Abstract
BackgroundSuccessful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services. Primary and community health services are the typical points of access for most people and the location where most care is delivered. The scope of primary healthcare is complex and multifaceted and therefore requires a practice framework with sound conceptual and theoretical underpinnings.The aim of this paper is to present a conceptual model informed by a scoping evidence review of the literature.MethodsA scoping evidence review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases included CINAHL, MEDLINE, PsycINFO and SocINDEX using the EBSCO platform and the Cochrane Library using the keywords: model, nursing, midwifery, community, primary care. Grey literature for selected countries was searched using the Google ‘advanced’ search interface. Data extraction and quality appraisal for both empirical and grey literature were conducted independently by two reviewers. From 127 empirical and 24 non-empirical papers, data extraction parameters, in addition to the usual methodological features, included: the nature of nursing and midwifery; the population group; interventions and main outcomes; components of effective nursing and midwifery outcomes.ResultsThe evidence was categorised into six broad areas and subsequently synthesised into four themes. These were not mutually exclusive: (1) Integrated and Collaborative Care; (2) Organisation and Delivery of Nursing and Midwifery Care in the Community; (3) Adjuncts to Nursing Care and (4) Overarching Conceptual Model. It is the latter theme that is the focus of this paper. In essence, the model depicts a person/client on a lifespan and preventative-curative trajectory. The health related needs of the client, commensurate with their point position, relative to both trajectories, determines the nurse or midwife intervention. Consequently, it is this need, that determines the discipline or speciality of the nurse or midwife with the most appropriate competencies.ConclusionUse of a conceptual model of nursing and midwifery to inform decision-making in primary/community based care ensures clinical outcomes are meaningful and more sustainable. Operationalising this model for nursing and midwifery in the community demands strong leadership and effective clinical governance.
Highlights
Successful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services
No single overarching model of nursing and midwifery practice in the community emerged from the literature
Operationalising a model for nursing and midwifery in the community demands strong leadership and effective clinical governance, which is seamlessly linked to and interacts with the broader area of health systems. This literature documents the fundamental contribution of community-based nursing and midwifery to improving and sustaining population health and well-being
Summary
Successful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services. There are ideals inherent within primary healthcare which encompass a person-centred focus involving collaborative, comprehensive and coordinated service delivery, that is family and community centred [1, 2]. A shift was articulated by Mason and Clarke [7] emphasising departure from ‘professional health care provider’ to ‘enabler and facilitator of health,’ and of partnership [8] This form of service delivery requires a person-centred mode of care delivery, with shared partnership and collaboration in decision making while recognising clients as being central to this process [1, 2]
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