This essay will discuss how community nursing can enhance the care given to service users and their carers’. It will discuss key terms such as the community nurse, the population group and how community nursing will enhance their care. Statistics will be used to support the findings. The essay will look into the shift to community care from the hospital and the role of the district nurse within this. This will be supported with political decisions and policies. This essay will discuss the role of the community nurse in providing health promotion for the service users and carers.
A description of a carer, their role within the community care services and how a nurse/patient therapeutic relationship can develop and benefit the service user. This essay will also focus on the district nurse as part of the community nursing team. Northern Ireland is an ageing society. Since the early 1930’s those aged over 65 has more than doubled, therefore making a fifth of the population over 60. People over 80 are set to increase by almost half and those over 90 will double by 2025. Older people continue to have a greater need for social care services.
As a result most of the social care resources are directed at their needs (DoH, 2001). “Old age and older people” are terms that are used every day and define a particular period in an individual’s lifetime. A definition of old age requires more than a physical outlook; even though “old” can be described as certain physical changes in life. Within society people aging may be considered as becoming more problematic for nurses. However, in reality this doesn’t necessarily have to be the case as older people are defined by the state retirement age of 65 (Pickering and Thompson).
This was argued by the DOH 2001 as they stated, societal attitudes have changed in previous years and retirement is now not considered as a preparation for decline. As a result of this, health services have had to adjust their approach to the elderly (DoH, 2001). This population group is important to define as it will be the focus population in this essay. In Northern Ireland those aged between 65 and 80 remain more independent than those aged older, however they do use more Health and Social care services than those of younger age.
In addition it is when they are over the age of 80 the demand for these services rapidly increases (DoH, 2001). According to WHO 1974, community is the people of a district or country considered collectively, especially in the context of social values and responsibilities. According to the Royal College of Nursing in 2010 (RCN), the work of a community nurse can be defined as promoting health, healing, growth and development, prevention and treatment of disease, illness, injury and disability to a variety of people. They will enable people to achieve, maintain or recover their independence where possible.
They will also minimise distress, while promoting quality of life where independence is not possible (RCN, 2010). The Community Nursing Team is an umbrella term for the team of nurses that work in the community, such as the health visitor, district nurse, community midwife and other specialist nurses such as the diabetic nurse. There are also care managers who assess patients both financially and for their care needs (RCN,2010). Within the community nursing team is the district nurse. The role of the district nurse involves assessing, organising and delivering care to support people living in their own homes.
The majority of people cared for tend to be of the older population. A district nurse provides one of the few 24 hour services in primary care for an often vulnerable, house bound population (Audit commission, 1999). The key purpose in providing community care services is to allow people to continue living in their own home and to retain as much freedom as possible while avoiding social isolation. Care needs can be difficult to gauge and the provision of these needs also involves matching the patient’s expectation, finances available and those persons willing to do the job (Sines, et al).
The district nurse will recognise the needs of the patient and refer them to the appropriate persons to meet their needs (Chilton et al) Older people are no different to anyone else in society they wish to enjoy good health while remaining independent as long as they possibly can. Their independence will often depend on the services provided for their health and social care, and the effectiveness of these services (DoH, 2001). According to the DOH, 2004 they estimate that there are 170,000 older people receiving personal care at home from their local council, therefore the role of the district nurse is crucial to provide the necessary health and social care for those who remain in their own home. Much of the focus of this care is promoting independence and early intervention in order to prevent a person from requiring long-term care in hospital. DOH 2012 stated, ‘Greater integration of Health Care has led to improved care processes, more satisfied staff and reduced use of hospitals. The study carried out by the DOH (2012), revealed that hospital care was needed less for elderly patients at risk of hospital admissions when their care was co-ordinated by a care manager and community nursing team.
