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Community Nurses Measure Up



Alison Wallis: Nursing Clinical Advisor,

Data Intelligence Group

Lee Davies: Project Manager,

Data Development

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  • Agenda

    • Background

    • Benefits

    • Communication and Engagement

    • The Dataset

    • Outcome

    • Reporting

    • Terminology Mapping

    • What’s next?

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  • 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

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    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

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    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

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    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


    Training Sessions

    Help desk

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    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

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    Nursing: Problems, Interventions

    Bladder/Bowel Care

    Care Management


    Pregnancy Postnatal

    Infant/Child Development

    Family Care

    Emotional/Psychological Issues


    Health Promotion

    Long Term Condition Management



    Nutrition / Fluids

    Personal Care

    Risk Management

    Social Circumstances

    Symptom Management



    Skin/Wound Care

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    • General Development Programme (I)

      Infant/Child Development

    • Elderly Gent, Lives alone (P)

      Social Circumstance(s)

    • Educating carer in procedure (I)


    • Check Environment (I)

      Risk Management

    • Reduced Fluid Intake (P)

      Symptom Management

    • Behavioural Temper Tantrum (P)

      Infant/Child Development

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    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


      Planned/ unplanned

      Reason for more than 1 staff member

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    The Census Experience

    IT Issues – ISD and Local



    IT Awareness


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    First fully electronic, national data collection initiative for community nursing


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

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    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.

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    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

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    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

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    What’s Next?


    • 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

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    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?

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    • 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

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    • Flexible

    • Comprehensive

    • Adaptable

    • Transferable

    • Comparable







    Terminology Mapping (1)

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    Additional problems &

    Interventions from

    Census comments









    Scottish Catalogue


    Community Nursing

    Terminology Mapping (2)



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    • 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

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    Report Published 25th November 2008

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