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Community Nurses Measure Up
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Alison Wallis:
Nursing Clinical Advisor,
Data Intelligence Group
Lee Davies:
Project Manager,
Data Development
Community Nurses Measure Up
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Agenda
Background
Benefits
Communication and Engagement
The Dataset
Outcome
Reporting
Terminology Mapping
What’s next?
Community Nurses Measure Up
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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
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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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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
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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

Pilots

Training Sessions

Help desk
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The Scenarios
1.
2.
3.
4.
5.
6.
General Development Programme
Elderly Gent, Lives alone
Educating carer in procedure
Reduced Fluid Intake
Check Environment
Behavioural Temper Tantrum
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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
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1.
2.
3.
4.
5.
6.
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
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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
Location
Planned/ unplanned
Reason for more than 1 staff member
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The Census Experience
• IT Issues – ISD and Local
• Access
• Helpdesk
• IT Awareness
• Communication
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Outcome
First fully electronic, national data collection initiative for community nursing
Staff
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
Saw 3 patients:
Male 91
Problems:
Interventions:
Medical Diagnosis:
Care:
work
Skin/Wound Care – Leg Ulcer
Skin/Wound Care – Leg Ulcer Care
Circulatory System Disease – Peripheral Vascular
Disease
Planned Curative, Face to Face in patients home
occurring once a week.
Female 72 Problems:
Interventions:
Medical Diagnosis:
Care:
Skin/Wound Care – Wound Care
Skin/Wound Care – Surgical Wound Care
Injury – Fracture of Tibia and Fibula
Planned Resolution, Face to Face in patients home occurring
twice a week.
Female 38 Problems:
Bladder/Bowel – Urinary Catheter in Situ
Medications – Unable to take Med’s
Skin/Wound Care – At risk of Pressure Sore
Bladder/Bowel – Catheter Care
Medication – Administration
Skin/wound Care – Pressure Ulcer Prevention
Paraplegia
Planned Stabilisation, Face to Face visit in patients home, is
occurring once a day.
Interventions:
Medical Diagnosis:
Care:
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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?
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
Possible Further Questions
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• 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 problems do 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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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
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Terminology Mapping (1)
Scenarios
PTI
Existing
Systems
NANDA
NIC
NOC
•Flexible
•Comprehensive
Omaha
•Adaptable
Census
Categorised
lists
Home
Healthcare
Classification
ICNP
•Transferable
•Comparable
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Terminology Mapping (2)
Categorised
lists
ICN
Additional problems &
Interventions from
Census comments
Scottish
terms
Terminology
Mapping
Tool
ICNP
Scottish Catalogue
of
Community Nursing
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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
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Report Published 25th November 2008
www.isdscotland.org
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