Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives.ObjectivesWhat is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service?DesignMixed methods case study.SettingPrimary care.ParticipantsNeighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses.ResultsThe adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service.ConclusionsThe adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses’ working lives. It now requires longer term investigation to understand both the mechanism for change and also the sustainability.
Background Quality improvement in general practice has increasingly focused on the analysis of its clinical databases to guide its improvement strategies. However, general practitioners (GPs) need to be motivated to extract and review their clinical data, and they need skills to do so. This study examines the initial experience of 15 practices in undertaking clinical data extraction and management and the support they were given by their local division of general practice. Objectives To explore the uptake of data extraction tools in general practice and understand how divisions of general practice can assist with their uptake. Method This study was conducted within a single division of general practice within the south-eastern suburbs of metropolitan Melbourne, Australia. Self-selected practices were offered a data extraction program ('tool') free of charge, with ongoing division support. Practice representatives, either GPs, practice nurses or other practice staff members, were given instructions on how to extract data using the data extraction tool. This was followed by discussion with division staff regarding which clinical areas might be focused on. Division staff systematically recorded information about the experience of the practices and collated their clinical data. Results Fifteen practices, representing 69 GPs, participated. The practices chose from the following
Information relating to sickness, accident, and work records in 45 people with epilepsy employed in the British Steel Corporation was obtained and compared with 38 matched control subjects. Fewer people with epilepsy were prepared to do shift work compared with controls, and prolonged absence from work due to sickness was more frequent in the epileptic group. There was no difference between the two groups in four out of five factors relating to job performance. Those in the epileptic group who had an associated personality disorder had significantly poorer job performance ratings.
District nursing services have struggled in recent years to cope with demand, maintain morale and retain staff. 1,2,3 A Dutch model provided by the social enterprise Buurtzorg has attracted much interest as offering possible solutions. 4 A central tenet of the Buurtzorg model is 'humanity over bureaucracy' which is enacted in two key strategies. 4 The first strategy is a patient centred, relationship-based nursing practice ethos with a focus on empowering patients. The second strategy is independent, self-managing teams of nurses, with 40-50 patients, supported by a coach (not a manager) and a small back office for all teams dealing with administrative processes such billing. A number of NHS organisations across the UK are starting to try out this model. We report on some of the learning from a pilot in England. Neighbourhood Nursing: an adapted pilot of the Buurtzorg model A central London NHS trust , facing increasing demands and high vacancy rates, piloted an adapted Buurtzorg model Neighbourhood Nursing (NN) team in order to 'Test and Learn' in late 2016.
The discussion of advanced practice in nursing is ongoing, yet the need for practice to advance and develop across the health economy is called for in much of the current literature and government policy. This article considers an educational intervention that set out to advance primary care nursing. The programme aimed to facilitated nurses to understand clients, families and carers in the community setting, to offer a high standard of care, to support specialist practitioner team leaders to work across community nursing disciplines and to make their own career development choices. Advancing practice in this novel primary care nursing programme required change management, collaboration, partnership, leadership and involvement of the staff nurses themselves.
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