Referral criteria: perceptions and experiences of district nursing students in Northern Ireland
An ever-ageing population and widening health inequalities intensify the complexity of care that is now delivered within community settings by district nurses. Appropriate referral criteria are required to facilitate the enhancement of efficient and equitable district nursing service provision. This study aimed to explore district nursing students' perceptions and experiences of district nursing referral criteria in Northern Ireland. A qualitative phenomenological approach was adopted using a purposive convenience sample of 10 district nursing students. Data were collected during online focus group interviews and analysed using a thematic framework. Four themes emerged: referral criteria; insight and inconsistency; task versus patient-centred care; and misunderstanding the service and referral quality. The themes reflect a lack of consensus with respect to referral criteria, contributing to inappropriate and poor-quality referrals. Appropriate and quality referrals to district nursing services are key to assuring sustainable service provision. Suitable access to district nursing services may be enhanced by developing consensus referral criteria.
The World Health Organization (WHO) (2006) encouraged governments worldwide to explore better ways of delivering healthcare to ensure the sustainability of healthcare services. Government strategies concluded that people's care needs could be best managed in primary care, specifically the home setting, using a ‘shift left’ approach (Department of Health, Social Services and Public Safety (DHSSPS), 2011a; 2011b; 2014; 2015; 2016a; 2016b; 2018; 2020; Department of Health and Social Care (DHSC), 2013; Bengoa, 2016). The NHS (NHS England, 2017) acknowledged that an ever-ageing population and related comorbidity, together with widening health inequalities, intensify the complexity of health and social care that is required, especially within primary care services (Ryder and Bain, 2013; Bengoa, 2016). With people living longer and care needs increasing, it is expected that the shift in services will weigh heavily on district nursing. As a result, the demand capacity gap will inevitably increase, leaving district nursing services to face expected difficulties in how to meet client demand and expectation (Royal College of Nursing (RCN), 2013; Chalk and Legg, 2017; McComiskey, 2017).
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