Written by experts i
Trade Review
“I would recommend this book to student nurses, community and district nurses and anybody with a passion for public health nursing. Clear, concise and structured it is a book I have found beneficial for my own learning.” (Nursing Times, 24 April 2015)
“Thorough, comprehensive, and up-to-date with the latest policy guidelines Community and Public Health Nursing is an invaluable resource for novice and experienced practitioners, and for all healthcare professionals who work in the primary care and community setting, including practice nurses, nurse practitioners, district nurses, community staff nurses, health visitors, school nurses, walk-in centre nurses and sexual health nurses.” (Newbooks.lib, 9 September 2014)
Table of Contents
Notes on Contributors xii 1 The context of primary healthcare nursing 1
The changing context of service provision 1
The changing face of the community healthcare workforce 4
The primary care vision for the next decade 8
The impact of primary care policy changes on the role of the primary care nurse 14
The scope of primary care nursing practice within the context of a changing workforce 15
Conclusion 19
2 Community Development and Building Capacity 22
Introduction 22
The current context for community development practice 23
Defining the terms 24
Defining community 24
Defining social capital 25
Defining empowerment 26
Defining capacity building 27
Defining community development 27
Defining community engagement 28
The role of community health professionals 29
Conclusion 34
3 Multi-Sector Working and Self-Management, Community Health Care 37
Introduction 37
Context for multi-sector working in the United Kingdom 38
Key drivers for multi-agency working 41
Examples of multi-sector working and self-management initiatives 43
Dementia 44
Obesity 45
Asthma 47
Concluding reflections 48
4 Moving Care Closer to Home 53
Hospital provision: A brief history of the last 50 years 53
Health care: What does it mean? 58
Selective definitions of health 58
Universal definitions of health 59
Caring and nursing: Where are we now? 61
Nursing at the interface between paid and unpaid care 63
Public health and care closer to home 65
Conclusion 68
5 Evidence-Based Practice and Translational Research Applied to Primary Health Care 71
Introduction 71
Evidence-based practice 72
Designing the study 73
Translational research 73
Overview 73
Experiments, randomised controlled trials and quasi-experiments 74
Health impact assessments 75
Surveys 76
Case studies 77
Different methodologies and methods give you new insights 77
Participatory approaches for community research 78
Participatory appraisal 78
Data collection methods 79
Data management, analysis and interpretation 79
A multi-method evaluation of a clinical educational innovation 80
Example of PA 81
General research issues 81
Validity, reliability and generalisability 81
Presentation and dissemination 82
The internet or world wide web (www) 83
Research proposals 83
Ethical issues 84
IRAS 85
The NHS research passport 85
Ethics committees 86
Conclusion 87
Acknowledgments 88
Further reading 88
Journals 88
Ethics 89
Funding 89
Statutory body 89
6 Integrating the Children’s Public Health Workforce 91
Introduction 91
Health indicators 92
The policy context 95
The role of the specialist community public health nurse 97
The HCP 97
Delivering the HCP 101
Pregnancy and the first 5 years of life 101
The recommended schedule: pregnancy (Universal Services) 101
The recommended schedule: pregnancy progressive services (Universal Plus and Universal Partnership Plus) 102
The recommended schedule: birth to 6 months (Universal) 102
The recommended schedule: birth to 6 months (progressive services) (Universal Plus and Universal Partnership Plus) 102
Recommended schedule: 6 months to 1 year (Universal) 103
Recommended schedule: 6 months to 1 year (progressive services) (Universal Plus and Universal Partnership Plus) 103
Recommended schedule: 1–5 years (Universal Services) 103
Recommended schedule: 1–5 years (progressive services) (Universal Plus and Universal Partnership Plus) 103
The recommended schedule: 5–11 years (Universal Services) 104
The recommended schedule: 5–11 years (progressive services) (Universal Plus and Universal Partnership Plus) 104
Recommended schedule from 11 to 16 years (Universal Services) 105
Recommended schedule from 11 to 16 years: progressive services (Universal Plus and Universal Partnership Plus) 106
Recommended schedule: 16–19 years (Universal Services) 106
Recommended schedule: 16–19 years (progressive services) (Universal Plus and Universal Partnership Plus) 107
The practitioner’s role in safeguarding and child protection 108
The practitioner role in improving emotional health and well-being 109
Conclusion: future development and challenges for practice 110
7 Community Children’s Nursing 113
Introduction 113
Early days 114
The NHS 115
NHS at home: Community children’s nursing services 118
Children with acute and short-term conditions 119
Children with LTCs 123
Children with disabilities and complex conditions, including those requiring continuing care and neonates 125
Technology dependence 127
Continuing care 128
Neonates 128
Children with life-limiting and life-threatening illness, including those requiring palliative and end-of-life care 128
Conclusion 130
8 Public Health Nursing (Adult): A Vision for Community Nurses 135
Introduction 135
The vision for health reform: the policy context 138
