Expanding the clinical role of the district nurse: legal aspects and practical experience

Aim. To justify a change in activities of a district nurse and the expansion of her clinical role.

Material and methods. An analysis  of  regulatory  legal  acts  governing  the  organization  of  primary  health care and the activities of a district nurse was conducted. A medical and sociological study was conducted — an anonymous questionnaire of district general practitioners, district nurses, patients and observations of the work of district general practitioners and district nurses in parallel in order to assess the activities of a district nurse in the current situation. Based on analysis of the data obtained, organizational solutions were developed with a change in the activities of a district nurse. An organizational experiment was conducted. The following methods were used: analytical, statistical, content analysis, organizational experiment.

Results. An analysis of regulatory legal acts showed that the functions of a district nurse include the implementation of a wide range of activities, but in practice many of them are not implemented. According to the survey results, the main functions of a district nurse were informing patients and inviting them to preventive measures (this function was noted by 90,8% of doctors and 99,0% of nurses) and preparing medical documentation at an appointment with a doctor (this function was noted by 85,5% of doctors, 94,3% of nurses and 45,4% of patients), which confirmed the results of observations. The organization of independent nursing appointments allowed to increase the effective time of the district nurse’s work with patients during an outpatient appointment from 14,2 to 49,5% and during a shift from 12,3 to 20,8%, as well as to reduce the functionally idle time during an outpatient appointment from 13,8 to 0% and during a shift from 10,7 to 2,4%.

Conclusion. Changes in the activities of the district nurse contribute to an increase in its importance in the formation  of  a  healthy  lifestyle  of  the  population,  in  the  prevention  of  noncommunicable  diseases  and  is a promising direction for improving primary health care. In matters of ensuring the availability of healthcare care, the professional competencies of the nursing staff should be taken into account.

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