Stroke Rehabilitation Specialist Nurse inGreat Yarmouth inGreat Yarmouth PUBLISHED 25 DEC 2023

Clinical

• To provide specialist nursing within the stroke survivor pathway including; medication reviews, clinical observations, prescribing of pressure care equipment, continence advice and mood screen assessments. To manage autonomously a significant caseload with supervision from senior staff members.
• To participate in the patients multi-disciplinary rehabilitation goals ensuring a functional approach to rehabilitation.

• To make appropriate clinical decisions following assessment, using evidence-based practice and outcome measures to provide the most effective treatment to patients, their families and carers within clearly defined inter-disciplinary care plans.

• To work within defined specialist department and national protocols/policies for stroke care such as the NICE clinical guidelines and National Stroke Strategy. To also work within the professional code of conduct as outlined by professional bodies.

• To be professionally and legally accountable for all aspects of own work and to ensure that work is within professional standards and clinical guidelines.

• To ensure that patients, families and carers are involved in the planning and prioritisation of their stroke rehabilitation care plans.

• To work collaboratively with other services that may be involved in the care of the patients for instance, social services, primary care and the volunteer sector.

• To attend and contribute to relevant multidisciplinary meetings and client reviews as appropriate.

• To demonstrate clinical effectiveness by use of evidence-based practice and outcome measures relevant to stroke, in particular regard to own profession.

• To provide supervision, specialist advice and support to more junior members of own profession within the team, as well as other members of the team, community colleagues and service users.

• To conduct multi-disciplinary initial contact assessments as a member of the team.

• To provide emotional support to patients and families including those with complex needs, with support from clinical psychologist and senior colleagues.

• To liaise with and support the wider team on discharge of patients from the service, when agreed objectives have been reached, or treatment is no longer appropriate. This may require planned referral onto other appropriate agencies/services.

• To work in a variety of settings including patients homes, care homes, and clinics.

Communication

• To use appropriate methods of communication with patients, families, and carers, to maximise rehabilitation and understanding of the condition.
• To communicate effectively and collaboratively with colleagues in health, social and third sector services to ensure delivery of a co-ordinated multi-disciplinary integrated stroke service.
• To provide specialist advice, teaching and instruction to relatives, carers and other professionals.
• To communicate complex information to patients, families, carers, other professionals, and other members of the multi-disciplinary team involved in the treatment of the patient.

• Identification of risk and subsequent liaison with appropriate agencies.

• To gain valid informed consent and work within a legal framework with patients who lack the capacity to consent to treatment and to contribute to capacity assessment with support from senior colleagues.

Management & Service Development

• Interpret clinical guidelines and adapt local service needs based on specialist knowledge.

• To communicate to professional lead and team leader on issues of service delivery including shortfalls, potential risks and service pressures.

• To use specialist clinical reasoning to provide guidance to junior staff and staff members of other professions, in order to assist in case management.

• To act as a stroke specialist nursing resource and provide advice and support to other members of the stroke team, service users, community colleagues and professionals from external agencies.

• To assume delegated tasks as requested by professional leads and service managers related to team management and service development.
• To work collaboratively with colleagues across the Integrated Stroke Service and support professional leads to improve patient care and share best practice across the service.

Leadership

• To act as a positive role model.

• 
  
  Support other staff members in providing comprehensive holistic assessment of patients and re-evaluation of their needs, to determine priorities of care and provide effective management of emotional, psychological and spiritual support.
  
  

Education, Training and Supervision

• To continue to develop competencies through reflective practices, clinical supervision and performance reviews.
• To assist in the development of specific Evidence Based Competencies in collaboration with professional lead, other members of the Integrated Stroke Services as well as external agencies.
• Work collaboratively with other peers in the other elements of the integrated stroke service to identify training needs and contribute to an across service training program for staff.
• To provide regular specialist training on a range of topics to service users, doctors, nurses, therapists, students and care staff.
• To attend relevant training and development in order to maintain and develop skills and knowledge required of a specialist nursing working in stroke.
• Act as a role model by offering support and work shadowing to other professionals, junior colleagues and students.
• All roles within East Coast Community Healthcare CIC (ECCH) require staff to demonstrate our Values and Signature Behaviours in the care and service they provide to patients, service users, stakeholders and colleagues. All members of staff should consider these as an essential part of their job role.
• Our Values outline the core behaviours that we can all achieve and are summarised as an acronym within the word
  CARE
  . These stand for:
  Compassion, Action, Respect and Everyone
  .
• Underpinning our Values are our Signature Behaviours which highlight by taking the right actions we continue to build a strong culture. Our four Signature Behaviours are:
  Compassion
  - We Listen, We Learn, We Lead|
  Action
  - My Accountability, My Responsibility |
  Respect
  - Respect Our Resources: People, Time and Money |
  Everyone
  - Work Together, Achieve Together
  .
  

Norfolk and Waveney Integrated Care System is working with NHS England to deliver transformation and strategic changes in community stroke rehabilitation and life after stroke services as described by the NHS Integrated Community Stroke Service (ICSS) model.

This role, fixed term for 9 months, is part of the ICSs NHS East of England Catalyst Project to improve outcomes for stroke survivors in line with the ICSS model. Alongside the delivery of patient care the post holder will be involved in the development and integration of the stroke nurse role within the community and subsequent evaluation activities feeding back to the NHS England.

Please note, a secondment will also be considered.

Part time and full time hours will be considered.

To provide specialist nursing within Neurology follow up services and stroke early supported discharge team consisting of assessment, liaison and treatment of patients following stroke.

To provide basic medication reviews, clinical observations and liaise with professionals as required.

To assess and prescribe basic pressure care equipment and signpost to other services requiring to be involved.

Complete basic mood screen assessments, have an awareness of the Psychological Step Care Model and carry out levels 1+2. Refer onwards to other agencies for further input if required.

To provide basic continence assessments, provide advice and refer to specialist team for input if required.

To manage autonomously a significant caseload with supervision from senior staff members.

To work in a variety of settings including patient homes, care homes and community settings.