District Nurses Research Articles

Trends in the primary health care nursing workforce providing diabetes care in Auckland, New Zealand: A cross-sectional survey

AimsTo describe trends from 2006–8 to 2016 in demographic, education and work settings of the primary health care nursing workforce who provide diabetes care in the Auckland region. MethodsA total of 1416 practice, Accident and Medical, district and diabetes specialist nurses were identified who provide community-based care. Of those, 459 were randomly selected and 336 were interviewed in 2016, and were compared with 287 nurses interviewed in 2006–8. ResultsA 73% response rate was attained in 2016. Compared with nurses in 2006–8, primary health care nurses in 2016 were younger, less experienced, more likely to be Asian, undertook more post-graduate education, worked more in Accident and Medical Clinics and worked in larger practices with ≥4 doctors. However, less worked with a dietitian or received visits from specialist nurses compared with nurses in 2006–8. Significantly more nurses in 2016 had their own room for administrative work and the ability to email patients suggesting greater autonomy. ConclusionsMajor demographic, educational and workplace changes have occurred in the Auckland primary health care nursing workforce from 2006–8 to 2016. A significant increase in practice nurses and a large decrease in the number of diabetes specialist nurses were evident, in the Auckland region.

Advocating for end-of-life choice at home: a survey of rural Australian nurses.

Rural healthcare resource limitations can affect the choices people make and their quality of life during its end stages. In rural regions of Australia, district nurses (DNs) working in generalist community roles provide access to care by visiting people in their homes. They may be well positioned to improve the quality of the end-of-life experience by advocating for choice and person-centred end-of-life goals; however, knowledge about care in this context is limited. Initial findings from an exploratory qualitative study describing how rural DNs are able to successfully advocate for the end-of-life choices and goals of people living at home need to be confirmed and further developed to inform clinical practice. This survey aimed to test and complement the findings from a narrative exploration of how DNs advocate successfully for the end-of-life goals of rural Australians. A sequential mixed methods study based on a pragmatic design was used to explore how DNs advocate successfully for the end-of-life goals of rural Australians. In the first phase of the study two stages of reflection on experience by rural DNs from the state of Victoria (N=7) provided written and in-depth narrative understandings of how advocacy is enabled and actioned in the practice context. The data were analysed with interpretive description, resulting in findings that could be used to inform a survey for the second phase. The survey, reported here, was designed as an online questionnaire to be distributed by email across inner and outer regional Australia. It was trialled by rural health professionals (N=13) and modified according to the advice received. The participation criteria for the survey specified registered nurses working in generalist community nursing roles with experience in providing successful end-of-life advocacy for people at home. Scales were used to test and complement the phase 1 findings and analysed using Cronbach's alpha and descriptive statistics, with a 95% confidence interval calculated. Open-ended questions added to complement the understanding of how successful advocacy is enabled and actioned in this context were analysed with descriptive interpretation. A self-selecting sample of nurses (N=91) responded to the survey between March and July 2015. The response came from most Australian states and territories, and confirmed the findings that willing nursing involvement in end-of-life experiences, specialised rural relational knowledge, and feeling supported, together enable nurses to advocate successfully for person-centred goals. Actions based on advocacy that were highly rated for success include holistic assessment, effective end-of-life communication and the organisation of empowering and supportive care, confirming the phase 1 findings. High levels of emotional intelligence, understandings of 'going beyond duty', the types of support used and the need for advocacy for resources were reported. The results provide both confirmatory and new knowledge that can be used with confidence to inform practice with a model for rural end-of-life nursing advocacy in the home setting.

Responding to emotions experienced by patients in palliative care.

The article discusses some important issues to consider when responding to emotions experienced by patients in palliative care. Topics mentioned include the need for health experts to correctly interpret a patient's body language to understand the full extent of what they are feeling, how district nurses can help patients to regulate their emotions to improve their wellbeing, and the importance of being aware that a patient will often be experiencing a range of emotions at any one time.

General practitioners' perceptions of their role and their collaboration with district nurses in wound care.

