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![Personal manner of staff
3
He seemed to care. And his
professional manner of course…there
was that thought, not just like ‘I’ll do my
job and go’.
Female carer, 60s
[Good care is] communication more
than anything. Discuss what you’re
doing, step by step: ‘I’m here now, my
name is, I’m going to take this bandage
off now, I’m going to clean, now I’m
going to put on a new bandage’. And tell
him everything you’re doing, so that he’s
not so fretful. Communication and
bedside manner.
Female carer, 50s
Quality of care improves because…
People receiving care:
feel at ease and more confident in the care.](https://image.slidesharecdn.com/districtnursingqualityframeworkslides-160830090344/75/A-quality-framework-for-district-nursing-8-2048.jpg)
![Scheduling and reliability of appointments
4
[If they come late] by the time you
get up it’s almost time to go back to bed
again, the day’s gone.
Male patient, 60s
I’ve got a friend who comes up to
see me and I go down to see her, but we
can't do it on the days the nurse is
coming. It’s every other day and it’s
tying the whole day up. I don't seem to
have any days.
Female patient, 80s
Quality of care improves because…
People receiving care can:
plan and maintain routines
plan hospital appointments or other
care visits
maintain social networks and contact.](https://image.slidesharecdn.com/districtnursingqualityframeworkslides-160830090344/75/A-quality-framework-for-district-nursing-10-2048.jpg)
![Being available between appointments
5
One individual described the comfort
she takes from being:
always able to ring them up if
something [isn’t] right.
Female patient, 60s
We heard a number of examples from
patients and carers of times when the
nursing service had supported them in a
moment of crisis, and had either made
an unscheduled visit or supported them
to access other emergency medical care.
Quality of care improves because…
People receiving care and carers:
can contact the service in the event of a
deterioration, a sudden worsening of a
problem or other issue, and receive helpful
intervention and support
get the information and advice they need to
manage between nurse visits
are reassured and experience
less anxiety.](https://image.slidesharecdn.com/districtnursingqualityframeworkslides-160830090344/75/A-quality-framework-for-district-nursing-12-2048.jpg)
![Valuing and involving carers and family members
6
[If they tell me what to do when
there’s a problem then] when it happens
I’m not going to panic – I feel like I know
what I should be doing, rather than
thinking I can’t leave it like that, I’m
going to have to make my own mind up,
and I might do something stupid.
Female carer, 50s
If we are struggling with a patient,
I will turn to the family most of the time
and say ‘encourage him to do that.’ They
tend to listen to them, they try to
implement it for us.
Support staff
Quality of care improves because…
Carers:
feel supported and reassured and more
confident in their caring role
feel valued and recognised
may be able to assist staff with treatment
can support staff to better understand the
individual’s preferences and needs.
People recieving care:
have improved patient experience
and outcomes.](https://image.slidesharecdn.com/districtnursingqualityframeworkslides-160830090344/75/A-quality-framework-for-district-nursing-14-2048.jpg)
![Clinical competence and expertise
8
I think [the good thing] was, she
used to change your catheter and you
used to have a lot of faith in her that it
would be alright
Male carer, 70s
Quality of care improves because…
People receiving care and their carers:
have increased confidence in the care they
are receiving.
Staff can:
complete procedures to a high standard
without causing harm or avoidable
discomfort.](https://image.slidesharecdn.com/districtnursingqualityframeworkslides-160830090344/75/A-quality-framework-for-district-nursing-18-2048.jpg)
![Patient education and support for self-management
9
Community [nursing] is about
empowering them, so educating them
about what they should do in terms of
their own health.
Support staff
[We should be] giving patients
empowered choices, yet helping them
understand their health needs and how
to access [care] appropriately… so they
can get a better understanding and it’s
done more in partnership.
Professional development lead
Quality of care improves because…
People receiving care can:
manage their own health and care needs
as far as possible, which promotes
independence.](https://image.slidesharecdn.com/districtnursingqualityframeworkslides-160830090344/75/A-quality-framework-for-district-nursing-20-2048.jpg)
Uploaded byThe King's Fund
A quality framework for district nursing
The document outlines a quality framework for district nursing, identifying nine key characteristics of good-quality care through interviews with patients, carers, and staff. These include caring for the whole person, continuity of care, and the personal manner of staff, among others, which collectively enhance patient experience and outcomes. The framework emphasizes the importance of staff competence and effective communication in delivering holistic and patient-centered care.
