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What makes a good district nursing service?

The King’s Fund research looks at why is it difficult to measure the quality of care district nurses provide.

District nursing services are a lifeline for many people. An ageing population, together with policy ambitions to shift care out of hospitals into community settings, make them a key part of the health service both now and in the future.

But patient experience and outcomes remain largely unknown at a national level.

The distinctive features of these services, particularly their work is carried out behind closed doors, make it difficult to measure the quality of care they provide.

What makes good district nursing care?

The distinctive features of these services, particularly as their work is carried out behind closed doors, make it difficult to measure the quality of care they provide.

What makes good district nurses?

So what does characterise good district nursing care? Over the past year, The Kings Fund has conducted research to understand

...

District nursing services are a lifeline for many people. An ageing population, together with policy ambitions to shift care out of hospitals into community settings, make them a key part of the health service both now and in the future.

But patient experience and outcomes remain largely unknown at a national level.

District nurses
District nurses offering care. Photo: iStock

The distinctive features of these services, particularly their work is carried out ‘behind closed doors’, make it difficult to measure the quality of care they provide.

What makes good district nursing care?

The distinctive features of these services, particularly as their work is carried out ‘behind closed doors’, make it difficult to measure the quality of care they provide.

What makes good district nurses?

So what does characterise ‘good’ district nursing care? Over the past year, The King’s Fund has conducted research to understand this from the perspective of people receiving care, their carers and district nursing staff. 

We reviewed existing literature, held focus groups, and interviewed patients, carers and staff. Using this evidence, we developed a framework for assessing quality in district nursing services.

The characteristics of good care identified in the research were:

  • caring for the whole person.
  • continuity of care.
  • the personal manner of staff.
  • predictable visit times.
  • being able to contact services between appointments.
  • valuing and involving carers.
  • nurses acting as coordinators and advocates.
  • clinical competence and expertise.

We didn’t only want to know what was important to our interviewees, but also why these things were important. Our report includes first-person accounts of individual care experiences, helping to bring these concepts to life and highlight the meaning and significance behind well-worn phrases such as ‘continuity’ and ‘person-centred care’.

We wanted to know why these things were important. Our report includes first-person accounts of individual care experiences. Throughout the research, we were struck by the strong alignment between the views of patients, carers and staff. 

A consensus on quality

Throughout the research, we were struck by the strong alignment between the views of patients, carers and staff. There was broad agreement about the most important characteristics, and even when they did not share the same priorities (for example around appointment scheduling), nurses recognised why they were important to patients and carers.

The details of this framework may not come as a surprise to nurses, but they provide a firm evidence-base to inform local and national quality assurance and improvement work. 

The components are discussed in detail in our report, and are summarised in a simple online tool available on our website. We would encourage staff to use this tool to reflect on their service, and to consider what their data, feedback and first-hand experiences can tell them about the extent to which this is reflected in practice.

A demand capacity gap

During our research, we found evidence of a profound gap between capacity and demand, and nurses working under enormous pressure. 

While action is undoubtedly needed at a national level to address this, local action is also needed to improve quality. This does not necessarily rely on a significant increase in time or resources, but a focus on how care is delivered. 

Patients and carers frequently spoke of the value of nurses talking them through procedures, asking after their general wellbeing, and updating them on the progress of their treatment. 

They recognised that it wasn’t possible to always see the same nurse, but described how much they would appreciate seeing a smaller group of nurses. Service managers were clear training and supervision are crucial in supporting staff to deliver high-quality care.

Leaders must recognise the vital importance of district nursing services and address the decline in staff numbers. 

But conversations about improving quality must focus on how to promote continued reflection and dialogue at local levels and seize the opportunity to capitalise on this common view of quality. The prize is to achieve the things most valued by patients, carers, and staff alike.

Read the King's Fund report here

Access the online framework


About the author

Anna Charles

Anna Charles is health policy researcher for The King's Fund

 

 

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