Defining the need: an analysis of varying teaching goals in antenatal classes

Abstract

‘Need’ is a term which lends itself to imprecise use. It has, indeed, been argued that it should be “banished from discussion of public policy, partly because of its ambiguity, but also because . . . in many public discussions it is difficult to tell, when someone says that ‘society needs . . .‘, whether he means that he needs it, whether he means that society ought to get it in his opinion, whether a majority of the members of society want it, or all of them want it. Nor is it clear whether it is ‘needed’ regardless of the cost to society” (Culyer, Lavers and Williams, 1972). However, the use of the word obstinately persists. A more fruitful approach to need as a concept can be found in the work of Bradshaw (1972). He distinguishes between normative need (defined by experts), felt need (defined by the person experiencing it), expressed need (felt need acted upon) and comparative need (assessed by comparing provision for individuals with similar characteristics; those less favourably treated are in comparative need). Culyer (1976) recognises only normative need in his discussion of the dilemmas of the British National Health Service, an institution suffering from increasing demand for medical care which outstrips the resources available and is likely to continue to do so. From a different starting point, that of nursing research, Inman (1975) adopts a similar stance; patient needs in the nursing context are made normative by a doctor’s diagnosis and prescription, and thus “the nurse researcher is in the favoured position of being able to ignore the debate about underlying values”. This may be true when research focuses on nursing care, but it cannot be taken for granted when nurses engage in educational activities related to their patients’ well-being. Henderson’s definition of nursing makes it clear that education is an integral part of nursing. “Nursing is primarily helping people (sick or well) in the performance of those activities contributing to health, or its recovery (or to a peaceful death) that they would perform unaided !‘f they had the necessary strength, will or knowledge. It is likewise the unique contribution to help people to become independent of such assistance as soon as