A global approach to promoting research and evidence-based practice for community nurses.

Community health nurses world-wide provide health promotion and preventative care, support and guidance as well as clinical care for people with long-term conditions or needing acute care at home and end-of-life care, across all age groups. The importance of health care in the community has been growing globally as health systems recognise both the economic and human need for people to remain in their communities rather than in hospital. Research in community nursing provides evidence to support policy, practice and education. This article describes the global contribution that the International Collaboration for Community Health Nursing makes towards disseminating evidence that could improve the lives and health of communities.

Community-based homecare nursing in Denmark: exploring factors related to substitution of nurses by ancillary health professionals.

BACKGROUND: Demographic changes and shorter hospital stays have made community-based homecare nursing an increasingly important part of the healthcare organisation. This development may also impact the secondary healthcare system. Optimal use of resources is key to meeting the future challenges. Nevertheless, the research-based knowledge on homecare nursing is scarce. The aim of this study was to examine factors related to homecare nursing tasks that could have been performed by ancillary health professionals. METHODS: A population-based survey involving all homecare nurses in the homecare services in one municipality in Denmark was performed. The nurses registered all contacts during daytime for one week using a registration form with a series of items to identify factors related to possible substitution of nurse-performed tasks. Statistical analyses were used to identify associations between specific factors and potential substitution of the performing type of healthcare professional. The study was approved by and is registered at VIA University College in accordance with the General Data Protection Regulation of the EU. RESULTS: Homecare nurses registered 941 representative visits in the municipality. Substitution by ancillary health professionals was considered a possibility by the nurses in 28.3% of the cases. When adjusting for age, gender, type of visit, need for extra healthcare services and vulnerability, we established that the nurses more often found that ancillary health professionals could have provided the care in unplanned visits and in visits to patients above 90 years of age. CONCLUSIONS: The results indicate potential for optimising the available nursing resources as substitution by ancillary health professionals was considered possible in numerous visits. In view of the increasing demands for community-based homecare nursing, it is important to make the most of the available resources in the future. Substitution of nurses for some tasks could be a feasible solution.

Population health management and its relevance to community nurses.

Local services can provide better and more joined-up care for patients when different organisations work collaboratively in an integrated system. Population health management (PHM) provides the shared data about local people's current and future health and wellbeing needs. Joint care planning and support addresses both the psychological and physical needs of an individual recognising the huge overlap between mental and physical wellbeing. Joint posts and joint organisational development are likely to become more commonplace and community nurses will have a vital contribution to planning and delivery of integrated care to improve health and care outcomes for their local populations.

Caseload management: a district nursing challenge.

The district nurse is accountable for the standard of nursing care that is delivered by the team they lead. One of the key challenges in ensuring the provision of a high standard of care is effective caseload management, and caseload management is a core component of the district nursing role. This article highlights the strategic drivers behind community care, outlines the challenges that impact effective caseload management and discusses why effective caseload management is significant in the delivery of community care. It also explores the delegation of workload, triaging referrals, caseload analysis and clinical supervision as methods that the district nurse can use to overcome and manage the challenges that caseload management can present.

Employers' duty of care to district nursing team members: health and safety concerns with lone domiciliary visits.

District nurses and their teams often work in isolation during domiciliary visits. As employers, providers of district nursing services have responsibility to ensure that appropriate policies and procedures are in place to keep district nursing teams safe. If the employer fails to do everything that was reasonable in the circumstances to keep the employee safe, the employer can be deemed to have breached their duty of care. Employees also have responsibility for their own health and wellbeing at work, and they are entitled by law to refuse to undertake work that is not safe, without fear of disciplinary action. Staff training in risk management, personal safety, handling aggressive behaviour, using safety devices such as mobile phone trackers, incident reporting and debriefing are essential for district nurses and their teams, as they face a steeply increased demand for their services and a severely compromised skill mix within their teams.

Community palliative care clinical nurse specialists as independent prescribers: part 2.

This study explored the lived experiences of clinical nurse specialists who can prescribe independently in their role of providing support to patients with palliative care needs within the community. Part 1 of this study examined how the study was carried out; this second part explores the findings. The nurses reported that being able to prescribe enabled them to provide seamless, holistic care, which gave patients faster access to medicines, especially at weekends when their GP was unavailable. Prompt availability of medicines led to effective symptom control and consequently a better quality of life for patients. The main barrier to prescribing was difficulty in accessing patient records. Independent prescribing by community nurse specialists is beneficial for patients receiving palliative care and their families while they are being cared for at home, and provides job satisfaction for the nurses.

Caseload profiling in district nursing: a systematic literature review.

This systematic literature review aims to identify and appraise current evidence to establish if caseload profiling (CP) provides a strategy to support district nurses to evidence and manage increasingly complex caseloads. A total of 17 studies where thematically synthesised and recurrent themes were identified and summarised under the headings of: defining caseload profiling; caseload profiling in the context of caseload management; workload analysis and its relationship to caseload profiling; potential impact of caseload profiling; and potential barriers to caseload profiling. The literature review showed CP is a robust method of articulating the complexity of care and practitioners could use it to help manage their own caseloads. However, the literature is mainly founded on expert opinion and further research is needed to strengthen the validity of the evidence.

District nurses now less likely to face prosecution for gross negligence manslaughter.

