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slide1

Community Nurses Measure Up

DID

V

Alison Wallis: Nursing Clinical Advisor,

Data Intelligence Group

Lee Davies: Project Manager,

Data Development

slide2

Agenda

        • Background
        • Benefits
        • Communication and Engagement
        • The Dataset
        • Outcome
        • Reporting
        • Terminology Mapping
        • What’s next?
slide3

Background

  • Electronic Patient Record
      • Need for standardised information for sharing patient information and secondary uses
  • Lack of other information sources about Community Nursing, e.g. Practice Team Information (PTI) and ISD 29/30 incomplete
  • AHP Census, September 2005 - Provided previously unknown information across Scotland, e.g.
      • Number of patients on caseload
      • Most common interventions
      • Most common conditions
slide4

The Census

  • 24th April 2008 – National, One Day
  • Web Based System
  • Focussing on Community Nursing Teams -

District Nursing

School Nursing

Health Visiting

Treatment Room Nursing

Family Health Nursing

slide5

Benefits

1. Support development of the Electronic Patient Record for use by Community Nurses:

  • Establish Minimum Nursing Dataset
  • Identify standard terminology and national data standards
  • 2. Provide information and intelligence to support service redesign, workload management and policy decisions:
    • Diversity of Health problems
    • Variation in nursing practice, roles, location
    • Provide national nursing baseline
  • 3. Communication with Community Nurses through workshops and training sessions
    • raised awareness of need for standardising information in clinical records
    • gained insight into the power of information
    • gained insight into the complexity of their day to day work using their terms to describe it
    • demonstrated the motivation and drive of community nurses to work together to make themselves heard
communication and engagement
Communication and Engagement

Communication through Community Health Partnership Leads and Directors of Nursing

User Reference Groups - Scenarios

Awareness Sessions

Website and publicity material e.g. newsletters

Pilots

Training Sessions

Help desk

the scenarios
The Scenarios

1. General Development Programme

2. Elderly Gent, Lives alone

3. Educating carer in procedure

4. Reduced Fluid Intake

5. Check Environment

6. Behavioural Temper Tantrum

nursing problems interventions
Nursing: Problems, Interventions

Bladder/Bowel Care

Care Management

Carers

Pregnancy Postnatal

Infant/Child Development

Family Care

Emotional/Psychological Issues

Equipment

Health Promotion

Long Term Condition Management

Medication

Mobility

Nutrition / Fluids

Personal Care

Risk Management

Social Circumstances

Symptom Management

Teaching

Procedures

Skin/Wound Care

slide9
General Development Programme (I)

Infant/Child Development

  • Elderly Gent, Lives alone (P)

Social Circumstance(s)

  • Educating carer in procedure (I)

Teaching

  • Check Environment (I)

Risk Management

  • Reduced Fluid Intake (P)

Symptom Management

  • Behavioural Temper Tantrum (P)

Infant/Child Development

slide10

The Census Dataset

  • About the Nurse: Registered/ unregistered with SPQ/ SVQ

Caseload holder / caseload size

Non-patient related activity

  • About the patient: Age, ethnic group, gender
  • About the care: Nursing Problem / Intervention(s)
          • Aim of Care
          • Medical diagnosis
          • Intensity (Child Health)
          • Planned frequency of care
  • About the patient contact: Individual/ group/ clinic

Face to face, telephone, etc

Location

Planned/ unplanned

Reason for more than 1 staff member

the census experience
The Census Experience

IT Issues – ISD and Local

Access

Helpdesk

IT Awareness

Communication

slide12

Outcome

First fully electronic, national data collection initiative for community nursing

Staff

3385 (74%) staff working on Census Day completed the census form

slide13
District Nurse:

North Lanarkshire CHP

Registered Without SPQ

Made individual contacts only

Also did some practice development work

Saw 3 patients:

Male 91 Problems: Skin/Wound Care – Leg Ulcer

Interventions: Skin/Wound Care – Leg Ulcer Care

Medical Diagnosis: Circulatory System Disease – Peripheral Vascular Disease

Care: Planned Curative, Face to Face in patients home occurring once a week.

