1. Review of Nursing in the Community Conference SECC 16 th March 2006 Professor John Atkinson Associate Dean Research and Commercialisation School of Health Nursing & Midwifery john.atkinson@paisley.ac.uk

2. Review of Nursing in the Community Nurses DO have the skills, education and expertise to take the community care agenda for the benefit of patients. HOWEVER …………..

3. Review of Nursing in the Community it is often … Difficult and always needs negotiated Messy Political Controversial and conflicting Under-valued Invisible Without status or leadership

4. Context of Change Some theory drivers Carper 1978 Patterns of Knowing in Nursing Empirical – Scientific The cost of EVIDENCE BASE Aesthetic – Creative but what Evidence? Personal – The individual as practitioner Moral – Ethical but multi-valued Now also ACCOUNTABLE & POLITICAL

5. Context of Change Some theory drivers Autonomy – Patient AND Carers – Democracy Justice Tendency to DISTRIBUTIVE not SOCIAL justice Beneficence Difficulty of Accounting in the Community Non-malfeasance Risk aversion, care of patient and carer

6. Context of Change Public Service Drivers UTILITY UNIVERSALITY VALUE FOR MONEY Actuarial Model (e.g. USA) Social Medicine Model (e.g NHS) CHANGES COME FROM DRIVERS!

7. Nursing Expertise models Clinical focus, scientific, fixed or narrow field, often institutional Reactive Specialist - distributive Group, context and advocacy focus, negotiated and fluid field, often community based, MULTI-PERSPECTIVE Pro-active Generalist - beneficent THE PATIENT NEEDS BOTH!

8. Pathways to Resolution Explore the big picture from the PATIENT perspective. (Research model) Describe the jigsaw pieces NOT who ‘owns’ them Establish positive interaction WE ARE VERY USEFUL- PEOPLE COME TO US

9. Focus on Workshops Negotiating the best deal for the patient Intensive to minimal intervention Long term conditions Non curative, chronicity, outcomes Keeping patients in touch. Rehabilitation Programmes Supervision and protocols Urban, Rural and Remote Equity does not mean the same – Social capital, multi –agency, needs The Hard to Reach – myths and truth

10. Pathways to Resolution Inter-disciplinary Diplomacy Working together does not mean total agreement Assume respect good will and integrity Negotiated shared values aims LEVELS Action Research Model Negotiated differences KEEP AT IT

11. Review of Nursing in the Community EVERY PATIENT NEEDS A NURSE THERE IS PLENTY OF WORK FOR EVERY ONE