In this document
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Introduces a quality framework highlighting nine characteristics of good-quality care in district nursing as informed by patient and staff feedback.
Emphasizes holistic, person-centered care over task-focused approaches to address patients' broader health and social needs.
Highlights the importance of consistent nursing staff for building trust and monitoring patient progress effectively.
Discusses the significance of staff's caring, polite, and professional attitudes, which enhance patients' comfort and confidence.
Focuses on the necessity of timely and reliable appointment scheduling to help patients maintain routines and social interactions.
Explains the benefit of nursing services being accessible for support and advice between scheduled visits, increasing patient reassurance.
Emphasizes support for family caregivers, involving them in care planning and addressing their needs for better outcomes.
Describes nurses’ role in coordinating care among multiple services and advocating for patients and families to improve care delivery.
Stresses the importance of nurses' technical skills and knowledge, boosting patients' confidence in the care provided.
Focuses on empowering patients through education to manage their health proactively and make informed care decisions.
Identifies the key characteristics valued by patients, carers, and staff in district nursing, emphasizing a holistic and supportive approach.
Concludes with resources for learning about quality in district nursing services, inviting wider usage of the framework.
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A quality framework for district nursing
- 1. A quality frameworkfor district nursing Nine characteristics of good-quality care in district nursing, taken from interviews with patients, carers and staff. Read more at www.kingsfund.org.uk/districtnursing
- 2. Caring for the wholeperson Continuity of care Personal manner of staff Scheduling and reliability of appointments Being available between appointments Valuing and involving carers and family members Nurses acting as co-ordinators and advocates Clinical competence and expertise Patient education and support for self-management Nine characteristics of good-quality care in district nursing 2014 2015 2016 Care pla n Community Center GP Surgery Hospital Patient In fo rm ation 2016 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Nurse Sarah Visit Nurse Sarah Visit
- 3. Caring for thewhole person 1 What does this involve? Taking a holistic, person-centred approach to care rather than a task-focused approach Seeing the person, not the need Considering the person’s other health conditions, social issues and wider circumstances, not just a particular condition
- 4. Quality of careimproves because…. People receiving care and their carers: feel supported benefit from the social interaction of visits. Staff can: understand and address the root cause of a problem identify undiagnosed health problems, including acute illness adapt care to an individual’s needs. Caring for the whole person 1 Just being there and chatting with the patients, because while you’re doing that you’re also doing an assessment of them, and there can be things that crop up while you’re chatting. District nurse team leader They just seem to go that little bit further to help, I mean, just being asked ‘are you feeling okay?’ Male patient, 60s
- 5. 2016 1 2 3 4 5 6 7 8 9 10 11 Nurse Sarah visit NurseSarah visit Continuity of care 2 What does this involve? The same nurse, or the same few nurses (who communicate information effectively) seeing each individual receiving care
- 6. 13 14 15 16 Continuity of care 2 Youget a reassurance…They say it’s getting better, so you feel better. Whereas a complete stranger can’t say what it’s like, if it’s getting better, because they’ve never seen it before so they can’t compare it with anything. Male patient, 60s If you’ve known the person when they’re well, you build up that rapport and that relationship with the patient and the family. Then when they begin to decline you’ve got more of a feeling for what they need, and then you know what they’re going to need and you can - to a certain extent - anticipate it. Community nurse Quality of care improves because… Staff can: monitor progress to detect improvements in the patient’s condition take a ‘whole person’ approach to care build relationships and trust with patients. People receiving care: do not have to repeat information have confidence in the abilities of a known and trusted nurse.
- 7. Personal manner ofstaff 3 What does this involve? Caring and compassionate attitudes Polite and respectful attitudes Not appearing to rush Effective communication and building trust Staff appearing to be professional and confident
- 8. Personal manner ofstaff 3 He seemed to care. And his professional manner of course…there was that thought, not just like ‘I’ll do my job and go’. Female carer, 60s [Good care is] communication more than anything. Discuss what you’re doing, step by step: ‘I’m here now, my name is, I’m going to take this bandage off now, I’m going to clean, now I’m going to put on a new bandage’. And tell him everything you’re doing, so that he’s not so fretful. Communication and bedside manner. Female carer, 50s Quality of care improves because… People receiving care: feel at ease and more confident in the care.
