Julie Bliss

Interprofessional working in palliative care in the community: a review of the literature

In the United Kingdom (UK) a range of professionals, who are employed within both statutory and non-statutory organisations, provide palliative care in the community. This paper explores how interprofessional working between these practitioners is facilitated, and considers how language and philosophies of care can impact upon the working relationship between professionals. It is suggested that often the difficulties experienced when working with another professional are outside the remit of the individuals involved. When working within large organisations within a legislative framework practitioners must be prepared to acknowledge the strengths of different groups, and to understand how these can be utilised to provide effective and appropriate palliative care.

The development of palliative care in national government policy in England, 1986–2000

Palliative care is an established and expanding speciality, important in many areas of service delivery within health and social services and the voluntary sector. Traditionally, palliative care is viewed as most closely linked to cancer services. National government policy has an inevitable impact on the organization and provision of such services. As part of a wider project, an investigation of the content and development of English government policy relating to palliative care was carried out. The development of policy follows a cycle that has no closure; it takes place within changing contexts, between multiple organizations and across sectors. Data collection involved the collation and close examination of policy documents and other documents that demonstrably influenced policy. This was in order to identify a national view of policy intentions for palliative care. In total, 53 policy documents were examined. The analysis revealed a number of pertinent issues relating to shifts in funding policies and an evolving definition of palliative care. There is an increasing recognition in the policy documents of the need for palliative care to extend beyond the traditional focus on cancer services and terminal illness. In tandem, is an increasing recognition of the need for partnership between sectors, reflected in more recent health and social services legislation.

Decision-making in palliative and continuing care in the community: an analysis of the published literature with reference to the context of UK care provision

Palliative and continuing care in the United Kingdom (UK) is provided by a range of health and social care professionals who work within a variety of statutory and non-statutory organisations. This selective review of the literature focuses upon palliative and continuing care decision-making undertaken by district nurses and social workers as an exemplar of interprofessional decision-making. The decision-making process is complex and heavily influenced by the organisations employing district nurses and social workers. A model of strategic decision-making is identified which facilitates the exploration of events within the context of practice, thus providing a greater understanding of the process and outcomes to inform the professional development of practitioners.

Does Preceptorship improve confidence and competence in Newly Qualified Nurses: A systematic literature review

AIM A systematic literature review to assess whether preceptorship improves confidence and competence in Newly Qualified Nurses. BACKGROUND Preceptorship was introduced into nursing in the United Kingdom in 1991 with the original aim to improve competence and confidence. This systematic review was undertaken to review the evidence of the impact of preceptorship on confidence and competence of nurses in their first year post qualifying. DATA SOURCES A comprehensive search of The British Nursing Index, CINAHL, Embase, Medline, PsycInfo, PyscArticles, Campbell Collaboration; Cochrane, HMIC, ERIC, ASSIA, Web of Science, Scopus, Scopus Conference, Web of Science Conferences; NHS Evidence, OpenGrey, National Technical, NINR, Opendoar, SSRN, Kings College London and the RCN was conducted. METHODS A PRISMA structured systematic review was carried out, 14 papers 4 mixed methods, 8 qualitative, 1 scoping review and 1 service development, published between 1996 and 2013 were critically reviewed, and data extracted using thematic analysis. RESULTS Four themes were identified from a thematic analysis: measurement, knowledge and experience, support, and structure. CONCLUSION While one-to-one preceptorship does influence confidence and competence, Preceptorship Programmes has greater impact than the individual preceptor. Due to limited empirical research there is no concrete evidence that Preceptorship has a direct impact on confidence or competence. Further research into team preceptorship/choice of preceptors and what impacts on Newly Qualified Nurses confidence and competence is required.

An innovative strategy to increase a professional workforce: the fast track initiative for health visitors in England

Objectives Fast tracking is one strategy that organizations use to ameliorate workforce shortfalls by attracting new recruits, and accelerating their skills development and experience. In response to the Government’s target of rapidly expanding the number of health visitors in England’s National Health Service, the fast track initiative was launched to recruit newly qualified (fast track) as well as experienced (standard entry) nurses and midwives onto health visiting programmes. This paper evaluates the fast track initiative, from the perspective of fast track and standard entry students, practice teachers and health visitor managers. Methods A mixed methods design was used comprising a questionnaire survey (n = 71 students), semi-structured interviews (n = 37 students), telephone interviews (n = 13 managers) and six focus groups (n = 24 practice teachers). Data were collected between April 2012 and July 2013. Descriptive statistics, t-tests and the Pearson Chi-square test were used to analyse the quantitative data. The qualitative data were analysed thematically. Results Motivations for health visiting as a career choice were similar for fast track and standard entry students, with career progression and interest in health promotion being key motivators. There was consensus that personal qualities and characteristics were more important than experience or qualifications. However, fast track students were significantly less confident about their public health competencies in leadership and management (p < 0.05) and communication (p < 0.02). Practice teachers and managers also reported that fast track students required more intensive supervision particularly at the beginning of the programme. Programme completion including pass rates and academic achievement showed no significant difference by route of entry (p > 0.5). Conclusion Fast tracking offers a useful recruitment strategy in order to expand the health visitor workforce, but longitudinal research is needed to confirm benefits such as retention and career trajectories.

RCN backs the district nurse specialist practice qualification

Students find the district nurse specialist practice qualification (SPQ) ‘transformational’—equipping them with knowledge and skills to be effective caseload managers and team leaders in a variety of community settings (QNI, 2015). As a result of the resolution passed at Congress in 2016 (Royal College of Nursing (RCN), 2016), the RCN committed to lobbying for all district nurse (DN) caseload holders to have the professional SPQ. The RCN will work with key stakeholders to raise the profile of DNs to ensure that they are adequately prepared to undertake their role over the coming year.

Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services

General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model – the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management.

Chelsea, Pimlico and Belgravia District Nursing Association 1930-1939:: A case study

The case study explores how the expansion of the health services during the interwar period impacted upon the status of district nursing and examines how being a voluntary service shaped district nursing associations. A range of primary sources were used; the Association Annual Reports, the Medical Officer for Health Annual Reports for the Borough of Chelsea, the Ministry of Health records, the archives of the Queens Nursing Institute (QNI) and the Borough of Chelsea Council Minutes. The Medical Officer for Health Reports and the Council minutes identify efforts to improve environmental factors that impacted upon health. These primary sources briefly note the contribution of the Association suggesting that it was integral to the health care provision but considered a constant. The impact of changes to the 1932 Sunday Entertainments Act provide an interesting juxtaposition between the acknowledged value of district nursing and the constant struggle to fundraise in order to provide home nursing. Throughout the 1930s the Association experienced staff shortages and challenges regarding recruitment. The complexities of payment for municipal health services following the 1929 Local Government Act contributed to the staffing challenges. The move to a block grant in 1938 provided increased stability with regards to income. The case study identifies a contradiction regarding the esteem and value placed upon district nursing associations providing home nursing and the constant challenge of resources. District nursing services face similar challenges and this is the 130th anniversary of the Queens Nursing Institute.

A patient's view on helping to shape a career framework for community nurses

Julie Bliss, Iain Upton Julie Bliss, Senior Lecturer, Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, Chair, Association District Nurse Educators, and Member, RCN DN Forum Steering Committee; Iain Upton, Member, Patient Advisory Forum Health Education England; Both Julie and Iain are members of the Transforming Nursing for Community and Primary Care Steering Committee julie.bliss@kcl.ac.uk