In this article the author discusses the Court of Appeal decision in R v Rose [2017] that redefines the threshold for prosecution for gross negligence manslaughter. The impact on district nurses will be that they are unlikely to face prosecution where a careless error contributed to a patient's death unless there was a serious and obvious risk of death at the time the error was made.

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.

Implications of the Working Time Regulations on district nurse practice.

In this article Richard Griffith considers the impact of two recent developments, in case law from the European Court of Justice and a professional misconduct from the nursing and midwifery council, on the application of the Working Time Regulations 1998.

Supporting pre-registration nurses within health visiting and school nursing.

During the Health Visitor Implementation Plan (DH, 2011), health visiting teams were flooded with high numbers of health visitor students and, as a result, preregistration student nurse placements for both health visitor and school nurse placements were reduced or temporarily suspended until its conclusion in 2015. Since then, pre-registration placements within health visiting and school nursing have been reactivated, and pre-registration students are once again able to join the clinical learning environment of specialist community public health nursing (SCPHN). The reintroduction of student nurses to some clinical areas and firsttime introduction in others has generated questions from health visitors and school nurses about pre-registration nurses and their learning needs. This article aims to answer some of the queries we have encountered about developing the quality of the practice learning environment, so that student nurses' development is supported in accordance with the NMC Standards for pre-registration nursing education (NMC, 2010). This article may provide the opportunity for professional development, reflection and learning that can contribute towards revalidation.

Caseload management methods for use within district nursing teams: a literature review.

Effective and efficient caseload management requires extensive skills to ensure that patients receive the right care by the right person at the right time. District nursing caseloads are continually increasing in size and complexity, which requires specialist district nursing knowledge and skills. This article reviews the literature related to caseload management with the aim of identifying the most effective method for district nursing teams. The findings from this review are that there are different styles and methods of caseload management. The literature review was unable to identify a single validated tool or method, but identified themes for implementing effective caseload management, specifically caseload analysis; workload measurement; work allocation; service and practice development and workforce planning. This review also identified some areas for further research.

Reviewing education challenges and solutions for health professionals in community care.

The biggest asset of the NHS is its staff. Health professionals working in the community are faced with a number of challenges to maintain and develop their knowledge and skills in their clinical practice. NHS England's Five Year Forward View describes the need for change, identifying the necessity to reshape care delivery, harnessing technology, and driving down variations in quality and safety of care. This article explores some of the challenges faced by community health-care providers and reviews possible solutions to meet community health-care needs for now as well as the future.

Developing a dependency and capacity staffing tool.

Policy drivers to move care out of hospital and into the community also emphasise the need to ensure resources are used effectively. However, there is a paucity of information and processes to support successful management of demand and capacity in community nursing services. With the current emphasis on achieving safe staffing, a solution had to be developed in Solihull that can assess the anticipated demand in terms of individual patient needs, to inform the required nursing capacity on a day-to-day basis. This article describes how involving staff helped create an effective dependency and capacity tool operated through the clinical recording system.

Using a complex audit tool to measure workload, staffing and quality in district nursing.

This major community, workload, staffing and quality study is thought to be the most comprehensive community staffing project in England. It involved over 400 staff from 46 teams in 6 localities and is unique because it ties community staffing activity to workload and quality. Scotland was used to benchmark since the same evidence-based Safer Nursing Care Tool methodology developed by the second-named author was used (apart from quality) and took into account population and geographical similarities. The data collection method tested quality standards, acuity, dependency and nursing interventions by looking at caseloads, staff activity and service quality and funded, actual, temporary and recommended staffing. Key findings showed that 4 out of 6 localities had a heavy workload index that stretched staffing numbers and time spent with patients. The acuity and dependency of patients leaned heavily towards the most dependent and acute categories requiring more face-to-face care. Some areas across the localities had high levels of temporary staff, which affected quality and increased cost. Skill and competency shortages meant that a small number of staff had to travel significantly across the county to deliver complex care to some patients.

Enabling the health and wellbeing of carers through district nursing support.

Carers provide care because they want to help the people they care about, and because their care recipient could not manage without them. For many carers, looking after their own health, combining caring with work, getting access to training or having time off can be a major challenge. Patients' and carers' experiences of home-based care are a key factor in the appraisal of the quality of the professional care services they receive. This article presents the evidence from a literature review that builds a substantial body of knowledge to inform district nursing teams and community nurses to develop a supportive approach towards carers' needs. The aim of the study was to appraise the published evidence base relating to carers' needs and how professionals can support carers' needs when providing care to patients in the community. The studies consistently reported carers' requirements of practical support and information as a theme across studies, suggesting that effective ways of delivering information and support to caregivers need to be developed and implemented as a matter of priority. It also highlighted the needs of the professionals providing support to carers, to ensure the health and wellbeing needs of carers, to include signposting and referral to avoid reaching crisis point and resultant burnout.

World War I remembered with reference to district nurses.

World War I is remembered for the appalling loss of life, but it also heralded major social and political change which included wider opportunities for women and, later, universal suffrage. World War I also formed the context for the emergence of the 1919 Nurses' Registration Act. District nurses (Queen's Nurses) undertook a range of roles during the war, including roles overseas as members of the military nursing services. Like nurses, they had their work supplemented by Voluntary Aid Detachments. This article discusses the war from the perspective of the district nursing profession.