East_Sussex_Healthcare_Trust

							                RCN Older People Resource – Best Practice Gallery

      Name                                     Angela Colosi
      Job title                                Nurse Consultant for Advanced Practice
      Employer/ organisation                   East Sussex Healthcare Trust
      Specialty/ setting                       Community


    Summary:
    Development of the Community Nursing workforce (including Community Matrons) in the skills of
    physical assessment and independent prescribing that will ensure that patients at home receive timely
    treatment in the most appropriate setting. This has included the concept of peer support to encourage
    transparent working and role modelling.

    Details:
    Our area has a high population of older people with subsequent long term conditions. The up-skilling of
    the community nursing workforce has been essential in order that we can treat our communities in the
    home setting, educate people to minimise exacerbations and assess their conditions quickly should they
    deteriorate thus avoiding unnecessary hospital admissions. The work described here has only been
    possible due to the dedication, hard work and commitment of the nurses involved in East Sussex.

    Advanced nursing skills provide patients with easier access to services (Department of Health, 2006);
    providing safe disease management away from a secondary care setting that is closer to home
    (Department of Health, 2005) and striving for quality improvement (Department of Health, 2009;
    Department of Health, 2011). To enable the workforce to comply with these requirements practitioners
    have to acquire the ability to practice at an advanced level (Department of Health & End of Life
    Programme, 2010; Royal College of Nursing, 2004; Royal College of Nursing, 2010). These are the
    policy drivers but advanced practice has been heavily influenced by the vast research base available on
    the benefits of advanced nursing practice.

   Benefits to patients:
   Benefits to patients in terms of avoiding duplication of assessment and thus speedier access to
    treatment. Staff have also benefited in relation to the motivating aspects of continuing professional
    development.

   Outcome measures:
     Evaluation from support group participants, narrative feedback from patients, data analysis in
       relation to admission avoidance, increased course applications.
     Securing medical mentorship has sometimes been a challenge but that in itself improves negotiation
       skills.
     To measure the frequency of skill usage following completion of physical assessment and non
       medical prescribing courses. All admissions avoidance data and Community Matron activity is
       reported to Board level.

   Plans for future work in this area:
   Regular audit plans and local analysis, including the collection of patients' views. To continue to improve
    the organisational culture by peer joint visits to support transparency of working, share best practice,
    regulation and role modelling.

    References:
    Department of Health (2005) Supporting people with long term conditions: Liberating the talents of
    nurses who care for people with long term conditions. London: The Stationery Office.

    Department of Health (2006) Our health, our care, our say: Putting people at the heart of public
    services. London: The Stationery Office.

    Department of Health (2009) Transforming community services. London: The Stationery Office.




      RCN Older People Resource http://www.rcn.org.uk/olderpeopleresource
      RCN Principles of Nursing Practice http://rcn.org.uk/nursingprinciples
           RCN Older People Resource – Best Practice Gallery

Department of Health (2011) Quality, Innovation, Productivity and Prevention (QIPP). London: The
Stationary Office.

Department of Health & National End of Life Programme (2010) A framework of national occupational
standards to support common core competences and principles for health and social care workers
working with adults at the end of life. London: The Stationery Office.

Royal College of Nursing (2004) Nursing assessment and older people. A Royal College of Nursing
toolkit. London: Royal College of Nursing.

Royal College of Nursing (2010) Advanced nurse practitioners – an RCN guide to the advanced nurse
practitioner role, competences and programme accreditation. London: Royal College of Nursing.


 The best practice case studies have been mapped against the Principles of Nursing Practice. We
 have shown those Principles that have been commented on by the person who has submitted
 the example.

             Nurses and nursing staff treat everyone in their care with          In any physical
             dignity and humanity – they understand their individual needs,      assessment this principle
             show compassion and sensitivity, and provide care in a way          is upheld.
             that respects all people equally.


             Nurses and nursing staff take responsibility for the care they      Physical assessment and
             provide and answer for their own judgements and actions –           non medical prescribing
             they carry out these actions in a way that is agreed with their     have a high degree of
             patients, and the families and carers of their patients, and in a   accountability
             way that meets the requirements of their professional bodies
             and the law.

             Nurses and nursing staff manage risk, are vigilant about risk,      Knowing when to refer
             and help to keep everyone safe in the places they receive           patients for specialist care
             health care.                                                        is paramount when
                                                                                 working at an advanced
                                                                                 level.

             Nurses and nursing staff provide and promote care that puts         Advanced nursing skills
             people at the centre, involves patients, service users, their       give greater choice to
             families and their carers in decisions and helps them make          patients.
             informed choices about their treatment and care.


             Nurses and nursing staff work closely with their own team and       Local policy and procedure
             with other professionals, making sure patients’ care and            ensures that all prescribing
             treatment is co-ordinated, is of a high standard and has the        decisions are fed back to
             best possible outcome.                                              our medical colleagues
                                                                                 and the wider team in a
                                                                                 timely manner.

             Nurses and nursing staff lead by example, develop                   The peer support process
             themselves and other staff, and influence the way care is           and the formation of local
             given in a manner that is open and responds to individual           nursing groups for
             needs.                                                              reflection and practice of
                                                                                 skills supports this
                                                                                 principle.




  RCN Older People Resource http://www.rcn.org.uk/olderpeopleresource
  RCN Principles of Nursing Practice http://rcn.org.uk/nursingprinciples