PubMed · 10119348
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R Singer. 1992-07-02. Patch workers.. https://pubmed.ncbi.nlm.nih.gov/10119348/
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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.
With the growing interest in community-based initiatives, this discussion paper focuses upon the evaluation of community development. It reviews three areas and highlights the complex and contentious nature of evaluation in this field. Commencing with approaches to evaluation, it critically reviews proposed methods and suggests that, rather than provide clarity and guidance, the competing designs are confusing for the potential researcher. Second, the discussion moves to evaluative terms that are applied to community development, suggesting that there is a mismatch between professional and lay interpretations with an ultimate impact upon the validity of their measurement. It uses the terms community and empowerment to make these differences more explicit. Finally, the paper argues that, although the aim of community-based initiatives is to bring about community health gain, gauging the pervasiveness of discreet project work is testing. It concludes by suggesting that a move away from an evaluative model based upon empowerment towards one which considers health and social capital may be a way forward.
In our modification of a quality of care framework, we blended the labels of both models with respect to structure, labeling it structure/inputs. We then specified the types of characteristics in each of the 12 cells that can guide the evaluation of the areas of interest in a primary care system. The identification of characteristics of this conceptual framework and its subsequent application are important for a number of reasons. Specifically, this framework systematically organizes standardized data elements that are critical to monitoring and subsequently improving quality of care, guiding research, influencing policy, and developing nurse-sensitive patient outcomes.