Journal of Academic Development and Education JADE Issue 10 | Page 110

HIGHLIGHT #3 | 110 HIGHLIGHT #3 Title Collected Stories: Being cared for at home Authors Julie Green & Paula Wood DOI http://doi.org/10.21252/ KEELE-0000037 Contact [email protected] Abstract Background: Service user and carer experience of their illness trajectory and the health care services they receive are integral to programme delivery and key to the development of an empathetic future nursing workforce. Methods: This project was developed to provide an insight into patient and carer experiences of their District Nursing Services. Patient stories, known to be an extremely valuable resource, have been gathered from a group previously not accessed for their stories. Stories have been collated, illustrated and will be formed into a ‘book’ which will be utilised to enhance pre- and post-registration health care programme delivery. Results: To date, 16 stories have been collected from a variety of patients and carers who have had contact, often during extreme circumstances, with their District Nursing Service. Professional notes accompanying the stories are aimed at focusing students on key aspects of the narrative where best practice is highlighted or where improvements to care could have been implemented. Background It has long been acknowledged that stories from the healthcare arena can be powerful and therapeutic for practitioners, patients and for their carers (Carwford et al, 2004; Guntaratnam & Oliviere, 2009). Indeed, Gallo (2016) maintains that we are all storytellers (Gallo, 2016). Service user and carer experience of their illness trajectory and the health care services they receive, in particular, are integral to health care professional programme delivery and are integral to the development of an empathetic workforce. It is acknowledged, however, that certain patient groups are harder to reach due to their demographics, location and illness experience. The District Nursing (DN) service is changing. The delivery of healthcare per se has undergone rapid change since the inception of the NHS in 1948. Patients are living longer with male life expectancy increased from 65 to 79 years and female from 70 to 83 years over the last 60 years (Office of National Statistics (ONS), 2014). With such longevity comes increasing complexity and dependency (Department of Health (DH), 2014). Along with shorter in-patient stays and early hospital discharges, these factors all impact on community nursing. Alongside both changes to demographics and healthcare delivery, the delivery of nursing care within the community has undergone quite dramatic ‘modernisation’ which has expanded the remit of DN teams to include the responsibility for patients with greater acuity; resulting busier schedules and competing demands on the service (Queen’s Nursing Institute (QNI), 2009; DH, 2014, Royal College of Nursing (RCN), 2013). Balancing the competing demands presented, often accompanied by diminishing staff numbers, presents every DN team with daily challenges (QNI, 2013). In such a dynamic but testing environment, it is essential that our pre-registration student nurses gain relevant up-to- date experience of service delivery, the pressures within the community workforce and the impact of striving to maintain the provision of best quality care. In 2006, ‘Our health, our care, our say’ (DH) emphasised the need for a national move of non-acute healthcare delivery to the community environment. This requirement has been the focus of many subsequent papers (National Health Service (NHS), 2014; 2017), however, over 10 years on, the reality of this shift remains a ‘work in progress’, with the move of patient care, funding and service delivery being patchy at best. Increasing work force issues, austerity measures and patient demographics are placing untold pressures on the NHS, not least, the DN workforce (Maybin et al, 2016). HIGHLIGHT #3 | 111 COLLECTED STORIES: BEING CARED FOR AT HOME The aim of the project was to develop a well-constructed, illustrated paper and online learning resource for student ‘case study’ use, focusing on care of the patient in their home environment, ensuring the resource includes the range and complexity of service delivery and is suitably challenging for student learning. As a first national collection of stories related to patients who are cared for at home, the ‘book’ will be a useful resource to share the lived story of DN services with other HEIs and key stakeholders including the RCN, QNI and Health Education England (HEE). Healthcare Education In response to this proposed ‘shift’ of healthcare delivery to the provision of care ‘closer to home’ (NHS, 2017), the Nursing and Midwifery Council (NMC) (2010) requires that all pre-registration nursing students experience and understand the challenges of healthcare delivery across these contrasting areas of service delivery. The NMC require that all students are fully equipped to provide care in both hospital and home environments. In response to this requirement, this project was developed to provide an insight into patient and carer experiences, specifically of the DN Service. The proposal aimed to collect patient stories from a group previously not accessed for their stories, which have then been illustrated and collated into a ‘book’ for use to enhance programme delivery. The need for such a personal insight into care at home is especially important as pressures on placement availability and a healthcare workforce under pressure, often means that student experiences are limited whilst on placement in the community in terms of the breadth of their experiences. Many Higher Education Institutions (HEIs) have found it necessary to re-badge their out of hospital care as ‘home nursing’, which serves to limit student access specifically to DN placements since, since, in effect, these are replaced by chronic and long-term conditions services. Whilst it can be argued that these ‘home nursing’ experiences are also community based, they provide a very different insight to care at home compared to a full DN placement. Patient stories of the care delivered by DNs, along with their community teams, and the experiences of the patients and carers that receive their support, aims to provide students with an insight into the lived experience of those who receive these services. This resource may be invaluable to many students, but more specifically for those who have not been able to experience a ‘full’ placement with the DN Service.