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What powers do district nurses have ? - Carers UK Forum

What powers do district nurses have ?

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Hi,
I used to be on here a couple of years ago and had a few problems with social workers etc and have been fine managing mum on my own as this was our preference.
Mum developed a sore on her leg and after getting the doctor to look at it she arranged for district nurses to come in to change the dressing.

Today was the second visit and I thought she was going beyond the boundaries a bit considering she was here to dress mum's leg wound.

She began saying she wasn't happy that mum wasn't using the profile bed (she didn't take to it and doesn't like it), that we should be using one of their pressure cushions (the one I have purchased cost £40 and is far far superior to their) and when I told her about the one we use she said they (whoever they are) would prefer her to have one of theirs.
I said we had one (it's an old well worn and has become hard and solid) and she said it was ok as long as we had one of theirs !

Then she said she wanted to come out on Friday when I change mum so that she can take a look at mum's bottom !
I told her that whenever mum develops the start of a sore I deal with it and get it cleared up. If I had a problem that wasn't clearing I'd call them out like I have done for her leg.

I just feel that she's treating me in a similar fashion to the way I was treated in 2012 by the social worker who I happened to offend and as a result she brought everyone in to check everything by way of disrupting us as much as possible and thereby casting doubt on my ability as a carer. The outcome from every professional who called on us was that I was doing a great job and am a great carer.

I would like to know whether it is normal for a district nurse to start making notes about things we spoke about and want to come out to check areas that haven't been requested to be checked.

On the one hand I can see that it's good to get a professional second opinion on things and they may notice something I don't recognise as a problem but on the other hand it seems a bit intrusive and unnecessary.

Many thanks
Hi Scruffy (and welcome back :) )

up to a point I can see your concerns - but perhaps the DN is just covering her own back (in a manner of speaking) ? By offering you advice on cushions, beds etc she's acting proactively so that you won't be saying "No-one told me this cushion or that cushion was better or worse" in the future.

Similarly with asking if she can check Mum's bottom - but of course she doesn't know you or how well you look after your Mum; once she realises that you are well on top of things then I expect she will just care of Mum's leg and leave it at that.
Hmm yes I can see that and it did cross my mind for a second. It was just the way she said 'she' wasn't happy with mum not using the bed, not using their cushion. My only concern is making mum happy not the district nurse. :)

The nurse remembered seeing us in the past and if they have access to our records they should show that mum is exceptionally well looked after. Everyone comments on it when they have been out to us. So I found it a bit insulting to be dismissed for what I do such as monitoring mum's blood pressure, pulse, oxygen, temperature, blood sugar etc. I write it all down in a book but this nurse dismissed that and said she'd bring the blood pressure equipment out when she comes on Friday... what's the point of that ?
When I asked she said it was so they could see what her base line was and if she became ill they'd have something to compare it with.

The doctor took her blood pressure last week why wouldn't that suffice ?

I'm suspicious of her intense intrusion.

We had late hour district nurses out on Friday when mum was seen for the first time. I had to chase someone to come out and when it hadn't looked like someone was coming I put a dressing on of the exact same type the nurses had used in the past. So when they called they said I'd done a good job, used the right type of dressing and they said they were impressed.

The district nurse today frowned when I said they had thought I'd done a good job as if disagreeing with them. They were really lovely, everyone has been so far until today.

I'd just like to know what my rights are regarding mum not using the bed and our own pressure cushion now that I have full power of attorney. I mean if I say we aren't using them can they do anything to force us ?

Mum and I were bullied so hard for months back in 2012 by social services who influenced so many people who they called out to us. They threatened us and made my mother cry and I had to get a carers advocate to be here when they visited. I'm just dreading this happening. I was advised back then to get power of attorney which I now have.

Thanks again. :)
Really Scruffy I can't see how anyone can 'force' your Mum to use a particular bed and/or cushion if she finds them uncomfortable - how will they even know unless they install someone 24 hours a day ?

The Occupational Therapists insisted on my Mum having a bed rail fitted to help her get in and out of bed - she used it once, hated it and we sent it back - they never made any fuss although they said they would have preferred us to keep it ! We never did get what we really needed which was a walk-in bath.

You know you are doing a good job caring for your Mum and enough people have confirmed this so I really don't think you have anything to worry about :)
It's so ironic, isn't it? Most family carers find it really hard to get SS/NHS to pay them attention, and now you get far too much that it's intrusive!

