Role Of Community Nurses Research Articles

Reduction of chronic sorrow: a health promotion role for children's community nurses?

Families who have a child with a chronic illness face losses in their lives and react in a variety of ways. The theory of constuctivism is used to examine these losses. The ongoing nature of these losses can lead to ongoing grief rather than acceptance. This is discussed within the themes of time-limited grief and chronic sorrow. The role of children's community nurses in assisting families with resolving this sorrow is discussed, the main suggestions being the provision of an empathetic presence, time and the provision of accurate and specific information regarding the illness and the ways of managing it within the familys life.

Fungal nail infections: far more than an aesthetic problem.

Onychomycosis (fungal nail infection) is common and causes considerable discomfort and pain for many otherwise health patients. However, onychomycosis is especially prevalent in some patient groups seen regularly by community nurses (e.g. the elderly and people with diabetes, human immunodeficiency virus (HIV) infection or psoriasis). This article discusses the causes and types of onychomycosis, and examines in detail the various treatments available. Both the infection and its treatment can cause several clinical problems including drug interactions, difficulties with differential diagnosis and compromise of clinical outcomes. In particular, onychomycosis can undermine foot care in people with diabetes. The role of community nurses in treating and preventing onychomycosis is discussed.

Clinical teaching by community nurses in the Australian context

A study was conducted to explore factors that impact on the clinical teaching role of community nurses involved in the education of pre-registration nursing students. Respondents were community nurses working in the Western Sydney Area Health Service in New South Wales, Australia. A self-report questionnaire was developed to collect data. Results indicate that community nurses are interested in clinical teaching, that it is an important part of their role and that they perceive themselves to be effective clinical teachers, with the majority indicating motivation to continue developing their clinical teaching skills. Aspects of clinical teaching important to community nurses included facilitating the transition of education from theory to practice, sharing expertise, knowledge and skills and maintaining high standards of nursing practice. There was little support for the view that community nurses experienced difficulty in managing the dual teaching and practice role. Approximately a third of participants reported that being with a student on a one-to-one basis could be stressful. Strategies to assist community nurses in their clinical teaching role were identified.

Factors affecting influenza vaccination rates in older people admitted to hospital with acute medical problems.

Influenza is a major problem both in the community and hospital and elderly people who are at particular risk should be included in vaccination programmes. In August 1998 the Chief Medical Officer for England extended the current influenza immunization policy to include all those aged 75 years or over. However, prior to this date only those patients with co-existing cardiac or respiratory diseases at increased risk of influenza were vaccinated routinely. In order to determine whether such patients had been immunized, we approached all patients admitted to Care of the Elderly wards during an 8-week period in January and February. The study additionally identified factors that may have influenced patients' participation in this immunization programme. Six hundred and forty-nine patients on Care of the Elderly wards with acute medical illness were questioned with regard to vaccination against influenza during the previous year. Of the 649 patients 279 were suitable for entry into the study. Of these 39% had been vaccinated against influenza. When considering the 171 who were not vaccinated, 25% (44 patients) had actually been offered and declined vaccination, in 46% of these cases due to previous side-effects, or fear of anticipated side-effects. In those unvaccinated three-quarters considered that the influenza vaccine was not efficacious. Unfortunately, patients with co-existing cardiac, respiratory or endocrine diseases were no more likely to have been vaccinated than were those without these diseases. Many older patients admitted with acute medical problems had not been vaccinated against influenza and the reasons for this included not being offered vaccination, a belief that influenza vaccination was not efficacious and concerns about possible side-effects. The role of community doctors and nurses in facilitating the vaccination of such an at-risk group is evident and should be incorporated into resource planning.

Primary role for community nurses in intermediate care

Primary role for community nurses in intermediate care

Public health: a new nursing role for community practitioners.

This article discusses the six key activities identified by the Royal College of Nursing (1994) as essential ingredients for public health nursing. Examples of public health practice and community nurse involvement are given to illustrate each activity. Public health skills such as health profiling, building healthy alliances and policy development are outlined. Current barriers to community nurses participating in these activities are identified and models of public health practice are reviewed. The potential for a radical transformation of community nursing practice is discussed in the context of an expanding public health role of community nurses in Scotland. Options for future practice are presented and discussed.

Community nursing and stroke: a reassessment of the issues.

