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District Nurses (district + nurse)
Selected AbstractsContinuing care after cancer treatmentJOURNAL OF ADVANCED NURSING, Issue 2 2003Brian Pateman MA MPhil RN DNT Background. Despite nearly three decades of debate and policy guidance there is evidence that, in the United Kingdom, patient hospital discharge remains problematic. District nurses, who deliver skilled home nursing care, receive referrals from hospitals for continuing nursing care needs. However, district nurses' expectations of appropriate patient referral from hospitals are not always achieved. In an attempt to improve services after hospital discharge, government policy has emphasized partnership between care providers, highlighting the need for smooth transition between care settings. Aim. To explore hospital discharge and referral procedures for patients with cancer, with particular emphasis on referrals made by hospital nurses to district nurses. Method. In-depth interviews were carried out with nurses actively involved in the discharge process as both referrers and recipients of referrals. Twenty nurses from a regional cancer centre and 20 district nurses from three adjacent primary care trusts were interviewed. Interviews were transcribed and analysed thematically, and themes compared between the two care settings. Conclusions. We conclude that competing sets of expectations, not only between hospital and community nursing settings, but amongst district nurses themselves, are a major factor impeding agreement on referral criteria and satisfaction with the referral process. [source] Boundaries and barriers: a history of district nursing management in regional QueenslandJOURNAL OF NURSING MANAGEMENT, Issue 1 2008WENDY MADSEN BA Aim, To explore administrative constraints of district nursing during the latter part of the 20th century in regional Queensland, Australia. Background, A greater understanding of the evolution of district nursing can illuminate why present conditions and circumstances exist. Method, Thirteen interviews undertaken and analysed historically in association with other documentary evidence from the time period 1960,90. Findings, District nursing services of regional Queensland were initially established by voluntary organizations that had very lean budgets. Throughout the study period, government funding became increasingly available, but this coincided with increased regulation of the services. Conclusions, District nurses have worked within considerable boundaries and barriers associated with either a lack of funds or imposed regulations. While greater government funding solved some working conditions, it did so by imposing greater administrative responsibilities on the nurses and services that were not always seen as advantageous for clients or as professionally satisfying for the nurses. [source] STRETCHING DISTRICT NURSING SERVICES TO MEET RURAL NEEDSAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2001Katrina Alford ABSTRACT: This article evaluates the adequacy of District Nursing Service (DNS) provision in the Goulburn Murray region in Victoria. It draws on a survey of the region's DNS and communication with several community health agencies in response to problems identified by service providers. The results suggest that these rural health services face problems not experienced in urban areas. District nurses in rural areas have to travel far and wide to accommodate their clients and they put in extra unpaid hours if necessary. Their travel time, management and communication skills are not sufficiently recognised in the current funding formula. Although this includes some weighting for rurality, it is insufficient for District Nursing Services catering for smaller, more dispersed populations. Current and future demand pressures on home and community-based nursing services highlight the importance of redressing this deficiency. Several issues raised in this article may reflect problems that are common in rural regions, including funding inadequacies, unpaid additional work, access and equity difficulties and boundary issues. As a result, recommendations to improve service delivery may have broader applicability. [source] Family Disruption and Support in Later Life: A Comparative Study Between the United Kingdom and ItalyJOURNAL OF SOCIAL ISSUES, Issue 4 2007Cecilia Tomassini Global population aging has led to considerable disquiet about future support for frail older people; however, the determinants are poorly understood. Moreover, most industrialized societies have witnessed considerable changes in family behavior (e.g., rises in divorce and declining fertility). Such trends may have adversely affected the support systems of older people; nonetheless, only recently has research begun to address this issue. Employing data from the longitudinal British Household Panel Survey (1991,2003) and the 1998 Indagine Multiscopo sulle Famiglie "Famiglia, soggetti sociali e condizione dell'infanzia," we investigated the association between family disruptions due to divorce, separation, or death and three key dimensions of informal support: (i) frequency of contact with unrelated friends (among all respondents aged 65 years and over); (ii) co-residence with children (among unmarried mothers aged 65 years and over); and (iii) regular or frequent help received from children (e.g., household assistance including care) among parents aged 65 years and over. In addition, we