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Review of Nursing in the Community

Review of Nursing in the Community Conference SECC 16 th March 2006 Professor John Atkinson Associate Dean Research and Commercialisation School of Health Nursing & Midwifery john.atkinson@paisley.ac.uk. Review of Nursing in the Community. Nurses DO have the skills, education

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Review of Nursing in the Community

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  1. Review of Nursing in the CommunityConferenceSECC16th March 2006Professor John AtkinsonAssociate Dean Research and CommercialisationSchool of Health Nursing & Midwiferyjohn.atkinson@paisley.ac.uk

  2. Review of Nursing in the Community • Nurses DO have the skills, education • and expertise to take the community • care agenda for the benefit of patients. • HOWEVER …………..

  3. Review of Nursing in the Community • it is often … • Difficult and always needs negotiated • Messy • Political • Controversial and conflicting • Under-valued • Invisible • Without status or leadership

  4. Context of ChangeSome theory drivers • Carper 1978 Patterns of Knowing in Nursing • Empirical – Scientific • The cost of EVIDENCE BASE • Aesthetic – Creative but what Evidence? • Personal – The individual as practitioner • Moral – Ethical but multi-valued • Now also • ACCOUNTABLE & POLITICAL

  5. Context of ChangeSome theory drivers • Autonomy – • Patient AND Carers – Democracy • Justice • Tendency to DISTRIBUTIVE not • SOCIAL justice • Beneficence • Difficulty of Accounting in the Community • Non-malfeasance • Risk aversion, care of patient and carer

  6. Context of ChangePublic Service Drivers • UTILITY • UNIVERSALITY • VALUE FOR MONEY • Actuarial Model (e.g. USA) • Social Medicine Model (e.g NHS) • CHANGES COME FROM DRIVERS!

  7. Nursing Expertise models • Clinical focus, scientific, fixed or • narrow field, often institutional • Reactive Specialist - distributive • Group, context and advocacy focus, • negotiated and fluid field, often • community based, MULTI-PERSPECTIVE • Pro-active Generalist - beneficent • THE PATIENT NEEDS BOTH!

  8. Pathways to Resolution • Explore the big picture from the • PATIENT perspective. (Research model) • Describe the jigsaw pieces • NOT who ‘owns’ them • Establish positive interaction • WE ARE VERY USEFUL- • PEOPLE COME TO US

  9. Focus on WorkshopsNegotiating the best deal for the patientIntensive to minimal intervention • Long term conditions • Non curative, chronicity, outcomes • Keeping patients in touch. • Rehabilitation Programmes • Supervision and protocols • Urban, Rural and Remote • Equity does not mean the same – • Social capital, multi –agency, needs • The Hard to Reach – myths and truth

  10. Pathways to ResolutionInter-disciplinary Diplomacy • Working together does not mean • total agreement • Assume respect good will and integrity • Negotiated shared values aims LEVELS • Action Research Model • Negotiated differences • KEEP AT IT

  11. Review of Nursing in the Community • EVERY PATIENT • NEEDS A NURSE • THERE IS PLENTY OF WORK • FOR EVERY ONE

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