How did student district nurses feel during the COVID-19 pandemic? A qualitative study.

BACKGROUND: The COVID-19 pandemic placed a huge strain on healthcare services around the world, including community services. Students also faced substantial disturbance to educational programmes. Student district nurses are usually employed members of staff and can be recalled to the workforce, whereas pre-registration students cannot. AIMS: This paper explores the feelings and experiences of student district nurses during the first UK national lockdown of the COVID-19 pandemic. An interpretative phenomenological approach was taken. METHOD: A semi structured 1:1 interview and focus group was held via zoom in July 2020. A total of eight student district nurses, who were all registered adult nurses, took part. Data was analysed using the Braun and Clarke model to identify themes. RESULTS: The findings related to their experience of being a community adult registered nurse on the frontline, while also being a student district nurse. Three themes were identified from the analysis: anxiety and uncertainty, management of risk and teamwork. CONCLUSION: This study highlights the contribution that community nurses made in the clinical response to the COVID-19 pandemic. It adds to a paucity of literature available from this clinical setting and specifically from the viewpoint of a student district nurse. There is much written on the strains on hospital care, but it should be remembered that district nursing is the service that never shuts its doors because it has reached capacity. This study found that a lack of communication and uncertainty about their future as students contributed to heightened stress and anxiety. Teamwork and camaraderie are a vital aspect of any team and one that can support resilience in times of heightened stress. A lack of face-to-face interaction can lead to team members feeling isolated. Digital technology can be used to reduce this feeling when possible.

A qualitative exploration of the thoughts, feelings, experiences and expectations of student district nurses.

A District Nurse (DN) is a registered nurse who has undertaken a Nursing and Midwifery Council approved programme. Over the years, there has been a dramatic decrease in the number of qualified DNs. However, this is slowly changing, with the number of nurses enrolled on to a Specialist Practitioner Qualification in District Nursing (SPQDN) programme now increasing. There is a strategic drive, as outlined in the NHS Long Term Plan, which strives to bring care into people's homes, as opposed to the acute setting. However, to do this, a highly skilled and competent workforce is needed. In order to explore the experiences and expectations of student DNs, a qualitative study was undertaken. A cohort of SPQDN students (programme commencing September 2019) located in the North West of England, were interviewed. A face-to-face focus group (n=9) was held within the first week of the start of the programme. An online focus group (n=7) and a single online interview (n=1) took place at the end of the programme (July 2020). Key themes were identified within the two data collection points. These included 'feelings', 'career aspirations', 'the role and title of District Nurse' and 'future practice'. Findings showed that initially, students were anxious, apprehensive and excited with regards to starting the SPQDN. However, at the end of the programme, the students noted that they had grown in confidence as a clinical practitioner and as a leader.

The Mental Capacity Act: 'Best interests'-a review of the literature.

The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 in order to provide a consistent, robust framework with the aim to protect and empower people to make decisions themselves. However, an assessment as per the MCA may demonstrate that a person is lacking mental capacity and therefore unable to make an autonomous decision at the time it needs to be made. In this case, a 'best interests' decision may be made on their behalf, ensuring their wishes and beliefs are at the centre of the decision-making process. When making a best interests decision, a health practitioner must follow the guidance as set out in the MCA legislation to ensure fair and consistent approaches to safeguard and provide assurance that the outcome is truly the best decision for the individual. This review of the literature supports the findings of a 2014 post-legislative review by the House of Lords, which concluded the principles of the MCA are not sufficiently embedded into the practice of all health practitioners, due to a lack of knowledge, awareness and understanding. However, the evidence base also appreciates making a decision on behalf of another person can be a stressful, complex and intricate process when further support may be required from the wider multidisciplinary team, including potentially seeking legal advice.

Young carer awareness, identification and referral.

Young carers often provide care because they have always done so for the people they care about, and because they believe that the care recipient could not manage without them. For many young carers, looking after their own health, combining caring with schoolwork, getting access to training or having time off from carer duties can be a major challenge ( Department of Health [DH], 2008 ). This paper presents evidence from a literature review that builds a substantial body of knowledge to suggest that community nursing teams must develop supportive approaches towards increasing an awareness of young carers' needs. Identification of young carers by community nurses will encourage referral to appropriate services and agencies. The aim of this study was to appraise, for the Queen's Nursing Institute, the published evidence base to explore young carers' needs and how community nurses could support young carers' needs in England. Databases were systematically searched. Title and abstract reviews found 606 potential studies (see Figure 1 ), which were identified around topics corresponding to the headings of three distinct categories: mental health and wellbeing; education needs and resilience; and development of coping strategies. Full-text review resulted in 26 publications that met the study's inclusion criteria. The results of this work show that there is a scarcity of publications around the community nursing needs of young carers. However, studies consistently report young carers are hidden from view and have a significant requirement for support and information. Therefore, effective ways of delivering community nursing support and information to young carers needs to be developed by service providers as a matter of priority, and implemented to give the support that young carers need.

Community nurse's knowledge, confidence and experience of the Mental Capacity Act in practice.

The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 to protect and empower people to make decisions for themselves and those who were deemed as unable to make choices would have decisions made on their behalf, often by health professionals. All health professionals must follow the guiding principles of this legislation. Yet a scrutiny report by the House of Lords concluded this legislation was under-used with a lack of knowledge among professionals regarding applying the legislation in practice. A review of the literature also supports these findings. A mixed method study was carried out among adult community nurses to explore if these findings were applicable within a health trust in the North West region. An electronic questionnaire (n=60), focus group (n=7) and a paired interview (n=2) were utilised to collect data regarding community nurse's experience and confidence of using the MCA in practice. Analysis identified key themes: training, knowledge and confidence among staff, working together with the wider multidisciplinary team, empowerment and improving documentation. While findings suggest clear examples of self-appraised confidence and excewllent patient care, there is also scope for development regarding the knowledge and utilisation of the MCA in the clinical practice of community nurses.

The Mental Capacity Act: a review of the current literature.

The Mental Capacity Act (MCA) is a piece of statutory legislation which is designed to empower and protect those who are assessed as being unable to make decisions for themselves. At the time of implementation, the legislation was described as visionary and it had the potential to change the lives of many. However, a post-legislative scrutiny report published in 2014 concluded that there is a lack of knowledge among professionals of the MCA, and so it is not embedded into daily clinical practice. This review of literature has identified four key themes: assessment, training, knowledge and empowerment. These appear to concur with the findings of the House of Lords report. The successful integration of the MCA into professionals' everyday practice is high on the political agenda, thus reinforcing the message that following the guidance set out in the MCA legislation is mandatory and not a choice. A shift in culture and improvement in knowledge and understanding of the MCA is required in order for it to be used in the correct manner for which it was designed.

Enabling the health and wellbeing of carers through district nursing support.

Carers provide care because they want to help the people they care about, and because their care recipient could not manage without them. For many carers, looking after their own health, combining caring with work, getting access to training or having time off can be a major challenge. Patients' and carers' experiences of home-based care are a key factor in the appraisal of the quality of the professional care services they receive. This article presents the evidence from a literature review that builds a substantial body of knowledge to inform district nursing teams and community nurses to develop a supportive approach towards carers' needs. The aim of the study was to appraise the published evidence base relating to carers' needs and how professionals can support carers' needs when providing care to patients in the community. The studies consistently reported carers' requirements of practical support and information as a theme across studies, suggesting that effective ways of delivering information and support to caregivers need to be developed and implemented as a matter of priority. It also highlighted the needs of the professionals providing support to carers, to ensure the health and wellbeing needs of carers, to include signposting and referral to avoid reaching crisis point and resultant burnout.