PubMed · 9807298
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M M Friedman. 1998. Problematic standard: medication administration.. https://doi.org/10.1097/00004045-199808000-00003
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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.
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.
Employing community psychiatric nurses to assess clients referred to community psychiatric teams can help target resources. The assessment nurses deal both with routine and emergency referrals. Some GPs were initially concerned about nurses undertaking assessments previously carried out by psychiatrists.