Nursing Times Award Winner

Juliet Shaw, District Nursing Student offers her thoughts on care in the community

We were delighted to get this e-mail from Juliet Shaw, District Nursing Student at Worcestershire Primary Care Trust.

These are just some of her suggestions which she has gained partly through her District Nursing experience and partly through caring for a close relative.

They are in no particular order. She writes.....

'Always ask patients and carers what they would like to be called as it puts them at their ease and makes communication much easier.

Don't make promises you cannot fulfil, but always follow things through that you do promise!

Keep patients and families informed about their care. For example, it may relieve anxiety to phone with a negative wound swab rather than wait until the next visit.

Give patients your undivided attention during visits. For example, turn your mobile phone onto silent and do not answer it. This is their time to feel listened to and important and you need to show that you have time for them, otherwise there is a risk of missing vital clues and information.

Position yourself so that it is easy for them to communicate with you.

Ask the patient where they would like you to put the rubbish after a dressing change.

If possible, avoid visiting at meal times. Patients should not feel rushed or watched when having a meal

Tell patients how long your visit is likely to be so that they can plan the rest of their day

Make a point of washing your hands. Patients often feel reassured by this.

Take time to stand back and assess the situation. Some interventions may be inappropriate and insensitive especially during end of life care.

Playing a patient's favourite music can relieve anxiety, especially during end of life care/procedures.

Live music and visiting pets can make a difference in a variety of health care settings

Always take religious and cultural beliefs into consideration

Keep accurate comprehensive records that can be used by the multi-professional team. These are often the main source of communication in the community, but if they are incomplete, it risks unnecessary duplicate questioning of patients and carers.

Make sure patients and carers are, whenever appropriate, included in decision making

Remember that caring is a privilege and treat people with respect as you would like your own parents, relatives or friends to be treated. Do everything you can to maintain comfort and dignity.

Make time for patient education. They may need a visit just for this (rather than at a busy dressing change visit etc) to give the patient time to take in the information and for education to be successful, especially when it is likely to involve a change of lifestyle such as pressure area care or diabetes management.

Take into consideration that some people cannot read or write or speak English, so you may need to adapt information accordingly ie picture cards, translation of information etc.

Spend that little bit of extra time allowing people to maintain their own independence and empower them with confidence. For example, teaching a diabetic to do their own insulin.

Tell patients who pay for prescriptions that they can purchase a pre-paid prescription care for a period of 3 months or more. This will save them money in prescription charges if they are having regular dressing changes etc.

A carer assessment by social services may give carers entitlement to well-earned breaks when they are caring for people with long term conditions

Lip balm can make a big difference to people at the end of life or with some long term conditions as dry lips can be very uncomfortable'

Juliet Shaw, District Nursing Student, Alymer Lodge Surgery, Kidderminster, Worcestershire Primary Care Trust. March 2011

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