Recent research has highlighted the difficulties that stroke patients and carers experience in navigating a recovery path through a complex array of service providers. Many of these difficulties relate to continuing recovery from stroke at home, often when professional help is decreasing. A study by Gibbon (1994) demonstrated a potential role for community nurses in helping patients and carers to cope with the aftermath of stroke. This article reassesses the issues that affect the capacity of community nurses to develop this role. A focus group conducted with community nursing students identified a number of barriers to the expansion of service provision for this patient group, including workload pressures, training and management support. Understanding of the problems faced by stroke patients and their carers in the current organization of continuing care and rehabilitation is required to support expansion of nursing practice in this area.

A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice.

The role and expectations of community nurses in carrying out needs assessments changed when an internal quasi-market was introduced to the British health service under the National Health Service (NHS) & Community Care Act 1990. This paper reports on a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment in the context of this legislation. A multiple case study design was utilized and four cases identified, incorporating the geographical variation in England. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (n=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. Participants were interviewed after the observation period (n=33 practitioners), to determine the extent of formality they attached to each assessment, and to elicit information about aspects which may be embedded in everyday practice. Single and multiple case analyses across the four cases used an iterative process of pattern-matching, replication logic and explanation building. The preliminary analysis yielded a descriptive 'taxonomy' which could serve as a basis for classifying the variants of needs assessment and help to clarify the whole phenomenon. When applied further to the data, this revealed the complex interactions between the different ideals (relating to policy, nursing and ascribed worth), the various types (purpose, formality/specificity and complexity) and timing (in relation to client, service and practice issues) within needs assessment.

Foot care in diabetes: developing the role of community nurses

Foot ulceration in patients with diabetes is a major cause of morbidity and mortality. The aim of this article is to inform readers of the major causes of foot ulceration in people with diabetes and to explore the role of community nurses in the assessment, treatment and prevention of foot problems in diabetes. It is argued that with the recent development of primary care groups, community nurses are well placed to become more proactive in the provision and commissioning of services for this group of patients.

Working with older people: opportunities for community nursing

This article briefly considers the role of community nurses working with older people and their carers, outlining the changing demographic trends and patterns of illness. It suggests the need for a more proactive approach which builds upon opportunities for health promotion in addition to support for family carers. The development of interventions which are of relevance to very frail older people are also discussed. The forthcoming year will see a number of major policy developments and therefore community nurses should seize the initiative and explore new possibilities while developing existing roles.

Augmentative and alternative communication: the role of community nurses in the rehabilitation of people with severe disabilities.

This article focuses on the importance of community nurses' involvement in the identification and early referral and intervention of children and adults who have very little or no speech. The use of Augmentative and Alternative Communication strategies with nonspeaking children and adults are described in terms of the different kinds of systems that can be used as well as the general principles involved in working with people with severe disabilities. In conclusion, it is emphasized that close collaboration between community nurses and rehabilitation specialists is vital in ensuring that a difference is made in the lives of people with severe disabilities in this country.

Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom.

This paper argues that the interfaces between formal and informal care-giving are changing as a result of two current trends; the increased scope of home-based nursing care and the emphasis on participation both within nursing and in the wider health and social care arenas. These various changes are explored in relation to the provision of intensive and complex nursing care in the home. It will be argued that the changing interfaces between formal and informal care have important implications for the respective roles of nurses and informal carers which hitherto have been relatively overlooked. These implications urgently need addressing in research, policy and public debate if professional nurses are to provide appropriate help and support to informal carers.

Emotional problems in primary care: what is the potential for increasing the role of nurses?

It has been suggested that the role of primary care and community nurses should be expanded in relation to mental health in order to assist in the prevention and management of prevalent emotional disorders such as depression and anxiety. However, relatively little is known about the mental health work presently undertaken by these nurses. Furthermore, nurses' training needs, attitudes and organizational barriers to role expansion in this area have not been systematically explored. This article seeks to review the literature on nurses' potential and current mental health work, current and future training needs, the views of patients and nurses concerning an expanded nursing role, and organizational issues of relevance. Educational interventions which have been systematically evaluated are also reviewed. The results suggest that nurses are already involved in emotional health care with a variety of patient groups, although this is not always acknowledged as mental health work. While clear potential for an expanded role exists, there is little consensus as to what role would be most effective for each nursing group, and few educational interventions have been demonstrated to be of proven effectiveness.

