This report identifies 65 separate district nursing services offering a wide range of home, clinic, and community based health care services usually seven days a week. Preventing hospital admissions and enabling early discharge are the main focus of the services.
People over seventy five years of age are referred most often for care and this group is likely to grow by thirty five percent over the next ten years. The bulk of the workforce is registered nurses alongside enrolled nurses and health care assistants.
Purpose
The main aim of this project was to provide an up-to-date resource for the health sector to identify what is happening in district nursing, how it contributes to improved health outcomes, and what more can be achieved in the delivery of care in the community by this workforce.
This project provides evidence to inform the future development of district nursing services (DNSs) across New Zealand in order to maximise the use of the workforce and to optimise patient outcomes.
These results will also provide a benchmark against which the impact and outcome of different community-based DNS models can be The key outputs of phase one of this project were to provide information and analysis of the: current and future skill mix of DNSs range of DNS models across New Zealand services provided including demographic and clinical data on the DN client population evidence of clinical outcomes from a DNS innovation and potential for new improvement initiatives.
The companion phase two report will present an analysis of current innovations within district nursing services measured in order to guide future service development.
Methodology
Project Methodology
The project process for phase one comprises three key components, as summarised below.
1) Project governance: A Project Advisory Group was established to provide critique and advice on the content and breadth of data to be collected for the project and to champion the project for the purpose of aiding data collection.
2) Data collection: The DHB Chief Executive Officer or the equivalent, along with the Director of Nursing or Nurse Manager, for each of the 65 identified services was advised of the project. In addition, a list of providers contracted to deliver DNS was obtained from each DHB. Between May and August 2010 data were collected from 64 of the 65 providers throughout New Zealand. Questionnaires were distributed to four key sets of informants within each DHB and NGO providers of a DNS:
- service manager(s)
- nurse leader(s)
- nurse educator(s)
- the department or person within the service responsible for data collection, performance monitoring and reporting.
Follow-up telephone interviews were completed to clarify and confirm information obtained in the questionnaires. In total 145 individual service managers, nurse leaders, DNs and nurse educators were interviewed. A national data set relating to the Nursing Council of New Zealand’s Annual Practising Certificate (APC) was obtained through Health Workforce New Zealand to enable triangulation of findings and to benchmark the DHB regional data collections. Population data from PHI Online and from Statistics New Zealand were also included to profile the populations that the services provide for.
3) Data analysis: Findings from the questionnaires (both quantitative and qualitative) and interviews were entered into a spreadsheet to enable analysis and theme building for each service.
Four workshops were held with the project team (one attended by the Ministry of Health) to develop this report from the multiple sources of data. Statistical support was provided for this process and findings were reviewed by the providers before the report was completed.