Across a person’s lifetime the district nurses work in various surroundings, of which they provide primary nursing and health care. The nurse’s role has begun to shift in recent years. Governments are aiming for the transition of patients out of the hospital and into a community environment and by directing more attention to the provision of disease recovery nursing care (RCN, 2011) Furthermore, the community nurse’s role has developed additional emphasis on the delivery of primary intervention measures to avoid exacerbations or problems for patients living with chronic illness.
Therefore (re)admission to hospital could be preventable (RCN, 2010). The nursing role has also significantly changed as the nurse is now involved in policy making and prescribing medications which was generally done by doctors (Courtenay 2000). McGregor (2008) noted the important role of the nurse in the implementation in the NHS plan (2000). The nurse’s role was expanded to, “Provide more secondary care in community settings,” while delivering 24 hour care across a variety of services.
In addition to the NHS plan came the NHS improvement plan. This introduced community matrons, this is a highly skilled nursing role, using case management; that managed and supported older people with long term conditions to remain at home for longer (DOH 2004a). This role however is known as a care manager within the Northern Ireland Health Service. It is often not a nurse carrying out this role, however the responsibilities remain similar. While district nursing mainly cares for elderly people.
District nurses therefore must be aware of the health and social needs for the area they are working in to deliver their care to older people in order to meet their needs and ensure that this group does not become socially isolated (Rawlinson 2012 et al in Chilton 2012 et al). According to the Nursing and Midwifery Council 2009 (NMC 2009) guidelines there are three main elements to provide safe and effective ways to provide care to the elderly; these are people, process and place. When referring to people it is considering the district nurse who is delivering this care by being competent, assertive and empathetic.
Process can be defined as delivering quality care. This care should promote the dignity of the older person by promoting self-respect and worth. This would be done by effective communication, assessment of needs, respect for privacy and dignity and working in partnership which the carers and multi-disciplinary team. Place can be considered as the diverse environment in the community where the care is provided to the older person. These environments must be committed to equality and diversity, resourced adequately and appropriate to the needs of the elderly person, while being effectively managed.
The National service Framework for older people came into existence in 2001 and is a comprehensive strategy with the purpose of ensuring fair, high quality intergraded health and social care services for older people (DoH, 2001). This was welcomed by the RCN who suggested that when put into practice it would support their existing gerontological nursing programme, currently carried out by the district nurse and make a major contribution towards the improvement of health and social wellbeing of older people (RCN and BGS, 2001).
The district nurse must be fully aware of the support that is available to the older person and impart this information in an appropriate way, “Being person centred requires the formation of therapeutic relationships between professionals, patients/clients and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge”. (McCormick and McCance, 2006). Peplau’s 1952 theory of nursing emphasised the importance of the nurse/patient relationship.
The aim of the theory is that the nurse will use therapeutic communication skills to provide a sense of wellbeing for patients by ensuring that they feel not only relaxed but also secure. Person centred care enables this as trust and rapport will established between the nurse, patient and carers. Due to changes in social policy and the fact that people are living longer as a result of improvements in public health and medical advances, there is now an increasing demand for community care services.
As older people are major users of care services within the community and those of the age of 65 is projected to rise to around 858,000 by the end of 2012. This further increasing the demand on these services (Bliss, 2006) Carers provide unpaid care by looking after an ill, frail or disabled family member, friend or partner. Carers can be defined by The Carers and Direct Payments Act NI 2002 as: ‘an individual, aged 16 or over, who provides or intends to provide a substantial amount of care on a regular basis’. Furthermore this care must be provided on an informal basis (NI Direct Government Services, 2009).
All carers including family and friends play a key role within the community health environment, not only supporting the older person but also the community nurse (Bliss, 2005). The DOH 2008 highlights that 1 in 10 people in Britain are carers, in addition they outline that 6000 people per day take on new caring responsibilities. District nurses play an important role in supporting carers and recognise the inextricable link between the welfare of the patient and the carer; that is if one deteriorates the other will inevitably be affected.