Female 72 Problems: Skin/Wound Care – Wound Care

Interventions: Skin/Wound Care – Surgical Wound Care

Medical Diagnosis: Injury – Fracture of Tibia and Fibula

Care: Planned Resolution, Face to Face in patients home occurring twice a week.

Female 38Problems: Bladder/Bowel – Urinary Catheter in Situ

Medications – Unable to take Med’s

Skin/Wound Care – At risk of Pressure Sore

Interventions: Bladder/Bowel – Catheter Care

Medication – Administration

Skin/wound Care – Pressure Ulcer Prevention

Medical Diagnosis: Paraplegia

Care: Planned Stabilisation, Face to Face visit in patients home, is occurring once a day.

analytical tables
Analytical Tables

Reported at Scotland Level Only

  • Participation and Contacts

Participation numbers and percentage

Skill Mix – Registered and non-Registered

Number of Patients seen – by service

Number of Contacts, Proportion of Planned Contacts – by service

Non-Patient Activity – by service type

analytical tables 2
Analytical Tables (2)

Reported at Scotland Level Only

  • Clinical Analysis

Aim of Care for Individual and Groups/ Clinics by service type

    • Intensity of Care by service type (Child Health)
    • Nursing Problems High Level Categories by service type
    • Nursing Interventions High Level Categories by service type
    • Medical Diagnosis High Level Categories by service type
  • Analysis by Patient

Age and Gender by Service type

    • Ethnicity
slide16

What’s Next?

Report

  • Identify local champions to assist with information dissemination
  • Work with key stakeholders to identify and answer further questions from the data
  • Distribute local data to their respective boards and support local analysis and interpretation of this in its local context
slide17

Possible Further Questions

  • What skill levels for each service type is associated with particular nursing interventions?
  • What is the difference in caseload numbers for different skill levels for each service type?
  • What range of nursing interventions were carried out for patients or clients seen as individuals,
  • groups or in clinics?.
  • What nursing problemsdo patients have who had 2 contacts from the same member of
  • staff for each service type?
  • What nursing problems and interventions were undertaken for patients across each
  • service type who had an unplanned contact?.
  • Which non patient related activity was undertaken by each skill levels for each
  • service type?
  • What nursing problems are associated with a particular care aim?
  • What care aims are associated with particular medical diagnosis?
  • What care aims are associated with particular contact types.
  • Is there any relationship between care aim and intended frequency of future visit?
  • What different types of nursing problems and interventions are offered to families with
  • children who require additional and intense levels of care intensity?
  • What nursing problems arise from specific medical diagnosis?
  • Where no medical diagnosis exists, what interventions are being carried out and why?
  • What interventions are associated with particular nursing problems?
  • What nursing interventions are undertaken by different skill levels in each service type?
  • What interventions were undertaken by each service type where no medical diagnosis
  • was identified?
slide18

Refine

  • Review the Dataset to further support other nursing initiatives i.e. NMWWPP
  • Review the definitions i.e. Planned/Un-planned Care, Caseload
  • Enhance pick list values to ensure they fully reflect the nature of nursing team activities.
  • Explore concept of nursing diagnosis to better identify nursing problems
  • Revise categories of non-patient activity
  • Progress the development of the International Classification of Nursing Practice Catalogue in partnership with the International Council for Nurses
slide19

Existing

Systems

PTI

Scenarios

NANDANICNOC

  • Flexible
  • Comprehensive
  • Adaptable
  • Transferable
  • Comparable

Omaha

Categorised

lists

HomeHealthcareClassification

Census

ICNP

Terminology Mapping (1)

slide20

Additional problems &

Interventions from

Census comments

ICN

+

Scottish

terms

Terminology

Mapping

Tool

ICNP

Scottish Catalogue

of

Community Nursing

Terminology Mapping (2)

Categorised

lists

slide21
Repeat
  • Refine the web based data capture system and develop a process to make it available for more frequent application or for the use of specific staff groups
  • Identify sponsors and resources for any future local or national census initiatives
slide22

Report Published 25th November 2008

www.isdscotland.org

Provide us with your e-mail address and we will send you the link to access the report

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