District nurses fail patients over appointment times into the nature and quantity of district R esearch nursing practice highlights the complex and valu
able skills of district nurses. It places high value on the relationship between the nurse and the patient and the ability of district nurses to act as a friend as well as a practitioner (Andrews, 1990). This professional friendship is an expression of the expertise and skill of the practitioner and focuses on a relationship with the patient and his/her familial carers in a partnership of care. The best of district nursing practice fosters this partnership and, as in any partner ship, the emphasis should be on negotiation. In district nursing, the negotiation is not simply about the direct care given but also about the contexts and networks within which it occurs. However, it appears that in most cases the partnership is somewhat unequal. Lack of flexi bility denies patients the care they would choose, at the time they would prefer. Preset appointment times for visits are becoming an integral element of the assessment framework in the best of district nursing practice. But all too often practi tioners respond: ‘I can’t give you a time for your visit, but it will be some time on Tuesday’. This tradition persists in a situation which, in many other ways, has rejected tradition for research-based practices. In the design of appropriate and considered plans of intervention, it must be the needs of the client and not those of the service and service providers that drive the planning. However, outmoded rituals too often dictate routine patterns of care which contradict the ideals of partnership and individualized care. Time management, along with team management, in the present climate of collaborative care, skill mix and practice audit, needs to be addressed. District nursing students, who often have community experience before undertaking the course, frequently
suggest that it is impractical to give clients specific ap pointment times. They say that failure to meet the set time may upset the patient, their carers, or indeed the district nurses themselves. This seems a poor argument on two points. First, the uncertainty of not having a set time can be as, if not more, distressing for patients and their carers than fail ure to meet set times. Second, the carers bear the respon sibility for care over a substantial period of time, perhaps as much as 23 hours a day. It is contradictory, on the one hand, to assume that carers are able to carry this responsibility and, on the other hand, to suggest that they are unable to negotiate a set appointment time and make contingency plans for emergency delays. District nurses can make and fulfil appointments with colleagues and attend pre-planned clinic sessions, so why should appointments with patients be any different? Another element that can hinder this practice is the degree of control of the patient, and hence the situation, assumed by the nurse. Ceding control of situations to patients and carers may be a painful process, but holding onto control denies the very people for whom we are caring the ability to make decisions and direct their lives. Criticism levelled by disabled people and their carers at community care provision frequently focuses on the inability or unwillingness of the professionals in control of services to provide appropriate and flexible services. The vital process of consultation with the patients is not an ideal to be aimed for, but a necessity which all practitioners must realize. Eileen Barnes Senior Lecturer/Practitioner in District Nursing University of Central England in Birmingham Andrews S (1990) ‘Nurse, you’re wonderful!’ J District N un Septem ber: 16
BJN CLASSIFIED SECTION Just the job for BJN readers! Are you looking for a job? Or are you interested in going on a course? Turn to our classified section starting on page 688
640
BritishbyJournal of Nursing,on1992,Voi l,No2019. 13 Downloaded from magonlinelibrary.com 129.215.017.188 January 11,
able skills of district nurses. It places high value on the relationship between the nurse and the patient and the ability of district nurses to act as a friend as well as a practitioner (Andrews, 1990). This professional friendship is an expression of the expertise and skill of the practitioner and focuses on a relationship with the patient and his/her familial carers in a partnership of care. The best of district nursing practice fosters this partnership and, as in any partner ship, the emphasis should be on negotiation. In district nursing, the negotiation is not simply about the direct care given but also about the contexts and networks within which it occurs. However, it appears that in most cases the partnership is somewhat unequal. Lack of flexi bility denies patients the care they would choose, at the time they would prefer. Preset appointment times for visits are becoming an integral element of the assessment framework in the best of district nursing practice. But all too often practi tioners respond: ‘I can’t give you a time for your visit, but it will be some time on Tuesday’. This tradition persists in a situation which, in many other ways, has rejected tradition for research-based practices. In the design of appropriate and considered plans of intervention, it must be the needs of the client and not those of the service and service providers that drive the planning. However, outmoded rituals too often dictate routine patterns of care which contradict the ideals of partnership and individualized care. Time management, along with team management, in the present climate of collaborative care, skill mix and practice audit, needs to be addressed. District nursing students, who often have community experience before undertaking the course, frequently
suggest that it is impractical to give clients specific ap pointment times. They say that failure to meet the set time may upset the patient, their carers, or indeed the district nurses themselves. This seems a poor argument on two points. First, the uncertainty of not having a set time can be as, if not more, distressing for patients and their carers than fail ure to meet set times. Second, the carers bear the respon sibility for care over a substantial period of time, perhaps as much as 23 hours a day. It is contradictory, on the one hand, to assume that carers are able to carry this responsibility and, on the other hand, to suggest that they are unable to negotiate a set appointment time and make contingency plans for emergency delays. District nurses can make and fulfil appointments with colleagues and attend pre-planned clinic sessions, so why should appointments with patients be any different? Another element that can hinder this practice is the degree of control of the patient, and hence the situation, assumed by the nurse. Ceding control of situations to patients and carers may be a painful process, but holding onto control denies the very people for whom we are caring the ability to make decisions and direct their lives. Criticism levelled by disabled people and their carers at community care provision frequently focuses on the inability or unwillingness of the professionals in control of services to provide appropriate and flexible services. The vital process of consultation with the patients is not an ideal to be aimed for, but a necessity which all practitioners must realize. Eileen Barnes Senior Lecturer/Practitioner in District Nursing University of Central England in Birmingham Andrews S (1990) ‘Nurse, you’re wonderful!’ J District N un Septem ber: 16
BJN CLASSIFIED SECTION Just the job for BJN readers! Are you looking for a job? Or are you interested in going on a course? Turn to our classified section starting on page 688
640
BritishbyJournal of Nursing,on1992,Voi l,No2019. 13 Downloaded from magonlinelibrary.com 129.215.017.188 January 11,
