Community nurse training for intravenous therapy administration skills within a central London home nursing service supporting patients with HIV-related infections living at home

OBJECTIVES:
To develop a training programme with respect to intravenous therapy (IV) administration skills for district nurses (DNs). To develop a training model to meet initial service need and evaluate. To incluae differing central venous access (CVA) devices, administration methods (AM) and update existing community policy.
METHODS:
Skill gaps were self-identified by NMs, DNs and clinical nurse specialist HIV/AIDS (CNS) via a training needs assessment. A training model was developed by nurse managers (NMs). Existant authority policy was updated from a review of the literature. DNs were recruited through their NM.
RESULTS:
Training model included two-days of theory, period of in-hospital observation and field practice with CNS. CVAs included "Hickman" line, "Port-a­ Cath" and peripheral access devices, respectively. Twenty-two (n=22) DNs were trained {1991, grades G:17; H:5) and twenty-one (n=21)(1992, grades G:18; H: 3) respectively. NMs nominated DNs at sister grade. Field assessment was undertaken with CNS by seven DNs to date and is ongoing. DN evaluation identified time required for home visits, nurse familiarity with equipment, 'psychomotor skill required to administer therapy and perceived lack of patients to !earn from as problematic.
DISCUSSION AND CONCLUSION:
Key issues include the limit to individual nurse responsibility for self­ training and updating skills ba e, number of clients with CVA devices available for practice and CNS training role. A revised model of training addresses paucity of patients to learn on at any point in time, theory/practice divide and IV therapy as a generic community nursing role. Implications are addressed for future training with respect to cost, projected numbers of IV patients requiring therapy and the role of a college of nursing in training.-