Abstract

Delivery of healthcare is changing, with a greater focus on a model of  prevention and self-care and a  move away from a focus on ill health .  Health and Wellbeing 2026: Delivering Together (2016), sets out a vision for  a greater emphasis on primary care services through the roll out of multidisciplinary teams which are embedded around general practice. The teams work together to keep people well by supporting self-management and independence by providing proactive management of high risk patients.  People today want to lead full and productive lives, staying independent for longer and in line with wider societal changes, expect improved access, choices, and control when it comes to public services.  

In order to meet these changing needs and make Health and Wellbeing 2026: Delivering Together (DoH 2016) a reality, the District Nursing Framework 2018-2026 was launched in 2018.  Its aim is to provide a twenty four hour, seven day a week district nursing service.  District nurses will work in Neighbourhood District Nursing Teams in partnership with patients, carers, families, and their communities to achieve better health and wellbeing outcomes.  They will be instrumental in:

• Population Health Management
• Improving people’s experience of care
• Optimizing health and care resources
• Supporting and empowering staff

To make delivering of this Framework a reality, district nurses were supported with the development of a bespoke leadership programme to enhance their ability to influence the current transformational agenda and enable them to become more innovative and entrepreneurial.

As this model began to roll out across the region,  the trusts have successfully implemented an 8am- 8pm district nursing service.   Significant changes have been made and the impact it has had on service delivery and the team is huge.  By incorporating  PACE (Person-centered, Assessment, Care Planning and Evaluation) documentation this has significantly improved true patient-centered care, involving patients and families every step of the way.

Communication within the whole team has been key, stemming from daily handovers on patients within the team, participation in practice meetings and widespread provision and adoption of technology.  This has resulted in staff being much more knowledgeable on their patients and their individual needs.  The extended working hours has improved communication between families and the district nursing service in particular outside of the normal Monday to Friday hours.  The increased availability of the district nurse outside of normal working hours has enabled the nurse to tailor their visits to allow the opportunity to assess and discuss the patient care with the General Practitioner and or other members of the multi-disciplinary team.  This has been especially beneficial when planning for palliative patients.  District Nurses  are finding that visits are often pre-emptive as opposed to reactive in nature.

With the improvement of communication and technology new relationships are being forged both inside and outside of primary care.  District nurses are more socially aware and are able to offer a much more holistic approach to person-centered care.

The adoption of the neighbourhood district nursing model has been transformational,  for the patients, families, and the staff.  The investment in staff training has witnessed a sea-change in mind-sets, attitudes, and approaches to delivering care.  Staff feel valued and supported to develop their career pathways by furthering their knowledge and skills.  

It is the vision for Northern Ireland that we further extend this model of neighbourhood district nursing to all areas and embrace it in its entirety as we move from a focus of ill health to enabling people to remain within their own families, homes, and communities for as long as possible.