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Given the current healthcare landscape and the focus of government policy, the way

nurses are prepared for working in people’s homes needs reconsidering.

The standards for pre-registration

nurse education (Nursing and Midwifery Council [NMC], 2010) do prepare nurses to work in the community at initial registration. However, staff nurses at this point of their career, or those that move from the acute sector to the community, do need to work under the supervision of a qualified district nurse during this transition.

The Queen’s Nursing Institute

(QNI) are about to launch an online resource (‘Transition to community nursing practice’), while NHS Scotland’s ‘Modernising nursing in the community’ website (http://www.mnic.nes.scot.nhs.uk) aims to support community staff nurses in developing the required skills and expertise. With nursing now a graduate profession, some may choose to develop their careers with a postgraduate district nurse qualification.

Currently, district nursing education is underpinned by specialist practice standards (NMC, 2001), which have not been updated since 1994. While higher education institutions have continued to meet these outdated standards, many have built on them to reflect local practice.

However, this lack of cohesion has resulted in divergence across the UK as employers have brought in alternative roles and models of service delivery. This is reflected in the number of nurses accessing district nursing programmes in recent years (QNI, 2013).

It has previously been suggested that the NMC (2004) standards for Specialist Community Public Health could be adopted for district nursing (Dickson et al, 2011). However, while it is acknowledged that public health is the responsibility of every clinician, recent reports focus on the clinical aspect of the district nurse role (Scottish Government, 2012; Department of Health [DH], 2013; QNI, 2013; RCN, 2013). All acknowledge that district nurses’ expertise is at the forefront of acute, long-term and end of life care.

District nurse education standards need to recognise the advanced level of skills required if contemporary district nursing is to deliver safe, effective and person-centred care.

The Scottish Government (2012) acknowledges the principles of advanced practice and recommends postgraduate education as the future of district nursing. Meanwhile, the DH (2013) suggests a graduate specialist practitioner programme is required. The strong argument for district nursing to move to Master’s level advanced practice is supported by district nurses who are already performing at this level. For district nursing as a whole to achieve this, nationally recognised benchmarks for advanced clinical practice (RCN, 2012) could be integrated with specific competencies. For example, one

Scottish institution has led the way by mapping the NMC standards (2001) to RCN accreditation (2012) and level 7 of the NHS Education for Scotland (NES) career framework (2011).

There is no need to reinvent the wheel — the resources needed to support a cohesive flexible approach to community nursing education are already there. However, the NMC needs to take note of recent developments and support this work to protect the public and meet future service delivery needs. JCN

REFERENCES

DH (2013) Care in Local Communities: a new vision and model for district nursing. DH, London

Dickson C, Gough, H, Bain H (2011) Meeting the policy agenda, part 2: is a ‘Cinderella service’ sufficient? J Comm Nurs 16(11): 540–45

NES (2011) Career and Development Framework for District Nursing. NES, Edinburgh

NMC (2001) Standards of Education for Specialist Practice. NMC, London

NMC (2004) Standards of Proficiency for Specialist Community Public Health Nurses. NMC, London

NMC (2010) Standards for Pre-Registration Nurse Education. NMC, London

QNI (2013) Report on District Nurse Education in England, Wales and Northern Ireland. QNI, London

RCN (2012) Advanced Nurse practitioners: An RCN uide to advanced nursing practice, advanced nurse practitioners and programme accreditation. RCN, London

RCN (2013) District Nursing, Harnessing the Potential: the UK’s position statement on district Nursing. RCN, London

Scottish Government (2012) District Nursing Skills Requirement and Options for Future Education Provision. Scottish Government

Heather Bain, Course Leader Masters Portfolio, Robert Gordon University, Aberdeen

COMMUNITY NURSINGMUST NOT REINVENT THE EDUCATIONAL WHEEL

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Aptamil Pronutra+ - Aptamil’s most advanced formula yetAptamil are pioneers in breastmilk research, devoting themselves to an even closer understanding of human milk and the impact all its components have on early life development. This research has led to the introduction of Aptamil’s most advanced formula yet developed from

a unique blend of ingredients. The combined blend of LCPs, GOS/FOS, Vitamin A, C, D and iron is known as Aptamil with Pronutra+ on all Follow On and Growing Up milk packs, with the composition of each stage being adapted to meet infants’ needs.

For further information see: www.aptamilprofessional.co.uk

Whatever your medical tube securement need – CliniFix® it!

