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Matthew Bradby. District Nursing at a Glance
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
District Nursing at a Glance
Preface
Additional sources of information
Acknowledgements
Introduction to District Nursing
Part 1 Introduction. Chapters
1 The early history of district nursing
2 History of the Queen’s Nursing Institute
Part 2 The learning environment. Chapters
3 Preparation for a learning environment in the community
Individual learning
The environment of care
Clinical staff
4 Providing student placements in the community
5 Supporting nursing students in the community
Box 5.1 Examples of clinical skill experiences students may undertake during their community placement
Box 5.2 Members of the multidisciplinary team that students may meet or work with during their community placement
Year 1 placement
Fundamentals of nursing
Experience the patient‐centred care approach
Challenging situations
Communication
Incident management
Health promotion
Year 2
Year 3
6 Mentorship and preceptorship
Preceptorship
Mentorship
Part 3 Working in the community. Chapters
7 The role of the district nurse: autonomous practice
Novice to expert
Autonomous practice
Physical examination and prescribing
Summary
8 Evidence‐based practice
Box 8.1 Useful evidence‐based resources to access. Systematic evidence review websites
Journals and books
Online database searches
Evidence‐based guidance
Evidence‐based mobile apps
Limitations in practice
Accessing resources
What constitutes good evidence?
9 Communication
Family and carers
Mobile technology
10 Initial assessment and collaborative working
The multidisciplinary team
Assessment and referral
The third sector and carers
11 Safer caseloads: service planning and caseload allocation
Box 11.1 Recommendations to support nurse staffing in the district nursing service
Box 11.2 Key factors for work allocation
Box 11.3 Additional key factors for work allocation
Patient demand
Safer caseloads
The process of caseload allocation
Conclusion
12 Skill mix in the community
Healthcare assistant
Assistant practitioner/associate practitioner
Nursing associate
Community staff nurse
District nurse
Advanced nurse practitioner
Conclusion
13 Nurse prescribing
Box 13.1 Sources of information – prescribing. Royal College of Nursing
Misuse of Drugs Regulations 2001
National Institute of Health and Care Excellence
British National Formulary
Nursing and Midwifery Council
NHS Supply Chain
Nurse independent/supplementary prescriber
Governance
The future of non‐medical prescribing
Medicines optimisation
14 Medicines management
Box 14.1 Six rights of administering medication
Medicines policies
Medicines administration
Community‐specific issues
15 Patient documentation
Patient access
16 Risk management
Box 16.1 Action plan for risk reduction
Risk scoring or grading
Example
Risk: Lone working
17 Measuring quality and patient outcomes
Defining quality
Understanding the patient experience
Measuring quality. Patient experience
Care process
18 Caring for yourself in the community setting
Travel
Lone working
Time management
Mental wellbeing
Clinical supervision
Physical wellbeing
Part 4 Caring for the whole person in the community. Chapters
19 How to make every contact count: health chat
20 Cultural issues associated with district nursing
Culture and ethnicity
Diversity and personal values
The culture of district nursing
21 Social isolation and loneliness
22 Health inequalities and engaging vulnerable groups
Effects of health inequalities
‘Hard to reach’ groups
23 Hygiene in the home, infection prevention and control
Patient factors
Transmission by indirect contact
Equipment and fomites
24 Substance and alcohol dependence
Box 24.1 Alcohol use disorders identification test (AUDIT). AUDIT is a comprehensive 10‐question alcohol harm screening tool. It was developed by the World Health Organization and modified for use in the UK and has been used in a variety of health and social care settings
Scoring:
Giving feedback and advice
Alcohol unit reference
Substance misuse
Alcohol dependence
Care, management and prevention
Recommended UK sensible drinking limits
25 Safety in the home, including falls prevention
Box 25.1 Safety in the home (including falls prevention)
Box 25.2 First aid for the home checklist
26 Effective discharge planning
Planned care
Patient‐centred care
27 Encouraging patient concordance
Box 27.1 Five dimension of adherence according to the World Health Organization (2003)
28 Community health equipment services
Supply of equipment
Prescribing
Delivery of equipment
Equipment for moving and handling
29 The use of new technology to assist daily living in the home
Understanding the health and social care landscape
Associated definitions and terminology
30 Use of mobile technology to support practice
Improving efficiency and creating capacity
Patients as partners
Evolving solutions
Time to care
31 Patient care in nursing homes
Demographics and regulation
Complex care: pain and dementia
Hospice at home
32 Person‐centred dementia care
Dementia
Development of a person‐centred dementia care approach
Role of the district nurse
Why is there a need for person‐centred dementia care?
