Nursing People at Home The issues, the stories, the actions Gill Allen QN

A paradox? Most people prefer to receive care in their own homes. The government is committed to providing more care outside hospitals. People are living longer – more frail elderly people with complex needs. Decline in number of qualified district nursing staff. Dilution of skill mix – more HCAs and fewer RNs. Reduction in specialist community training places. Increasing work loads.

What’s different about nursing in the patient’s own home? We are their guests? We are on our own? We may not have the ideal kit? – May need to improvise. We may not have the ideal environment – space, light etc. We have to manage the whole situation – not just carry out scheduled tasks.

What matters to patients? Competent – Good knowledge of illness, treatments and support systems. – Treatments etc. carried out well. – Able to coordinate services and manage on-going care. Confident – Speak with authority and certainty. – Trust – information and advice is honest. – Character – proud and professional. Caring for me as a person – Taking time to understand the person. – Showing compassion. – Go the extra mile!

How satisfied are patients? 75% good to excellent. 25% poor to fair. Would we accept this for airline pilots or surgeons? Would we accept it for holidays or restaurants or a new car?

What needs to happen? Think through the practical implications of providing more care for more people with more illnesses in their own homes. Think through the skills and knowledge that people delivering various aspects of nursing care in the home need. – This is not just a registered/non-registered debate. Think through and stick to safe caseloads. Put in the systems which will enable safe high quality home nursing.

Some grounds for optimism GPs may understand “district nursing” better than health service managers. Technology could enable home nursing to be delivered much more efficiently. Could be a very attractive career for nurses who enjoy independence and responsibility. The Francis report may scare politicians and managers sufficiently for them to worry more about care than they do about money!

The future of healthcare? Hospitals are places where people go if they are acutely ill and need short term high tech interventions. Nearly all care and treatment takes place in the home or the community. Maintaining health and well-being is as important as treating illness. Physical health and mental health will not be sharply divided. Every patient with a long-term condition will have a case manager. Community nurses will have a wide skill-set, deep knowledge and the authority to make things happen.