Community nursing: the linchpin of quality care.

Abstract

❛If community nursing is to be recognised as the linchpin of high-quality care outside hospitals, the invisibility of community nurses needs to be reversed ...❜ Before the modern era of pharmaceutics and other medical advances, the GP and community health services used to constitute the mainstay of people’s health-care experience. However, in recent years, hospital care has become pre-eminent to the neglect of the breadth and sophistication of current out-of-hospital services, with the consequence that many patients view nonhospital care as inferior, if not second best. There is a tendency for patients to equate self-sufficiency and self-care with appropriate local support as an absence of needed health-care support, because opportunities to reassure the general public, and patients in particular, and to signpost access to high-quality community services have not been grasped. Indeed, all too frequently, various health-care users are reported in the media as being ‘forgotten’, or worse ‘neglected’, by a hard-pressed health service. Davies et al’s (2015) qualitative study of 20 people with multiple sclerosis (MS) and 13 carers highlights the importance of health-care support in the lives of patients as they transition to secondary progressive MS. They summarised the patient experience as: ‘You are just left to get on with it’, in the absence of being adequately informed by their health-care team. The authors’ study sample wanted to know what secondary progressive MS would mean for them including increased disability and its consequences regarding employment and other roles and what they should and could do for themselves. They also wanted to know what health-care services could do for them, particularly in terms of potential treatments; the management of symptoms such as fatigue, pain, low mood, personality, and cognitive changes; and what future support they may expect. The infrequency of reported health-care contacts and lack of carer support were noteworthy as was the failure to convey a confirmation that there would be a supportive network that would include community nurses as the disease progresses. If community nursing is to be recognised as the linchpin of high-quality care outside hospitals, the invisibility of community nurses needs to be reversed and the breadth and scope of their work advertised, both by community nurses themselves and their primary care colleagues. The Queen Nursing Institute’s (QNI’s) (2014) 2020 Vision 5 Years On summarised the recent ‘bumpy’ history of district nursing since the early 2000s, with the challenges of clinical grading, confusing job titles, new specialisms, and major organisational changes. Disappointingly the report noted that widespread confusion continues relating to the district nurse job title, qualifications, and roles, with some of the QNI survey respondents reporting despair at the uncontrolled use of the ‘district nurse’ title. The current multiplicity of workload-management systems highlights the need for an intelligent and robust demand and capacity-management tool to enable community nurses to deliver care to the ‘right’ patients at the ‘right’ time, thereby enabling community nurses to provide appropriate support within the constraint of resources. The QNI’s championing of the role of nurses as the linchpins for the avoidance of unnecessary hospital admissions and delivery of high-quality care in the home needs community nurses themselves to inform the public of their nursing contribution. This will require community nurses not only to articulate the outcomes of their care delivery, but also ensure that other primary care staff, such as GPs and pharmacists, ‘sing their praises’ alongside patients and carers. This is not the time for community nurses to be invisible. BJCN