District Nursing at a Glance E-Book

Matthew Bradby

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Wiley Series on Cognitive Dynamic Systems
• Sprache: Englisch

Seitenzahl: 422

Veröffentlichungsjahr: 2022

Beschreibung

District Nursing at a Glance is the perfect study and revision guide for students and qualified nurses alike, providing a concise yet thorough overview of community care and its implications for nursing practice. A new addition to the market-leading at a Glance series, this dynamic and highly visual resource covers a wide range of fundamental topics, from the historical and theoretical background of district nursing to practical information on prescribing, mental health, home assessment, pain management, end of life care, and much more. Beautifully illustrated throughout, this portable and accessible guide:

• Provides a clear picture of delivering care in a patient’s own home and addresses many contemporary and emerging aspects of practice
• Covers stroke, cancer, diabetes, epilepsy, chemotherapy, and other common diseases suffered by patients in the community setting
• Offers up-to-date information and advice on evidence-based practice, educational pathways, and career development
• Discusses the use of mobile technology to support professional practice of caring for patients in their homes
• Includes summary boxes, key points, full references, links to online resources, and recommendations for practice to improve the learning experience

District Nursing at a Glance is a must-have revision guide and reference for pre-registration nursing students, particularly those in community clinical placements, post-registration students on district nursing courses, and newly qualified district nurses and healthcare assistants.

Leseprobe

District Nursing at a Glance

Edited by

Matthew Bradby

The Queen's Nursing Institute

1A Henrietta Place

London, UK

This edition first published 2022© 2022 John Wiley & Sons Ltd

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The right of Matthew Bradby to be identified as the author of the editorial material in this work has been asserted in accordance with law.

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Library of Congress Cataloging‐in‐Publication Data

Names: Bradby, Matthew, editor.Title: District nursing at a glance / Matthew Bradby.Other titles: At a glance series (Oxford, England)Description: Hoboken, NJ: Wiley‐Blackwell 2022. | Series: At a glance | Includes bibliographical references and index.Identifiers: LCCN 2021028067 (print) | LCCN 2021028068 (ebook) | ISBN 9781119023418 (paperback) | ISBN 9781119023425 (adobe pdf) | ISBN 9781119023456 (epub)Subjects: MESH: Community Health Nursing | United KingdomClassification: LCC RT98 (print) | LCC RT98 (ebook) | NLM WY 106 | DDC 610.73/43–dc23LC record available at https://lccn.loc.gov/2021028067LC ebook record available at https://lccn.loc.gov/2021028068

Cover Design: WileyCover Image: Courtesy of The Queen’s Nursing Institute

This book is dedicated to Alison Burton Shepherd, Queen’s Nurse (1965–2020).

Preface

The nurses who have written the chapters of this book are Queen’s Nurses. The title of Queen’s Nurse was reintroduced by the Queen’s Nursing Institute in 2007 as a way of recognising the excellence of community nursing practice in England, Wales and Northern Ireland, the three countries where the charity operates. The title has also subsequently been reintroduced north of the border by the Queen’s Nursing Institute Scotland. Today there are over 1700 Queen’s Nurses in every community specialism, not just district nursing.

This book is divided into six main parts, preceded by an introductory section.

Part 1 Introduction aims to give the reader an introduction to the heritage of the district nursing profession and also to the charity, the Queen’s Nursing Institute, which has been indelibly associated with the profession for over 130 years.

Part 2 The learning environment gives the reader an introduction to the framework of district nurse education at the present time, although this framework continues to evolve and develop at a rapid pace.

Part 3 Working in the community focuses on the district nursing team, on the systems and ethics that guide its successful working, and on the place of the individual within that team.

Part 4 Caring for the whole person in the community looks at the people district nurses will meet in their professional life as they carry out visits in their local community. It looks at the whole person, as a member of a family, of a culture and a community. That person may have carers, who may be friends or family members, or support workers. We have tried to use the word ‘person’ rather than ‘patient’; for people living with one or more long‐term conditions; they may not view themselves as a patient when they are being cared for at home, but they are all people whose quality of life is made significantly better by the support of a district nurse. Often it is this support that enables the person to live at home and avoid admission to hospital or residential care; in this role the nurse is both a vital support to the individual and their family and also a hugely important part of the whole health and social care system.