The public health outcomes framework (2012) 140
Improving the determinants of health 140
Health improvements 141
Health protection 141
Healthcare public health and preventing premature mortality 142
Health promotion versus public health 143
An upstream approach 145
Health protection 145
Community nursing and public health 146
Conclusions: the future 149
9 Caring for the Adult in the Home Setting 151
End of life 152
The policy context 152
Managing LTCs in the community 154
Case Study based upon complexities of patient care in the home setting 155
Maximising health and well-being: helping people to stay independent 158
Working with people to provide a positive experience of care 158
Adult safeguarding 159
Measuring impact of service through patient feedback 160
Delivering high-quality care and measuring impact 160
Building and strengthening leadership 161
Ensuring we have the right staff, with the right skills in the right place 161
Technology 164
Informal carers 164
Supporting positive staff experience 165
Conclusion 166
10 General Practice Nursing in Context 169
Introduction 169
Origins 170
The advent of contemporary general practice nursing 172
Practice nursing roles and functions 174
Core skills for the GPN 174
Education 175
Scheduled care 176
Unscheduled care 178
Chronic disease management 179
Asthma management 180
Hypertension 180
The future 181
11 Occupational Health Nursing 184
OHNs as specialist practitioners 184
Historical perspective 185
Provision of OH services in the United Kingdom 189
The changing nature of UK workplaces 191
Changing work patterns 192
Workplace practices 193
The domains of OH nursing practice 193
The professional domain 194
The environmental domain 197
The educational domain of practice 197
Public health strategies 198
Specialist community public health nursing: Part 3 of the register maintained by the NMC 198
12 Caring for the Person with Mental Health Needs in the Community 201
Introduction 201
Background: Why bother with community mental health nursing? 202
Clinical profile: John 203
Recovery: Conceptual explanation 203
Development of therapeutic relationship 205
Assessment of needs 206
Instilling hope 207
Promoting life beyond distress 208
Promoting connectedness 209
Promoting personal responsibility 209
Principles of community mental health nursing 210
Examining experience with service users 210
Linking experiences 210
Acknowledging service users’ wishes 211
Working together 211
Therapeutic presence 211
Risk assessment and management 212
Conclusion 213
13 Caring for the Person with Learning Disabilities in the Community 216
Introduction 216
People with learning disabilities 217
The number of people who have learning disabilities 218
Service principles in learning disability services 220
Moving forward 224
The health of people with learning disabilities 226
Physical health 227
Mental health 228
What community nurses for people with learning disabilities do? 230
The future role of community nursing services for people with learning disabilities 233
Conclusion 236
14 Leadership: Measuring the Effectiveness of Care Delivery 241
Introduction 241
Influences on leadership 242
Government policies 245
Front-line staff 247
Spend some time looking at these four scenarios 251
Measuring the effectiveness of delivery 253
Conclusion 254
15 Social Innovation and Enterprise 257
Introduction 257
What is social innovation? 258
Research on social innovation 259
Characteristics of a social innovator 260
Social innovation and community health 261
Commissioning 263
Approaches to social innovation 264
Social innovation as a concept 265
Conclusion 268
16 Adult Vulnerability in the Community 271
Introduction 271
Adult safeguarding 271
Definitions of abuse of adults 272
Legal framework of adult safeguarding 274
Mental Capacity Act 2005 274
Recent adult safeguarding guidance 275
Domestic violence 276
The prevalence of domestic violence in the United Kingdom 277
Effects of domestic violence 277
Contextual issues 278
Substance and alcohol misuse 279
Conclusion 281
17 End-of-life Care 285
Whole systems approach 286
Assessment: The foundation to providing good care 288
Symptom management 289
Beyond the management of physical symptoms 290
Advance care planning 290
Advance statement/Preferred priorities for care 291
Advanced decisions to refuse treatment (ADRT) 292
Assisted suicide 292
Do not attempt resuscitation orders 293
Care in the last days of life 294
Models of interdisciplinary working: The road to successful end-of-life care 295
Community nurses: The lynchpins of successful end-of-life care in the community 295
Death of a child 296
Dementia 297
Care of the bereaved 298
Conclusion 299
Case study 300
18 Interprofessional Learning and Teaching for Collaborative Practice Community 305
Introduction 305
Inter-professional education and collaborative practice 305
Learning theory 308
Teaching and learning in practice 314
Responsibilities for teaching and learning of all members of the team 315
Team leader 315
Community practice teacher 316
Mentor 316
Associate mentor 316
Learner 316
Sign-off mentor 317
Mastering mentorship 317
Adult safeguarding: an example 318
Conclusion 318
19 User Involvement, Self-Management and Compliance 322
The modern PPI system 323
The rationale for greater user involvement 324
The patient as co-producer 332
Co-production cannot be realised without support 334
Conclusion 335
Acknowledgement 336
Index 338
