Named Trust of the Year in 2012, Cambridge University Hospitals Foundation Trust is a destination employer for nurses wanting to work in a world-leading medical division
With its international reputation as a centre of research and excellence, it is hardly surprising that Cambridge University Hospitals Foundation Trust (CUH) was named Trust of the Year in 2012 by the independent health information provider Dr Foster Intelligence.
Its main hospital, Addenbrooke’s is world renowned for a range of services, particularly organ transplantation. Her Majesty the Queen opened The Rosie Hospital, the trust’s brand new women’s and maternity services provider in May this year.
Its world-leading status makes CUH a destination employer, and for nurses it offers a plethora of specialist opportunities in forward-thinking services, backed by excellent professional development. Its renal service is a perfect example of these opportunities. The service employs around 140 nurses, across the nephrology ward and dialysis unit at Addenbrooke’s, three satellite dialysis units (Kings Lynn, Huntingdon and Bury St Edmunds) and a Home Therapies team based at Addenbrooke’s.
The main dialysis unit cares for an average of 140 patients receiving hospital-based dialysis and 60 on home therapy, while each satellite unit has around 60 patients. The renal specialist nursing teams look after patients who require preparation for dialysis, anaemia management, vascular access management and for some patients, palliative care.
Madeleine Seeley, senior clinical nurse, renal services, has worked across all areas of renal services - nephrology, dialysis and transplantation, as well as intensive care. She has experience of caring for patients with acute renal problems and those whose condition is chronic.
“One of the things I love about renal care is that even though it is very specialist, there is huge variety within my job and the service,” she says. “I work across a range of settings in Addenbrooke’s and our satellite units, and with patients of all ages, many of whom you get to know well because they move through the service over their lifetime. I still have patients pop in to say hello 20 years after they received a kidney transplant.”
“I have patients who still pop in to say hello 20 years after they received a kidney transplant”
Renal care includes a number of pathways involving treatment, cure or palliative care. Some patients with early-stage problems come to the service as outpatients, then move on to dialysis and some on to transplant. Others have acute problems and require hospital admission, while those with end-stage disease or who have decided against active treatment receive palliative care.
Many patients are given the option of receiving dialysis at home, although this requires careful assessment of their ability to manage the procedure themselves and of the support available to them at home, and intensive education and training from the renal nurses. While most will have peritoneal dialysis, in which the patient’s own abdomen is used, haemodialys machines can also be used at home.
Ms Seeley says CUH takes staff development very seriously. “There are lots of in-house opportunities, utilising the huge amount of expertise within the division of medicine,” she says. “We also link with Anglia Ruskin University for academic study, and network and share good practice both nationally and internationally. The renal industry is also very proactive in ensuring we have the skills we need to use their products, which is essential since renal care can be extremely technical.”
In addition to pushing treatment boundaries, CUH is committed to improving the patient experience, as demonstrated by its work to improve staff skills in communicating with those who have dementia. This uses VERA, a framework that was initially developed by Anglia Ruskin University to help students who lacked confidence when caring for patients with dementia, which is now being rolled out across the whole of CUH.
The name VERA is taken from the four steps it incorporates: validation, emotion, reassure, and activity. Senior sister Gemma Coteman says it gives health professionals an honest and respectful way of communicating with patients who have dementia that reduces the distress they often experience as a result of confusion and disorientation.
“When patients are confused it can be difficult to know how to deal with their concerns,” she explains. “For example, if a retired patient gets out of bed in the middle of the night and tries to leave the ward because he has to go to work, inexperienced people may either try to get him back in bed without discussing the concern, or go along with it and try to make him think he is on holiday.
“VERA encourages staff to validate the patient’s concern by accepting the situation rather than trying to tell him that he is confused, acknowledge his emotion by empathising with him, reassure him that they are there to look after him, and find a relevant activity to distract him from the issue causing concern. It’s about taking patients’ minds off the source of their distress rather than dismissing their concerns or lying to them.”
Staff across CUH are being taught how to use VERA, and Ms Coteman says it has been particularly helpful for new staff who have little experience of working with this group. Where the framework is in operation staff report seeing fewer incidents of distress or agitation.
Divisional lead nurse for medicine at CUH Tracey McClelland says: “Working in the medical division you are part of a large but friendly and supportive team who work hard on a daily basis to deliver excellent care. There is a broad range of experiences available throughout all stages of the patient journey, from ambulatory and day cases, to acute and long-term inpatients. If you want to know more please contact us; we are also proud to show you what we do first hand and can arrange informal visits.”