The effects of policy changes on community nurses

National Health Service (NHS) reforms have sought to refocus the purpose of health care by shifting the provision and commissioning of health services from the secondary to the primary care sector (Department of Health and Social Security (DHSS) 1987, the NHS and Community Care Act 1990, Department of Health (DoH) 1989, 1992a). However, short termism in policy making has tended to create health care policies which are often unconnected and divergent in their implications (Williams et al 1993, Salter 1994). As a result, community nurses are having to manage such contradictions in a general management structure where access to professional leadership is increasingly elusive (Kitching 1993). This paper explores some of the impact of these reforms on the organisation of patient care and examines the role of community nurses within a primary care led NHS.

Community development: theoretical and practical issues for community health nursing in Canada.

Despite the importance currently given to community development as an increasingly significant role for community nurses, there is little analysis of the role in the nursing literature. This paper provides background information on the historical origins of community development work through an extensive review of the literature. As well, four models of community development are synthesised from literature in sociology, social psychology, education and political science. These include economic development models, education models both formal and informal, confrontational models, and empowerment models. Each is discussed, and the relevance for community health nursing practice is critiqued. Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed. Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve. The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health. However, much additional work will be needed to test out models for community development in actual practice. Evaluation of the role will also be important to determine the degree to which it can be implemented and the resultant health outcomes for the population.

Preventing child maltreatment through community nursing.

The role of community nurses, such as health visitors, in the prevention of child abuse and neglect by home visits is reviewed. The paper evaluates the potential of community nurses for predicting and identifying families at high risk for child maltreatment in order to support them through the promotion of positive parental knowledge, attitudes, skills and behaviour. The success of health visitor interventions to prevent family problems is also evaluated. The review concludes that accurate prediction of child-maltreating families requires more than one screening procedure to reduce the number of false alarms, and suggests that health visitors might be trained in the objective assessment of parent-child interaction. Few health visitor interventions were deemed a success, indicating that greater support and training is required for community nurses if they are to be used to prevent child abuse and neglect. However, recent changes in the community nursing services and the purchaser-provider split in health care has reduced this possibility.

Educating nurses for community care.

This article examines the shift in emphasis in community care provision and how this will affect the role of community nurses and contribute to the need for new community nursing skills.

Community nurses & discharge planning.

The role of community nurses in discharge planning for elderly patients leaving hospital is of increasing importance in the wake of the NHS and Community Care Act 1990. Community nurses can play a key role in contributing to pre-discharge assessments and in providing continuing post-discharge assessment and care. The Nursing Research Unit at the University of Edinburgh conducted a survey early in 1993, just prior to implementation of the Community Care Act in Scotland, to ascertain the views and experiences of a national 1 in 3 sample of community nurses relating to the discharge of elderly people from acute hospitals. This article presents the results of that survey and offers recommendations regarding the role of community nurses in discharge planning for elderly patients.

Nurse practitioner: redefining the role of the community nurse?

Currently there is considerable uncertainty regarding the future for community nurses in the United Kingdom (UK). Within the present social and political context the development of the nurse practitioner is examined as one possible means of redefining the role of some community nurses. The historical development of the nurse practitioner in the United States of America (USA) and the UK reveals that such a role has, previously, been a response to changing health trends and to deficits in the provision of care to communities. The evolution of an independent nurse practitioner role is suggested as a way forward for different groups of community nurses and should enable them to meet the health demands of people in a variety of settings. The 'needs' of patients and clients and a multidisciplinary approach are emphasized as being important to the redefinition of community nursing roles. The preparation of community nurses as nurse practitioners would have obvious implications for community education; this matter is briefly discussed. The future of nursing as a whole is set to change; it is imperative that all nurses delivering patient care in this arena should examine the changing needs of society in the context of political reform, and consider how their roles may be developed and redefined.

Team tactics: a study of nurse collaboration in general practice

THIS paper examines the extent and type of collab orative work amongst community and practice nurses based in general practice in relation to health promotion. The data were drawn from a quantitative and qualitative study carried out from Autumn 1991 to Spring 1992, which investigated the prevention of coronary heart disease in general practice and the role of community nurses. This study formed part of a national survey of health promotion in general prac tice in relation to coronary heart disease, com missioned by the HEA and undertaken in collaboration with Kent University Centre of Health Services Studies. The study shows that there is mutual support and communication between prac tice nurses, health visitors and district nurses. How ever there is a strict division of labour within general practice which does not necessarily maximise the expertise and skills of the nurses concerned, and further training needs are identified. The new ar rangements for health promotion in the GP contract place emphasis on practice-based team work, to which the role of community nurses is central, but important management and training issues will need to be addressed for such team work to be successful.