To explore the perceptions of general practitioners (GPs) regarding their role and their collaboration with district nurses (DNs) in the management of leg ulcers in primary healthcare. Earlier research regarding the treatment of leg ulcers in a primary care context has focussed primarily on wound healing. Less is known about GPs' understandings of their role and their collaboration with DNs in the management of leg ulcers. Since the structured care of patients with leg ulcers involving both GP and DN is currently rather uncommon in Swedish primary care, this study sets out to highlight these aspects from the GP's perspective. Semi-structured individual interviews with 16 GPs including both private and county council run healthcare centres. Thematic analysis was used to analyse the data. Four themes were identified. The first theme: 'role as consultant and coordinator' shows how the GPs perceived their role in wound care. In the second theme: 'responsibility for diagnosis' the GPs' views on responsibility for wound diagnosis is presented. The third theme: 'desire for continuity' is based on the GPs' desire for continuity concerning various aspects. In the fourth theme: 'collaboration within the organisation' the importance of the organisation for collaboration between GPs and DNs is presented. The GP's often work on a consultation-like basis and feel that they become involved late in the patients' wound treatment. This can have negative consequences for the medical diagnosis and, thereby, lead to a prolonged healing time for the patient. Shortcomings regarding collaboration are mainly attributed to organisational factors.

How can a measure improve assessment and management of symptoms and concerns for people with dementia in care homes? A mixed-methods feasibility and process evaluation of IPOS-Dem.

BackgroundAssessment of people with dementia is challenging; with undetected and under treated symptoms and concerns resulting in avoidable distress, and few evidence-based interventions to support this. We aimed to understand the mechanisms of action of a measure to support comprehensive assessment of people with dementia in care homes; and its acceptability, feasibility, and implementation requirements.MethodsA qualitative study with an embedded quantitative component in three residential care homes, underpinned by an initial theoretical model of mechanisms of action. The measure, the Integrated Palliative care Outcome Scale for Dementia (IPOS-Dem), was introduced into the care of residents with dementia for 12 weeks. Qualitative data comprised focus groups and semi-structured interviews with family, care home staff, general practitioners and district nurses; and non-participant observations. Quantitative data comprised IPOS-Dem data. Directed content analysis for qualitative data, and descriptive statistics were used for quantitative data.FindingsKey mechanisms of action were: improved observation and awareness of residents, collaborative assessment, comprehensive ‘picture of the person’, systematic record keeping, improved review and monitoring, care planning and changes to care provision, and facilitated multi-agency communication. Potential benefit included improved symptom management, improved comprehensive care, and increased family empowerment and engagement. IPOS-Dem was found to be acceptable and feasible. It was perceived as quick and easy to use, with proportion of overall missing data decreasing from 2.1% to 1.1% from baseline to final time points. ‘Trust’ in the measure was important; and leadership essential to ensure integration into care processes.ConclusionsIn a population with complex care needs, with challenges to assessment and barriers to multi-agency working, a measure introduced into routine care is feasible and acceptable, and supports assessment and management of symptoms and concerns. A refined theoretical model demonstrating the likely mechanisms of action was developed. Further evaluation is required to test its effectiveness.

District nurses must guard against inappropriately accessing patient records.

Two NHS workers were recently disciplined after inappropriately accessing the records of the singer Ed Sheeran who had required treatment for a fractured wrist and elbow after falling from his bicycle ( Embury-Dennis 2018 ). The increasingly common use of electronic records across the NHS now allows nurses, including district nurses, to access a large archive of patient information that was much more difficult to obtain when records were manually held paper records. There have been several instances where curiosity and, occasionally, more malicious reasons have led district nurses and others to access those records and read the notes of high profile patients or persons known to them. In this article Richard Griffith cautions that district nurses who access and read the record of a person who is not in their care is in breach of both their duty of confidence and the requirements of the General Data Protection Regulation (Regulation 2016/679 EU ).

The role of the district nurse in caring for patients with dementia.

District nurses require a vast array of skills to enable effective care delivery for patients living with a diagnosis of dementia in the community setting. Complex care needs provide challenges for the provision and delivery of district nursing services, which must be overcome to provide patientcentred care. Demographic and financial constraints hamper service delivery and the availability of services; however, district nurses are required to use their problem solving skills and tacit knowledge to deal with these challenges. The Northern Ireland Single Assessment Tool (NISAT) uses a person-centred framework to provide a holistic approach to care. The case study reflects a holistic and person centred approach to care for a person with dementia by a district nursing student.

Where does the real problem lie?

