The Queen's Nursing Institute

The Queen's Nursing Institute works with the public, nurses and decision-makers to make sure that good quality nursing is available at home for everyone when they need it.

Healthcare at home
 
 
 

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Frequently Asked Questions

Getting Nursing Care in your Home

Quality of Care

More about Services

Who’s Who

Glossary


GETTING NURSING IN YOUR HOME

Q: I think I need a district nurse – how can I get one to come and see me?
A: Your GP should be your first port of call. You may not need to see him/her – just ring the surgery and ask about being referred to the district nursing team.

Q: I think my mother needs a nurse to go in to her at home – can I ask on her behalf?
A: You may be able to do this – first have a word with your mother’s GP, if she isn’t able to do this for herself.

Q: I am going to have an operation soon – will a nurse come and see me at home afterwards?
A: This depends on the operation, and your state of health, amongst other things. If your hospital team think you will need a nurse at home, for example to check on your wound or to give you antibiotic injections, then this will be arranged by the hospital before you are discharged. The hospital team will tell you what they have organised for you. In some areas, information about patients being discharged goes to a central point where the district nursing team can assess individuals’ need for support. They may phone the patient to see how they are, invite them to a clinic or visit them at home.

Q: My neighbour is not really ill, but he is very frail and really needs help to wash and dress and get to bed. Will community nurses do this for him?
A: No, this kind of social care is provided by social services, or by agencies working on their behalf. Either he, his family or his GP can request an assessment of his needs by contacting the local social services department.

Q: We don’t seem to have district nurses in our area, is this possible?
A: There will be a nursing service that can look after people at home who need this kind of care. But it may be called something other than ‘district nursing’: for example, some areas have ‘community matrons’, ‘case managers’ or ‘hospital at home’ teams; some have Intermediate Care, Rapid Response or Community Intervention teams and Hospice at Home. There will also be nurses who specialise in particular kinds of care, like community children’s nurses or mental health nurses. See our Glossary which explains what these are. Your GP practice will know what services are available to you where you live.

Q: Can anyone have an assessment of their needs? What is this assessment?
A: Yes, anyone can request an assessment of their need for health care or social care in their own home. In some areas, both community nurses and social workers carry out the same assessment, asking the same questions, to find out exactly what needs you have, and how they can best be met. This is called the ‘single assessment process’. In other areas, you might find that the nurse’s assessment and a social worker’s assessment are a bit different. But both aim to find out what help you need, and how it can best be provided.

Q: I’m not a patient, but I do spend a lot of time caring for my wife which is affecting my health. Can I get any help with my own needs?
A: Yes, there is also a carer’s assessment which gives you a chance to discuss with the social services department of your local authority what help you need with caring. For example, help that would maintain your own health and balance caring with other aspects of your life, such as work and family. Social services uses the assessment to decide what help to provide. You can find contact details for your local authority in the directory of local carers services: http://www.nhs.uk/CarersDirect/carerslives/updates/Pages/Directoryenquiries.aspx


QUALITY OF CARE

Q: Some nurses come in to do my wife’s dressing every other day, but they are often different people and I don’t really know who they all are. How can I tell who’s who?
A: Anyone who comes into your home to care for you or your family should have an identity badge and will be happy to tell you their name, who they work for and what their job title is. Job titles do vary a lot, but you can always ask them to explain whether they are, for example, a registered nurse, a healthcare assistant (who has training but isn’t a nurse) or another kind of carer. See our Glossary for explanations of what these and other titles mean.
 
Q: What if the person giving me my injections isn’t a nurse? Is this legal?
A: Yes, it is. What is important is that everyone who provides care for you is trained to do the tasks they are undertaking for you. So, if a healthcare assistant (HCA), for example, is giving you an injection, he or she should have been trained in giving injections, and how to make sure beforehand that you are fit to have the injection and how to look after you afterwards. They should also be able to answer questions you might have about the injection, or your condition. A healthcare assistant will be working under the guidance and direction of a registered nurse or a doctor (even though this person will not be physically with them all the time), who is responsible for making sure that the HCA is competent to do the task they have delegated to them.

