District Nurse and Other Stories

Dutch district nurses rediscover 'complete care' role

These issues included the condition of the home, access to the home, animals in the home, smoking issues, trip hazards, family domestic issue, falls risk for clients and community nurses, firearms, and tension between community nurses and clients related to home modification, while attempting to negotiate client care.

The most common WHS issue within a client's home was working with each individual client and overcoming the issues around poor behaviour. Aggressive behaviour from a client or their family members was the most common cited issue. Six participants stated that they encountered aggression and violence.

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In many cases, managements were assisting their staff to achieve service objectives under the auspice of WHS practices. There was great autonomy among staff; however, currently there were poor processes in place to ensure the capable and well-skilled staff are practising safely when providing care in a complex and unforgiving environment. Vertical and horizontal violence Among the participants, there was a mixed response regarding the experience of vertical and horizontal violence in the workplace. I expected more about nursing in the '50's. Penny died on 31 December

The most common was verbal abuse or verbal threats and in some cases there was physical aggression. This was demonstrated by one community nurse who stated I was caring for a lady with dementia…her husband who was her carer didn't understand dementia at all…and it was a very, very difficult relationship. In the end it got so bad that this fellow actually threatened my life.

Participants indicated that aggression commonly involved clients with dementia or a mental illness. In these cases when aggression was observed, participants stated that they would communicate with the client, investigate root causes of the situation and offer social support or immediately leave depending on the severity of risk.

One nurse stated that In some cases I would back out immediately and leave the scene, while in other cases I may try to talk the client around and calm them down. It depends on whether anyone else in the house is at risk…I have, on a few occasions managed the situation until the police and ambulance arrived. Various homes were cluttered, filthy and untidy with unpleasant odours.

Other homes had poor ventilation, poor lighting or damp floors. In one case, there was a snake found in a client's home and to facilitate greater WHS standards, the client had to keep the area around the home clear of clutter and have the grass cut regularly. At times bathrooms were too small and beds were too low to provide appropriate and safe care. Manual handling issues included heavy patient lifting and positioning clients that related to the care of palliative care clients and wound care-related activities.

At times, it was highlighted that appropriate equipment was unavailable, delivery was often delayed or that the community nurse may be the sole operator of the equipment which may place them at greater risk. Despite the manually handling issues, and the condition of the home, it was stated that the community nurses always try to improve the manual handling situation or condition of the home for the client and for their own safety.

However, one nurse stated We try and educate people, but often they have lived in this sort of environment for so long. It's a comfortable environment for them and if we go in and start posing our values and judgment too much, it may not work and it is not really what we do. For these specific situations, community nurses would try and educate clients, offer services to help cleaning, wear protective equipment, create a clean zone where possible, and discuss with clients and families how best to provide care through the use of additional equipment.

It was recognised that animals such as a dog or a cat may be beneficial for many clients, particularly the elderly, as they provide company and emotional attachment. However, some community nurses did express discomfort when working in home environments where animals were present, such as large barking dogs or dogs that become aggressive when providing physical care to a client. Beyond animals, smoking was raised as a significant concern.

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Participants agreed that passive smoking is dangerous for their health and is a WHS issue that remains difficult to overcome. In many instances, clients were requested not to smoke while the nurse was present but to participants it did not change the environment where cigarette smoke had been building up over time. Regardless of the issues that community nurses encountered, there were always difficult decisions to be made which by the community nurse, to accept the current risk s and continue care or withdraw service.

Most participants said before withdrawing service they would propose creative solutions with the client then let them decide whether the service would be continued or ceased. I have had experience of patient's houses not being safe places to work in and there's ways around that. You'd bring them into the district hospital to deliver wound care or shower them…because their home environment was not conducive to safe practice. In addition to the geographic and physical WHS issues that community nurses encountered, they also experienced WHS issues that were embedded within the organisations where they were employed.

The three key issues that participants highlighted encompassed workload challenges, vertical and horizontal violence and work-related stress. Among the participants, there was a mixed response regarding the experience of vertical and horizontal violence in the workplace. Three participants confirmed they got along well with their colleagues, two highlighted issues with both managers and staff, while three participants shared stories of bullying and harassment from their managers and other staff.

One participant indicated that she did not want to discuss the issue, however stated that she was aware of it occurring in her workplace. Overcoming violence, various strategies were attempted to be employed, such as risk assessment and cultural safety techniques yet were all based on experience, advice of other staff and not based on service policy. When asked about the biggest WHS issue that impacts on their health, three participants emphasised vertical violence that had occurred in various situations as community nurses.