Admission to the community and hospital sector
33 Safeguarding
Box 33.1 Key areas of district nurse assessment in the home environment
Box 33.2 The six key principles of safeguarding
Box 33.3 The five principles of the Mental Capacity Act
Types of abuse
Assessment
Making a referral
Carers and safeguarding
The Mental Capacity Act 2005
34 Supporting carers
The needs of carers
Partnership working
Assessment of carer needs
Summary
35 Supporting young carers and older carers
Caring through the life course
The impact on carers
Young carers
36 Palliative care
Palliative care in practice – example
Palliative care in district nursing
Other palliative care services
37 Spirituality
Benefits of spirituality
Barriers to integrating spirituality into practice
Facilitators for integrating spirituality into practice
38 Bereavement
Family bereavement
Role of the district nurse in bereavement care
Bereavement help for district nurses
Part 5 Physical and mental health in the community. Chapters
39 Holistic nursing assessment in the community
Environment
Family and culture
Communication
Future plans and expectations
40 Baseline observations
Box 40.1 A systematic approach
Safety netting
41 Long‐term conditions and co‐morbidities
Disease pyramid
Self‐management
Integrated health and social care planning
House of care
Mental health
42 Hydration
The uses of water in the body
Fluid and electrolyte balance
Nursing considerations for the client presenting with dehydration
43 Nutrition in the community setting including enteral feeding
Balanced diet
Obesity
Undernutrition
Identification and screening
Enteral feeding
44 Kidney/renal health
Key anatomical points
Kidneys and ageing
Community‐specific considerations
45 Skin assessment
Assessing a patient presenting with a rash
Clinical examination
Distribution
Shape
Skin types
Character
Primary lesions
Coping with the skin condition
46 Continence
Role of the district nurse
Diagnoses/types of incontinence. Stress urinary incontinence
Overactive bladder
Neurogenic bladder
Functional incontinence and the frail elderly
Faecal incontinence
Conclusion
47 Constipation
Box 47.1 Some common symptoms of constipation
Prevalence
Predisposing factors
Diagnosis
Complications
Management
Medication
Good clinical practice
48 Catheter care
Assessment and documentation
Consent
Balloon inflation
Catheter insertion
Drainage bags
Fixation and support
Self‐care
Sex and catheters
Catheter‐associated urinary tract infection
Troubleshooting
49 Recognising lymphoedema, lipoedema and chronic oedema in the community
The lymphatic system
Lymphoedema
Lipoedema
Chronic oedema
Assessment, diagnosis and treatment
50 Pressure ulcer prevention
Box 50.1 Associated assessments
Box 50.2 Patient and carer education
Risk factors
Mobility
Moisture
Circulation/vascular disease
Nutrition and hydration
Sensory impairment
Acute illness
Previous pressure damage
Terminal illness
Mental illness
Medical devices
Special considerations
Interventions
Concordance and safeguarding
51 Lower leg ulceration
Box 51.1 Types of leg ulceration
Box 51.2 Risk factors for venous and arterial disease. Venous disease
Arterial disease
Box 51.3 Signs and symptoms of venous and arterial ulceration. Venous ulceration
Arterial ulceration
Box 51.4 How to measure ankle–brachial pressure index (ABPI)
Measuring the brachial pressure
Measuring the ankle pressure
Box 51.5 Ankle–brachial pressure index (ABPI)
Anatomy and physiology
Presentation and assessment
Management of leg ulceration
Conclusion
52 Management of type 2 diabetes in the older person: using the International Diabetes Federation Guidelines in practice
Box 52.1 Comprehensive geriatric assessment for older people with diabetes. A. Microvascular complications
B. Cardiovascular risk factors
C. Geriatric syndromes: screening for the following geriatric syndromes should be addressed in the initial assessment
Challenges when caring for an elderly person with type 2 diabetes
Care planning
Self‐management of type 2 diabetes
53 Ischaemic heart disease
What is ischaemic (or coronary) heart disease?
