LEAD NURSE EVENT 29/1/09 CENSUS INFORMATION/FEEDBACK

1. LEAD NURSE EVENT 29/1/09 CENSUS INFORMATION/FEEDBACK

2. A National Community Nursing Team Census took place on 24th April 2008. • First fully electronic, national data collection initiative for community nurses • 77% of staff working on census day completed a census return. • This amounts to 3,385 completed returns. • The objectives of the census • Information gap • Support electronic patient record – care summaries and secondary use • An initial report published 25th November 2008. • Further investigations at Health Board and Community Health Partnership (CHP) level to better understand findings within their local context.

3. Results Contacts • The majority of patients were seen individually by District Nursing, with Health Visitors doing more clinics. School Nurses have more patient contacts in the Group setting. • Most patients had a single contact, 23 patients being seen more than 3 times on the same day. • Treatment room nurses most unplanned contacts (1 in 4) with Health Visitors next.

4. Caseloads • Caseload figures indicative only. • District Nursing 99, Health Visiting 272 • Lack of consensus among School Nurses re definition of caseload. • Some staff managing multiple caseloads or covering for another caseload holder or Corporate caseload model in use.

5. Non-Patient Activity • The highest non-patient activity for all disciplines was “other.” • Anecdotally “Other” was used incorrectly by some to record other types of patient activity like writing prescriptions and reports for children’s hearings; • For Treatment Room Nursing and District Nursing there was a high proportion of supply ordering. For Health Visiting and School Nursing there was a high proportion of attending professional meetings.

6. Aim of Care • Nurses were asked to record the main aim of the total care plan for their patient – an unfamiliar concept to many staff • Overall, the highest numbers (almost one third) of individual contacts were for Maintenance care. Prevention is the overall most common care aim for groups and clinics, as opposed to being the second lowest for the individual patient contacts. • Highest aim for District Nurses were Curative and Maintenance - The Health Visitors’ most common care aim was Supportive, Followed by Assessment and Enabling.

7. Intensity of Care • Intensity of care derived from Hall 4, was identified for health visitors, school nurses and family health nurses. The highest was additional followed by core and intense. • It should be noted that Health Board protocols may vary, for example the specific length of time which a family with a new baby is considered to be at the additional level of care, this may explain the high proportion of care at this level.

8. Problems • Individuals, groups and clinics could be assigned a main, second and third nursing problem. Skin / wound care was the highest reported problem category overall. District Nursing and Treatment Room Nursing reporting the highest proportions of problems in this area. • The second most recorded problem overall was Long Term Conditions Management. • Almost half of the problems reported by Treatment Room Nursing were for procedures. • Infant / Child development was the main problem reported for Health Visiting • Health promotion for School Nursing. • Bladder and bowel management, medication management and procedures overall 4th most common problems. • Health visiting teams had issues in allocating “a Problem” where they were carrying out a Health Promotion Activity.

9. Interventions • For this report the problems and interventions were grouped into high level categories, it is these categories which are being reported on. A more detailed breakdown of these categories can be reported on in subsequent reports. Diagnosis • High numbers of Treatment Room Nurses, Health Visitors and School Nurses not recording a diagnosis. Health Visitors and School Nurses in particular, “Not Available” in 80% of the cases compared with 17% for all the other disciplines combined. • Circulatory System Disease was the highest reported diagnosis category overall. • Second Endocrine, Nutritional Metabolic and Immunity Disorders, supporting Long term conditions • Mental Disorders was the main diagnosis reported for Health Visiting and School Nursing. • For Family Health Nursing the main Diagnosis was Neo plasms.

10. Patient’s age, sex and ethnicity • 62% were women and 38% were men. • Extremes for Health Visiting and District Nursing age profiles. Family Health Nurses both ends of spectrum. Treatment room nurses worked across all ages. • The ethnicity profile of the patients close to the profile for Scotland obtained from the General Register office for Scotland statistics.

11. What Next? Report • Identify local champions to assist with information dissemination • Distribute local data to their respective boards (early 09) and support local analysis and interpretation of this in its local context • Discontinue ISD 29/30 Repeat • Refine the web based data capture system and make available for Boards to use more frequently or for specific staff groups • Identify sponsors and resources for any future local or national census initiatives • ? Repeat the National Census on a yearly basis

12. Getting to next step Refine • Progress the development of the International Classification of Nursing Practice Catalogue in partnership with the International Council of Nurses • Review the Dataset to further support other nursing initiatives i.e. NMWWPP • Review the definition of Caseload • Review the usefulness of care aim and terminology for category Nursing problem • Review planned and unplanned definition for clinics and groups • Review categories within non-patient activity