New style of community nursing improves care for patients with complex needs, Kingston University and St George's, University of London researchers find

Posted Tuesday 16 January 2018

Plans are being put in place by a leading London NHS Foundation Trust to adopt an innovative style of community nursing after a report by researchers from Kingston University and St George's, University of London showed it benefited patients, carers and nurses.

Guy's and St Thomas' neighbourhood nurses are self-managing teams who work on a one-on-one basis with people in their own homes. Nurses get to know their patients and develop personalised care packages tailored to meet their specific, and often complex, needs.

The Trust commissioned an independent report led by Professor Vari Drennan MBE from the Faculty of Health, Social Care and Education, run jointly by Kingston and St George's, to assess the impact of the scheme. Professor Drennan and her team found the new approach had real benefits for both those giving and receiving care.

"This model of community home nursing offers real potential for addressing some of the challenging issues facing patients, carers and nursing staff," Professor Drennan said.

"It empowers nurses to be able to have a real impact on patients' lives. Having more time to spend with those they care for allows these nurses to build relationships that enable them to understand and address the health issues most important to patients. They are then able to put in place joined up packages of care tailored specifically for each individual that help keep people in their own homes for as long as possible, rather than having to go in to hospital." 

Professor Vari Drennan said the community nursing model offered real potential for addressing some of the challenging issues facing patients, carers and nursing staff.Guy's and St Thomas' is the first NHS organisation in England to implement the scheme, which uses key elements of the Dutch nursing  model known as Buurtzorg. Neighbourhood nurses are supported by a coach, rather than managers, to make decisions and provide patients with substantial nursing and personal care. They see patients with several complex conditions, such as heart and kidney problems or people who are nearing the end of their life, and co-ordinate the support needed, working closely with other health professionals. The level of care which can include administering medicine, dressing wounds, washing, dressing, meal preparation and shopping reduces over time as patients become independent and take control of their care.  

Professor Drennan and her team found patients and carers involved in the pilot programme said it made a big difference to the care they received the fact that nurses had more time to devote to them to assess their needs was repeatedly highlighted as a major benefit. Equally, nurses themselves were positive about their experiences particularly in terms of professional development and job satisfaction despite some challenges, such as adapting to working as self-managing teams.

Neighbourhood nurse Yasmin Kamara, who has been caring for patients in Brixton, said she found being involved in the scheme very rewarding.  "It's every nurse's dream to work in this way. Working like this means that most of the time we have is spent purely with the patient. We take as long as is needed with them, until they feel empowered to become less reliant on health and care workers and can begin to take control of their own care," Ms Kamara said.

Cepta Hamm, Head of Nursing, Adult Community Nursing, at Guy's and St Thomas' said patients and carers were at the heart of the scheme. "We're doing something quite radical here but we are not doing this alone," she said. "We don't have all the answers yet and we will need to work closely with our partners like social care colleagues to make this happen.

"This is an important step towards finding a new way of caring for people in our community, so they can stay at home longer and out of hospital.

"It's about putting the patient and their carers at the centre of what we do while ensuring that this new way of working helps us to recruit and retain highly motivated and satisfied community nurses who are given the time to care."

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