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Reflections on shadowing community nurses
The Personalised Care Deputy Director, Workforce & National Clinical Lead, and the Personalised Care Deputy Director, Policy and Strategy recently spent a day shadowing a Queen’s Nurse to better understand how personalised care applies to practice, and what opportunities and challenges there are:
Queen’s Nurses are community or primary care nurses who have demonstrated a high level of commitment to care and nursing practice and had the title conferred on them by the Queen’s Nursing Institute (QNI).
The QNI is a registered charity dedicated to improving the nursing care of people in the home and community.
Michelle spent the day shadowing Val, Queen’s Nurse, Clinical Lead and District Nurse in Walsall. Val had attended a joint Personalised Care Group / QNI event focussing on what personalised care is and what it means for nurses in practice). Nicola spent the day shadowing Gail, Queen’s Nurse and District Nurse Team Manager in Whitton and Twickenham.
During the day we visited a range of people and their families as well as attending multidisciplinary team meetings to assess people’s care packages. The visits clearly illustrated the variety and challenges in the role, from caring for people right at the end of their lives to supporting people living in sub-standard accommodation facing wider difficulties around the social determinants of health.
What struck us from the outset was Val and Gail’s pride in their jobs as district nurses and a strong sense of being privileged to be a guest in someone’s home and life. They both highly valued giving direct care and were keen that their administrative duties did not impact on this.
During visits it became apparent that community nurses operate as skilled generalists, often with specialist knowledge in a variety of areas such as tissue viability or end of life care. They often go in to support someone with one identified need which turns into a bigger need – medical or non-medical – requiring coordination with other services and a real understanding of the individual’s circumstances and preferences.
Nurses go out of their way in these circumstances to make sure people have the support they need.
The visits showed the potential of the personalised care model to free up nurse time. Nurses encounter daily issues where people may struggle to self-manage their conditions as they have low levels of activation – knowledge, skill and confidence.
With more tailored support and interventions from others like health coaches or through peer support, people who have low activation can be better supported and have improved outcomes. This has the potential to free up district nursing time to focus on people with more complex needs and redesign services that better match a person’s needs.
Nurses have a strong motivation to come into the profession to help and are natural ‘doers’ to solve problems for people in their care. Moving to a more facilitator/coach model and taking a more asset based ‘what matters to you’ approach, rather than ‘what’s the matter with you’, can be quite a shift for some practitioners.
Many nurses already deliver great personalised care and it’s fantastic to see them in action, but we need to support them so that it’s more consistent. We have been working to bring national nurse leaders together to see how we can collectively support the profession, raise awareness and ensure that nurses have better knowledge, skills and confidence to deliver personalised care.
The conversations that health and care staff have with people, their carers and families are at the heart of personalised care. What could be regarded as routine conversations can have huge impact on individuals. Enabling people to manage their own health and wellbeing, based on their priorities and concerns, means people feel listened to, understood and more in control. The skills needed to do this effectively need to be learned and it requires a fresh mindset.
Over the next ten years, the Personalised Care Group is rolling out training and development for health and care staff to develop their knowledge, skills and confidence as part of Universal Personalised Care.
Nurses have a key role to play and will be integral in driving improvements in personalised care.