Appropriate care in district nursing

By using evidence based alternatives and actively applying nursing guidelines and care aids, ineffective care in district nursing can be reduced. This saves a lot of time. This time can be used for care that demonstrably contributes to people's lives and health. Nurses and carers in district nursing thus demonstrate that they can play an important role in the transition to appropriate care.

Over a period of six months, the “RENEW strategy”—a tailor-made de-implementation strategy—was introduced in 31 district nursing teams from two healthcare organizations (n = 432 professionals). Teams were able to choose from three actions to reduce.

Using a multiple interrupted time series, the outcome was measured consistently at several points in time: two measurements before and three measurements after the introduction of the RENEW strategy.

The analysis used a method that looks at the difference in time at the various measurement moments. The results, measured as the weighted average number of minutes per client per week, showed that the RENEW strategy led directly to a reduction in two of the three selected Better Left actions.

The third action showed a slight increase in time:

• a reduction of 4.42 minutes for ‘assisting with putting on and taking off compression stockings when the client can do this themselves (possibly with an aid)’,
• a reduction of 13.61 minutes for ‘standard washing with soap and water’ & ‘washing the client completely every day’,
• an increase of 1.25 minutes for ‘applying zinc ointment, powders, or pastes in the treatment of skin lesions’.

The process evaluation identified 44 factors that influence the implementation of the ‘RENEW strategy’ in practice.

The working environment is a major obstacle to changing daily practice in district nursing. Although project leaders within the project were given extra time and resources, in practice it often proved difficult to actually free up time. Work agreements and team culture also have a major influence in this regard.

The results show that it is important for nurses, caregivers, managers, administrators, and policymakers to continue to focus on reducing unnecessary interventions.

Read the full publication here

Wendt B, Oostra DL, Teerenstra S, Nieuwboer MS, Vermeulen H, Van Dulmen SA, Huisman-de Waal G. A tailored de-implementation strategy to reduce low-value

home-based nursing care: A multiple interrupted time series study. Int J Nurs

Stud. 2025 Jul 8;170:105159. Epub ahead of print. PMID: 40683088.