COMMENT
Care closer to home: the role of district nurses
676
T
he reduction of about 40% of district nurses within the last decade, who held the specialist practitioner qualification (SPQ) (Health and Care Information Centre, 2013), raises cause for concern at a time when health policy is moving to care closer to home. Community nursing services and the local populations benefit from skill mix. However, the move in some areas away from employing SPQ district nurses has been at the detriment of quality patient care. For example, a recent King’s Fund report (Imison et al, 2012) identified that the availability of community services and integrated care reduces emergency bed use, and yet 68% of emergency bed days are filled by the over 65s. For nurses working within primary and secondary care there is an opportunity to consider a move into district nursing, where advanced practice can be developed to provide safe quality care for individuals in their own home and avoid patients being admitted to hospital unnecessarily. In order to support the increase in district nursing numbers, it is crucial that nurses across all areas of healthcare delivery understand the complexity and potential of the role. It is acknowledged that people who receive care from the district nursing service at home are generally housebound, either due to ill-health, frailty or loss of mobility, and are reliant on others for their care and often isolated and alone for much of the time. The Queen’s Nursing Institute (QNI) Right Nurse, Right Skills campaign and the Nursing People at Home report (QNI, 2011) set out the need for staff with specialist knowledge and skills, an ability to manage risk, assess complex needs, apply a variety of complex clinical interventions and work across organisations. The Department of Health (DH) (2013) identifies district nurses as key professionals in the delivery of care closer to home. The community nurse development programme confirms that district nurses are ‘qualified nurses with a graduate level education and specialist practitioner qualification recordable with the Nursing and Midwifery Council’ (DH, 2013: 10). District nurses and their community nursing teams are involved in population and caseload management, support and care for patients who are unwell, recovering at home or require end-of-life care, they also provide support and care to promote independence (DH, 2013; Royal College of Nurses (RCN), 2013). These complex areas of care delivery often take place over an ongoing period of time. District nurses are autonomous practitioners who, along with other members of the community nursing team, enable and support individuals to remain in their own home. Their role in ensuring safe, effective quality care, often coordinating complex packages of care across professions and organisations, is valued by the users of
the service (QNI, 2011). A study of 10 district nurses with an average of 15 years experience found that district nurses develop a shared understanding of need with an individual and act as an advocate for both the patient and their informal carers (Ohman and Soderberg, 2004). Putting the patient first and the need for caring, compassionate and considerate nursing, as identified in the Francis Report, is equally applicable in community nursing. For nurses considering a move to community nursing the opportunities are varied. As a staff nurse in a community nursing team, there is an opportunity to develop an understanding of care delivery in the home, promoting self-care, the management of long-term conditions and supporting end-of-life care. The SPQ for district nurses provides an opportunity to further develop advanced practice skills and expertise to deliver tailored care in the home that reflects individual choice and circumstances. The UK Association of District Nurse Educators (ADNE) is committed to raising the profile of district nurses and community nursing teams and is working collaboratively with Wendy Nicholson at the DH and the Queen’s Nursing Institute. The website www.adne.co.uk provides links to relevant publications and organisations involved in community nursing, including prescribing and higher education. At a time when district nurses and community nursing is high on the policy agenda, nurses are encouraged to consider the breadth of opportunities community and district nursing offer BJN for professional and personal development. Department of Health (2013) Care in local communities: a new vision and model for district nursing. http://tinyurl.com/or4zkw3 (accessed 12 June 2013) Imison C, Poteliakhoff E,Thompson J (2012) Older people and emergency bed use: exploring variation. http://tinyurl.com/nef84q6 (accessed 12 June 2013) Ohman M, Soderberg S (2004) District nursing-sharing an understanding by being present. Experiences of encounters with people with serious chronic illness and their close relatives in their homes. J Clin Nurs 13(7): 858–66 NHS Information Centre for Health and Social Care (2013) NHS hospital and community health service (HCHS) workforce statistics in England, nonmedical staff 2002-2012, as at 30th September 2012. http://tinyurl.com/ psxt374 (accessed 12 June 2013) Royal College of Nursing (2013) District nursing. Harnessing the potential: the RCN’s uk position on district nursing. http://tinyurl.com/p4wn5cr (accessed 12 June 2013) Royal College of Nursing (2012) Advanced nurse practitioners: an RCN guide to advanced nursing practice, advanced nurse practitioners and programme accreditation. http://tinyurl.com/24xsm3 (accessed 12 June 2013) The Queen’s Nursing Institute (2011) Nursing People at Home: the Issues, the Stories, the Actions. http://tinyurl.com/cbp9flj (accessed 12 June 2013)
Julie Bliss
Head of Department of Mental Health, Florence Nightingale School of Nursing and Midwifery, King’s College London, Member UK Association of District Nurse Educators
Heather Bain
Lecturer, School of Nursing and Midwifery, Robert Gordon University, Chair UK Association of District Nurse Educators
© 2013 MA Healthcare Ltd
Editorial Board Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Ruhi Behi, Head of School, School of Healthcare Sciences, University of Wales, Bangor Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
British Journal of Nursing, 2013, Vol 22, No 12
British Journal of Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 14, 2015. For personal use only. No other uses without permission. . All rights reserved.
