PubMed · 11977656
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M Jones, S Rote, M Daly. Special interest.. https://doi.org/10.7748/ns.16.2.20.s44
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Higher level practice (HLP) is the determinant characteristic of any maturing profession. Nursing should make a quantum leap with the development of HLP if the patient, the nurse, the context of caring and the acquisition of expertise are at the forefront of such growth. This study shows the matching of nursing concepts with nursing context is at the heart of HLP. It also shows that nurses are developing their own understanding of HLP which is different from the UKCC functional criteria. The intention here is to contribute to the development and understanding of HLP. Seven key concepts emerge in the definition of HLP. These concepts are unpacked to reflect the possible criteria, which could be used in the practice, teaching, assessment, and further refinement of HLP. A series of thought provoking recommendations are made for the Nursing and Midwifery Council to consider.A learning module entitled "Higher Level Practice" anchored in the epistemology of practice has been developed and successfully implemented by the author within the MSc Nursing Practice course attended by senior and consultant nurses.
BACKGROUND: There is, nominally at least, a universal health visiting service in Great Britain, although the frequency of contacts may be severely restricted. Debates about whether home visiting should be universal or selective, therefore, focus on whether health visitors should use professional judgement or structured assessment tools to target attention within their caseload. Research attention has focused mainly on unstructured needs assessments and professional judgment or the development of assessment tools, so that the views of practitioners using structured instruments and their clients are not known. METHODS: A two-phase qualitative study examined the acceptability and effectiveness of a structured health needs assessment tool (HNAT) implemented in London. Views about the tool were elicited from 30 health visitors through telephone interview, and then 21 assessments were observed and tape-recorded; 19 clients were interviewed after the event. Data were evaluated for adequate coverage of views across the target population and analysed using the framework approach. FINDINGS: A range of views were expressed, but the HNAT caused anxiety and distress to, particularly, the most vulnerable clients. The structured format of the tool appeared to encourage the health visitors to question instead of listen. It did not help to identify all the needs and intruded into normal practice in an insensitive and unhelpful way. LIMITATIONS: This study investigated only one form of structured HNAT. These are commonly used to prioritize undifferentiated needs of clients who have been offered an unsolicited, health promoting service. Our findings therefore do not apply to validated instruments used for screening or specific diagnostic purposes where a client has requested help with a problem. CONCLUSIONS: Given the problems in use and potential for harm, this form of structured assessment tool appears unsuitable for routine use to determine the intensity of health visiting contacts.
This paper explores the role and contribution of district nursing within primary health care. Examples of how this service is organised within different health care systems are used to discuss the context-dependent nature and challenges of the work. By drawing on UK policy change, health priorities and recent research into district nursing, the paper concludes that, in attempting to deal with the challenges of health care in the 21st century, the significance and potential of district nursing services are frequently overlooked. It is recommended that a research strategy for district nursing should build on the profession's comprehensive understanding of the needs of families and communities and should aim to provide evidence for practice that will further improve patient and client outcomes.