conducted a comparative investigation of the relationship between family disruptions and the use of home care services (i.e., health visitor or district nurse; home help; meals-on-wheels) among parents aged 65 years and over. Our findings suggest that in a culture like the U.K.'s, where relations between kin are primarily influenced by individualistic values, support in later life appears to be primarily related to need, whereas in societies with a strong familistic culture (like Italy's), support is received irrespective of the older person's individual characteristics. [source] Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of deathEUROPEAN JOURNAL OF CANCER CARE, Issue 5 2010B. JACK phd, bsc (econ), head of research, scholarship JACK B. & O'BRIEN M. (2010) European Journal of Cancer Care19, 636,642 Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of death Giving patients with cancer a choice in where they want to die including the choice to die at home if they so wish, underpin the recent UK government policies and is embedded in the End of Life Care Programme. However, this presents increasing challenges for the informal carers particularly with an increasingly aging population. Despite the policy initiatives, there remain a persistent number of patients with cancer who had chosen to die at home being admitted to hospital in the last days and hours of life. A qualitative study using two focus group interviews with community nurses (district nurses and community specialist palliative care nurses) was undertaken across two primary care trusts in the north-west of England. Data were analysed using a thematic analysis approach. The results indicated that informal carer burden was a key reason for prompting hospital admission. Recommendations for the development of a carer assessment tool with appropriate supportive interventions are made. [source] Relationships in nurse prescribing in district nursing practice in England: A preliminary investigationINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2005Rick Fisher RGN DNT BA(Hons) MScArticle first published online: 25 APR 200 Nurse prescribing is a significant change in the working lives of district nurses in the United Kingdom. It has been achieved as the result of a 13-year sociopolitical struggle, eventually culminating in an Act of Parliament, which enabled selected nurses to prescribe from a limited formulary. This research attempts to discover the nature of its impact on the relationships between prescribers, nurses, doctors, pharmacists, patients and carers. Using a qualitative approach, guided interviews were carried out with nurses, doctors, pharmacists, patients and carers. Initial findings indicate that far from producing an independent prescribing workforce, some prescribers are reverting to their preprescribing behaviour. For these prescribers, there is a suggestion that old hierarchies are being reinforced, which might be detrimental to nurse prescribing. [source] Continuing care after cancer treatmentJOURNAL OF ADVANCED NURSING, Issue 2 2003Brian Pateman MA MPhil RN DNT Background. Despite nearly three decades of debate and policy guidance there is evidence that, in the United Kingdom, patient hospital discharge remains problematic. District nurses, who deliver skilled home nursing care, receive referrals from hospitals for continuing nursing care needs. However, district nurses' expectations of appropriate patient referral from hospitals are not always achieved. In an attempt to improve services after hospital discharge, government policy has emphasized partnership between care providers, highlighting the need for smooth transition between care settings. Aim. To explore hospital discharge and referral procedures for patients with cancer, with particular emphasis on referrals made by hospital nurses to district nurses. Method. In-depth interviews were carried out with nurses actively involved in the discharge process as both referrers and recipients of referrals. Twenty nurses from a regional cancer centre and 20 district nurses from three adjacent primary care trusts were interviewed. Interviews were transcribed and analysed thematically, and themes compared between the two care settings. Conclusions. We conclude that competing sets of expectations, not only between hospital and community nursing settings, but amongst district nurses themselves, are a major factor impeding agreement on referral criteria and satisfaction with the referral process. [source] Individualized care: its conceptualization and practice within a multiethnic societyJOURNAL OF ADVANCED NURSING, Issue 1 2000Kate Gerrish BNurs MSc PhD RGN RM DN Cert Individualized care: its conceptualization and practice within a multiethnic society This paper reports on the selected findings from a larger ethnographic study of the provision of individualized care by district nurses to patients from different ethnic backgrounds. Undertaken in an English community National Health Service (NHS) Trust serving an ethnically diverse population, the study comprised two stages. First, an organizational profile of the Trust was undertaken in order to analyse the local policy context. Data were collected by means of in-depth interviews with managers and a review of policy documentation and caseload profiles. Second, a participant observational study was undertaken focusing on six district nursing teams. Purposive sampling was used to identify four teams with high minority ethnic caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and field notes were analysed by drawing upon the principles of dimensional analysis. This paper focuses upon aspects of the second stage, namely how the nurses' conceptualized and practised individualized care. Six principles underpinning the philosophy of individualized care expounded by the nurses were identified: respecting individuality; holistic care; focusing on nursing needs; promoting independence; partnership and negotiation of care; and equity and fairness. Each is examined in turn and consideration given to how they were modified in their transformation into practice. Some implications for patients from minority ethnic backgrounds of the nurses' conceptualization and practice of individualized care are discussed. The lack of internal consistency within the nurses' discourse, the impact of policy directives on care delivery and the influence of factors outside the nurses' control, served to illuminate the complexity whereby the ideals of individualized care were adjusted and reworked in the realities of everyday nursing practice. This in turn raised questions about the appropriateness of the current interpretation and practice of individualized care in a multi-ethnic society. [source] The patient's vulnerability, dependence and exposed situation in the discharge process: experiences of district nurses, geriatric nurses and social workersJOURNAL OF CLINICAL NURSING, Issue 10 2006IngBritt Rydeman MSc Aim., The aim of the study was to obtain a deeper understanding of the experiences of the discharge process among different professionals. Background., An optimal discharge process for hospitalized elderly to other forms of care is of crucial importance, especially since health and medical policies encourages shorter hospital stays and increased healthcare service in outpatient care. Methods., Nurses and social workers from inpatient care, outpatient care, municipal care and social services were interviewed. Eight focus-group interviews with a total of 31 persons were conducted. The subsequent analyses followed a phenomenological approach. Results., The findings revealed three themes, Framework, Basic Values and Patient Resources, which influenced the professionals' actions in the discharge process. The overall emerging structure comprised the patient's vulnerability, dependence and exposed situation in the discharge process. Conclusion., In conclusion some factors are of special importance for the co-operation and the actions of professionals involved in the discharge process. Firstly, a distinct and common framework, with conscious and organizationally based values. Secondly the need to take the patient resources into consideration. Together these factors could contribute to secure the patients involvement in the discharge process and to design an optimal, safe and good care. Relevance to clinical practice:, Collaborative approaches among a range of professionals within a variety of organizations are common, especially in the care of the elderly. The role and support of both the organizations and the educational units are decisive factors in this area. [source] A study of nurses' inferences of patients' physical painJOURNAL OF CLINICAL NURSING, Issue 4 2006Benita Wilson BSc Aim., The aim of this study was to establish if postregistration education and clinical experience influence nurses' inferences of patients' physical pain. Background., Pain is a complex, subjective phenomenon making it an experience that is elusive and difficult to define. Evaluation of an individual's pain is the product of a dynamic, interactive process that frequently results in ineffective pain management. Educating nurses should address the deficit, however the clinical environment is thought to be most influential in the acquisition of knowledge. Design., A series of vignettes was used to consider nurses' inferences of physical pain for six hypothetical patients; these were employed within a self-administered questionnaire that also addressed lifestyle factors of patients in pain, general attitudes and beliefs about pain management and general knowledge of pain control. Method., One hundred questionnaires were distributed; 86 nurses returned the questionnaire giving a response rate of 86%. Following selection of the sample 72 nurses participated in the study: 35 hospice/oncology nurses (specialist) and 37 district nurses (general). Data analysis was carried out using SPSS and qualitative analysis of the written responses. Results., The specialist nurses tended to infer lower levels of physical pain than the general nurses when considering the patients in the vignettes. Conclusion., Education and clinical experience influence nurses' knowledge, attitudes and beliefs about pain. However, it would appear that the specialist nurses' working environment and knowledge base engenders a practice theory divide, resulting in desensitization to patients' physical pain. Relevance to clinical practice., It is suggested that the specialist nurses use defence mechanisms to protect them from the conflict that arises from working within the clinical environment. These cognitive strategies have the potential to ease cognitive dissonance for the nurse, but may increase patient suffering. [source] Building the capacity for evidence-based clinical nursing leadership: the role of executive co-coaching and group clinical supervision for quality patient servicesJOURNAL OF NURSING MANAGEMENT, Issue 