80 likes | 240 Views
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.
E N D
Nursing People at HomeThe 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.