The overall detrimental effect was so intense that community nurses required ongoing counselling and psychology consultation for high level of stress, anxiety and depression. They each share similar stories of taking stress leave which led to eventually leaving their respective workplaces. It was indicated that they were not the only community nurses to experience this type of vertical violence, stating that many staff had left the various workplaces and even the profession altogether. Within the community nursing setting, workload fluctuates throughout the year where there may be higher or lower than normal client numbers.

However, this workload may fluctuate week to week and day to day. One participant suggested that the time required delivering care for clients varied depending on their individual care needs and the impact of overall workload. Some participants shared similar experience where unanticipated situations occur suddenly that may impact their work day even when carefully planned in advance. You might visit someone and they have had a fall.

So your planned 15—20 minutes visit will turn into a couple of hours. You may have to get the ambulance or you would have to wait for their family to come. In addition to the fluctuation of workload, there were other major factors that cause stress and burnout among community nurses and was felt to be a WHS issue if appropriate support was not provided. Caring for palliative clients and encountering confronting situations, such as death and tragedy was the most discussed burnout issue among participants.

Despite these challenges, many participants showed strong self-awareness and discussed work—life balance, such as not taking work home or taking a break or time off if necessary. Participants said they would share their stress or concerns with colleagues, managers or loved ones, however not all of them was able to do this.

It was highlighted that community nurses would, if possible, organise their workloads to share clients if a nurse was overloaded with palliative clients. It was noted that many of the WHS issues were reflective of the current literature that is focused on remote area nursing and there were many commonalities between the two disciplines. This included working across large geographical areas, working in isolation, driving issues, and poor behaviour from clients and family members. It also encompassed the state of the client's homes; manual handling issues especially relating to palliative care; workplace issues including conflict, bullying, excessive workload, stress and burnout.

The strategies that were elucidated were often aspirational and included organisational approaches to remove stress. These also included addressing overall workplace demands, a greater focus on improved debriefing systems, and greater awareness of and access to employee assistance programmes. In addition, coping with stress and burnout included seeking social support, planned problem solving, self-controlling, positive reappraisal.

Overcoming violence, various strategies were attempted to be employed, such as risk assessment and cultural safety techniques. However, these approaches were often not based on policy and procedure, but on experience and advice sought from other community nurses. In addition, educating staff around violence, its negative consequences was highlighted, but rarely provided to staff. Similarly, implementing zero tolerance as part of the workplace culture was aspirational, yet in many cases it was not consistently occurring in practice.

In addition, it was suggested that health services need to work more closely with communities to develop greater safety programmes to address violence between health consumers and healthcare providers. In terms of strategies to prevent musculoskeletal disorders, it has been suggested a risk assessment to be conducted during the first visit to a client's home, which was dependent on the service and the assessments that were developed.

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In addition to assessing and addressing client's needs, it was felt that community nurses required additional time for thorough WHS assessments and planning with adequate devices and procedures to be in place until care could be provided. Another intervention that was considered to be beneficial was aerobic and strength building exercise training programme for nursing staff. Beyond the day-to-day WHS issues that many community nurses were encountering and addressing as best they could, it was demonstrated that current approaches to workload issues were inadequate.

For example, addressing workload issues included client load being divided between teams or frequent rotation of staff between clients. This addressed driving distance issues and overburden of client contact, however decreased continuity of care among clients.

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In other circumstances, it was shown that when workload was excessive, nurses would prioritise tasks that may have included cancelling appointments, not completing paperwork in a timely manner or working unpaid overtime to meet the needs of the service. There was great autonomy among staff; however, currently there were poor processes in place to ensure the capable and well-skilled staff are practising safely when providing care in a complex and unforgiving environment.

Overall, there were a number of issues that were highlighted which included chronic underfunding of services; lack of discipline-specific training and access to training for rural community nurses; poor-quality improvement and pastoral care systems; and workforce supply problems, encompassed by poor recruitment, staff relief systems and inadequate orientation of new staff. In addition, it highlights that there is inadequate preparation and capacity of a number of operational managers to appropriately manage systems and support staff to meet the needs of the community in an environment that is centred on WHS practices.

It must be noted that a number of telephone interviews were undertaken, which may have influenced the data that were collected in terms of quality and its depth of information. Face-to-face interactions allow greater probing, clarification and more in-depth data to be gathered from the participants than telephone interview. As an alternative to no interview, the phone interviews were seen as the best alternative.

