Community nursing

Informal carers play a vital role in enabling people with ongoing support needs to be cared for at home, but this has a negative impact on carers' own health and wellbeing. Although community nurses are well placed to identify and support carers, falling numbers of district nurses and the increasing needs of an ageing population mean they have limited time and so focus on patients. This article proposes the creation of a 'carer support nurse' role entirely dedicated to supporting carers.

For community nurses, the first step in ensuring a carer's wellbeing is to be mindful of not adding to the person's burden themselves. To create and maintain safe and effective care for patients relies on collaboration between nurses and the families and carers, which may involve nurses delegating caring duties to a carer. But, in line with the professional code, this should only happen if the carer is competent, supervised, supported, and understands the task, its complexity and expected outcomes (Nursing and Midwifery Council, 2015).

AIM: To compare the satisfaction levels of patients and carers with a community night nursing service. METHOD: Thirty seven patients and 23 carers completed satisfaction postal questionnaires. Respondents were further subdivided into acute, chronic and terminally ill patients and their carers. RESULTS: Satisfaction levels with the service were generally high, although respondents from the terminally ill group showed the lowest levels of satisfaction overall. The Kruskal-Wallis test showed that results between the groups were not significantly different.

The present paper reports on a qualitative research project designed to expose the presently unrecognised minutiae of community nurses’ work with cancer patients at home, and to identify the ways in which these, combined to form comprehensive care episodes, contribute to physical and psychosocial well-being. The project was conducted in two locations in New South Wales, Australia, one metropolitan and one rural.

Most terminally ill patients will express a wish to die at home. To achieve this, patients must rely on the support of family carers, who may experience emotional and health difficulties in providing such care, both before and after the death. Healthcare professionals can help to relieve the burden on family carers, and there is guidance available to direct GPs and other community healthcare professionals on providing good anticipatory palliative care for patients, and support for carers.

The author examines the pressures that may be experienced by carers in the community and discusses ways in which nurses can help to address these problems. 

Nurse-led case management programmes have become increasingly popular over the last 15 years. Countries such as the USA, Canada, Sweden and the Netherlands have long running case management programmes in place for frail elderly people. The Department of Health in England has recently introduced a 'community matron' role to provide case management to patients with highly complex long-term conditions; a group that is predominantly comprised of elderly people.

In this video we meet Jim and Janet Swift, both keen travellers until Janet was diagnosed with dementia at the age of 58. Jim's account of their experience illustrates the widespread effect of a very rapid deterioration, and explores the sense of loss and loneliness that can be part of the caring role. His account also highlights the need for skilled, experienced support for carers – in this case provided by an Admiral Nurse - together with access to regular breaks from the caring role.

Swaleh Toofany examines the evolution and possible future options for hospital at home schemes

Healthcare providers are under pressure to deliver cost-effective care to a population that is ageing. Increased longevity means the number of patients with long-term conditions and chronic illness is growing. Expanding the range of services delivered to patients in their homes may provide a solution by keeping patients out of hospital.

Caring for a loved one can take its toll physically and emotionally. Caroline Swinburne discovers how district nurses can ease the load. Supporting unpaid carers is an important but often unseen aspect of community nursing.