Part 5 Physical and mental health in the community looks at a whole range of physical and mental health conditions that are commonly encountered by district nurses during the course of their work. The conditions covered in the book are not meant to be exhaustive but are indicative of the kind of long‐term conditions that require an in‐depth knowledge of the person and careful case management of their condition. The skilled district nurse will have the ability, working in partnership with the person she cares for, to progress and improve their health. He or she will also be one of the most important sources of emotional and psychological support to the person and their family.

Part 6 Specialisms in the community explores some of the other specialisms that district nurses will encounter during their work. Again, this is not meant to be an exhaustive list but an introduction to some of the other specialisms that are employed by healthcare providers and voluntary organisations. This links back to Part 3 and the importance of collaborative working, drawing on the skills of the most suitably qualified professionals to deliver enhanced care to people in need.

Additional sources of information

Some of the chapters contain links to additional sources of information and a final chapter gives a list of References and further reading.

Acknowledgements

The editor would like to thank the staff of The Queen’s Nursing Institute for their support and encouragement, in particular Dr Crystal Oldman CBE, Dr Agnes Fanning and Joanna Sagnella, QNI Publications Manager, who produced many of the illustrations in this book, and QNI interns Joanna Boughtflower, William Carter, Olivia Hicks, Alice Knapton and Chloe McCallum for their valuable assistance.

The editor would also like to thank Hallam Medical, Malinko, Kate Stanworth, Mark Hakansson, Harriet Stuart‐Jones and the editorial staff at Wiley.

Queen’s Nurses are supported by funding from the National Garden Scheme, a national charity that opens private gardens to raise money for nursing and caring charities. Since 1927 the garden scheme has raised millions of pounds for healthcare in the community.

Introduction to District Nursing

A District Nurse is a specialist generalist nurse in the community, an expert who is accountable at an advanced level of practice.

The District Nurse serves a whole community, holding and being responsible for a large and varied caseload of people with complex health needs, and managing admission to and discharge from that caseload. They are responsible for autonomous clinical decision‐making, deploying a team of regulated and unregulated staff to deliver care in peoples’ homes, and leading all the nursing care required. A community staff nurse is one of the nurses working under the direction of the District Nurse. District Nurses work above all in people’s homes and may give support to staff working in Nursing and Residential Homes too.

A qualified District Nurse is prepared for their role with a post‐registration Specialist Practitioner Qualification in District Nursing (SPQ DN) at a Higher Education Institution. These post‐registration programmes are currently approved and regulated by the Nursing and Midwifery Council (NMC) to ensure consistency and quality of standards for education and practice and to prepare nurses for the role of an autonomous practitioner.

Specialist Practitioner Qualifications are also available in Community Children’s Nursing (CCN), Community Learning Disabilities Nursing (CLDN), Community Mental Health Nursing (CMHN), and General Practice Nursing (GPN), and the NMC is consulting on additional qualifications for other community specialisms (2021).

This book describes some of the most important parts of a District Nurses’ role. It is not intended as an exhaustive or comprehensive list of everything that a District Nurse might be called upon to do, which is always changing and developing. The Covid‐19 pandemic has changed the landscape of nursing in the community profoundly and rapidly, and District Nurses are now caring for many people who are recovering from this novel disease.

The landscape of health services in the United Kingdom is also changing, and there is growing variation between England, Wales, Scotland, and Northern Ireland. Healthcare policy demands that more care is delivered in people’s homes and communities and a greater reliance on self‐care and the prevention of ill‐health, lessening people’s dependence on hospital services.

It is an exciting time to be a District Nurse, working with people, carers, and families across the life course, helping them to maintain health and independence, in communities in every part of the UK.

Part 1Introduction

Chapters

1

The early history of district nursing

2

History of the Queen’s Nursing Institute

1The early history of district nursing

Matthew Bradby

Figure 1.1Cartoon of Queen’s Nurses in 1918.

Figure 1.2Queen’s Nurse with a bicycle, c. 1900.

Figure 1.3The celebrated midwife’s case, 1925.

Figure 1.4Queen’s Nurses magazine advert, 1913.

Figure 1.5Ground floor plan of a district nurse’s cottage, 1945.

Figure 1.6Architect’s design for a district nurse’s cottage, 1945.