However, the themes that occurred among most community nurses were reported within this paper. In some cases, site-specific challenges, such as dealing with animals that were brought into the community nursing clinic for care, were outside the scope of the paper. Overall, it was indicative that many nurses were achieving good outcomes to meet the needs of community health consumers. In many cases, managements were assisting their staff to achieve service objectives under the auspice of WHS practices. However, many current processes that were highlighted by participants were considered unsafe, unsustainable, impracticable, and demonstrated a number of underlying issues within the current community health system.

Again, it was highlighted that many community nurses and managers were doing their best; however, greater training and capacity building is required to meet the needs among all staff. Meeting the needs of the community was achieved; however, there was a reactive approach among many services and healthcare providers, rather than a proactive approach to ensure both nursing staff and health consumers were safe when providing care. The authors acknowledge the community nurses who participated in this project and who gave both their time and information.

Acknowledgement is also expressed to Tasmania Health Organisations North and Northwest for their support of this study and for allowing their staff to participate. Contributors DT and QL developed the research design, assisted with data collection and developed, wrote and edited the final manuscript.

District nurses are the real heroes of the NHS, but they are under total siege

UN undertook the data collection and provided assistance with manuscript development and its initial writing, while HH provided technical advices throughout the research process and wrote and edited the final manuscript. Provenance and peer review Not commissioned; externally peer reviewed. Data sharing statement No additional data are available. You will be able to get a quick price and instant permission to reuse the content in many different ways. Skip to main content.

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Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Latest Content Archive Authors About. Log in via Institution. Workplace health and safety issues among community nurses: Abstract Objectives The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers.

Stress and burnout Stress is a common issue in community nurse populations which leads to nurses having a greater likelihood of taking time away from work. And follow us on Twitter GdnHealthcare to keep up with the latest healthcare news and views. Order by newest oldest recommendations.

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District Nurse by Patricia Jordan

Will this help to create more places or damage the healthcare sector? Over the last few years I have rediscovered my teenage passion for books about nurses at the same time as discovering a new love of women's fiction set in the wars.

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This book ticks both boxes as it tells the story of nurses Alice and Edit as well as the families they help in their role as district nurses. The story is well written with believable characters and I hope there will soon be more books in the series. Sep 17, Barbara Helen Plumb rated it really liked it Shelves: This is my first Annie Groves, although she is now no longer with us.

The District Nurses of Victory Walk

This one is written by Jenny Shaw and I hope it is the beginning of a series as so many of Annie's were. It is one of those delightful chatty novels that ambles along relating the lives of the district nurses and the families they come into contact with. Set in the very early days of World War II, it describes the evacuations of children out of London and into the country, and the lives of families living in a working class sub This is my first Annie Groves, although she is now no longer with us.

Set in the very early days of World War II, it describes the evacuations of children out of London and into the country, and the lives of families living in a working class suburb of London. It's hard to imagine now in these days of indoor plumbing that families had no indoor running water and had to share a toilet with the rest of the tenements. Several of the characters are involved in the remarkable rescue of the BEF from Dunkirk. I'm going to keep an eye on this series hopefully and look forward to more installments.

Call the Midwife comes to mind and we follow the nurses in their rounds tending to the sick with passion and falling in love with equal passion. Such is the depth of the author's writing you will find yourself emerged in every page you will even smell Flo s home made stews and hear the cries of despair at Dunkirk. Aug 16, Rachel Muumbo rated it it was amazing.

A really good read!! Loved this book, the characters and the fine details written with such care. Cannot wait to read more about the times. Jun 12, Joy rated it liked it. Not as good as Donna Douglas. Jun 16, Jennifer Mawdsley rated it it was amazing Shelves: I really enjoyed reading this book. I read it because I am training to be a nurse and wanted to read about what nursing was like during ww2. I found it really interesting and able to relate to the characters. Karen rated it it was amazing Jun 16, Sheila Alker rated it really liked it Aug 22, Margaret Sweeney rated it it was amazing Aug 17, Sarah Fullgrabe rated it really liked it Jul 11, Brenda Ralph rated it it was amazing Jun 28, Philip Cleary rated it it was amazing Jun 05, There are no discussion topics on this book yet.

‘You never feel bored’

Penelope Jones Halsall aka: She had been a keen reader from the childhood.