Care closer to home: the role of district nurses
676
T
he reduction of about 40% of district nurses within the last decade, who held the specialist practitioner qualification (SPQ) (Health and Care Information Centre, 2013), raises cause for concern at a time when health policy is moving to care closer to home. Community nursing services and the local populations benefit from skill mix. However, the move in some areas away from employing SPQ district nurses has been at the detriment of quality patient care. For example, a recent King’s Fund report (Imison et al, 2012) identified that the availability of community services and integrated care reduces emergency bed use, and yet 68% of emergency bed days are filled by the over 65s. For nurses working within primary and secondary care there is an opportunity to consider a move into district nursing, where advanced practice can be developed to provide safe quality care for individuals in their own home and avoid patients being admitted to hospital unnecessarily. In order to support the increase in district nursing numbers, it is crucial that nurses across all areas of healthcare delivery understand the complexity and potential of the role. It is acknowledged that people who receive care from the district nursing service at home are generally housebound, either due to ill-health, frailty or loss of mobility, and are reliant on others for their care and often isolated and alone for much of the time. The Queen’s Nursing Institute (QNI) Right Nurse, Right Skills campaign and the Nursing People at Home report (QNI, 2011) set out the need for staff with specialist knowledge and skills, an ability to manage risk, assess complex needs, apply a variety of complex clinical interventions and work across organisations. The Department of Health (DH) (2013) identifies district nurses as key professionals in the delivery of care closer to home. The community nurse development programme confirms that district nurses are ‘qualified nurses with a graduate level education and specialist practitioner qualification recordable with the Nursing and Midwifery Council’ (DH, 2013: 10). District nurses and their community nursing teams are involved in population and caseload management, support and care for patients who are unwell, recovering at home or require end-of-life care, they also provide support and care to promote independence (DH, 2013; Royal College of Nurses (RCN), 2013). These complex areas of care delivery often take place over an ongoing period of time. District nurses are autonomous practitioners who, along with other members of the community nursing team, enable and support individuals to remain in their own home. Their role in ensuring safe, effective quality care, often coordinating complex packages of care across professions and organisations, is valued by the users of
the service (QNI, 2011). A study of 10 district nurses with an average of 15 years experience found that district nurses develop a shared understanding of need with an individual and act as an advocate for both the patient and their informal carers (Ohman and Soderberg, 2004). Putting the patient first and the need for caring, compassionate and considerate nursing, as identified in the Francis Report, is equally applicable in community nursing. For nurses considering a move to community nursing the opportunities are varied. As a staff nurse in a community nursing team, there is an opportunity to develop an understanding of care delivery in the home, promoting self-care, the management of long-term conditions and supporting end-of-life care. The SPQ for district nurses provides an opportunity to further develop advanced practice skills and expertise to deliver tailored care in the home that reflects individual choice and circumstances. The UK Association of District Nurse Educators (ADNE) is committed to raising the profile of district nurses and community nursing teams and is working collaboratively with Wendy Nicholson at the DH and the Queen’s Nursing Institute. The website www.adne.co.uk provides links to relevant publications and organisations involved in community nursing, including prescribing and higher education. At a time when district nurses and community nursing is high on the policy agenda, nurses are encouraged to consider the breadth of opportunities community and district nursing offer BJN for professional and personal development. Department of Health (2013) Care in local communities: a new vision and model for district nursing. http://tinyurl.com/or4zkw3 (accessed 12 June 2013) Imison C, Poteliakhoff E,Thompson J (2012) Older people and emergency bed use: exploring variation. http://tinyurl.com/nef84q6 (accessed 12 June 2013) Ohman M, Soderberg S (2004) District nursing-sharing an understanding by being present. Experiences of encounters with people with serious chronic illness and their close relatives in their homes. J Clin Nurs 13(7): 858–66 NHS Information Centre for Health and Social Care (2013) NHS hospital and community health service (HCHS) workforce statistics in England, nonmedical staff 2002-2012, as at 30th September 2012. http://tinyurl.com/ psxt374 (accessed 12 June 2013) Royal College of Nursing (2013) District nursing. Harnessing the potential: the RCN’s uk position on district nursing. http://tinyurl.com/p4wn5cr (accessed 12 June 2013) Royal College of Nursing (2012) Advanced nurse practitioners: an RCN guide to advanced nursing practice, advanced nurse practitioners and programme accreditation. http://tinyurl.com/24xsm3 (accessed 12 June 2013) The Queen’s Nursing Institute (2011) Nursing People at Home: the Issues, the Stories, the Actions. http://tinyurl.com/cbp9flj (accessed 12 June 2013)
Julie Bliss
Head of Department of Mental Health, Florence Nightingale School of Nursing and Midwifery, King’s College London, Member UK Association of District Nurse Educators
Heather Bain
Lecturer, School of Nursing and Midwifery, Robert Gordon University, Chair UK Association of District Nurse Educators
© 2013 MA Healthcare Ltd
Editorial Board Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Ruhi Behi, Head of School, School of Healthcare Sciences, University of Wales, Bangor Dr Lizzy Bernthal, Research Fellow and lead nursing lecturer, Medical Directorate, Birmingham, Honorary Research Fellow University of Southampton. Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser (U.K) Joy Notter, Professor, Birmingham City University, UK & Saxion University of Applied Science, NL Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Head of School, Nursing, Midwifery and Healthcare, Thames Valley University Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Jo Sharman, Operational Commissioning Manager, University Hospitals Birmingham NHS Foundation Trust John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
British Journal of Nursing, 2013, Vol 22, No 12
British Journal of Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 14, 2015. For personal use only. No other uses without permission. . All rights reserved.
