The changing role and critical importance of the DN in the future of community-based health care for...
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![Page 1: The changing role and critical importance of the DN in the future of community-based health care for those with dementia and for the frail elderly LOIS.](https://reader037.fdocuments.us/reader037/viewer/2022110323/56649d875503460f94a6be9e/html5/thumbnails/1.jpg)
The changing role and critical importance of the DN in the future of community-based health care for those with dementia and for the frail
elderly
LOIS SEDDONSenior lecturer University Campus Suffolk With contributions from District Nurse Students:Zoe Thompson and Tracy Schofield
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What We know….
• Access to a flexible and skilled community nursing workforce is increasingly important as the focus of care shifts from hospital to the community.
• Nurses in the community need advanced knowledge and practice skills and skills in advanced specialist practice in complex case management and coordinating care across professional boundaries
• Many nurses already have these skills but this needs to increase along with confidence to practice with greater independence.
(Willis 2015)
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What we know…
‘Dementia is every nurse’s business – with a change in mindset, practice, commissioning and education, nurses can make a real difference to people living with dementia and their carers and families’. (Pauline Watts. 2013, Nursing Professional Officer, Clinical Advisor Public
Health Nursing and DH Nurse Lead for Dementia Care).
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District Nurses and Dementia Care
For a range of reasons District Nurses are in a pivotal position to ensure dementia care is effective.
This is their ‘bread and butter’ work:• Holistic assessment • Managing multiple and complex needs• Care planning in partnership with patients and carers • Delivering and leading sensitive and compassionate expert clinical care• Case management to integrate care• Coordinating collaborative approaches to care • Evaluation of interventions / care • Research
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Training
• Recognition of the impact that District Nursing can have in taking dementia care forward
• Specific skills training for District Nurses in dementia care – assessment / pre diagnosis / post diagnosis / palliative care / end of life care
• Training for District Nurses in using technology
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Commissioning
• Commissioning more District Nurse training• Workload analysis and commissioning to
incorporate dementia care in the role of the District Nurse
• Workload analysis and commissioning to incorporate carers’ assessment and support by District Nurses
• More real integration of health and social care
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Professional development to enhance dementia care in the community
• Facilitate clinical supervision for District Nurses and their teams specifically related to complex care delivery
• Facilitating communities of practice to enhance the District Nurse’s role in joining / leading the development of dementia friendly communities / memory clinics.
• Incorporating a dementia care pathway and its evaluation into the organisations’ governance structure
• Enabling and supporting community based research projects led by District Nurses
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In summary:• District nurses are highly trained in advanced clinical practice and
their specialism is in providing, leading and coordinating care for patients in a domestic setting.
• This places District Nurses in the optimal position to coordinate care for the frail elderly, those with dementia and their families and carers.
• The structure of delivery of community care can impede the potential impact of the District Nurse in this area of care, which means their skills may not be acknowledged.
• Commissioners of care services and workforce training and education need to consider developing a more integrated approach, and investing in the existing expertise of the District Nursing services.
• Professional development for the District Nursing workforce should focus on instilling confidence in assessment and management understanding and responding to dementia
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References and resources• Compassion in Practice:http://www.england.nhs.uk/nursingvision/
• Department of Health Self assessment – The Dementia Challenge:https://www.gov.uk/government/publications/dementia-self-assessment-framework
• Department of Health 2013 – Making a Difference in Dementia Care:https://www.gov.uk/government/publications/making-a-difference-in-dementia-nursing-vision-and-strategy
• Department of Health 2013 Care in local communities: A new vision and model for district nursing. London: Crown:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213363/vision-district-nursing-04012013.pdf
• Health Foundation 2011 Spotlight on Dementia care:http://www.health.org.uk/publications/dementia-care/
• NICE Dementia Guideline:https://www.nice.org.uk/guidance/cg42
• Lord Willis 2015 – Shape of Caring Review:http://hee.nhs.uk/wp-content/blogs.dir/321/files/2015/03/2348-Shape-of-caring-review-FINAL.pdf
• National Voices:http://www.nationalvoices.org.uk/
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• Pauline Watts 2013:https://www.gov.uk/government/news/making-a-difference-to-dementia-nursing-vision-and-strategy-launched
• Queens Nursing Institute (2012) Working with healthcare professionals to increase carer awareness, identification and referral. London: Queens Nursing Institute:
http://www.qni.org.uk/supporting_carers/carers_project_resources
• RCN Dementia resources:http://www.rcn.org.uk/development/practice/dementia