Community health care nursing

This book is established as an essential source of reference for all those working in the community health care domain. It addresses some of the main issues for the introduction and implementation of a sound infrastructure for community health care nursing delivery. These ideas may be taken and adapted to suit local requirements.

Government investment in the design of a new infrastructure to support primary care and public health initiatives has required a review of the education and practice base of community health care nursing. This new edition has been updated throughout with the help of two new co-editors. There is now additional information on school nursing, interprofessional collaboration, nurse prescribing and scope of practice. It takes account of the challenges involved with the implementation of clinical governance, clinical excellence, evidence-based practice and the necessity of systematically measuring the quality of service delivery.

Contributors to this text have been selected for their own knowledge, experience and excellence in service delivery. Many who have realised the introduction of excellence in their localities will recognise common elements that relate to their own experience as they read this book.

Community Health Care Nursing provides an excellent example of the application of knowledge and theory to community health care nursing practice. It will be of use to practitioners, curriculum planners, educationalists and students alike.

Contributors	p. ix
Preface	p. xi
1 The Context of Community Health Care Nursing	p. 1
The context of service provision	p. 1
The context for primary care	p. 3
The changing focus of primary care	p. 5
The scope of primary care nursing practice within the context of a changing workforce	p. 7
International influences on the health care agenda	p. 10
Conclusion	p. 11
References	p. 12
2 Social Policy in Public Health and Primary Care	p. 13
Introduction	p. 13
The policy-making and implementation process	p. 13
The evolution of the NHS	p. 16
Health care under the Conservative Government 1979-1997	p. 18
Labour Government health care policy	p. 20
Conclusion	p. 24
References	p. 24
3 Primary Health Care in the Community	p. 26
Introduction	p. 26
Primary health care - the concept	p. 26
Primary health care and the NHS	p. 29
Primary health care in the community - key issues and initiatives	p. 32
Looking to the future	p. 37
References	p. 38
Further reading	p. 40
4 Communication, Skill and Health Care Delivery	p. 41
Introduction	p. 41
Interpersonal communication	p. 42
Communication and skill	p. 44
Communication skill: a conceptual framework	p. 46
Conclusion	p. 51
References	p. 51
5 Community Development in Public Health and Primary Care	p. 57
Introduction	p. 57
The current context for community development practice	p. 57
Defining community development	p. 59
Making it work - key issues in successful community development	p. 62
The role of community health professionals	p. 65
Conclusion	p. 66
References	p. 67
6 Health Needs Assessment, Risk Assessment and Public Health	p. 70
Introduction and overview of chapter	p. 70
Health - a contested concept or a chimera?	p. 70
Perspectives on health needs assessment	p. 71
Health needs assessment - the contribution of community nurses	p. 81
Risk assessment	p. 85
Conclusion	p. 86
References	p. 87
7 Research Perspectives Applied to Primary Health Care	p. 89
Introduction	p. 89
Priorities for nursing and health care research	p. 89
The knowledge base for public health and primary health care practitioners	p. 91
Reflective practice and research mindedness	p. 92
The research process	p. 94
Research examples	p. 95
General research issues	p. 105
Conclusion	p. 109
References	p. 110
8 Public Health Nursing - Health Visiting	p. 114
Introduction	p. 114
The development of health visiting	p. 114
Principles of health visiting	p. 115
Modernising the role of the health visitor	p. 116
Dilemmas for health visiting practice	p. 119
A framework for health visiting practice	p. 120
Examples of public health activities in health visiting practice which reflect the above model	p. 121
Changing to a 'family-centred public health' approach to practice	p. 123
The way forward	p. 124
Conclusion	p. 125
References	p. 126
9 General Practice Nursing	p. 128
Introduction	p. 128
Historical development	p. 128
The developing role of the practice nurse	p. 129
Impact of policy on general practice and practice nursing	p. 129
The new GMS contract	p. 132
First contact	p. 134
Public health	p. 134
Health needs assessment	p. 137
Chronic disease management	p. 138
Systems for accountability and responsibility	p. 141
The future	p. 143
References	p. 144
10 Contemporary Issues in District Nursing	p. 146
Introduction	p. 146
Historical origins	p. 146
The changing role of the district nurse	p. 147
Health needs assessment and profiling	p. 149
Clinical governance	p. 151
Managing chronic disease through population management and a geographical perspective	p. 152
Nurse consultants and community matrons	p. 154
