Defence Medical Rehabilitation Centre – Nursing Division update

DMRC Stanford Hall is run by a professional team drawn from members of the Armed Forces and MOD-employed civilians. The DMRC multidisciplinary team uses the skills of its professionals within various clinical departments, supporting patients through their care. It incorporates technology with therapies that have been established through clinical research. Its buildings and spaces have been specifically designed to aid the healing process and deliver the functions of rehab medicine. It includes gyms, a range of swimming and hydrotherapy pools, a gait lab and all other elements crucial for its clinical purpose.

I was posted to DMRC in March 2019 and adapting to my new role within a unique clinical environment was initially daunting. However, I was equally excited to take the opportunity to acquire new skills and savour my experiences. I was amazed to see a real mix of patients from amputees to those with spinal cord injuries. Likewise, among the patients, some of them were injured during their duty whilst others were involved in unfortunate accidents off-duty. There are three wards in the DMRC Nursing Division: Complex trauma (CT), Neuro and the Health Care Assistant (HCA) ward.

LCpl Kandangwa & MA Shaw working on the HCA Ward
LCpl Kandangwa & MA Shaw working on the HCA Ward

CT ward deals with patients following an accident resulting in complex trauma injuries. The focus remains on regaining mobility, fitness and independence. This is achieved through the interdisciplinary team providing a full range of therapies for rehabilitation such as physiotherapy, occupational therapy and hydrotherapy. The patients come for several admissions and get access to a wide range of specialities to help them manage their injuries. Whilst working in CT ward as an HCA I was able to help with the activities of daily living. Moreover, I was able to witness the support received by serving members of the Armed Forces from the multidisciplinary team in order to return to service or transition to civilian life and a new career. This has given me a good understanding of disabilities and their rehabilitation process which I was unaware of. I feel fortunate to have gained this experience which we do not routinely obtain in other healthcare settings.

Subsequently, I also had the opportunity to work in the Neuro ward which was extremely challenging. The goal of neurological rehab is to help serving members return to the highest level of function and independence while improving their quality of life. Nurses and HCAs help with the activities of daily living, such as eating, dressing, bathing, toileting and basic housekeeping. The neuro rehab programme also includes speech therapy, activities to improve mobility, muscle control, gait and balance. In addition, the programme integrates activities to improve cognitive impairments, such as problems with concentration, attention, memory and poor judgement which was fascinating.

I currently work in the HCA ward which is a ward led by the Health Care Assistants. This ward focuses on more independent patients compared to the Neuro and CT wards, but with a similar aim of providing aid for the rehabilitation process. Working in this ward also means taking the overall responsibility of a range of situations involving patients with different issues and care needs. This role gives HCAs more accountability and independence to use our own initiative and work within clear boundaries, but with access to support from doctors and nurses 24 hours a day if required.

Following the arrival of the pandemic and the required Infection Prevention and Control (IPC) measures for COVID 19, Nursing Division has undergone several administrative changes. Testing of patients for COVID is done prior to admission, and the use of various facilities within the Unit like kitchens, gyms, pools, and waiting areas have been re-organised in order to meet the criteria for IPC guidelines. These changes also ensure the number of people in our facilities allows for 2-metre social distancing, especially in therapy sessions. One of the challenges for patients has been the restriction to go on weekend leave until the end of their course. Similarly, ensuring staff are well trained on the use of personal protective equipment, handling COVID samples and strengthening the Unit’s response mechanisms by becoming familiar with COVID 19 specific and standards of care has not been easy. The guidelines and restrictions are disruptive and challenging but have been implemented and followed by everyone in the Unit to ensure we stay safe and continue to protect our patients.

QA Gazette 3
DMRC Nursing Division

When it comes to COVID 19 recovery, the HCA ward has taken on a new role. We now have a huge responsibility of supporting serving personnel suffering from the long-term effects of Coronavirus. The majority of serving personnel we manage have suffered from breathlessness, cough, fatigue and difficulty in performing physical tasks.  One of the new support programmes is a two-week COVID Recovery course which primarily focuses on ways to self-manage symptoms and setting realistic goals. It also provides sources of advice and support with regards to physical and psychological aspects of rehabilitation. Additional support is being given through a three-day Defence COVID Recovery Service course which is also run by the HCA ward. The course is designed to examine the physical and mental state of serving personnel affected by Coronavirus. Various tests and assessments are conducted within the facility and at John Radcliffe Hospital in Oxford to determine whether an individual is fit to work without risking their own and others health and safety. For our efforts in shifting focus to support COVID recovery, the ward received a CO’s commendation.  More recently, DMRC has been asked to operate a Defence COVID Bedding Down Facility (DCBDF) if needed with 2 hours notice of any incoming patients. CT ward is on standby to take low dependency COVID patients with their patients transferring either to Neuro or HCA ward.

During this time of lockdown, DMRC has been very active. We continue to provide our core role of supporting rehabilitation but remain adaptive to new requirements. Despite the profound shock and misery caused by the coronavirus pandemic on our health care sector, we look forward to continuing to provide world-class treatment for our patients and contributing to combating this global crisis.

LCpl Kandangwa

 
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