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Challenges and complexities of discharge planning from a district nursing perspective

02 April 2021
Volume 26 · Issue 4


Over the past 30 years, the Government has been promoting the transition of care from the acute setting to the community setting. Within the community setting, district nurses are described in the latest reports as endorsers of the care close to home. However, with the surge in hospital discharge, the district nursing workforce is faced with further pressure to cope with the drive to move care into the community. The purpose of this extended literature review (ELR) was to deconstruct the available data on the challenges and hurdles experienced by district nurses to manage hospital discharge. On reviewing the selected data, it was found that fragmented communication between secondary and primary sectors poses problems for effective care in the community. Additionally, the lack of understanding of the district nursing service and its remits creates obstacles for effective hospital discharge. Some practical solutions to resolve these problems are proposed.

In 1986, following the release of the report ‘Making a Reality of Community Care,’ the local authorities acknowledged the advantages of care in the community setting (Health Foundation, 1986). This paper was a benchmark for addressing care in the community and acknowledging its benefits for the patients, as well as financially.

The Five Year Forward View (NHS England, 2014) established that the primary care system is the pillar of healthcare. It proposed the need for integrated care among general practice, district nursing, specialist services and social care, thus enabling a reduction in unnecessary attendance to the emergency department and facilitating timely discharge.

In 2019, the ambitious NHS Long Term Plan (NHS England, 2019), was released to target the bridge between primary and secondary care. It highlighted the pressure due to the shortage of GPs and in the district nursing service. This is mentioned by Maybin et al (2016), who described the increasing complexity of care in the community.

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