Journal of Wound CareVol. 27, No. 6 EditorialFree AccessWhere does the real problem lie?Rachel WebbRachel WebbSearch for more papers by this authorRachel WebbPublished Online:8 Jun 2018https://doi.org/10.12968/jowc.2018.27.6.353AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail At the end of May I was invited to attend a meeting at the House of Lords (HoL, London, UK) to discuss a National Wound Care Strategy. The event was attended by 50 people with differing interest in the project, including NHS improvement, tissue viability nurses, podiatrists, surgeons, industry, wound care societies and charity representatives and academics. Quite a mixture of people. The meeting was hosted by the Rt Hon. Lord Hunt of Kings Heath and started with a talk from Prof Julian Guest on the burden of wounds,1 who was followed by Margaret Kitching (Chief Nurse North) who gave a overview of how a national wound care strategy was to be created. A summary of the key points made can be found on page 403. However, on reflection I wanted to talk about something that was perhaps not given the significance it deserves.It the meeting it was said that 74% of wounds were managed by district nurses, however, the number of district nurses in England has halved since 2010.2 So most wound are managed by district nurses and the number of district nurses in England has fallen. Neither of these points was given much time at the meeting—although Baroness Watkins did state that 5000 more district nurses would be recruited by 2019. I don't have a full list of participants at the meeting, however I do not believe there were any district, practice and general nurses in attendance, and if so, they didn't offer any comments from their perspectives. It was also unclear as to whether these groups, and in particular district nurses, would be represented on/at any of the boards/workshops/work stream groups which will create a National Wound Care Strategy.Given this, here is my point. The people who manage most wounds should be key to the strategy. It is from those who deal with the most wounds that we can learn why we are failing patients, and what is required to facilitate wound healing. Is it as simple as more resources and better education? Furthermore, as best practice and National Institute for Health and Care Excellence (NICE) guidelines already exist, but are not always adopted, are new pathways created by another set of experts really required, or should we examine what the hurdles are to using the current guidelines. Lack of time/money/education? Before we reinvent a wheel that seems to have been invented many times before, maybe we should look and see why it's not being used in its current form, and while having panels of wound care experts will provide the best and most up-to-date evidence and practice available, this may not be where the problem lies. If the most basic information on wound care is not getting to those who deal with the majority of the wounds whatever else we choose to do may end up being a little pointless.Don't misunderstand me. I think creating a national strategy in England is hugely exciting, important and a great step forward for wound care—or woundology, as one panel member suggested—especially given the predicted increase in the problem. However, this must include input from those who see the majority of wounds so we can clear identify the problems and undertake the appropriate initiatives. References 1 Guest JF, Ayoub N, McIlwraith T et al.. Health economic burden that wounds impose on the National Health Service in the UK. BMJ Open 2015; 5(12):e009283. doi: https://doi.org/10.1136/bmjopen-2015-009283 Crossref, Medline, Google Scholar2 Hughes D. District nurse numbers under pressure. BBC http://www.bbc.co.uk/news/health-41974736. 20 Nov 2017 (accessed 31 May 2018) Google Scholar FiguresReferencesRelatedDetails 2 June 2018Volume 27Issue 6ISSN (print): 0969-0700ISSN (online): 2052-2916 Metrics History Published online 8 June 2018 Published in print 2 June 2018 Information© MA Healthcare LimitedPDF download

The development of a district nursing caseload review tool.

District Nursing (DN) caseloads are increasingly unwieldy. ( Queen's Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient's needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.

The development of a district nursing caseload review tool.

District Nursing (DN) caseloads are increasingly unwieldy. ( Queen's Nursing Institute, 2016 ). They can also be difficult to manage due to the unpredictability and increasing complexity of the patient's needs. It is an essential component of DN teams that caseloads are reviewed on a regular basis to support the delivery of efficient, effective and safe patient care. This article illustrates how a caseload review tool was developed, which would standardise the process in all teams, analyse and monitor the outcomes, identify any trends and themes and give assurance that DN caseloads were productive and safe. The testing, piloting and evaluation of the DN caseload review tool was over a period of 12 months and included 35 DN teams across the Trust. The method used was standardised and systematic, in order to ensure that the results were consistent across the pilot site. It also allowed for standardised challenges to be made by the reviewers, ensuring that the process was efficient and meaningful, the outcomes measured and documented and the clinical systems updated appropriately. Results from the initial reviews have been positive. They have produced both qualitative and quantitative data, which has supported further development of the tool. In addition, actions and outcomes identified for individual patients have been documented and addressed, where possible, at local level. A governance process is in place which supports unaddressed challenges, themes and trends. The conclusion of the pilot has confirmed that this process is valid and will continue to be used within the organisation.