The district nurse recognises and addresses the needs of both the patient and the carer and in doing so protects the physical and mental health of both. The district nurse is in a distinctive position where they can monitor the carers’ situation and in doing so anticipate or avert a crisis (Bliss, 2005). This saves the NHS from the work as well as the costs involved in health deterioration and crisis intervention; therefore making economic sense. Carers save the economy ? 57 billion annually, and it is said that having carers can be likened to having a second NHS (Martin 2007). Within the role of the district nurse is the responsibility to help carers realise their rights and there is also a duty to encourage the carer to seek assessment and other sources of help (Henwood 1998). These assessments can prevent physical and mental deterioration of the carer, as the carers can feel social isolation, hit financial hardship and let their own health issue decline (Haire 2004).
The white paper, Our Health, Our Care, Our Say (DOH 2006), is intended to bring a new deal for carers and make it easier to access the help that they need, including support in the form of help lines and information services, respite services and funding for training. In 2002 Carers & Direct Payments Act NI came into force to provide carers the lawful right to an assessment, it affords the trusts the control to offer services to carers, make direct payments accessible to more people, place a duty to inform on HSC boards and trusts and finally recognise
children adversely affected by caring as ‘children in need’ under the Children Order (Ni Direct Government Services, 2009).. In Northern Ireland the establishment of the new public health agency, health and social care board and the patient client care council came about in 2009, because there was a need to improve health and wellbeing of people in Northern Ireland. These agencies decided that they needed to be more proactive and work towards to being able to anticipate and prevent health and social care problems as supposed to reacting to them. (Public Health Agency, 2012).
The community nurse will be the first contact provider of care and will manage diseases and offer preventable services where possible (Rawlinson et al in Chilton et al). The district nurse also has to promote health to the elderly. The World Health Organisation 1984 defines health promotion as, “The process of enabling people to increase control over and to improve their health”. Within health promotion district nurses also have to divide health promotion into three segments to be able to give appropriate care and advice to their patients and carers.
These are primary, secondary and tertiary health promotion (Scriven, 2010). Primary health promotion based on caring for the person rather than the disease, therefore ill-health can be prevented in the healthy person and thus promoting a better quality of life (Scriven, 2010). Primary health promotion is provided by a multi-disciplinary team, within which the district nurse is one of the professionals. The multi-disciplinary approach has been a key reason for primary health promotion to be positioned in the community.
The role of the district nurse is both preventative and supportive, for example educating and supporting patient on healthy eating to prevent illnesses. The district nurse must also be responsive, flexible and adaptable as well as proactive in managing long and short term patients (Rawlinson et al, 2012 in Chilton et al 2012). Secondary health promotion is when a person already has an illness. Secondary health promotion aims to prevent the illness turning into chronic or irreversible decline in health (Scriven, 2010).
The role of the district nurse is to educate the patient in their own illness for example teaching a patient about their diabetes and how to administer the correct dose of insulin or managing their diet to reverse this illness. Subsequently enabling the patient to become experts in their own health and promote self-care and self-help (Rawlinson et al, 2012 in Chilton et al 2012). When the patient has ill-health that could not have been prevented or completely cured, is when tertiary health promotion comes into action (Shriven, 2010).
The district nurse’s role within this health promotion is to educate patients and carers to make the most of their remaining healthy life, while preventing any further complications. By doing this the district nurse would have to educate the patient and the carer on the illness, examples of this are educating patients and potential carers on Alzheimer’s , and making them aware of potential complications of this disease (Rawlinson et al, 2012 in Chilton et al 2012). In conclusion this discussion outlines the effect that community nursing has on the Health and Social care for older people.
The ageing society has enforced the need for an updated health and social care sector. If the system and delivery of health and social care did not adapt to changes in the needs and requirements of the community then to cope with the extra need. Community nurses are ideally positioned to help challenge this They communicate and mediate with hospitals, health and social care professionals, patients and carers. Furthermore with the use of therapeutic relationships and health promotion, the community nursing team will provide more effective and positive care service, not only to the patient but to the caregiver also.