How about this as a possibility? Do you think the nurse is under pressure to 'justify' her job? If she is being threatened with cuts, she might be currently being 'over eager' to prove how 'necessary' she is to the surgery.

Or, perhaps, she is just one of those 'bossy types' who like to wave their expertise all over the place at us lesser mortals - after all, how can she be an 'expert' if you are as well????!!!!

I've often found it helpful, from a practical point of view, to be very 'servile' (!!!!) when it comes to dealing with any experts at all, in any field - let them feel 'expert' and 'important' etc, and bestowing their knowledge on dim little me (!), and then I actually get better info/service/attention from them.....

None of the above may be relevant, but you never know!
Hi Scruffy,

My situation is very different to yours so I don't know about the nursing side of things but just wanted to say this:

I was falsely accused when my son was was little and the damage it did was immense and to be honest it's only recently (this happened eight years ago) that I started to realise just how much damage it did.

What I have realised it that since that time, I do hear any question or query as an accusation or something that might lead to an accusation. What I eventually realised is that (a) a lot of the people that we see don't understand our situation so are just asking questions to find out more in the normal way that any of us would ask, (b) a lot of people don't really know what they're doing so they have to do everything 'by the rule book' because they can't make decisions and judgements on their own, (c) a lot of people in the public sector are so blinkered that they can't see any way other than their own (ie it's impossible for anyone to see that you may have found a cushion that suits your mum better than theirs would), (d) the tick box culture assumes they're always dealing with people who know nothing so they have to go through umpteen things that you can probably do in your sleep and (e) some of them are just control freaks who like to throw their weight around. I'm always fully aware that no-one ever reads my son's notes so everyone we speak to needs me to explain the whole situation every single time.

I think it's impossible for you, or anyone else, to judge what this nurse's intentions are and I completely understand your concern and your worry about this, but hopefully it is needless. I personally cope better with this sort of thing by being well prepared; you said you write down the information re your mum's readings so you have all of that, plus you have the previous investigation which in our situation eventually worked in our favour because all the good things I was doing came out in the course of the investigation, if you see what I mean, so there is a huge amount of written proof that the earlier allegations were false. You've got power of attorney which is legally binding and you are absolutely right, your focus is to make your mum happy, not this woman and you are obviously doing that. It sounds as if you had a lot of people in your corner last time so that, too, is beneficial for you.

Do you or have you checked all your records? I got copies of everything and now I do it regularly; I correct things that aren't accurate or add additional information if I feel something hasn't been explained properly and could be taken out of context. It is a pain and very time consuming but it helps to reassure me that all of our records are accurate and that just makes me feel a bit more in control. It also makes me feel like I'm showing them I'm not a pushover and I will fight them which again just makes me feel better. If you need info on this you can get it from the Information Commissioner's website:
https://ico.org.uk/for-the-public/personal-information/

Hopefully this woman just has an unfortunate manner about her and will be on her merry way again before long; I won't say don't worry as I think it's impossible when it's happened before! But hopefully it won't become an issue for you.
Hi Scruffy

I think perhaps you are reading the D/N in the wrong way and she has no concerns whatsoever about your style of caring. She is just offering what is considered at the moment to be best practice so feel free to pick her brains and be guided by her experience. I bought an expensive doughnut pressure cushion for Dad thinking I was doing the right thing by him but D/N came in and told me he would be better off with one of her bubble wrap ones. I asked why and she explained which made sense when I discussed it with her so I happily went back to her sort after getting her professional advise. At no time did I feel as though she was criticising me.
District Nurses are checking all elderly/vulnerable people for pressure sores on their bottom and it is totally routine for them to ask to see your mum's bottom. People will often prefer to show a nurse than a family member and had she not asked , and a sore left undetected she would be severely criticised by GP, senior nurse and family member. Once again it is no reflection on your level of care, just nurse doing her job well. They are there to support us carers so learn from their wealth of experience .
Once pressure sores develop they can be life threatening and very lengthy and difficult to resolve so it is far prefereable to avoid and prevent them by use of special cushions and following advise on regular momement etc than it is to miss the early warning signs that someone with less experience may miss resulting in treatment and discomfort.
Thank you all soo much for replying with very useful information and support. Woke up in a mild panic when I remembered what I'm facing and what I went through before but after reading the messages on here I'm feeling calmer.