Do not attempt resuscitation orders in primary care settings.

A Do Not Attempt Resuscitation notice (DNACPR) is an important mechanism for avoiding inappropriate CRP attempts, and protects district nurses and others from allegations of ill treatment or wilful neglect. The DNACPR notice must be discussed with the patient or their relatives, before placed on file ( Tracey v Cambridge Uni Hospital NHS Foundation Trust and others [2014] ; Winspear v City Hospitals Sunderland NHSFT [2015] ). In this article Richard Griffith set out the steps district nurses must take to ensure that a DNACPR notice is lawful.

Do not attempt resuscitation orders in primary care settings.

A Do Not Attempt Resuscitation notice (DNACPR) is an important mechanism for avoiding inappropriate CRP attempts, and protects district nurses and others from allegations of ill treatment or wilful neglect. The DNACPR notice must be discussed with the patient or their relatives, before placed on file ( Tracey v Cambridge Uni Hospital NHS Foundation Trust and others [2014] ; Winspear v City Hospitals Sunderland NHSFT [2015] ). In this article Richard Griffith set out the steps district nurses must take to ensure that a DNACPR notice is lawful.

Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study

Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives.ObjectivesWhat is the impact of...

More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England.

ObjectivesMany countries seek to improve care for people with chronic conditions and increase delivery of care outside of hospitals, including in the home. Despite these policy objectives in the United Kingdom, the home visiting nursing service workforce, known as district nursing, is declining. This study aimed to investigate the factors influencing the development of district nursing workforces in a metropolitan area of England.MethodsA qualitative study in a metropolitan area of three million residents in diverse socio-economic communities using semi-structured interviews with a purposive sample of senior nurses in provider and commissioning organizations. Thematic analysis was framed by theories of workforce development.Findings: All participants reported that the context for the district nursing service was one of major reorganizations in the face of wider National Health Service changes and financial pressures. The analysis identified five themes that can be seen to impact the ways in which the district nursing workforce was developed. These were: the challenge of recruitment and retention, a changing case-mix of patients and the requirement for different clinical skills, the growth of specialist home visiting nursing services and its impact on generalist nursing, the capacity of the district nursing service to meet growing demand, and the influence of the short-term service commissioning process on the need for long-term workforce development.ConclusionThere is an apparent paradox between health policies which promote more care within and closer to home and the reported decline in district nursing services. Using the lens of workforce development theory, an explanatory framework was offered with factors such as the nature of the nursing labour market, human resource practices, career advancement opportunities as well as the contractual context and the economic environment.

Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers: A modified Delphi consensus study.

To provide national consensus on the range of conditions community practitioner nurse prescribers manage and for which it is considered important that they can prescribe. Around 35,000 community practitioner nurse prescribers in the United Kingdom are able to prescribe from a limited formulary. Although prescribing is a key role for these nurses, there has been a decline in the numbers of community practitioner nurse prescribers who prescribe. It is evident that changing patterns of client and service delivery, changes the role of community nurses and the conditions they manage, however, little is known about the conditions community practitioner nurse prescribers manage. A modified Delphi approach comprising three on-line surveys delivered to a national Expert Panelof 89 qualified community practitioner prescribers. Data collection took place between January-March 2017. Panelists reached a consensus, with consistent high levels of agreement reached, on nineteen conditions for which it is believed community practitioner nurse prescribers should be able to prescribe. Conditions identified by school nurses (N=12) and health visitors (N=7) were mainly acutely focused, whereas those identified by district nurses (N=9) and community staff nurses (N=6) included both long-term and acute conditions. Given the high degree of consensus, this list of conditions should influence any decisions about the items community and public health nurses should be able to prescribe. The findings should also influence the education and training of these nurses.

District nursing renascent as Wales adopts safe staffing levels.

This article reflects on the history of the NHS in Wales and how this has led to its current structure. How this structure supports integrated working across primary, community and secondary care and how further integration with social care is moving forward and its direct effects on district nursing are explored. This article describes how district nursing is meeting these challenges. Support for district nurses as part of integrated multiprofessional teams is being developed to promote appropriately staffed teams centred on meeting the requirements of people within a designated area and ensuring that home is the best and first place of care.

