The Unique Knowing of District Nurses in Practice

Several issues have impacted on district nursing practice and education within the UK, which can be conceptualised within four main areas: national policy; local organisational structures and practice; professional and disciplinary theory; and practice of individuals (Bergen and While 2005). However, there has been a lack of direction in district nursing in recent years within the UK, with a decline in the number of district nurses being educated (Queen’s Nursing Institute 2014a) and the educational standards supporting district nurse education being over 20 years out of date (Nursing and Midwifery Council 2001). In addition to this, the standards of education for pre-registration nursing (Nursing and Midwifery Council 2010) have supported a graduate workforce with an increasing focus on nursing in the community. This was identified as a consideration for me as an educator when examining the future educational requirements of nurses beyond the point of registration in the community, and became the focus of this study. Knowing in practice is a key concept within this thesis, that is, the particular awareness that underpins the being and doing of a district nurse in practice (Chinn and Kramer 2008). This study explores the unique knowing of district nursing in practice, and how this professional knowing is developed. Understanding the knowing of district nurses and how this is developed will contribute to future educational frameworks and ways of supporting professional development within community nursing practice. A question that is often asked is what makes district nurse knowing different from nursing in inpatient settings, and this emerges in this thesis. A qualitative study using an interpretative approach within a case study design was adopted using three Health Boards within Scotland as the cases. Within each Health Board area, interviews were undertaken with key informants and also, group interviews with district nurses were undertaken using photo elicitation as a focussing exercise. The data were analysed using framework analysis (Spencer et al. 2003). This approach illuminated a depth and breadth of knowing in district nurse practice and how this knowing is developed. The study findings depict the complexity of knowing in district nursing, acknowledging the advancing role of district nursing practice, where the context of care is an essential consideration. The unique knowing can be described as a landscape that the district nurse must travel: crossing a variety of socio-economic areas; entering the private space of individuals, and the public space of communities; as well as acknowledging professional practice; navigating the policy agenda while maintaining clinical person-centred care; and leading others across the terrain of interprofessional working. The unique knowing in practice that characterises the expertise of district nurses is a matrix of elements that incorporates different aspects of knowing that contribute to leadership, as suggested by Jackson et al. (2009). The participants in this study recognised that due to the complexity of the district nurse role, and its continuing advancements, that district nurse education needs to move to a Master's level preparation and it needs to continue to be supported by a suitably qualified practice teacher. Furthermore, the findings within this study demonstrate that the development of the unique knowing in district nurses does not happen in isolation and it is very complex. It consists of networks, conversations, engagement with policy, understanding of professional contexts, adhering to organisational boundaries, and interaction with complex and challenging situations. Theory and practice are mutually dependent on each other; change is inevitable and is unpredictable; and practices change by having experiences, therefore change is integral to practice. Consequently, it was concluded that the interdependent elements, which interact, develop the unique knowing of district nurses in practice. Finally this thesis makes recommendations and discusses future implications for policy, practice and researc

Principles and practice of nurse prescribing.

Feel prepared to take on nurse prescribing with this short and accessible text. Whether you are pre-registration or undertaking a prescribing course, this book is your perfect introduction to the world of nurse prescribing. Covering the legal, professional and pharmacological considerations as well as core skills such as assessment and teamworking, this accessible text explores all aspects of non-medical prescribing in clear, straightforward terms

Assessment framework for prescribing: lower limb skin tears.

Prescribing by a variety of professionals continues its progression in response to the growing demands for health care. Prescribing by nurses was initiated in the 1990s and supported by the National Prescribing Centre's 'prescribing pyramid' or seven steps or principles for good prescribing (NPC, 1999). This article explores a new prescribing consultation model (RAPID-CASE), which is composed of elements from the prescribing pyramid and the Competency Framework for all prescribers (Royal Pharmaceutical Society [RPS], 2021). The RAPID-CASE consultation model is applied to a clinical scenario to illustrate how it can guide a systematic approach to decision-making, using the example of a lower limb skin tear injury

Professional, legal and ethical dimensions of prescribing: part 1: professional.

Prescribing by nurses and midwives continues to expand and has consistently been evaluated as safe and effective. This article is part one of two exploring the core professional, legal and ethical dimensions of prescribing. Reference is made to a contemporary prescribing model, RAPID-CASE, devised by the authors to demonstrate the application of key prescribing practice principles. The importance of a structured approach is demonstrated with reference to the Royal Pharmaceutical Society competency framework for all prescribers, applicable legislation and underpinning ethical principles. This first article identifies the main professional dimensions of prescribing practice, while the second article focuses on the legal and ethical aspects

Professional, legal and ethical dimensions of prescribing: part 2: legal and ethical.