The district nursing movement started in Victorian England in the mid nineteenth century. The Victorian period was characterised by rapidly growing cities, where many people lived in extremely poor, cramped conditions. Malnutrition and unclean water supplies contributed to severe and regular outbreaks of contagious diseases, such as cholera, typhus and tuberculosis, which were the mass killers of the period. District nursing as an organised movement began when William Rathbone (1819–1902), a wealthy Liverpool merchant and philanthropist, employed a nurse, Mary Robinson, to care for his wife at home during her final illness. In May 1859 William Rathbone’s wife died, and he later wrote:

it occurred to me to engage Mrs. Robinson, her nurse, to go into one of the poorest districts of Liverpool and try, in nursing the poor, to relieve suffering and to teach them the rules of health and comfort. I furnished her with the medical comforts necessary, but after a month’s experience she came to me crying and said that she could not bear any longer the misery she saw. I asked her to continue the work until the end of her engagement with me (which was three months), and at the end of that time, she came back saying that the amount of misery she could relieve was so satisfactory that nothing would induce her to go back to private nursing, if I were willing to continue the work (Hardy, 1981).

William Rathbone decided to try to extend the service started with Mary Robinson, but soon found that there was a lack of trained nurses and that nurse training was disorganised and very variable in quality. In 1860, he wrote to Florence Nightingale, who advised him to create a nurse training school and home for nurses attached to the Liverpool Royal Infirmary and, with typical Victorian organisation and energy, this was built by May 1863.

For district nursing purposes, the city was divided into 18 ‘districts’, each made up of a group of parishes. Each district was under the charge of a Lady Superintendent drawn from a wealthy family. The system was non‐sectarian, though local ministers were encouraged to become involved. Liverpool was not alone in experiencing poverty and ill health and district nursing associations soon spread to other industrial cities – Manchester in 1864, Derby in 1865, Leicester in 1867, and London in 1868. The Victorian district nursing movement was characterised by several long running debates, which had their roots in views about social class and the role of working women. It took time, experimentation and organisation for the training of district nurses to become established. This coincided with an era of great advances in medical science and new ideas about the emancipation of women into paid occupations (Figures 1.1 and 1.2).

District nurses had to work hard to gain the confidence and trust of poorer families, for whom home nursing was a novelty: extended families were used to caring for their own relatives, but lacked the knowledge to do this effectively. Much attention was given to ‘putting the patient’s room in nursing order’, with reference to hygiene, ventilation and light. Nurses also educated people about the danger posed by flies and other pests. First aid and emergency interventions were also part of district nursing work. In the days before disposables, all equipment had to be sterilised in the home, either by boiling on a stove or heating in an oven. Used dressings were burned on the household fire (Figures 1.3 and 1.4).

The first nurses’ homes were rented flats or cottages, but by the 1930s dedicated nurses’ homes were being designed and built all over the country. These often included a ‘district room’ where a nurse could see patients, as well as stores for medical supplies and a garage (Figures 1.5 and 1.6). The earliest district nurses either walked to visit their patients or used a pony and trap. In the early twentieth century, bicycles were widely adopted, replaced in turn by motor scooters and small cars. In rural areas, where doctors were often remote, nurses were given additional responsibility. Many district nurses were trained as midwives and, after 1920, as health visitors too.

At least until the 1950s most district nurses were single women, living in nurses’ homes provided by local nursing associations. The nursing associations also employed the nurses in the days before the NHS; salaries were funded by donations and subscriptions. Nurses often had to collect fees from their patients, something that many nurses found very uncomfortable. From 1948, district nurses were employed first by local authorities and then by community healthcare organisations that have continued to evolve as part of the NHS ever since.

Post‐1948, in the early years of the NHS, much district nursing work involved combating infectious diseases such as tuberculosis, as well as caring for people with diabetes, cancer, bronchitis, or mental illness, and people who were disabled through accident or other cause. End‐of‐life care and wound care was very important, as was the coordination of other services. Modern district nursing has continued to evolve to meet the needs of people in their own homes, leading and coordinating the work of the multidisciplinary team. Today, as specialist practitioners, district nurses play a vital role to play in enabling people to live in greater comfort in their own homes, preventing unnecessary suffering and distress and promoting independence.

2History of the Queen’s Nursing Institute

Matthew Bradby

Figure 2.1 Insignia of Queen Victoria’s Jubilee Institute for Nurses, 1887.