Causes
Risk factors for atherosclerosis
Symptoms
Treatment
Preventing complications of coronary heart disease
Tips for district nurses on assessment of patient
54 Respiratory health
Factors affecting respiratory health
Improving respiratory health
Management of respiratory health
55 Chronic obstructive pulmonary disease
What is COPD?
Symptoms
Diagnosis
COPD exacerbations
Managing exacerbations
Treatments. Self‐management
Stopping smoking
Inhaled therapy
Pulmonary rehabilitation
Use non‐invasive ventilation
Nutrition
Rest
56 End‐stage respiratory care in the community
Clinical indicators of advanced lung disease
Why do patients with end stage disease suffer from uncontrolled symptoms?
Treatment of symptoms
Other drugs commonly used for both breathlessness and anxiety
57 Neurological conditions
Paralysis
Motor neurone disease
Parkinson’s disease
Role of the district nurse
58 Multiple sclerosis
Diagnosis
Symptoms
Treatment and therapies
59 Cancer as a chronic condition
Box 59.1 Local cancer support services to consider
Box 59.2 Common long‐term and late effects of cancer and its treatment
Holistic assessment
Late effects of treatment
Emotional needs
Financial needs
60 Mental illness
Box 60.1 Important factors that can trigger mental illness
Box 60.2 Common screening tools
Box 60.3 Summary of the impacts of the Covid-19 pandemic on individual mental health. Covid‐19 Pandemic and Mental Health
Common types of depression
Common types of anxiety
61 Assessing mental capacity
Box 61.1 Key principles of the Mental Capacity Act 2005
Box 61.2 Helping people make their own decisions – factors to consider
What is meant by incapacity?
The Mental Capacity Act (2005)
Who should assess capacity?
What is the test of capacity?
Stage 1
Stage 2
1 Understand the information relevant to the decision
2 Retain relevant information
3 Weigh up the information
4 Communicate the decision
Making decisions in a person’s best Interests
Lasting power of attorney and enduring power of attorney
Professional record‐keeping
62 Dementia
Alzheimer’s disease
Vascular dementia
Lewy body dementia
Rarer causes of dementia. Frontotemporal lobe dementia
Creutzfeldt–Jakob disease
HIV‐associated neurocognitive disorder
63 Learning disability
Community learning disability teams
Hospital liaison nurse
Part 6 Introduction. Chapters
64 Specialist nurses and the role of district nurses in coordinating care
Box 64.1 Case management: main principles of case management
Box 64.2 Key skills
Box 64.3 Care management: main principles of care management
Core role of the district nurse
Working with specialist nurses and services
Examples of specialist nurses in community care
Summary
65 Voluntary organisations and district nurses
What is a voluntary organisation?
66 Occupational health: specialist community public health nurses
Specialist role
Synergistic working
Future expectations
67 Community learning disability nursing
Case study
68 Tuberculosis nursing
Epidemiology
Clinical features
Acquisition
Diagnosis
Treatment
Vaccination
District nursing role
69 Prison nursing
Prison environment
New arrivals
Mental health
Health promotion
70 Nursing in defence primary healthcare
Box 70.1 Activities related to occupational health, health promotion and disease prevention
Box 70.2 Occupational medical assessments may be needed for:
Medication considerations in these groups
Box 70.3 Common conditions
Box 70.4 Deployment preparation
Box 70.5 Vaccinations required. National vaccination programme
Travel vaccinations
Risk assessment
Biological warfare risk
Box 70.6 Vector‐borne diseases
Defence primary healthcare
Health maintenance
Military operations
Families
71 Homeless and inclusion health nursing
Box 71.1 District nurse contact with people experiencing homelessness
Box 71.2 Some issues that can impact on the person’s ability to engage with healthcare
Box 71.3 Case study 1
Box 71.4 Case study 2
Homelessness
Impact on health
Engagement and effective working
End‐of‐life care
72 Gardens, health and district nurses
References and further reading. References
Further reading. General
COVID-19 care
Evidence-based practice
Detection and management of frailty
Community palliative care
End-of-life anticipatory prescribing
Advanced end-of-life decision-making
Grief and bereavement care
Index
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