Jean McIntosh

The question of knowledge in district nursing

This paper focuses on the development of the experiential knowledge base in district nursing with reference to changes in professional preparation for district nurses and to a research study conducted by the author during the 1970s. The process of conducting the research showed that an exclusive focus on activity fails to capture the range and depth of nursing care in the home. Schöns concept of professional artistry is employed as an interpretive framework to consider some of the study findings and with reference to more recent research studies the author concludes that while it has always been central to skilled nursing, professional artistry has remained hidden. The problems confronting academics and practitioners in articulating such knowledge are explored together with the possible consequences of continued failure to address this issue. These difficulties are discussed in the context of the current changes in the National Health Service with particular reference to the introduction of grade mix in community nursing. The paper concludes by arguing that a better understanding of the district nurses knowledge base must be vigorously pursued.

Disclosure of disability: exploring the perspective of parents

OBJECTIVE To explore the perspective of parents with regard to disclosure of disability and early follow-up care. DESIGN The research approach was hermeneutic phenomenology. Data were collected using focused interviews that were audio-taped, transcribed and interpreted. SETTING Scotland. PARTICIPANTS The parents of 63 children born with a congenital limb deficiency. FINDINGS The findings demonstrate the complexity and variability in parental response. Additionally, what is shown is that disclosure was often handled poorly and that the support offered during the stay in the maternity unit was frequently inadequate. CONCLUSION In order to handle disclosure effectively, health professionals require appropriate education and training and it is recommended that innovative ways of encouraging discussion and debate are sought.

Exploring district nursing skills through research

This chapter discusses the early stages of a study that was planned in response to a Scottish Office call for research proposals in the field of community nursing. The invitation to tender identified a number of areas of interest, most of which were of significance to policy or service provision. In selecting the area of district nursing skills and skill mix, the authors hoped to be able to make a contribution to a contentious topic that is underresearched and has important implications for patient care and nurse education. The chapter will therefore examine the policy context of skills and explore the meaning of the term ‘skill’. It will go on to identify the challenges of setting up a research study designed to explore the use of district nursing skills and will then outline some early results from the study.

The evidence base for individual patient and client assessment by community nurses

There is wide recognition that patient and client assessment by community nurses is central to the provision of high quality care. It is also acknowledged that assessment in the home setting is a complex process requiring a wide range of knowledge and skills. This article identifies two distinct approaches to assessment that have emerged in different contexts around the world. These approaches comprise the formal, structured questionnaire-based assessment that has been developed particularly in response to the requirement to determine service eligibility and the informal, conversation-based assessment that draws on nursing concepts and theories. The article briefly traces the professional and policy influences that have shaped the development of these two approaches before turning to a critical analysis of selected empirical work that has examined their effectiveness. Research undertaken on the structured form of assessment has focused largely on issues of reliability. While the majority of studies indicate that this form of assessment is reliable in identifying patient need, some research highlights its failure to take account of patient and client perspectives. This raises questions about the appropriateness of the nursing interventions that are planned in response to a structured assessment. Less research attention has been devoted to exploring the conversation-based approach to assessment, but this body of work has drawn attention to the potential for practitioners to adopt a controlling influence over the assessment process. Reference is made to research in which the author has collaborated that illuminates the way in which two styles of conversation-based assessment impact differently on patients and clients. The article concludes by identifying the need for further research and argues that a key focus should be the ways in which assessment contributes to care planning and patient outcomes.