CliniFix® from CliniMed Ltd is a unique, multi-purpose catheter and tube securement device which can help solve the problems often associated with traditional tapes and straps. Able to be used in two distinct ways

for different securement needs, it has a hook and loop securing device for some movement, or an inner adhesive strip for extra security. It can be positioned anywhere on the body and the resealable design allows repeated access. With no rigid plastic edges, straps or clips, it’s comfortable to wear and kind to the skin. Accidental tugging or free movement of a catheter or tube can lead to infection, site irritation and patient discomfort. By using CliniFix you can reduce these risks and because it’s made from skin-friendly hydrocolloid, it can remain in place for up to seven days without damaging the skin.

For free samples call the CliniMed Careline on: • 0800 036 0100

Owen Mumford appoints new Global Marketing HeadOwen Mumford, an industry leader in the UK’s medical device market with sales offices in China, the USA and Europe has appointed Richard Simmonds to lead a new Global Marketing Team. The Team will work closely with the company’s international Sales and Marketing groups as well as the OEM business, by providing strategic oversight and helping to co-ordinate support for all regions worldwide.

www.owenmumford.com

Gel-filled insoles bring reliefEverybody wants to avoid sore feet, aching/tired legs and varicose veins – a challenge when much of your day is spent standing. Most

of these common problems come down to uneven weight distribution on the soles and due to prolonged standing, restricted circulation to the feet and lower leg. Advice is often to ‘sit with your feet elevated’, a sensible recommendation but not practical for a health professional.Liqua Care gel filled insoles offer a solution (see page 23). These are unique in that they are the only insoles, worldwide, that are clinically proven to dramatically reduce peak forefoot pressures and increase circulation at the same time (clinical paper on website). Liqua Care are thin, washable and fit in everyday footwear. Cost £27.75 including despatch.

To order visit site or call: • www.autonomed.co.uk • 0870 041 0150

Softform Premier Active 2 from InvacareThe Softform Premier Active 2 from Invacare provides two mattresses in one. It offers a ‘Very

High Risk’ static surface and should a patient require stepping-up to a dynamic surface, a discreet pump can be fitted to the air insert that will transform the mattress into an alternating surface,

delivering additional levels of pressure relief. There is no requirement to transfer the client, thereby minimising any discomfort and reducing manual handling.

The ‘Strikethrough Resistant Technology’ cover is made from a highly chemically resistant polyurethane polymer, making it much more resistant to abrasion and damage and swells less with water contact. The specialist cover

helps to prolong the life of the mattress and reduce replacement costs.

• 01656 776222 •ordersuk@invacare.com •www.thinkpressurecare.co.uk

Richard Simmonds, Owen Mumford’s new Head of Global Marketing

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Calpol® Suspension (paracetamol):Starts to work in 15 minutes Calpol® Infant Suspension (paracetamol) and Calpol® Six PlusTM Suspension (paracetamol) are proven to provide fast, effective relief from fever; the antipyretic effect starts to work in just 15 minutes (data on file). Calpol® has a good safety profile and is suitable even if a child has an upset stomach, as it is gentle on the tummy.To help support practice nurses and health visitors, the makers of Calpol® have created the FREE Calpol® E-stick. It contains valuable information on childhood-related health topics, including a new module on fever. To request your free Calpol® E-stick, simply email calpol@webershandwick.com For children with fever, recommend Calpol®; trusted by parents and healthcare professionals for over 45 years.

For more information on the Calpol® range, visit: www.calpol.co.uk orcontact the McNeil Healthcare (UK) Ltd Care Line on 01344 864042

Northern Ireland PaLs opts for Sidhil productsHealthcare equipment specialists Sidhil have been awarded two key contracts let by Northern Ireland’s Procurement and Logistics Service (PaLS) on behalf of NI Health and Social Care Trusts, the first of which calls for the supply of community beds and the second for selected aids for daily living (ADLs).Under the terms of the first contract, Sidhil’s beds will be used across the province for a five-year period, with a possible two-year extension. The beds selected by NI HSC Trusts have been developed specifically to meet the needs of the community sector and include the Freedom 2, the Solite UK and the Bradshaw Bariatric. The beds are designed around client comfort, versatility, functionality and performance.

• 01422 233 000 • www.sidhil.com

Zeroderm® ointment – cost effective 3-in-1 emollient therapyZeroderm® ointment from T+R Derma offers convenient 3-in-1 emollient therapy with cost-savings of up to 37% against similar proprietary ointments. It can be used as a skin cleanser, a bath additive and as a leave-on moisturiser. Free from additives, preservatives, colours and fragrance, Zeroderm ointment can be used to moisturise and soften dry skin in eczema, psoriasis and other dry skin conditions.Zeroderm ointment is part of the SLS-free Zeroderma® range of emollients and is suitable for both adults and children. It is listed on the Drug Tariff and Nurse Prescriber’s Formulary and is also available on NHS contract. It is available in 500g and 125g tubs. For further information or to receive a 50g sample tub, or for patient evaluation,

please email: zeroderma@thorntonross.com•www.trderma.co.uk •01484 842217

Applied emollient gels – Doublebase Gel, Doublebase Dayleve GelSoap substitutes – Doublebase Shower, Doublebase Wash, Doublebase Bath