Q: Someone I know has a private company that sends nurses to help him with his son’s illness, but he doesn’t pay them – how can that be?
A: The NHS now ‘commissions’ – that is, organises and pays for – care to be given by a variety of different organisations. For example, the NHS pays for hospices to look after people at the end of their lives: the hospices aren’t NHS organisations (they are usually charities), but they are experts in end of life care, so the NHS pays them to look after NHS patients. Similarly, the NHS will sometimes pay a private company to deliver specialist equipment or care from specialist nurses to patients who need it at home.

Q: If lots of different companies can be doing health care, how do we know they are any good at it?
A: All organisations that provide health or social care – whether the NHS, charities or private companies – have to register with the Care Quality Commission. They can only do this if they meet minimum standards of safety and quality of care. The CQC carries out regular inspections (and can inspect without warning if they are concerned) and an organisation that fails its inspection can be closed down.


MORE ABOUT SERVICES

Q: Who is in charge of community nursing in my area?
A: This will vary depending where you live. The community nurses may be employed by the NHS Trust that runs your local hospital, or they may work for a charity, a private company or another community-based organisation such as a mental health Trust. You can ask them, or look at their name badge, which will probably have the name of their organisation on it. Community nurses work very closely with your GP, but they are not usually employed by GPs.

Q: Why do some areas have nurses who will give them chemotherapy at home, but in other places, the person has to go into hospital for this?
A: Services do vary in different places for a variety of reasons. It might be the nature of the area – in a very rural area, people may have to travel too far to a hospital, so local health managers have set up home services instead. Or it might be to do with whether local hospital doctors agree with treatment at home, or whether there are enough nurses trained to carry out a service in the home. 

Q: Can I have a say in my local health services?
A: Yes. You can join your local Healthwatch - http://www.healthwatch.co.uk/find-local-healthwatch
There is a website called Patient Opinion, where you can describe your experiences of health care, and see what other people are saying about services in your area. And your GP surgery might have a ‘Patient Participation Group’ (see our Glossary) which you could join.

Q: Why do I have to fill in a form about my income and savings to get some care in my home, when I don’t have to do this for health care?
A: Social care budgets are run by the Local Authority in your area, and they are ‘means-tested’ – so what you get depends on your income as well as your need. NHS budgets, which pay for health-related care only, are not means-tested: health care is ‘free’ to you when you need it, as it is paid for from general taxes.


WHO’S WHO

Q: What are Macmillan nurses and Marie Curie nurses? How are they different from our district nurses?
A: See our Glossary for an explanation of these nurses. These two kinds of nurses work closely with district nursing teams when a patient needs their special expertise or services.

Q: What about a Queen’s Nurse? The nurse at my GP’s practice says she is a Queen’s Nurse.
A: These are nurses who have shown that they are dedicated and experienced nurses in the community, and that they are actively trying to improve the care their patients receive. The Queen’s Nursing Institute assesses these nurses, and, if they meet our rigorous standards, they are given the title of Queen’s Nurse. We then help them to increase their knowledge and skills so that they both improve care, and inspire other nurses to do the same.


GLOSSARY

People:

Assistant Practitioner – this is someone who been trained to assist Registered Nurses (RN) to care for patients. They may do some medical tasks, such as giving injections, or dressing wounds. Some APs may also carry out ‘social’ tasks like helping people to wash and dress, if they work in an Integrated Support Worker post. Their work is delegated to them by a RN, and the RN is responsible for only giving them tasks they have been trained for and are capable of doing.

Case Manager/Care manager – this is usually an experienced and expert Registered Nurse, or other registered professional such as a physiotherapist or occupational therapist. The case or care manager is responsible for keeping a close eye on your condition, looking after you when necessary and organising other members of the team to help you when needed. They will usually leave you a phone number so that you can contact them if you have any problems.

Community Matron – this is case manager who is a RN, and is expert in nursing people in their own homes, helping them to be as independent as possible, and organising care from other professionals as required.

Community Nurse – this is a general term for any RN who works with patients in their own homes, or sees them in community clinics (rather than in hospital).  

Community Staff Nurse – this is an RN who works in the community, but is not yet a team leader. They usually don’t have a special qualification in working in the community, but they may be doing extra training to get this qualification.

District Nurse – at one time, this term was only used to mean a community nurse (RN) who had also successfully completed special training to work in the community. The District Nurse would have been the team leader, supervising the work of community staff nurses and assistants. Today, though, the term ‘District Nurse’ is often used for any nurse who works in the community, whether or not they have the special qualification. You can always ask your nurse whether they have the DN qualification.

