About

District Nursing

District Nursing is an evolving service which is highly responsive to changing needs and the challenges of providing high quality individualised care and services within the community setting.

District Nursing has a long history that predates the National Health Service. Current debates in health care policy and practice could be seen as questioning the fundamental nature of District Nursing practice.

There may be room for debate around the title of ‘District Nurse’ but in relation to the future role… “There exists a clear vision and a determination that the district nurse of the future shall deliver a flexible, high quality and forward thinking service that works in partnership with diverse communities to place the patient at the centre of care delivery”. (Boran and Clarridge 2005, p145).

District Nurses are accountable for the care and care planning for individuals and carers with a range of needs including the management of those with complex care needs. In addition to holistic needs assessment and the skilled care of individuals, District Nurses undertake service review and health needs assessment with the aim of coordinating or influencing the development of services.

With good communication and advocacy skills, District Nurses are able to act or speak on behalf of those individuals who are often least able to be involved in influencing service delivery (individuals who are house bound).

The roots of District Nursing as one of the first of the caring professions have been retained in order to provide high quality, holistic care of individuals in the community setting.

What Is District Nursing?

When asked what it means to be a District Nurse, a range of views are expressed by the public, patients, District Nurses themselves and by the students of District Nursing

Please find below some definitions provided by the group of District Nursing students (2009-10) at one University:

“District nurses have many roles. They undertake complex patient assessments which help to reduce/shorten hospital admissions. They are responsible for managing teams of staff and delegating work according to skill mix. As well as providing nursing care to patients in their own homes they provide health education and promote healthy lifestyles and work closely with other members of the MDT to facilitate care packages. They are frontline workers responding to the needs of the community.”

“To me, District Nursing is an art and the district nurse is the artist. We meet people in different colour phases of their lives, be it the black times or the shady times, we meet them when they are stuck in that abstract phase. As the artist we help them to understand those colours, and hopefully bring them, and their families out of the abstract and into the clear. We are the ones who arrange the colours on the palette, because we are the ones at the heart of the community. We are the ones who provide the light in the darkness, the ones who give direction to the flow of colour. What we need to do as a group is keep our images sharp and focused and not let those images be dulled by those who think they know best.

I know this is different to what other people have written but I feel District Nursing is more than just learning skills and knowledge, it is something that is inherent in us all, otherwise we would not be on this (District Nursing) course.”

“The district nurses’ role is pivotal in providing nursing care to patients in the community that have a diverse range of conditions.  Fundamental aspects of this role are health promotion, illness prevention, patient and carer support and empowerment. The DN should be an innovative leader, with the ability to undertake complex patient assessments and have a commitment to delivering excellence.”

“A District nurse is the one who is relied upon to bring “order to the chaos” and to at least make people feel better. They are a conduit between Healthcare and the masses. District nurses Care”

“District Nurses are senior nurses who manage care within the community, leading teams of community nurses and support workers. Typically much of their work involves visiting house-bound patients to provide advice and care. Examples include: palliative care, wound management, catheter and continence care and medication support. They may be trained to assess patient’s needs for equipment provision such as mobility and independent living aids, medical equipment such as specialist beds and mattresses, as well as guidance in applying for grants and welfare benefits. Their work involves both follow-up care for recently discharged hospital inpatients and longer term care for chronically ill patients who may be referred by many other services, as well as working collaboratively with general practitioners in preventing unnecessary or avoidable hospital admissions.

District nurses provide nursing care that allows people to remain in their own homes, maintain their independence, or have additional support after discharge from hospital. As well as treatment, a district nurse can offer advice and support with health concerns.”

“District nurses are seen as pivotal in the assessment of individual needs as well as displaying leadership skills within nursing teams and in liaising with multi-disciplines”

“The role of the District nurse would be difficult to define in a sentence or paragraph due to be it being highly complex and varied. With each role and responsibility they have comes with a whole new field of additional roles and responsibilities. Take for example the ‘Educational role / facilitator’. They are responsible for the education of self, students, colleagues within team, patients and relatives alike as well as any significant others i.e Multi-discplinary teams. A further example is the management role. Management of team, caseload, budget, resources etc.”

The question “What is a District Nurse?” has been answered so well by my colleagues that I have decided to look at it from a different angle. I asked my sons the question-they replied:  “A nurse who goes round visiting people at home doing whatever nurses do!”

This led me to think of what patients would say-the term “angel “, or things such as “couldn’t manage without them” or “Have you come to wash me?” or “they want me to change the way I’ve always done things!” are phrases that spring to mind.

Hospital staff may define us as carrying out their role at home, but also as people who have time to “pop in” Some GPs see us as valuable members of the MDT, whilst others prefer to communicate electronically rather than seeing you face to face.

My PCT has moved to not use the word “District Nurse” any more. The terms community nurses, intervention team lead, case manager and complex case manager are the new role descriptors. Interestingly enough we have been told that Case Managers don’t necessarily even have to be District Nurses-a Social worker could do the job! This obviously provides definite food for thought. To me District Nursing means being able to do do my job to the best of my ability, having hopefully, but not always, more time to offer holistic care without the constraints present in a hospital environment.

“District nurses have many roles. They undertake complex patient assessments which help to reduce / shorten hospital admissions. They are responsible for managing teams of staff and delegating work according to skill mix. As well as providing nursing care to patients in their own homes they provide health education and promote healthy lifestyles and work closely with other members of the MDT to facilitate care packages. They are frontline workers responding to the needs of the community.”

“What is District Nursing? Could the answer be to provide a ‘service’ which is both effective and efficient? Effective in that every intervention achieves the aim / desired outcome in the best, most appropriate and focused manner. Efficient in that the intervention achieves the aim/desired outcome in the shortest time and in the most cost effective way.

Efficient is added because of budget limitation. The more efficient a service we can offer, the greater the number of patients we can serve and a greater variety of products we can supply. Defining the ‘service’ is like defining beauty; it’s in the eye of the beholder. It is driven by many people with many goals, attitudes and ideas.

Politicians who want to please / appease voters, in order to stay in power. Academics that have theoretical ideas. Medical staff that see nurses as a labour force to undertake menial tasks, “to be seen but not heard” and managers who try to co-ordinate an ever changing organisation.”

“In my Trust we are now a business but I would also like to think that we are always striving to make our practice safer and more effective… carrying out holistic assessments aiming to provide the highest quality individualised care possible and promoting independence and education.”

“District nursing has evolved through many different social, political and cultural transitions. Despite this the vocation has retained a complex of core principles that provide the foundation on which community nursing has stood for 150 years.

The district nurse is a dynamic individual that responds swiftly; with knowledge, decision and humility to the needs of the community of which she is integral.”