Severn Hospice comprises two separate units and notably different geographical areas, each with a team of community-based ‘outreach nurses’ (linked to GP practices). Population totals 500,000 people, roughly equal per area. Telford & Wrekin has a population density of 584/km2, Shropshire 136/km2.
We aim to fulfil the national ‘Ambitions’ for palliative care and adopted a ‘Living Well’ strategy in 2017.
We offer nurse-led clinics within both hospices, an option given to all patients at initial triage. This initiative began in our Telford base and was evaluated positively by nursing staff. Shropshire clinics began in February 2019. We have evaluated these by reviewing everyone referred to the team from June - September 2019 to establish if clinic appointments may have been suitable.
The results revealed a total of 186 patients accepted our nurse outreach service over the four months; 181 patients were visited in their own homes. Of these only 16 were identified by the assessing nurse as being able to attend a clinic appointment: the main themes suggesting inappropriateness: end of life care, too unwell to attend a clinic or transport, travel & distance difficulties.
We also sent out clinic questionnaires in July 2019 to all twelve hospice outreach nurses, across both bases. Our questionnaires demonstrate significant differences by area: the more rural nurses noting difficulties with travel, including comments about cancelled and missed clinic appointments. Both areas were concerned about missed ‘clues’ from the home environment. Interestingly the nurses within the more urban, generally lower socioeconomic class area, within the Telford team, repeatedly mentioned easier, ‘less distracted’ reviews in a clinic environment.
In Conclusion nurse-led clinics may be a useful adjunct for hospices and the option does fit with individualised care. However we encountered significant difficulties with patient demographics and nurse-assessed suitability for this service.
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