Health Care Assistant – this is a person who is not a nurse, but has been trained to assist nurses in caring for patients. They may do some medical tasks, such as giving injections, as well as some ‘social’ tasks like helping people to wash and dress. Their work is delegated to them by a RN, and the RN is responsible for only giving them tasks they have been trained for and are capable of doing.

Health Visitor – a Registered Health Visitor (RHV) is a public health specialist who has completed a specific health visiting course. A RHV works with children and families to help them be as healthy as possible, and also develops and supports community projects and services that will help everyone in the community.

Integrated Support Worker - this is someone who been trained to assist Registered Nurses (RN) to care for patients by meeting both ‘medical’ and ‘social’ needs. So they may do some medical tasks, such as giving injections, or dressing wounds, and some ‘social’ tasks like helping people to wash and dress. Their work is delegated to them by a RN, and the RN is responsible for only giving them tasks they have been trained for and are capable of doing.

Macmillan Nurse – Macmillan nurses are Registered  Nurses with at least five years' experience, including two or more years in cancer or palliative care. They have completed a specialist courses in managing pain and other symptoms, and in providing psychological support to patients with cancer. They are usually employed by the NHS and their posts are funded by the charity Macmillan Cancer Support for a set time, often for the first three years. After that time, the long-term funding is taken up by the NHS or other partner organisations. Macmillan nurses don’t do routine nursing tasks, but provide expert help and advice to the patient and to the community nursing team, where necessary.

Marie Curie Nurse – the Marie Curie Nursing Service, run by the charity Marie Curie Cancer Care, helps people who are approaching the end of their lives to remain at home if they wish to, through its nationwide network of Marie Curie Nurses who provide nursing care at home. They cover 95 per cent of the UK, and the service is free to the people they care for, their families and carers. Marie Curie core service is one-to-one overnight nursing from a Registered Nurse or Senior Healthcare Assistant in a patient’s home, usually for eight or nine hours. In some parts of the UK, they also offer shorter shifts, evening shifts and day shifts. In a limited number of areas, they also run a rapid response service in which nurses go in to a patient’s home at short notice in a crisis. We want to offer this service more widely, but need an agreement with local NHS trusts to provide it.

Nurse Consultant –  this is a nurse who is highly qualified, and does research and teaching as well as seeing patients.

Nursery Nurse – nursery nurses are not Registered Nurses, but have had training to work with children, and often work in a team with RNs or Registered Health Visitors, helping to deliver children’s services.

Nurse Practitioner – this is a Registered Nurse who has extra training and often a qualification that enables her/him to make a full physical assessment of a patient, order and interpret tests, diagnose problems, and decide on and arrange treatment, without consulting a doctor. Nurse Practitioners often work in GP surgeries, in walk-in centres or in specialist clinics.

Nurse prescriber – all district nurses and health visitors are taught to prescribe from a limited list of medicines as part of their specialist training. This means that they can often provide a prescription while they are visiting a patient and save them a trip to the GP. Many other nurses who work in the community have taken an additional prescribing course and can prescribe more medicines, when appropriate. Nurses’ prescriptions are treated in exactly the same way as doctors’ prescriptions at the pharmacy.

Practice Nurse – this is a Registered Nurse who is usually employed directly by a General Practitioners (GP), rather than by the NHS, to work in his/her surgery. PNs – sometimes also called General Practice Nurses or GPNs – will usually have extra training in the kinds of tasks undertaken in general practice, such as vaccinating children, taking smear tests, taking blood samples and looking after patients with long-term conditions such as asthma and diabetes.

Queen’s Nurse – this is a nurse who has shown that they are dedicated and experienced nurses in the community, and that they are actively trying to improve the care their patients receive. The Queen’s Nursing Institute assesses these nurses, and, if they meet our rigorous standards, they are given the title of Queen’s Nurse. We then help them to increase their knowledge and skills so that they both improve care, and inspire other nurses to do the same.

