Duties and Responsibilities Communication and Key Working Relationships To use a range of verbal and non-verbal communication tools (e.g., explanation, negotiation, motivation) to communicate effectively with patients to implement rehabilitation and treatment programmes. This will include patients who may have difficulties in understanding or communicating *General Practitioners/primary care *Infection Control Team *District Nurses *Community Hospital Ward Manager and Nurses. *Integrated community stroke team *Acute Trusts *Patient / Carers *Specialist Nurses *Practice Nurses *Stroke Team Leaders *Integrated Community Stroke Nurse Lead *LWAS Team Lead *Stroke Service Lead *Consultant Therapist Stroke *Other care staff including those from other agencies, e.g. Social Services, Community nurses, Care agencies, tertiary providers as part of clinical work.
Planning and Organisation *To work collaboratively with both the nursing and LWAS teams in the provision of clinical supervision and leadership for Band 4 support workers and nurses. *To act as a role model for junior staff, with clear expectations of staff behaviour. *As an autonomous practitioner, to consistently pursue self- directed support and learning, and formal agreed supervision according to Trust policy. Ensuring appropriate preparation for professional revalidation.
Analytics *Participate in team audit research. *Ensure all patient records are completed contemporaneously, up to date and accurate. Responsibility for Patient / Client Care, Treatment & Therapy *The post holder will be responsible for ensuring the nursing and LWAS components within an interdisciplinary assessment of patient care needs, the development, implementation and evaluation of treatment plans. To work alongside other professionals within the multidisciplinary team; ensuring high quality care and rehabilitation and effective communication.

This will involve delivering care to a caseload of appropriate patients. *To use specialised skills to provide assessment and treatment of chronically ill/frail stroke patients, taking account of other pathologies and associated complex needs. *To be aware of and appropriately manage sensitive and/or complicated information. To deal sensitively with patients who may have challenging behaviour, have high levels of anxiety and aggression caused by pain, cognitive change, dementia, limited mobility, terminal illness, degenerative disease etc.

• To develop and deliver an individualised treatment programme and agree patient centred goals in partnership with patients, carers, and other members of the health and social care team. *To assist with implementation of consistent patient medication self-administration trials post discharge home to increase personal independence. *To be able to utilise and promote specialist nursing skills e.g. understanding and management for VTE assessment and prophylaxis, physiological monitoring, bladder/bowel dysfunction, understanding and support of management of cardiovascular issues i.e.

AF, blood pressure control, monitoring and management, identify complications of stroke and assess secondary prevention regarding reducing further incidence of stroke. *To act as or support the role of key worker, this may include managing the longer term social, emotional, financial and vocational concerns arising from having had a stroke. Additionally, seeking support of outside agencies. *To provide specialist nursing and LWAS advice to the wider MDT.

• To work with patients undertaking rehabilitation programmes to support and encourage them to achieve their optimum level of independence and quality of life as directed by team therapists/nurses. *To deliver six month review assessments in line with the Sentinel Stroke National Audit Project (SSNAP) particularly for patients with identified stroke nursing needs. *Contribute to the triaging process using skills to identify nursing related stroke needs for a large cohort of patients. Policy, Service, Research & Development Responsibility *Engage effectively with research to promote evidence-based stroke nursing practice.
• Comply with all relevant Somerset NHS Foundation Trust policies and procedures in exercising the duties of the role. *Undertake any necessary skills training, professional updates, continue professional development and mandatory training as appropriate to the post in agreement with the line manager. Responsibility for Finance, Equipment & Other Resources *Comply with all Health and Safety guidance in use of equipment, reporting immediately concerns Responsibility for Supervision, Leadership & Management *The Band 5 Nurse will provide clinical supervision for more junior colleagues and is accountable for ensuring that the patient care needs are met (with particular regard to medication, physiological monitoring and identifying deterioration and complications and secondary prevention). *To deputise for the senior stroke nurse, with prior arrangement and with support from the Team Leads.
• To work pro-actively with other partners, such as secondary care, to identify and refer patients for specialist advice *Contributing to the education of the stroke team in the nursing referral criteria, monitoring of physiological signs of the patient, bladder/bowel dysfunction, secondary prevention and identifying complications associated with stroke. *To be professionally and legally responsible and accountable for all aspects of your own work including the management of patients in your care, (including care delegated to students and assistant staff). To ensure a high standard of clinical care for the patients under your supervision and support more junior staff to do likewise. Information Resources & Administrative Duties *Be responsible for effective time management and effective use of resources available and of the wider nursing and LWAS teams.
• To maintain accurate record of patients’ attendances and treatments using the relevant IT and audit systems. This includes contributing to patient letters, reports and onward referrals. Any Other Specific Tasks Required *To carry out work in a range of locations, including hospital departments, patients’ own homes and other community locations as directed. *To use communication tools (verbal and non-verbal) to gain valid informed consent with patients where there will often be barriers to effective communication e.g.

loss of hearing, altered perception, expressive and receptive dysphasia, pain, fear. To have the capacity to work within a legal framework with patients who lack capacity to consent to treatment e.g. those with cognitive or speech difficulties. *To use a range of verbal and non-verbal communication tools (e.g.
explanation, negotiation, motivation) to communicate effectively with patients in order to implement rehabilitation and treatment programmes. This will include patients who may have difficulties in understanding or communicating. *Duties as instructed by your manager or appropriate authority, to include work on Trust-wide projects and Quality Improvement

• To work with patients undertaking rehabilitation programmes to support and encourage them to achieve their optimum level of independence and quality of life as directed by team therapists/nurses. *To deliver six month review assessments in line with the Sentinel Stroke National Audit Project (SSNAP) particularly for patients with identified stroke nursing needs. *Contribute to the triaging process using skills to identify nursing related stroke needs for a large cohort of patients. Policy, Service, Research & Development Responsibility *Engage effectively with research to promote evidence-based stroke nursing practice.
• Comply with all relevant Somerset NHS Foundation Trust policies and procedures in exercising the duties of the role. *Undertake any necessary skills training, professional updates, continue professional development and mandatory training as appropriate to the post in agreement with the line manager. Responsibility for Finance, Equipment & Other Resources *Comply with all Health and Safety guidance in use of equipment, reporting immediately concerns Responsibility for Supervision, Leadership & Management *The Band 5 Nurse will provide clinical supervision for more junior colleagues and is accountable for ensuring that the patient care needs are met (with particular regard to medication, physiological monitoring and identifying deterioration and complications and secondary prevention). *To deputise for the senior stroke nurse, with prior arrangement and with support from the Team Leads.
• To work pro-actively with other partners, such as secondary care, to identify and refer patients for specialist advice *Contributing to the education of the stroke team in the nursing referral criteria, monitoring of physiological signs of the patient, bladder/bowel dysfunction, secondary prevention and identifying complications associated with stroke. *To be professionally and legally responsible and accountable for all aspects of your own work including the management of patients in your care, (including care delegated to students and assistant staff). To ensure a high standard of clinical care for the patients under your supervision and support more junior staff to do likewise. Information Resources & Administrative Duties *Be responsible for effective time management and effective use of resources available and of the wider nursing and LWAS teams.
• To maintain accurate record of patients’ attendances and treatments using the relevant IT and audit systems. This includes contributing to patient letters, reports and onward referrals. Any Other Specific Tasks Required *To carry out work in a range of locations, including hospital departments, patients’ own homes and other community locations as directed. *To use communication tools (verbal and non-verbal) to gain valid informed consent with patients where there will often be barriers to effective communication e.g