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Hospital 125th: A patient-focused district nursing service

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MidCentral has a district nursing service to be very proud of.

 A group of over 70 nurses provide care in people’s homes, in clinics, in workplaces, across the whole region, with nurses based in Palmerston North, Foxton, Levin, Ōtaki, Pahīatua, Dannevirke and Feilding. This means patients can be receive the specialised nursing care they need, wherever is most appropriate for them.
District nurses have been in Manawatū since 1900. Back then the service was run through a District Nurses’ Society, not the hospitals.
It wasn’t until 1936 that the district nursing service was taken over by the hospital board and by the following year there were two district nurses stationed in Palmerston North, two in Feilding and one each in Foxton, Shannon, Levin and Ōtaki.

Muriel Hancock, former Director of Patient Safety & Clinical Effectiveness, who retired this year, was involved with MidCentral’s district nursing service for 20 years.
She said: “When I joined the district nursing team in 1981, it had its own leadership and systems and there was not a lot of co-ordination with the hospital. But in 1996 there was a major change to the way district nursing was run.  As project leader I undertook a significant review into the service and as a result it became far more centralised.”
“We went to a 24/7 service and put in an 0800 number for after hour services.”
Some district nursing functions are now centralised. Supplies are standardised and are sent out to district nurses in standard packs. In the past supplies were held in various communities and the nurses had to spend time restocking their own kits.  Often it was unclear which stocks were held where.
Muriel said: “Other changes included the way nurses took patient notes – which were all written on cards”. That was changed to clinical record folders that patients could access. 
“I remember the first huge cell phones, I think we had two for the weekend staff. Then every nurse had a phone. It was safer and there is much better contact. There are still risks, of course, but they can be managed.”
In 2002, Muriel was responsible for the implementation of the enhanced in-home service, where more was offered to patients, including intravenous therapy. Nurses were upskilled and as a result the team became a much more highly skilled workforce.
Another innovation was the introduction of clinics in some areas, which were well received by people in remote areas as it meant no waiting for a nurse to call at their home.

Muriel said: “The whole philosophy of district nursing was that it is easier to care for patients in their own home surrounded by their family, pets and cherished possessions. It is easier to get to know your patients and in turn I believe you are much better appreciated.”
“Our service was ahead of its time and other DHBs often expressed interest in how it worked. I used to do a lot of conference presentations, because what we had was held up as a role model. For example, in 1985 we introduced computers into nursing care, and as a result we had the first computer to manage home help and meals on wheels.
“District nursing is just one example of how we have got a lot better at focusing on the consumer or patient. We understand that the quality of our service is not only about what nurses do, but how they do it. MidCentral has gone a long way with this major shift in thinking and is opening up better access to information for patients and families.
“I believe the organisation has a great future and if I had to do it all again, I would still be a district nurse. It is incredibly rewarding.”
District nursing has continued to adapt its service model and for the last two and a half years has been a key player in a regional project to align the roles of nurses who work in various primary health care roles in the community. The primary health care nursing project is using co-production processes, so that people who use services and the clinicians and managers work together to improve services, and many district nurses and the senior district nursing team have been very involved.
Rather than focusing solely on nursing work within services, the project is streamlining processes across services, such as between the district nursing service and general practice teams. Patients therefore experience a smoother transition between services and don’t have to repeat so much information to each service. A new shared care model has been developed and district nursing clinics held in conjunction with general practices are now more common. Patients find these clinics easily accessible, and as the district nurses and the general practice team use one clinical record, everyone knows what care a patient is receiving. Also, the patient benefits from nurses and doctors sharing their skills and knowledge with each other.
District Nursing is now a core part of a programme that aims to keep patients out of hospital by providing care and support in the community and in patients’ homes. So now patients with a DVT, or a skin infection or an acute episode of their chronic lung condition might be staying at home with the right support from a combined team of their general practice team and district nursing.
A large component of current work is exploring how technology can bridge the gaps between services to improve patient care. As a result district nursing is a visible example in the DHB digital strategy and soon nurses will have access to laptops to be able to document care in the home or clinic. We are currently testing lots of new processes, such as video consults, and in all of these developments, we seek patients’ feedback so that we know it meets their needs and improves their care before that process is adopted.
- Written by Paula McCool

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