Source: Queen’s Nursing Institute.

Figure 2.2 Queen’s Nurse’s Outdoor Uniform, 1905.

Source: Queen’s Nursing Institute.

Figure 2.3 Uniform hat for Queen’s Nurses, 1913.

Source: Queen’s Nursing Institute.

Figure 2.4 Queen’s Nursing Institute badge for Jamaican nurses.

Source: Queen’s Nursing Institute.

Figure 2.5 Queen’s Nurse’s indoor uniform, 1943.

Source: Queen’s Nursing Institute.

Figure 2.6 Queen’s Institute of District Nursing logo, 1928.

Source: Queen’s Nursing Institute.

Figure 2.7 Queen’s Nursing Institute logo, 1973.

Source: Queen’s Nursing Institute.

Figure 2.8Modern Queen’s Nurse badge. Source: Queen’s Nursing Institute.

The Queen’s Nursing Institute is a registered charity, created to organise the training of district nurses in the UK. It traces its origins to 1887 with a grant of £70,000 by Queen Victoria and a Royal Charter in 1889 named it Queen Victoria’s Jubilee Institute for Nurses. Its original objectives were the ‘training, support, maintenance of women to act as nurses for the sick poor and the establishment … of a home or homes for nurses and generally the promotion and provision of improved means of nursing the sick poor.’ William Rathbone, who had pioneered the concept of district nursing in 1859, and Florence Nightingale were closely involved in the creation of the new charity. Queen Victoria was the charity’s first Patron in a tradition that has continued to the present day: Her Majesty Queen Elizabeth II became Patron in 2002.

District nurses who undertook the Institute’s training and passed its examination were called Queen’s Nurses and were entitled to wear the badge and insignia of the Institute (Figures 2.1–2.3). Early training contained a broad range of subjects, including sanitary reform, health education, ventilation, water supply, diet, infectious diseases, sexual health, and the feeding and care of newborn infants (in this period, infant mortality was around 154 per 1000 live births). Queen’s Nurses began visiting schools in London when it was realised that school children suffered from a wide variety of ailments made worse by lack of treatment – a key milestone in the development of modern school nursing.

The Institute’s Council – its governing body – laid down the ‘Conditions of Affiliation’ for district nursing associations, the local charities that employed nurses until 1948. These conditions included the qualifications required of Queen’s Nurses, including training at an approved hospital or infirmary for at least a year; approved training in district nursing for at least six months; training in nursing of mothers and infants after childbirth (subsequently, this contributed to the development of the health visitor profession). Nurses in country districts also had to have three months’ training in midwifery. Nursing was carried out under the direction of medical practitioners, and services were confined to the poor, ‘while not excluding cases of such patients as are able to make some small contribution.’ Nurses were ‘strictly forbidden to interfere in any way with the religious opinions of patients or members of their families’.

The idea of district nursing spread rapidly in areas of British colonialism and other regions overseas. The Victorian Order of Nurses for Canada was founded in 1897, while in Australia the ‘Bush’ Nursing Association was founded in 1911. In the United States, the Boston district nursing association was founded in 1886 and the National Organisation for Public Health Nursing by 1912. The King Edward VII Order of Nurses was founded in South Africa in 1913. European countries also experimented with the district nursing model. In many cases, trained district nurses from Britain and Ireland helped to staff these overseas organisations. In 1909 the Jubilee Congress of District Nursing was held in Liverpool, attended by delegates from all over the world. District nursing had become an international movement.

After the Second World War, the Institute helped arrange for 50 Greek women to come to Britain for nurse training. In 1955, 41 Queen’s Nurses were appointed to posts abroad. The January 1958 Queen’s Nurses’ magazine listed overseas district nursing services that had started in Malta (1946), Jamaica (1957) (Figure 2.4), Singapore (1956), Nigeria (1954), Tanganyika (1957) and Kenya (1956) in collaboration with authorities in those countries. Nurses from those countries came to the Institute for training, some returning home and others staying in the UK. Delegations came from France, Brazil, Turkey, India, Greece and Finland to find out more about the administration and training of district nurses in Britain.

In 1948 the NHS began operating and the employment of district nurses fell to local authorities. Local district nursing organisations no longer had a purpose and quickly ceased to exist; however over 50 accredited training centres training 700 nurses a year were still affiliated to the Institute (Figure 2.5). The Institute finally ceased to offer full training for district nurses in 1968 when the qualification was absorbed into higher education, and the title of Queen’s Nurse lapsed.