- 9. 2014 2015 2016 Scheduling and reliabilityof appointments 4 What does this involve? Advance warning of appointment timing Reliable/predictable timing Information and updates when scheduling is disrupted
- 10. Scheduling and reliabilityof appointments 4 [If they come late] by the time you get up it’s almost time to go back to bed again, the day’s gone. Male patient, 60s I’ve got a friend who comes up to see me and I go down to see her, but we can't do it on the days the nurse is coming. It’s every other day and it’s tying the whole day up. I don't seem to have any days. Female patient, 80s Quality of care improves because… People receiving care can: plan and maintain routines plan hospital appointments or other care visits maintain social networks and contact.
- 11. Being available betweenappointments 5 What does this involve? Services being available to be contacted between visits for information, advice or support or in case of emergency
- 12. Being available betweenappointments 5 One individual described the comfort she takes from being: always able to ring them up if something [isn’t] right. Female patient, 60s We heard a number of examples from patients and carers of times when the nursing service had supported them in a moment of crisis, and had either made an unscheduled visit or supported them to access other emergency medical care. Quality of care improves because… People receiving care and carers: can contact the service in the event of a deterioration, a sudden worsening of a problem or other issue, and receive helpful intervention and support get the information and advice they need to manage between nurse visits are reassured and experience less anxiety.
- 13. Care plan Valuing and involvingcarers and family members 6 What does this involve? Offering practical support to carers in their role Involving carers in care planning and decisions Valuing and recognising carers’ contributions and expertise Addressing carers’ own needs and personal wellbeing
- 14. Valuing and involvingcarers and family members 6 [If they tell me what to do when there’s a problem then] when it happens I’m not going to panic – I feel like I know what I should be doing, rather than thinking I can’t leave it like that, I’m going to have to make my own mind up, and I might do something stupid. Female carer, 50s If we are struggling with a patient, I will turn to the family most of the time and say ‘encourage him to do that.’ They tend to listen to them, they try to implement it for us. Support staff Quality of care improves because… Carers: feel supported and reassured and more confident in their caring role feel valued and recognised may be able to assist staff with treatment can support staff to better understand the individual’s preferences and needs. People recieving care: have improved patient experience and outcomes.
- 15. Community center GP surgery Hospital Nurses actingas co-ordinators and advocates 7 What does this involve? Supporting patients and carers in contact with multiple services Advocating on the patient or carer’s behalf
- 16. Nurses acting asco-ordinators and advocates 7 They’re so on the ball. I’ve got an ulcer on my heel – they told the podiatry people and now they see me every month. She arranged the ambulance to pick me up for my appointments. Female patient, 80s You pick up so much about what they want and what they need, and can liaise with others, and bring services into the home Community nurse Quality of care improves because… Staff can: alert other professionals to problems and ensure appropriate intervention identify the need for other services and support people to access them.
- 17. Clinical competence andexpertise 8 What does this involve? Knowledge, experience and expertise Clinical skills and advanced technical skills Skills in assessment and care co-ordination
- 18. Clinical competence andexpertise 8 I think [the good thing] was, she used to change your catheter and you used to have a lot of faith in her that it would be alright Male carer, 70s Quality of care improves because… People receiving care and their carers: have increased confidence in the care they are receiving. Staff can: complete procedures to a high standard without causing harm or avoidable discomfort.
- 19. Patient inform ation Patient education andsupport for self-management 9 What does this involve? Supporting and educating patients to self-manage Involving people in decisions about their own care
- 20. Patient education andsupport for self-management 9 Community [nursing] is about empowering them, so educating them about what they should do in terms of their own health. Support staff [We should be] giving patients empowered choices, yet helping them understand their health needs and how to access [care] appropriately… so they can get a better understanding and it’s done more in partnership. Professional development lead Quality of care improves because… People receiving care can: manage their own health and care needs as far as possible, which promotes independence.
- 21. Who values andrecognises these characteristics? Highest priority for people receiving care, carers and staff: Caring for the whole person Continuity of care Personal manner of staff High priority for people receiving care and carers, recognised by staff: Scheduling and reliability of appointments Being available between appointments Important to people receiving care, carers and staff: Valuing and involving carers and family members Nurses acting as co-ordinators and advocates Clinical competence and expertise Important to staff: Patient education and support for self-management
- 22. Understanding quality in district nursingservices Learning from patients, carers and staff More detail on this quality framework is available in our report, Understanding quality in district nursing services Download it from www.kingsfund.org.uk/districtnursing We hope this framework and these slides will be a useful resource for you – please feel free to use them in your work, in documents and presentations.