Warning
Mae'r hysbyseb swydd hon wedi dod i ben ac mae'r ceisiadau wedi cau.
Frailty Nurse - Neighbourhood Nursing Teams
| Dyddiad hysbysebu: | 20 Mawrth 2024 |
|---|---|
| Cyflog: | £28,407.00 i £34,581.00 bob blwyddyn |
| Gwybodaeth ychwanegol am y cyflog: | £28407.00 - £34581.00 a year |
| Oriau: | Llawn Amser |
| Dyddiad cau: | 03 Ebrill 2024 |
| Lleoliad: | Barnsley, S70 3RD |
| Cwmni: | NHS Jobs |
| Math o swydd: | Parhaol |
| Cyfeirnod swydd: | C9378-B1859 |
Crynodeb
JOB SUMMARY This job description is an outline of the main duties of the post. The postholder will be required to undertake other duties commensurate with the grade as directed. The content of this post will be reviewed in consultation with the postholder when necessary and in line with the service developments. JOB PURPOSE 1. To work within the Integrated Neighbourhood Teams under the direction of the Community Matrons providing appropriate services to people who are moderately / severely frail and have long term conditions. 2. To assess the health needs of designated clients and plan, implement and evaluate programmes of care in response to identified need. 3. To contribute to the public health role within the team. KEY RESULT AREAS: CORE DUTIES AND RESPONSIBILITIES: To visit clients who meet the Frailty Nursing criteria within their usual place of residence (care homes and/or the clients own home) and undertake designated duties. To assess for and identify the health needs of patients who are frail and who may have a long-term condition using single assessment process. To assess, plan, implement and evaluate programmes of care to address the identified needs of patients identified as being frail and / or those with long-term conditions. To support the development of patients individual Personal Health and Social Care Plans. Develop disease specific patient information and education to support patients self care.. To contribute to/lead on the delivery and development of public health activities in response to identified needs and local ICS or national targets. Topics include nutrition, physical activity, falls prevention, mental health promotion, stop smoking and affordable warmth. To work in partnership with other health professionals, statutory and voluntary services in order to improve health outcomes for clients and address inequalities in health. Link people to voluntary and peer groups for support with self management e.g. Diabetes UK, Age UK where appropriate. To provide support for Carers, including facilitating independent assessment of carers needs as appropriate. Record all client contacts and activities accurately and contemporaneously, maintaining accurate records in line with trust standards, via SystmOne. Be responsible for updating knowledge and skills and maintaining professional competency and development, including accessing clinical supervision. Work within the clinical governance framework to maintain consistent high standards of care, working from an evidence base or current best practice. Participate in the training and education of other health care professionals and students providing an appropriate learning environment. Have an awareness of and adhere to trust policies and procedures in relation to matters of child and adult safeguarding. Adhere to the NMC Code of Conduct and Trust Policies and Procedures. Supporting Housebound Patients Undertake an in-depth holistic frailty assessment for all patients identified as having moderate and high-risk levels of frailty, as identified by Integrated Neighbourhood Team clinical colleagues. Implement appropriate plans of care to address the patients existing level of frailty and minimise further deterioration. This may include onward referral to appropriate services / agencies and regular review as necessary. Undertake advanced care planning (including the completion of EPaCCS) with frailty and / or long-term condition patients who are deemed to have capacity, as appropriate. Participate when required in best interest decision making at MDTs. Undertake a comprehensive falls assessment on patients identified as requiring this assessment following an initial falls screening tool being undertaken by the Community Matron. Undertake long term condition reviews (Chronic Disease / COPD / Asthma) for housebound patients as requested by primary care colleagues. Supporting Care Home Residents Following notification from the RightCare Integrated SPA of a care home residents discharge from hospital, the Frailty Nurse will liaise via telephone with the care home to ascertain whether a face to face intervention is required. Support the Community Matron by attending and contributing to the Enhanced Care in Care Homes care home MDTs / weekly ward rounds. Continue to undertake annual LTC review requests (Chronic Disease / COPD / Asthma) for care home residents received from GP Practices. Virtual Ward Related Duties To support the virtual ward pathway through playing an active role in providing care to patients accessing the Virtual Ward frailty pathway. This will include being dispatched to virtual ward frailty patients in the event of a virtual ward nurse requesting a visit following their virtual monitoring identifying that the patient is requires a face to face intervention. Support the Community Matrons by visiting virtual ward patients as requested by the Matron to undertake observations and appropriate clinical assessments. To respond to patients who may have alerted via the virtual ward digital monitoring equipment following notification of the alert from the RightCare Barnsley virtual ward nursing team. Participate within the Virtual Ward Multi-Disciplinary Team Meetings to discuss and feedback regarding patients that the Frailty Nurse has supported. COMMUNICATION WITH OTHERS: Clients, carers and their families. Members of the Primary Health Care Team. Other health professionals and statutory and voluntary agencies as appropriate For full details of the role please see the supporting documents attached.