2 2007BA (Hons), JO ALLEYNE DProf Aim, The general aims of this article were to facilitate primary care nurses (District Nurse Team Leaders) to link management and leadership theories with clinical practice and to improve the quality of the service provided to their patients. The specific aim was to identify, create and evaluate effective processes for collaborative working so that the nurses' capacity for clinical decision-making could be improved. Background, This article, part of a doctoral study on Clinical Leadership in Nursing, has wider application in the workplace of the future where professional standards based on collaboration will be more critical in a world of work that will be increasingly complex and uncertain. This article heralds the type of research and development activities that the nursing and midwifery professions should give premier attention to, particularly given the recent developments within the National Health Service in the United Kingdom. The implications of: Agenda for Change, the Knowledge and Skills Framework, ,Our Health, Our Care, Our Say' and the recent proposals from the article Modernising Nursing Career, to name but a few, are the key influences impacting on and demanding new ways of clinical supervision for nurses and midwives to improve the quality of patient management and services. Method, The overall approach was based on an action research using a collaborative enquiry within a case study. This was facilitated by a process of executive co-coaching for focused group clinical supervision sessions involving six district nurses as co-researchers and two professional doctoral candidates as the main researchers. The enquiry conducted over a period of two and a half years used evidence-based management and leadership interventions to assist the participants to develop ,actionable knowledge'. Group clinical supervision was not practised in this study as a form of ,therapy' but as a focus for the development of actionable knowledge, knowledge needed for effective clinical management and leadership in the workplace. Findings, ,,Management and leadership interventions and approaches have significantly influenced the participants' capacity to improve the quality of services provided to their patients. ,,Using various techniques, tools, methods and frameworks presented at the sessions increased participants' confidence to perform. ,,A structured approach like the Clinical Nursing Leadership Learning and Action Process (CLINLAP) model makes implementing change more practical and manageable within a turbulent care environment. The process of Stakeholder Mapping and Management made getting agreement to do things differently much easier. Generally it is clear that many nurses and midwives, according to the participants, have to carry out management and leadership activities in their day-to-day practice. The traditional boundary between the private, the public and the voluntary sector management is increasingly becoming blurred. Conclusion, It is conclusive that the district nurses on this innovative programme demonstrated how they were making sense of patterns from the past, planning for the future and facilitating the clinical nursing leadership processes today to improve quality patient services tomorrow. Their improved capacity to manage change and lead people was demonstrated, for example, through their questioning attitudes about the dominance of general practitioners. They did this, for example, by initiating and leading case conferences with the multi-disciplinary teams. It became evident from this study that to use group clinical supervision with an executive co-coaching approach for the implementation and to sustain quality service demand that ,good nursing' is accepted as being synonymous with ,good management'. This is the future of ,new nursing'. [source] Leg clubs: A new approach to patient-centred leg ulcer managementNURSING & HEALTH SCIENCES, Issue 3 2000DNCERT, DipHE, Ellie Lindsay BSC(HONS) Abstract Loneliness is a significant health-care issue for many elderly patients in the community. The correlation between social isolation, poor compliance to treatment, and low healing rates for patients suffering from leg ulcers is well documented. Pain, odour, bandages etc. contribute to low self-esteem, depression and social stigma. Home visits by community nurses cannot provide the social and psychological support required by these patients. Responding to the holistic needs of this client group, the author set up Debenham Leg Club in 1995 to provide leg ulcer management in an informal, non-medical setting, where the emphasis is on social interaction, participation, empathy and peer support. This social model was conceived as a unique partnership between the district nurses and the local community, in which patients are empowered, through a sense of ownership, to become stakeholders in their own treatment. The value of the ,club' concept is evident in the happy, welcoming, uninhibited atmosphere that characterizes the clinic. Non-compliance to treatment has been virtually eliminated and evidence of greater healing rates has been illustrated through many patients whose long-standing ulcers have healed or greatly improved as a direct result of this change in approach. Patients' willingness to attend for systematic ,well leg' checks and ongoing health education has dramatically reduced the incidence of recurrence. 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