Specific responses for older people	p. 154
GMS contract and nurses with specialist interests	p. 155
Extended and supplementary prescribing	p. 155
Continuing professional development and lifelong learning	p. 156
Conclusion	p. 157
References	p. 158
11 Community Children's Nursing	p. 160
Introduction	p. 160
Quality	p. 161
Monitoring and measuring quality and effectiveness	p. 164
Appendix	p. 176
References	p. 176
12 School Nursing	p. 181
Children as the future	p. 181
Education high on agenda	p. 181
Emphasis on public health for school health	p. 182
The recent past and contemporary situation	p. 184
Education and training	p. 185
New future	p. 186
The outworking of the public health nurse in school health	p. 186
Search for health needs	p. 187
Stimulation of awareness of health needs	p. 187
Influence on policies affecting health	p. 187
Facilitation of health enhancing activities	p. 188
Leadership and organisation	p. 189
Mental health - a specific issue	p. 190
The need for marketing	p. 192
Conclusion	p. 192
References	p. 192
13 Occupational Health Nursing	p. 195
Occupational health nurses as specialist practitioners	p. 195
The effect of work on health	p. 196
Historical perspective	p. 197
Provision of occupational health services in the UK	p. 197
The changing nature of UK workplaces	p. 198
Changing work patterns	p. 199
Workplace practices	p. 199
The domains of occupational health nursing practice	p. 200
Public health strategies	p. 203
Specialist community public health nursing - Part 3 of the register maintained by the Nursing and Midwifery Council	p. 204
Appendix	p. 204
References	p. 206
14 Community Mental Health Nursing	p. 207
Introduction	p. 207
A guiding paradigm	p. 207
The National Service Framework	p. 210
The principles of community mental health nursing	p. 210
Conclusion	p. 219
References	p. 220
15 Community Learning Disability Nursing	p. 224
Introduction	p. 224
People with learning disabilities	p. 224
Changing service principles	p. 226
The health of people with learning disabilities	p. 227
The role of the community nurse for people with learning disabilities	p. 230
The future role of community nursing services for people with learning disabilities	p. 232
Conclusion	p. 234
References	p. 234
16 Assessment of Competence to Practise and New NMC Teaching Standards	p. 237
Introduction	p. 237
Entry to the register	p. 237
Standards of education for specialist community public health programmes	p. 238
Levels of attainment in academia	p. 238
The development process of levels of attainment in practice	p. 238
Knowledge in practice	p. 240
Action in practice	p. 241
A consideration of competence and proficiency in practice	p. 243
Tools for assessment of proficiency in practice	p. 246
Conclusion	p. 255
References	p. 255
17 Inter-professional Practice and Teamwork	p. 257
Introduction	p. 257
Potential team members in community services	p. 257
The continuing need for effective teamwork	p. 258
The nature of teams	p. 259
When teamwork is not effective	p. 261
When teams work well	p. 263
Conclusion	p. 265
References	p. 266
18 Measuring the Effectiveness of Community Health Care Nursing	p. 268
The measurement of effectiveness in the NHS	p. 268
A model of evaluation in health care	p. 269
NHS policy developments	p. 272
Measuring effectiveness in public health and primary care - established evidence	p. 274
Effectiveness in public health and primary care - emerging evidence	p. 275
Ongoing issues for community nurses and specialist community public health nurses (health visitors)	p. 276
Measuring health gain	p. 277
Conclusion	p. 278
References	p. 278
19 Non-medical Prescribing	p. 281
Medicines management and prescription, supply and administration of medicines	p. 281
Non-medical prescribing in the current health care agenda	p. 282
Non-medical prescribing in community nursing	p. 282
Supply and administration of medicines	p. 285
Prescribing in practice: achieving and maintaining competence	p. 286
Education	p. 286
Supervision in practice as part of education	p. 288
Maintaining competence in practice and CPD	p. 289
Professional and legal accountability	p. 290
Conclusion	p. 292
References	p. 292
20 Public Health Nursing	p. 295
Introduction	p. 295
The context of public health work	p. 295
The Modernisation Agenda	p. 296
Specialist community public health nursing	p. 299
New roles for specialist community public health nurses	p. 301
Conclusion	p. 304
References	p. 304
21 Modernisation in the Primary Care Workforce	p. 306
Introduction	p. 306
The case for change	p. 306
Modernising primary and community health care nursing	p. 308
Ensuring a responsive workforce	p. 308
Constraints and challenges to workforce redesign in primary and community nursing	p. 310
The vision for redesign	p. 310
Ensuring the 'right' mix of skills	p. 311
People at the centre of new approaches to care	p. 312
A local framework for redesign in community nursing	p. 314
New roles, new competencies	p. 315
Conclusion	p. 316
References	p. 316

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