Registered Nurse (RN) [previously known as a State Registered Nurse (SRN) or Registered General Nurse (RGN)] – this is the general term for a nurse who has successfully completed a nurse education course and whose name is on the Register of nurses held by the Nursing and Midwifery Council (NMC). The NMC sets the standards that nurses have to achieve during their education to become a nurse, and standards for the way that nurses practice and behave after qualification. If a RN does not keep to these standards, or cannot meet them (e.g. due to ill health), then they can be taken off the Register, and forbidden to practice. The title Registered Nurse is protected by law, so no-one should call themselves a Registered Nurse unless they are on the Register. A Registered Nurse will have a unique personal identification number (PIN).

Specialist nurse – this is a nurse who has had additional training and experience in caring for a particular condition, such as diabetes or epilepsy; or who works with a particular group of people, such as children or people with cancer. A specialist nurse may look after patients directly, or may give advice to other nurses about how best to care for particular patients.

Services:

Chemotherapy – this literally means treatment with medicines, but is usually used to mean anti-cancer drugs. In some areas, cancer chemotherapy may be given in the home.

Evening service – these services usually run between 5pm and 11pm or midnight, and allow people to receive care outside of ‘office hours’. Not all areas provide these; your GP practice will know what evening services are available where you live. 

Hospice – this is an organisation that specialises in helping people at the end of their lives. This can include helping to control symptoms such as breathlessness, and some patients will visit the hospice during the day for this advice or help, while continuing to live at home. Hospices also have beds for people who need to be nursed continually. Hospices are usually small, and much more informal and ‘home-like’ than hospitals. Many hospices are run by charities, though the NHS will pay for patients to have a place there when they need it (see ‘Commissioning’). There are specialist hospices for children.

Hospice at Home – this is a team of nurses and other professionals such as dieticians and occupational therapists who can visit a patient frequently at home towards the end of their life to provide care and help manage difficult symptoms so that the patient is as comfortable as possible.

Hospital at Home – this is sometimes used as an alternative to taking a patient into hospital. A team of nurses and other professionals can visit the patient at home, maybe several times a day, bringing the necessary equipment and expertise to treat them as though they were in hospital.

IV therapy – when medicines are injected directly into a vein, usually in the patient’s arm, this is ‘intravenous therapy’. Once you would have had to go into hospital to have this form of treatment, but now this may be done at home by suitably-trained and experienced nurses.

Out of hours services – these may be evening services (e.g. 5pm to 11pm or midnight), or include the full period outside of office hours, that is from 5pm in the afternoon until 8 or 9am the next day. They include services that replace your GP during this period, as well as ‘walk-in centres’ where anyone can call in without an appointment, and ‘primary care centres’. If you ring for a GP during the out of hours period, you may be asked to go to a primary care centre, which will be staffed by doctors and/or experienced nurse practitioners. Your GP practice will know which out of hours services are available in your area.

Outreach – this term is used when nurses or other staff from a hospital contact or treat patients who are not in hospital but living at home. For example, a specialist hospital dietician may visit someone at home as part of an ‘outreach’ service, to help them manage a special diet.

Palliative Care – palliative care aims to relieve symptoms and give the patient the best possible life once it is clear that there is no way to cure the patient’s condition, and death is likely within a foreseeable period e.g. within a year. It doesn’t mean that nothing will be done: there are many treatments and facilities that can make a big difference to the quality of a person’s life, even if their condition is not curable.

Rapid Response Team – this is a team of different professionals which can be sent to a patient’s home to provide urgent treatment, rather than the patient being taken into hospital. The team may provide care several times a day for several days, before leaving the patient in the care of a community nursing team once the crisis is over.

Telecare/telemedicine – these terms are both used to mean the use of technology to help with the provision of health care. Some technology is used for checking on a person’s condition e.g. the patient has their own machine at home that can measure the amount of oxygen in their blood, with the nurse being alerted if this falls to worrying levels. Other technology, such as laptop or palmtop computers, is used to keep, update and share medical records, so that everyone caring for a patient knows what treatment they are on and how they are. Some equipment is used to help a vulnerable person stay in their own home, such as a personal alarm that will connect to a centre and send help if someone has a fall or feels ill. Some telemedicine saves a patient going to a hospital, for example when the nurse photographs a wound and sends the picture to a colleague for their advice. All such technology should be used with the agreement of the patient, and its purpose and use will always be explained by professionals.

Venepuncture – this means taking a blood sample for testing. Many nurses and some health care assistants are trained to do this.

 

 

 

 

 

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