As I near the end of the Specialist Practice Qualification in District Nursing (SPQDN) programme, I reflect on how much I have learnt and how it has changed my practice. I was fortunate enough to be offered a part-time place on the programme, studying over 2 years. It was suggested to me that studying part time would be difficult, since your time is split between attending university, placement, studying and work, but I disagree. I have found that placement work and working with my usual team has allowed me to practice what I have learnt.
As part of the programme, I had the opportunity to complete the nurse independent prescribing (V300) non-medical prescribing qualification. I spent a significant amount of time with a GP practising invaluable assessment skills, which has increased my knowledge and confidence in both the holistic and physical assessment of patients. Advanced assessment skills are integral to making safe and effective prescribing decisions. I have learnt so much about the importance of identifying ‘red flag’ signs and symptoms that could indicate a serious illness (Nuttall and Rutt-Howard, 2016) and the potentially significant implications of polypharmacy in patients with long-term conditions (National Institute for Health and Care Excellence, 2019). The programme has equipped me to become an assured, safe and proficient practitioner.
The NHS Long Term Plan (NHS England, 2019) highlights the need to harness innovation and technology in order to improve healthcare. The ‘Leading Innovation in Practice’ module of the SPQDN provided the opportunity to identify and plan the implementation of an innovation that would improve care. I focused on using new technology to improve care of people living in the community with diabetes. In the 10 years that I have worked in the community, the number of patients with diabetes on our caseload requiring insulin-administration support has risen significantly. The World Health Organization (2019) designated insulin a high-risk medication, as it has a high risk of causing harm when used in error. Despite this, the insulin pen administration system used today is a device invented in the 1980s. Many patients are only seen by community nursing teams when they are no longer able to safely use their insulin pens, due to sight problems, arthritis and mild forgetfulness. It is estimated that by 2035, the number of people living in England with diabetes will have reached a staggering 4.9 million (Public Health England, 2016). If growing caseloads are to be effectively and efficiently managed, changes are needed in the way patients are assessed, managed and cared for. Inexpensive gadgets are available with the potential to audibly read out a dose before a patient injects it, thus reducing the risk of dosing errors. These also have reminder functions and enable carers to monitor dosage and timing and record blood sugar readings. By using such technology, patients could remain independent for longer, and the workload of community nursing teams could be reduced.
The SPQDN programme has opened my mind to the critical role of the programme itself and ‘the bigger picture’ of district nursing. Prior to the course, my main focus was on managing the everyday needs of my patients and helping to support an increasingly pressured service. There was rarely time to stop and truly assess patients holistically, which perhaps, at times, resulted in task-orientated care, with no goal setting or long-term plans to manage patients' health needs. If the NHS Long-Term Plan is to be successful, investment in training and technology should not be overlooked. By equipping the district and community nursing workforce with the right knowledge, skills and technology, care could be transformed to meet the needs of the population in the 21st century.