District nursing assessment practice: case study findings

Patient assessment is widely acknowledged as a core element of community nursing expertise (Griffiths and Luker, 1994). With the current drive towards evidence-based practice, it is becoming increasingly important to provide sound evidence about this key aspect of community nursing practice. This article describes how district nurses' assessments of a carefully constructed simulated patient have provided new insight into community nursing expertise. The innovative approach used in this study of district nursing assessment practice is outlined. One of the simulated patients developed for the study is then described. A case study of one nurse participant who assessed this simulated patient forms the main focus of the article. The case study (one of four) is based on a synthesis of simulation and interview findings relating to a particular study participant. It reveals some interesting associations between various elements of nursing knowledge and provides important insight into how the quality and effectiveness of patient assessment may be affected by a practitioner's approach and knowledge base. The usefulness of this approach and the relevance of the findings for nursing practice and education are also addressed.     

District nursing and the National Health Service reforms:

The challenges to the district nurse's role within the purchaser/provider culture of the National Health Service (NHS) are discussed. The inherent problems of describing community working and the seeming invisibility of what district nurses do is placed in the context of GP fundholding, contracting and commissioning. The paper concludes that district nursing's history of not being involved in policy development and change may lead to it losing aspects of patient care that it is well placed and qualified to deliver.     

District nursing workforce planning: a review of the methods

District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs.     

Loss and bereavement: a nursing response

Nurses often have to support people who have suffered loss and bereavement, through death of a loved-one or other life events. Sue Read explores the issues involved.     

District nursing and social work: palliative and continuing care delivery

The growing number of older people has seen a concomitant increase in the number of people with chronic conditions who require continuing and palliative care increasing the need for the relevant professional groups and organizations to work together. This paper reports on a multiple case study which explores the different ways that district nurses and social workers work in delivering palliative and continuing care. Each professional group operationalized their care differently across five themes: assessment, care delivery, focus of care, place of care and funding of care. The balance between care organization and care delivery needs to be addressed within emerging primary care delivery structures as primary care nursing moves towards case management for long term conditions.