Recruiting the next generation: applying a values-based approach to recruitment

The qualified district nurse (DN) role demands high levels of leadership. Attracting the right candidates to apply for the Specialist Practice Qualification District Nursing (SPQDN) education programme is essential to ensure fitness to practice on qualification. Anecdotal evidence suggested that the traditional panel interview discouraged candidates from applying and a need to improve the quality of the overall interview process was identified by the authors. The University of Central Lancashire in partnership with Lancashire Care NHS Foundation Trust adopted the National Values Based Recruitment (VBR) Framework to select candidates to gain entry onto the SPQDN course. This involved using 'selection centres' of varying activities including a multiple mini interview, written exercise, group discussion, and portfolio review with scores attached to each centre. The ultimate aim of utilising VBR was to align personal and profession values to both the nursing profession and the Trust whilst allowing a fairer assessment process. An evaluation of the VBR recruitment process demonstrated 100% pass rate for the course and 100% satisfaction with the interview process reported by all 16 candidates over three academic years. Interviewer feedback showed deeper insight into the candidates' skills and values aligned with the core values and skills required by future District Nurse leaders within the Trust.

Best interest meetings.

Best interests is the standard by which the law judges the propriety of care and treatment for adults who lack decision making capacity. The Mental Capacity Act 2005 Code of Practice argues that the best way to decide on a person's best interests is through a multidisciplinary best interests meeting to enable all views, including those of the patient and their carers to be properly considered. In this article Richard Griffith considers the conduct of a best interest meeting and the role of district nurses in those meetings.

Put resources into district nursing and reduce strain on the NHS.

British Journal of Community NursingVol. 23, No. 4 CommentPut resources into district nursing and reduce strain on the NHSAlistair QuaileAlistair QuaileSearch for more papers by this authorAlistair QuailePublished Online:10 Apr 2018https://doi.org/10.12968/bjcn.2018.23.4.186AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Christie and Co. Adult social care 2017: funding, staffing and the bed blocking challenge. Edinburgh: Christie and Co; 2017 Google ScholarGreen MA, Dorling D, Minton J, Pickett KE. Could the rise in mortality rates since 2015 be explained by changes in the number of delayed discharges of NHS patients? J Epidemiol Community Health. 2017;71(11):1068–1071. https://doi.org/https://doi.org/10.1136/jech-2017-209403 Medline, Google ScholarHealth Education England. HEE commissioning and investment plan 2016–17. Leicester: Health Education England; 2016 Google ScholarHobbs R, Bankhead C, Mukhtar T et al.. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. Lancet. 2016;387(10035):2323–2330. https://doi.org/https://doi.org/10.1016/S0140-6736(16)00620-6 Crossref, Medline, Google ScholarKing's Fund, Nuffield Trust, Health Foundation. Autumn budget 2017: what it means for health and social care. London: King's Fund; 2017 Google ScholarMaybin J, Charles A, Honeyman M. Understanding quality in district nurses services: Learning from patients, carers and staff. London: King's Fund; 2016 Google ScholarNHS Digital. NHS workforce statistics in England, non-medical staff: 2004–2014, as at 30 September. Leeds: NHS Digital; 2015 Google ScholarNHS Digital. NHS workforce statistics, September 2017, provisional statistics. Leeds: NHS Digital; 2017 Google ScholarNHS Digital. PHE weekly national influenza report: summary of UK surveillance of influenza and other seasonal respiratory illnesses. 15 February 2018—week 07 report (up to week 06 data). Leeds: NHS Digital; 2018 Google ScholarNHS England. Five year forward view. Leeds: NHS England; 2014 Google ScholarNHS England. Bed availability and occupancy data—overnight. NHS organisations in England, Quarter 2, 2017–18. Leeds: NHS England; 2017 Google ScholarQueen's Nursing Institute. Report on district nurse education in the United Kingdom 2015–16. London: QNI; 2017 Google ScholarRobertson R, Wenzel L, Thompson J, Charles A. Understanding NHS financial pressures: How are they affecting patient care? London: the King's Fund; 2017 Google Scholar FiguresReferencesRelatedDetails 2 April 2018Volume 23Issue 4ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 10 April 2018 Published in print 2 April 2018 Information© MA Healthcare LimitedPDF download

A guide to community mental health law for district nurses: the right to aftercare.

District nurses frequently provide physical care and treatment to patients in their own homes and care homes who have previously been detained under the Mental Health Act 1983 for the treatment of a mental illness. Such patients are commonly subject to community provisions of the Mental Health Act 1983 and it is important that districts nurses are aware of the implications of these provisions on the patients care and support. In this article the author considers a detained mental health patient's right to aftercare under the Mental Health Act 1983, section 117.