanalsobetiringbeingonyourfeetandonthegoformostof the 12 hour shift. Before going off shift check that youhave completed all the bedside documentation for yourpatients such as Care Rounding; Food and Drink; FluidBalance Chart and other charts which are important in thecareweprovideforpatients.

Wherepossible,it’simportantthatthestaffonthenextshiftcomeontoacleanandtidywardinorderforthemtocontinuetoprovidesafecare.Thereforemakingsurealldirty linen is tiedup,new linen isavailable,binsareemptiedandremoved fromthe ward and the ward kitchen is clean and tidy are very important duties to beundertakenbythewardteam.

Ending the shift

Youmustmakesurethatanyhandoversheets(withpatientdetailsonthem)areplacedintheconfidentialwastebeforeleavingthewardandthatyouknowwhenyouarenextrosteredonshift.Oncethenextshifthavehadtheirhandoveryoucangetreadytogohome.Washyourhandsbeforeleavingthewardareaandchangeoutofyouruniformandtakeithomeinaplasticbagtoreduceanyriskofinfection.Whenathome,launderyouruniformsseparatelyfromotherhouseholdlinenandatamaximumtemperaturethatthefabriccantolerate,beforetumble-dryingorironing.

Going home It is important for your own mental healthand wellbeing to follow these steps beforeheading for home and rest, recharge andlook after yourself so that you are in goodhealthtoreturntonextshift.