Biomedical subjects
F Badger
Publications and source records attributed to F Badger.
District nursing, the disabled and the elderly: who are the black patients?
Community care research in central Birmingham has shown that disabled and old black people are under-represented on the caseloads of district nurses compared to their white counterparts. Whilst factors suggested as contributing to this (service ethnocentrism and general practitioners as 'gate-keepers') are discussed elsewhere, this paper focuses on those few old and disabled black people who are district nurse patients. Following comparisons between these black and white patient groups, the differing perspectives of black patient and district nurse are explored. Stereotypes and myths, knowledge about each other and language/communication are discussed as important areas which may disadvantage black patients in their interaction with district nurses. Attention is drawn to the urgent need for district nursing to address the issue of black disabled and old people in the community and the accompanying central role of research.
The nursing auxiliary service and the care of elderly patients.
Although nurse auxiliaries comprise a large and rapidly expanding part of the district nursing service, nursing research has largely neglected this group of nurses and the people they see. Using a patient-centred approach, which is a key element of the research, we studied the characteristics of patients who were either physically handicapped, frail elderly or elderly mentally infirm, who make up a large majority of the patients. We found that auxiliaries' patients fell into a typical 'at risk' group; they were older and more likely to be living alone than qualified nurses' patients, and yet they received less frequent visits. Motives for providing and continuing the service to patients were not always related to nursing need, and while recipients were grateful for the service, both they and auxiliaries themselves identified areas of potential improvement. The need to continue to monitor and improve the overall quality, effectiveness and efficiency of the service to patients and potential patients, demands that practitioners, managers and researchers systematically review referral to the service and the work of the nurse auxiliary using a patient-focused approach.
District nurses' patients--issues of caseload management.
Current pressures on all community services mean that practitioners must give more detailed attention to evaluation of patient outcomes and caseload review. District nursing caseloads in one health authority have been examined using a patient-focused approach. Random samples of patients who were either physically disabled, frail elderly, or elderly mentally infirm (n = 202) were examined for the distinctive and differing characteristics, if any, of recently referred and long-stay patients. Recently referred patients in our sample were either terminally ill, or had more chronic physical disorders. Patients who stayed on the books received either injections, general care from qualified staff or baths from nurse auxiliaries. Although covering similar areas of the health authority, nursing teams varied in the proportions of recently referred and long-stay patients, suggesting that individual nurses' caseload management is a crucial determinant of length of time on the books. In particular, nursing and medical review of all patients receiving vitamin B12 injections is urgently called for. In order for caseload monitoring to be facilitated, practitioners need relevant local and patient based data in order to make inter-team comparisons. The findings also have training and management support implications.
Finding the limits.
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