The Code and the community nurse: prioritising people

All registered nurses, midwives and nursing associates must be aware that their practice must be in line with the professional standards set out in the Nursing and Midwifery Code (NMC) (2018) at all times. While these values and principles can be applied in a range of settings, they are not negotiable or discretionary (NMC, 2018).

Registrants need to uphold these standards so that there is a clear and consistent message to patients and service users, and they are aware of what they can expect from the professionals that provide their care. For community nurses, it is equally vital to prioritise patient needs while ensuring safety, privacy and responsiveness. They must also uphold the rights of the populations they serve, while adapting to the ever-evolving landscape of healthcare delivery outside hospital settings.

The NMC (2018) code clearly outlines how this will be achieved within its ‘prioritising people’ section:

It is indisputable that caring for patients in their own homes fosters an effective therapeutic relationship, which facilitates patient-centred care. This is particularly relevant for those working in community nursing teams. This relationship has often been categorised as a ‘therapeutic alliance’ that can help patients achieve their goals (Arnold, 2020). However, these professional relationships represent more than just an effective way to deliver clinical interventions or to measure outcomes; they place emphasis on the patient's wishes and views regarding their own care (Griffith, 2016). This enables the patient to understand their options and available treatment choices, and make their own decisions after weighing the risks and benefits.

This truly aligns with section 2 of the NMC Code (2018), where it is essential to work in partnership and recognise the contribution patients can make to their own wellbeing when they have a true understanding of how much they wish to be involved. This demonstrates respect and upholds the patient's dignity. Community nurses can enable this high standard of care with a level of emotional intelligence and by considering each person's inseparable connection to their significant others, their culture, community and the environment in which they live (Allan et al, 2025).

Section 2.6 of the NMC Code urges registrants to recognise when people are anxious or in distress, and respond compassionately and politely. For the majority of people, regardless of their diagnosis or condition, their preferred place of care would be their own home, where they feel more comfortable in their own surroundings (Allan et al, 2025).

Studies have identified that being in hospital can adversely impact an individual's wellbeing and have psychological consequences such as anxiety, depression and uncertainty about the future, and may increase the risk for poor health outcomes (Barry et al, 2019; Alzahrani 2021). Much of this stems from the isolation and loneliness they experience when away from their home, friends and family. This places community nurses in an excellent position to provide emotional support to people in their own homes, when they can recognise the subtle nuances that indicate distress displayed by patients. It is well documented that district nurses have an important role in assessing and meeting patients’ emotional needs (Griffiths, 2017), and a repertoire of expert communication skills to deliver the support where required, thereby ensuring this section of the code is met in a compassionate way.

However, the privileged position that community nurses assume can often bring with it some challenges, as some patients are more concerned that they might be judged on their living conditions or the lifestyle choices they have made, which would not be evident if their consultation was in a neutral setting. While community nurses may always take a personalised approach and uphold dignity, as section 1.2 of the NMC Code (2018) stipulates, they also have a duty to deliver the fundamentals of care effectively, making sure that people are kept in clean and hygienic conditions—this is often where conflicts arise. As Bosley and Parham (2025) explain, while hospitals and care homes must abide by standards for environmental cleanliness, there are no such standards for patients’ homes, so professionals are left to make decisions as autonomous practitioners regarding appropriate hygiene expectations for their patients.

At times, there might be a conflict between respecting the patient's preferences to decide how they live and the nurses’ rights to provide care in a suitable setting to avoid the transmission of microorganisms (De Veer et al, 2022). This often raises issues such as capacity and public duty to environmental health, but whatever the outcome, the situation needs to be addressed with dignity and sensitivity and onward referrals made, where appropriate.

Section 3 of the NMC Code (2018) focuses on the physical, social and psychological needs of the people that healthcare professionals care for, and the communities they serve are possibly the best places to ensure that this holistic care takes place. Section 3.2, in particular, refers to recognising and responding compassionately to the needs of those who are in the last few days and hours of life.

As the National Institute for Care and Excellence (2019) outlines, there are tools and frameworks that can be useful in initiating conversations about advance care planning, organising additional care and supporting carers. Often being the only person who has a close relationship with the patient and their family, providing continuity of care enables the nurse to notice subtle changes and indications of deterioration, which might not be identified otherwise. To achieve this, a nurse needs adequate training and experience but palliative care and supporting those at the end of life is something that most district and community nurses consider their preferred and most rewarding level of practice (Ferguson et al, 2023). However, challenges may arise when providing this level of care to individuals in their own homes, especially when surrounded by close-knit, supportive friends and neighbours. The physical boundaries of confidentiality can often feel less defined, a situation not typically encountered when delivering care within the structured environment of a hospital setting. Consider the scenario presented in the case study.