From the patient perspective
When District/Community Nurses visit people at home we’re often met with the comment ‘oh another new face’. This is unsettling and frustrating for people (having to retell their story) and makes it hard for us to identify when things are changing for someone, especially when they are deteriorating quickly. If a person needs visits twice weekly and the team is ten strong them they could see a new nurse every visit for five weeks, this does happen and is difficult to avoid when caseloads are large.
As pressures in the community setting have increased, teams have tried to work more effectively, such as allocating one person a geographic area to cover. This sometimes diminishes the quality of the care delivered to people in their own homes.
Positive steps
After digesting the Compassion in Practice and Francis report documents 2013, we started using a named nursing system in one of our teams to support continuity of care and encourage more defined responsibility of co-ordination of care for people on our caseload. This was an informal system of using a white board in the office. Named nurses have responsibilities for planning and evaluating care as well as communication across other services, for example attending MDT meetings or consulting specialists.
We still use this system within the team for the most complex care but there have been problems with keeping it at the forefront of planning care as it is not on the electronic system. One example of how continuity has worked was a lady with bilateral, circumferential leg ulcers and diabetes. She needed daily visits from Community Nurses to change bandages and dressings, she struggled with following advice due to the restrictions it placed on her lifestyle; tensions were high, she was in a negative cycle.
Through continuity of care we built a trusting relationship, involved family and other healthcare professionals (GP and GPN) to assist us in a co-ordinated approach in helping her manage things in a way that promoted her health and wellbeing. She gradually became more mobile, we shared care with GPNs when she could get to the surgery, she was better able to understand diabetes, she felt able to elevate her legs, her ulcers improved and although not always completely healed she is often without ulcers, much more independent and not needing home visits.
Nurses enjoy working like this because they see good results for patients, can develop their expertise and exercise pro-active care.
What next
We’re in the process of getting assistance from clinical systems, enabling a function on the electronic system that will allow us to see named nurses, prioritising continuity of care. This information will be available to other professionals using the system giving a point of contact. It will also be possible to see lists of patients/nurses for the team which is essential for supervision of care, and for this view to be historical so not lost when rubbed off the board. We plan to roll out across Dorset.