This is the second of two articles exploring the core professional, legal and ethical dimensions of prescribing. Part one presented a contemporary prescribing model, RAPID-CASE, devised by the authors to demonstrate the application of key professional principles to prescribing practice. This second article examines pertinent legislation and underpinning ethical principles that guide decision-making in prescribing

Integrated health and social care; exploring of the needs and experiences of service users and their families.

Protocol for a review, aiming to address the following questions: 1) What are the perceptions of service users and their families in relation to their health and wellbeing needs? 2) What are the experiences of service users and their families who access integrated health and social care to meet their health and wellbeing needs? 3) What is the relationship between the service users (and their families) experiences of integrated health and social care, and their perceived health and wellbeing needs

Exploring the experiences of people who use and deliver integrated health and social care (IHSC) in a regional area of Scotland.

This study was to explore the experiences of people who use and deliver IHSC (Integrated Health and Social Care) in a regional area of Scotland. The main aim of the study was to understand the experiences of integrated health and social care, for service users and people that help them at home. It's main objectives were to: 1) describe the HWB (Health and well being) needs of services users and informal carers, 2) to investigate the relationship between HWB needs and the experiences of key stakeholders who receive IHSC, 3) to explore the experiences of key stakeholders who access and deliver IHSC services in an area of Scotland and 4) to explore the significance of relationships in experiences of IHSC

Exploring the health and wellbeing needs and experiences of people who use and deliver integrated health and social care in the community: a multi-case study.

Safe, people-centred, effective, affordable, and coordinated health and social support systems are a global priority. Current research in the field focuses on evaluation of services and models of integrated health and social care (IHSC). This qualitative multi-case study was designed with key stakeholders to explore the experiences and needs of people who use and deliver IHSC at home, in a regional area of Scotland (UK)

Integration of health and social care in the a regional area of Scotland: exploring the needs and experiences of service users and their families.

This presentation gave an overview and review process to-date of the research project: A case study of service user, informal carer and staff experiences of integrated health and social care at a NHS Grampian Excellence Event, Inverurie in October 2018

Perspectives of crisis intervention for people diagnosed with 'borderline personality disorder': an integrative review.

What is known on the subject? - People diagnosed with 'BPD' often experience crisis and use services 'BPD' is a controversial diagnosis, and the experience of crisis and crisis intervention is not well understood. What this paper adds to existing knowledge? - People diagnosed with 'BPD' have different experiences of crisis, and using the diagnosis alone as a basis for deciding care and treatment is not appropriate There are many human factors which can influence how professionals deliver care to people diagnosed with 'BPD'. What are the implications for practice? - The education of staff, views on responsibility, team conflicts and access to clinical supervision can have an impact on how care is delivered, and should be addressed by organizations providing crisis care. Access to care often occurs when a person is self-harming or suicidal, but does not address underlying distress. Crisis care should go beyond managing behaviour and address any underlying needs. Abstract: Introduction 'Borderline personality disorder' ('BPD') is associated with frequent use of crisis intervention services. However, no robust evidence base supports specific interventions, and people's experiences are not well understood. Aim: To explore the experiences of stakeholders involved in the crisis care of people diagnosed with 'BPD'. Method: Integrative review with nine databases searched January 2000 to November 2017. The search filtered 3,169 titles and abstracts with 46 full-text articles appraised and included. Results: Four themes were constructed from thematic analysis: crisis as a recurrent multidimensional cycle, variations and dynamics impacting on crisis intervention, impact of interpersonal dynamics and communication on crisis, and balancing decision-making and responsibility in managing crisis. Discussion: Crisis is a multidimensional subjective experience, which also contributes to distress for family carers and professionals. Crisis interventions had limited and subjective benefit. They are influenced by accessibility of services, different understandings of 'BPD' and human dynamics in complex decision-making, and can be experienced as helpful or harmful. Implications for practice Subjectivity of crisis experiences shows limitations of the diagnostic model of 'BPD', emphasizing that interventions should remain person-centred. While thresholds for intervention are often met after self-harm or suicidality, professionals should review approaches to care and support people with underlying distress