I've been attempting to see this new situation as being unconnected to the trauma we experienced in the past. That began because I'd just been bereaved and hung up on the social worker who was having a go at me because I'd dared to say the occupational health visitor who had recently been out to us, had not assessed mum's upper body strength.

I had obviously offended her by hanging up and she came after us with all guns blazing. Threatened me with taking mum off me and then brought everyone to check mum, ignored what mum's wishes were and caused her pain and made her cry. If I'd have reacted I'd have given them justification to do more against us. It has damaged me. It's almost my biggest fear having to go through all that again. I learned at the end of all that, that that social worker and the occupational therapist who she got onside, were breaking the mental health code of conduct once mum had said she didn't want anyone but me helping her.

It just felt that this D/N was spouting the same line 'Hmm I'm not happy about your mum not using this or not having that'. That was how they started in the past to justify what they wanted to do. As a result of the OT not assessing mum properly mum became completely immobile and bed/chair-ridden. :(

This D/N may not be aware of how wrong and out of order the social worker and OT were back then and may be thinking I am someone who needs watching.
I can't see any justification for wanting to check mum's bottom. She has been called in to change the dressing on mum's leg and I don't know if I can refuse to let her see mum's bottom. I know for sure mum wouldn't like that but I'm afraid of upsetting another hornet's nest.
Last time I was set up to fail when being checked about using the hoist, sling etc.
If I raise mum when the nurse is here I don't want her judging me and my big fear of bringing in those awful people we were dealing with in the past.

I didn't write to mum's GP at the time and they may have no idea as to why social services were taking such an interest or what lies they were spreading about me.
I know we saw mum's own GP some time after all that trouble and she expressed surprise but it wasn't possible to explain at that point.

I just wonder what is in my notes. It would be interesting to find out.
I've found a pressure mattress for recliners so I'm considering getting one of those. :)

Thank you to everyone again.
Hi Scruffy,
I know exactly what you mean. I think, however, that this DN may have an unfortunate manner but, as others have said, she is responsible for checking up your mum's skin.
I've only been in this country caring for my brother for just over a year and I had problems with social workers when I started. I've also bought equipment (a heavy-duty sliding board to help brother to wheelchair) and been asked very rudely on the phone how I could take it upon myself to buy medical equipment - and yet no one else was helping me with it. So I understand what you mean and I'm used to being overlooked.

Our experience with the pressure mattress is that one was supplied at great expense just one year after it was requested. In mid-2014 the tissue viability nurse considered what mattress to recommend. My brother is very heavy and I had bought him a hospital bed, 110 cm wide, so the mattress had to be specially adapted. It also had to be one that suited his distribution of weight - your mother's may be more normal. On top of everything else, I kept asking when we would get it, but I found out in November that a new head DN in August had said my brother was spending more time out of bed (not true, it didn't work out) and no longer needed a mattress! Hence some months' delay. No one told us the mattress was no longer on order. It was ordered again when that nurse changed her job.

So if you can, try to get some DN or TVN advice before you buy your own mattress. I wanted to buy our own too, but in view of the advice on a particular distribution of weight, I didn't think I should. I do find it a big problem that you can buy your own stuff with no advice, but if it's supplied by the NHS it may mean a very long wait. (Some time in the course of the year a very small mattress that didn't fit the bed was suddenly delivered and we sent it back! communication is not wonderful).

I have had problems with social services, not as bad as yours but potentially so. Currently our social services are excellent. But district nurses won't know what social services have done, and in my experience social services don't know what their colleagues did last year. District nurses do really know how to deal with sores and they're just the long arm of the NHS. Maybe you can encourage your mother to accept them.
How about telling your mum that the DN wants to give her a quick overall check up, not particularly mentioning the bottom end (!), but as if it's just a whole body check up.

I agree that your mum may well prefer a professional nurse to do the check, rather than her daughter!

Also, remember that professionals do have quite a good way usually of getting patients to do what is necessary.

Getting it checked in the first place does seem to be sensible, though - hopefully there won't be any sign of problems building up, but if there is, then treatment can be started. It is NOT a criticism of your standard of care for your mum! It sounds like you are doing a brilliant job, but the professionals are there to help (!!!), even if they have a 'bumpy' attitude!