The charity was renamed the Queen’s Institute of District Nursing in 1928 (Figure 2.6) and the Queen’s Nursing Institute (QNI) in 1973 (Figure 2.7). Today the QNI operates in England, Wales and Northern Ireland. The Queen’s Nursing Institute Scotland (QNIS) is a separate charity with its headquarters in Edinburgh. The Queen’s Institute of District Nursing in Ireland is an affiliated charity in the Republic of Ireland.

The title of Queen’s Nurse (QN) was reintroduced in 2007 as a means of reinforcing the professional identity of community nurses. Today the QN title is no longer restricted to district nurses: any nurse who has worked in the community for 5 years is eligible to apply (Figure 2.8). The Institute also offers educational bursaries, awards, professional development and financial assistance to nurses in need. The charity also works to influence healthcare policy, supports innovation and practice development, undertakes research, publishes reports on community nursing practice and holds regular educational events, including an annual conference and general meeting for all Queen’s Nurses.

Part 2The learning environment

Chapters

3

Preparation for a learning environment in the community

4

Providing student placements in the community

5

Supporting nursing students in the community

6

Mentorship and preceptorship

3Preparation for a learning environment in the community

Shirley Willis, QN

Figure 3.1The three pillars supporting learning within the community setting.

Figure 3.2Individual learning styles.

Figure 3.3Quality in community education.

Table 3.1Elements contributing to effective clinical supervisor–student relationships.

Clinical placement supervisor

Student

Identify expectations

Professional approach

Set boundaries

Dedicated time for the student

Competence and experience

Credible role model

Questioning

Facilitates learning

Realistic expectations

Professional approach

Willingness and commitment

Reflective learner

Self‐awareness

Understands own learning needs

Questioning

Caring for patients within their home environment, which could be a private house or a residential or nursing home setting, provides the nursing student with a number of unique learning opportunities. In preparing to learn within this very diverse and often challenging setting, it may be helpful to begin by considering the learning opportunities in terms of the skills that the student may be able to develop:

Communication skills

: Talking to patients, family members, carers and other health professionals in an environment where the nurse is the ‘visitor’.

Observational skills

: Recognising the challenges that the patient may face in achieving concordance with any identified plan of care.

Consultation skills

: History taking and information gathering in order to inform the development of a care plan. It is important to consider the limitations of the environment and the absence of many of the structures and support services that may be taken for granted within the acute healthcare setting in order to inform the plan.

Presentation skills

: Presenting information both formally and informally in a manner that can be understood by the particular audience and is appropriate to the setting.

Flexibility, adaptability and competency skills

: Being able to carry out skills competently and effectively whilst adapting to the challenges of the environment.

Evaluation skills

: Considering outcomes of care in terms of the patient themselves, the delivery of the service in this setting, and in relation to the organisation’s objectives and targets.

Although these skills are all transferable to other healthcare settings, learning within the community setting allows the practitioner to really develop these ‘generalist’ skills towards a more ‘specialist’ level, with clear benefits to patient care.

In order to be able to take full advantage of these learning opportunities, preparing to learn within this generalist/specialist arena will pay dividends in terms of both personal and professional development. Preparation for practice could be considered from a number of different perspectives relating to the individual student, the environment of care, and the clinical staff working in the practice area (Figure 3.1).

Individual learning

For the individual student, preparing to learn within the community setting may be guided by asking a number of questions:

What are my personal learning and development needs at this point in time?

What is my own learning style (

Figure 3.2

)?

What do I understand by the term ‘community’?

What are my expectations of the community setting as an environment for learning?

What knowledge/skills/experience can I bring to the community setting to enhance and maximise my learning experience?

In answering these questions it may be helpful to use a structured framework, such as the Strengths/Weaknesses/Opportunities/Concerns approach, to guide your decision‐making.

The environment of care

It could be argued that any care environment that is clinically effective will also be an effective learning environment. However, a conscious effort is required in order to ensure that a clinical setting provides both students and practitioners with a safe and worthwhile learning experience. In ensuring quality within the learning environment it is helpful to consider the structure, process, and outcome of the learning experience (Figure 3.3).