Page last updated: 25-NOV-2008

Community Nurse Census

Statistical Publication Notice

25 November 2008

Community Nurses Measure Up link to an adobe pdf file

INTRODUCTION

The report details the national level findings from the first national census of Community Nursing Teams which took place on the 24th April 2008.

KEY POINTS

The publication shows that :
  • An estimated 74% of Community Nurses completed a return, recording a total of 29,145 patients seen on census day. This includes 16,842 patients seen on an individual basis, 4,413 patients seen in groups and 7,890 seen at clinics (Table 4)
  • Nurses were asked to record the main aim of the total care plan for their patients. The highest recorded (almost one third) main aim of care for individual patient contacts was Maintenance care (Table 8).
  • Out of 21 categories for nursing intervention, the highest reported intervention category was for skin/wound care. District Nursing and Treatment Room Nursing teams reported the highest proportion of intervention in this category. Long-term condition management was the second most recorded intervention category. (Table 12).

INTERPRETATION

As this is the first national census of Community Nurses and their support teams it should be noted that there are several caveats when interpreting the findings, or making comparisons between disciplines, settings, or NHS boards.
 
Not all clinicians were able to attend the training sessions or access the support / guidance materials and therefore it is acknowledged that some of them may have interpreted the questions differently from how they were intended. Education is particularly important to ensure valid and reliable data collection.
 
It is also recognised that there are limitations with certain data items and further work is required to ensure the integrity of those items for the future.  This work will include supporting improved data definitions to ensure there is a common understanding of the terms used.   A review of the appropriate use of some items may be required to ensure they are applied consistently across Boards but take into account local variation.  The relevance of some items for the purpose they are intended should also be reflected on.  This relates in particular to caseload, aim of care and non-patient activity. The context of the data must also be noted to prevent misinterpretation of the results.
 
It was not possible for the data supplied by clinicians to be systematically verified by either the clinicians themselves or by ISD.  Therefore these data may be subject to errors of data entry.

DETAILED FINDINGS

The remainder of this report describes a summary of findings followed by an analytical breakdown of the data at a national level in three main groups:
  • Service types and contacts
  • Clinical analysis
  • Demographic analysis
Service Types and Contacts
The total number of census returns completed was 3,385. (Table 1)

Based on an estimate of the total staff working on census day, the completed 3,385 returns equates to a 74% participation rate. (Table 1).

Of those nurses that returned a census form, 1,865 (55%) were from District Nursing, 1,026 (30%) from Health Visiting, 234 (7%) from School Nursing, 138 (4%) from Treatment Room Nursing and 15 (0.4%) from Family Health Nursing.  A further 115 (3%) reported working in multiple service types. (Table 2)

Of the 2,837 registered nurses (excluding Treatment Room Nurses), 1649 (58%) reported that they were caseload holders.

A total of 29,145 patients were seen during census day. This includes 16,842 patients seen on an individual basis, 4,413 patients seen in groups and 7,890 seen at clinics. (Table 4)

The majority of District Nursing patients were seen individually, with Health Visitors seeing most clients in clinics.  School Nurses have more client contacts in the Group setting. (Table 4)

Of the 16,842 patient contacts made on an individual basis, 675 (4%) were contacted more than once on census day by the same member of staff. (Table 5)

In total, nurses reported 29,934 patient contacts on census day (including individual contacts, groups and clinics). This equates to one person in 177 of the Scottish population being seen by a member of the community nursing team who participated in the census.

2,575 of the 3,393 nurses (76%) reported non-patient activity (Table 7)

Clinical analysis

Aim of care

Overall, the highest recorded (almost one third) main aim of care for individual patient contacts was Maintenance care.  (Table 8)

For individual contacts, District Nurse care aims were mostly Maintenance and Curative. The Health Visitors? most common care aim was Supportive followed by Assessment, then Enabling. Preventive Care was the 4th most common care aim for Health Visitors. There was a similar picture for School Nurses. Treatment Room Nurses most common care aims were assessment then maintenance. Overall, the highest number (almost one third) of individual contacts were for Maintenance care.  (Table 8)

Prevention is the overall most common care aim for groups and clinics. This may indicate that clinic and group situations are utilised for health promotion whereas this may be a secondary rather than a main aim for patients seen on an individual basis.(Table 9)

Nursing problems (actual or potential)
The range of problems is spread across service types but also within each service type there was a wide variety of problems addressed.
 
Skin / wound care was the highest reported nursing problem category overall (22%), with District Nursing and Treatment Room Nursing reporting the highest proportions of problems in this area. The second most recorded problem overall was Long Term Conditions Management (11%). (Table 11)

Nursing intervention
The range of interventions is spread across service types but also within each service type there were a wide variety of interventions carried out.
 
Skin / wound care was the highest reported intervention category overall, with District Nursing and Treatment Room Nursing reporting the highest proportion of intervention in this area.  This mirrors the data recorded within the problems category. The second most recorded intervention category was Long Term Conditions Management. (Table 12)

Medical diagnosis
31% of contacts had the medical diagnosis  entered as ?Not available?.  Of those contacts that had a diagnosis recorded, Circulatory System Disease was the highest reported diagnosis category overall, with District Nursing, Treatment Room Nursing, Family Health Nursing and Multiple Service Type Nursing reporting the highest proportion of diagnosis in this category.  The second most recorded Diagnosis category was Endocrine, Nutritional Metabolic and Immunity Disorders. (Table 13)

Demographic Analysis
Of the 16,842 patient contacts made on an individual basis, 10,497 (62%) were women, 6,342 (38%) were men and 3 had their gender described as other (0.02%). A similar gender split was found in all service types.

Each of the service types recorded a very different age profile. District nursing mainly saw patients in the older age groups. Health Visitor and School Nurse patients were in the younger age groups. Treatment Room Nurses and Family Health Nurses saw patients with a wider range of ages. (All Charts)

CONCLUSIONS

The national level report provides a high level summary and is intended to stimulate questions that can be answered by more in depth analysis of the census data.  As the first exercise of this nature  it forms a baseline and further benefits will be realised in future with further censuses providing trend data and potential links to other data sources for a fuller picture contributing to quality assurance activities, workload management, service redesign and policy decisions. 

The next steps will be to: engage with NHS Board Directors of Nursing and key stakeholders to agree how best the dataset can be maximised; enable NHS boards to respond to the challenges of designing and delivering services of the future; support learning about service changes; and measure their impact on patient care.

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MAIN CONTACTS:

Fiona MacKenzie
Programme Principal, Data Development Programme
0131 275 6515
Fiona.Mackenzie@isd.csa.scot.nhs.uk

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GLOSSARY:

CHP - Community Health Partnership
HB - Health Board
ICNP - International Classification of Nursing Practice
HALL4 - Health for All 4
ISD - Information Services Division
NSS - National Services Scotland
SGHD - Scottish Government Health Department
NHS - National Health Service
SVQ - Scottish Vocational Qualification
SPQ - Specialist Practice Qualification
GRO - General Register Office
PDR - Personal Development Review
 
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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

Community Nurse Census Project Steering Group, Scottish Government, Royal College of Nursing (Scotland), Directors of Nursing in NHS Boards, NSS Nurse Director
 
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HISTORY OF THIS PUBLICATION:

Last Published: n/a
Next Due: no agreement to undertake another census
Data Avaliable Since: This is the first census of Community Nursing teams.

 


Main contact: Email Fiona Mackenzie