Doublebase range of emollients The Doublebase range can help provide ‘complete emollient therapy’ for patients of all ages, from babies to the elderly, with dry skin conditions including eczema and psoriasis. The Doublebase range of emollients are all available on the Nurse Prescribers’ Formulary — prescribe by name for formulation of choice.2013 sees Dermal celebrate 50 years of successful topical innovation. This extensive experience in developing highly effective, yet cosmetically elegant treatments for application to the skin, has benefited millions of people for half a century. For more information on Doublebase, other Dermal products or for dermatology resources, please visit:

www.dermal.co.uk

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Amanda Munday (above left), Community Nursing Sister, and Jane Jennion, Community Staff Nurse are both community nurses who work for Berkshire Healthcare. They work in West Berkshire, which is a large rural area with a spread out population. They aim to deliver care that enables people to stay in their homes, rather than going into hospital.

WHAT IS YOUR BACKGROUND IN COMMUNITY NURSING?

JJ: I qualified as a nurse in 1983 and after three years I went to work in the pharmaceuticals industry as trainer and sales rep for 25 years. I always had a long-held ambition to get back to nursing and become a community nurse. Whilst re-training I worked as a healthcare assistant in my current team. I am now embarking on my next challenge, a university course to become a specialist practitioner in district nursing. I am fortunate that my placement is with my current team.

AM: I qualified as a nurse in 1991 and started my career working in hospitals. Working as a disability nurse gave me a great insight into community nursing, and I decided it was something I would like to pursue. Luckily I secured a position and I now manage a team of three in a rural area not too far from my home.

WHAT DOES YOUR TYPICAL DAY LOOK LIKE?

JJ: There is no typical day! We meet at the surgery and check messages, as these can change the plan of the day. We then check on our more poorly patients. Planning is important but time management is key. Due to the diverse nature of physical ailments we deal with we have to prioritise our time and resources.

AM: As a team we work very closely together to allocate resources to plan in visits for the day. We stay in touch with one another throughout the day as well checking messages at the surgery.

What people don’t realise is just how fast-paced this job can be, you have to be flexible and dynamic. We can be examining post-operative wounds, taking bloods, educating people about looking after themselves, looking after dementia patients and caring for people who are nearing the end of their life. Alongside this, we always

ensure that we respect the decision and choice of the patient. We always plan for the day, but the day never goes to plan!

DO YOU HAVE ONE PRACTICE EXPERIENCE THAT TAUGHT YOU SOMETHING VALUABLE ABOUT COMMUNITY NURSING?

JJ: Always remember you are never on your own; you are part of a highly skilled team who are your back-up and support. They are only a phone call away and due to the nature of the job and our dedication to putting the needs of the patient first, you need to pick up the phone and get that rapid response. It’s great to know your colleagues will be there when needed.

AM: Be prepared and take a note of the weather. In the last heavy snow fall I had my wellies and waterproofs and the GP arrived at the patient’s home in shiny shoes with his briefcase.

WHAT IS THE MOST IMPORTANT PIECE OF EQUIPMENT OR TECHNIQUE THAT YOU REGULARLY USE?

AM: Your senses. Whilst my mobile and laptop are really handy, no piece of equipment is as good as my senses. Hearing what a patient is saying, being aware of smells that could be a sign of infection and examining a patient are all so important but I would say my sight is the most valuable: looking at and assessing the situation. And don’t forget your sixth sense, if you feel something is wrong then it probably is. Always trust your gut instinct.

WHAT ONE THING WOULD MAKE THE MOST DIFFERENCE TO YOUR PRACTICE?

JJ: An integrated IT service that everyone is linked into. We work with other care providers and having one system which everyone uses would be beneficial to patients as they won’t have to repeat themselves and it will save time. It is something that our Trust, is looking into and we think this would be a great advantage to everyone.

WHAT PIECE OF ADVICE/PRACTICE WOULD YOU PASS ON TO OTHER COMMUNITY NURSES?

JJ: If things are getting on top of you and you feel stressed, just stop, take a deep breath and remember what a great job you have and that you are privileged to be making a huge difference to someone else’s life, every day. The rewards of doing this this job outweigh everything else.

AM: Keep it simple, communication is crucial, be realistic and more importantly keep smiling. You act as a selfless advocate for patients and as long as you keep the patients at the centre of your thoughts and actions, you can’t go wrong. People who do this job do so because they are passionate about helping others, I thrive on being needed and I am certainly needed in this role.

My community

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