SWYPT NHS - NEIGHBOURHOOD NURSING

The neighbourhood nursing service is essential in preventing unnecessary admission to hospital. Community matrons provide case management for individuals within community settings who have complex long-term conditions requiring support from both health and social care services. Community matrons are responsible for providing service users with an individualised care management plan which helps them to increase their awareness and manage their condition.

District nurses use their skills, knowledge and experience to assess when home-based treatment is the best option for nursing a particular patient.

The neighbourhood nursing service offers the following planned, individualised and patient-centred care:

• Complex long-term conditions management
• Case management
• Assessment and management of complex, chronic and acute nursing needs
• Wound assessment and management
• Acute and chronic disease management
• Health education and promotion
• Palliative care
• Technical nursing interventions
• Referrals from other areas or other district nurses

In the interest of patient care, neighbourhood nurses will use their clinical skill and judgement, be flexible and work with other disciplines and agencies.

All referrals to the neighbourhood nursing service will be treated as new admissions. This means that patients who may have had the care in the past may not necessarily have the same treatment as before.

After treatment, the neighbourhood nursing team will carry out a full assessment of the patient’s nursing needs to determine if further home visits are required.

Out of Hours

Outside of working hours, the service is covered by the rapid response team. In an urgent situation they will visit any patients at home on our behalf.