In today's National Health Service (NHS) developments in technology, changing patterns of disease and reduced length in hospital stays are putting district nurses at the heart of Government policy. Liberating the Talents, the governments framework for nursing in primary care (Department of Health 2002), challenges our traditional way of seeing nursing roles determined by titles rather than by the needs of patients and communities. It describes three core functions for all nurses, regardless of their employer or job title: first contact care, public health and management of chronic and long term conditions. District nurses will have a major role to play in each area. However, with regard to long term conditions, patients have a special need for the skills and knowledge that district nurses have, enabling them to make a unique contribution to the care of this vulnerable group (Turner 1998).
[...] Perhaps a solution to this situation would be to spend time with, for example, the diabetic nurse specialists in order to receive knowledge from her regarding what services are out there for the patient with diabetes. Tight blood pressure and blood glucose control in people with diabetic nephropathy has been shown to reduce the rate of deterioration of renal function, as well as risk of cardiovascular disease (BDA 2005). The management of tight blood glucose levels help to prevent hyperglycemia and regular blood pressure monitoring to ensure effective blood pressure control are required. [...]
[...] Larson Apelqvist CD, Stenstrom A (1995) Decreasing Incidence of Major Amputation in Diabetic Patients; a Consequence of a Multidisciplinary foot care team approach. Diabetic Medicine 12 770-776. Mayers M (2000) Management of the Older Person with Diabetes in the Community. British Journal of Community Nursing 448-453. Nursing And Midwifery Council (2002) Guidelines for Records and Record Keeping. NMC, London. Patel (1993) Empowerment of diabetics, a challenge for community nursing. Journal of Community Nursing 405-409. Rogers Wood J (2001) Standards for professional monitoring of capillary blood glucose. [...]
[...] A New Approach to Chronic Disease Management for the 21st century. DOH, London. Department of Health (2002) Liberating the Talents; Helping Primary Care Trusts and Nurses to Deliver the NHS Plan. DOH. London. Department of Health (2004a) National Standards, Local Action; Health and Social Care Standard and Planning Framework. DOH London. Department of Health (2004b) NHS Improvement Plan, Putting people at the heart of services. DOH, London. Edmonds Boulton Buckenham Every Foster Freeman Gadsby O,Knowles Pooke Tovey Wolfe U. (1996) Report of the Diabetic Foot and Amputation Group. [...]
[...] For example, many district nurses are reactive in responding to complications such as a patient developing diabetic foot ulceration where a district nurse will prescribe and treat the ulcer as opposed to being proactive, in preventing complications with the use of education. This may be due to lack in knowledge of the nurse, time restraints, or district nurses believing it not part of their role. Jerreat (1999) emphasizes that early recognition of diabetic foot ulceration and intensive treatment in multidisciplinary foot clinics has reduced the need for amputation. [...]
[...] However patients who are housebound may not get this standard of care, therefore district nurses are in an ideal position to ensure that housebound diabetic patients receive the same standard of care as those who can attend clinic by using a multidisciplinary approach to holistic diabetes management that embraces the psychosocial, as well as the clinical management of living with diabetes (The British Diabetic Association (BDA) 2005) Diabetes mellitus is one of the most chronic conditions in the United Kingdom affecting people in all age groups. [...]
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