Early referral
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Relationship with the patient and family
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Patients/family and the district nursing team
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Mechanism for the early referral of patients to the service | The district nursing service: | The patient: |
Family circumstances
| • establishes early contact with the patient/family to assess their needs/expectations | • receives care in the place of their choice |
Patient and/or family who: | • provides continuity of care for the patient by limiting the number of district nursing staff caring for the patient | • retains some control over their circumstances |
• are aware of the diagnosis | • plans and coordinates care for patient/family | • maintains some quality of life |
• have a strong supportive relationship | • ensures the patient/family are aware of services available to them | • has their symptoms controlled to a level which is acceptable to them |
• are receptive to district nursing and other services | • provides support for both the family and the patient | • dies in the place of their choice |
• are receptive to advice regarding care | • provides care in a way which is consistent with the patient's/family's wishes | The family: |
• agree to utilising support equipment in the home and adapting the home to meet the patient's needs | • supports the family following the patient's death (e.g. by attending the funeral, making post bereavement visit(s)) | • feel able to cope with caring for the patient in the place of the patient's choice |
• are keen to participate in patient care |
Relationship with other healthcare professionals and formal carers
| • feel the patient was comfortable and retained their dignity whilst receiving palliative care |
Availability of time
| • maintains a positive working relationship with other healthcare professionals and formal carers | • have the opportunity to discuss concerns/anxieties with a member of the district nursing service |
District nursing service: | | The district nursing team: |
• Nurses with expertise in palliative care | | • feel the patient was comfortable and retained their dignity whilst receiving palliative care |
• Staffing levels which ensure that staff have time to meet the patient's physical and psychological needs | | • feel they have done a good job |
Availability of services and equipment
| | • have cared for the patient in the way they would wish to be cared for |
Access to support services e.g.: | | • have felt able to provide care “over and above” that required to meet the patient's/family's immediate needs |
• Hospice | | |
• Macmillan nurses | | |
• Marie Curie services | | |
• Supportive and accessible GP | | |
Access to equipment e.g. | | |
Beds/mattresses/hoists/syringe drivers | | |