Study of the Implementation of a New Community Health Nurse Role in Scotland

2 INTRODUCTION

Background

2.1 In 2006 the Scottish Executive, as part of the modernisation of the National Health Service (NHS), began a radical and far reaching review of nursing in the community (Scottish Executive 2006). The review responded to the health challenges faced by Scotland and many other countries, namely an ageing population, degenerative or chronic diseases, rapid technological developments and the need to change the emphasis from acute care to community care (Scottish Executive Health Department 2006). Scotland is a small country, has a range of population profiles which demand differing approaches to healthcare provision and comprises areas which are densely-populated, sparsely-populated and remote.

The new model

2.2 The Review of Nursing in the Community (RONIC) proposed the absorption of district nursing, health visiting, school nursing and family health nursing into a single community health nurse role (CHN) role (Scottish Executive 2006). The new CHN role was distinct from the generic staff nurse role as it had a wider range of responsibilities and specialist skills. Within the proposed model the community health nurse would be supported by advanced practitioners and consultant nurses to provide expertise and advice, and by community staff nurses, health care support workers and administrative support to deliver care to patients and clients as illustrated in Figure 1.

Figure 1.1 New Community Nurse Model
(From Visible, Accessible and Integrated Care 2006)

2.3 The following seven core elements identified by the Review of Nursing in the Community formed the basis of the new role:

• Working directly with individuals and their carers
• Adopting public health approaches
• Co-ordinating services
• Supporting self-care
• Multi-disciplinary and multi-agency team working
• Meeting health needs of communities
• Supporting anticipatory care

The transition education programme

2.4 By the end of 2009 a total of 48 nurses completed the transition education programme across all areas (Table 1). NHS Education for Scotland consulted on and then formulated an education framework which informed the development of the transition education. The transition education programme was designed and implemented by higher education institutions (HEIs) in partnership with NHS boards. It was based on the seven core elements and was grounded in a work-based learning approach that enabled the application of theory to practice. Each student had access to an educational supervisor from their host HEI and a local work-based facilitator. HEIs set a prescribed time for the achievement of learning objectives and assessment of portfolios of evidence, or adopted a flexible approach that reflected individual learning needs. Annex A provides a breakdown of those completing the transition by area.

Table 2.1 Number of Nurses completing Transition

Education by the end of 2009*

*Based on figures provided by the NHS Boards

2.5 The education programme was designed to be delivered over five-stages:

Stage 1 involved the practitioner completing a personal development plan with his or her manager, using the national capability framework to identify his or her strengths and gaps.

Stage 2 linked students to their local HEI where they then created a personal learning development plan. This identified outcomes specific to their individual learning needs, the activities necessary to meet the outcomes and the evidence of their achievement.

Stage 3 lead to the creation of a personalised education programmes. For example at Queen Margaret University, students were offered four study days that focused on work-based learning, public health approaches, anticipatory care and person-centred approaches, at undergraduate and postgraduate level. The Universities of Dundee and Abertay jointly offered two modules, one at undergraduate and one at postgraduate level, and four study days. The University of Stirling used a mix of portfolio based learning and website support for students who lived in remote areas.

Stage 4 involved work-based activities which were identified in the previous stages. This included "shadowing" opportunities with experienced practitioners in areas where they had a specific learning need.

Stage 5 focussed on developing a portfolio of evidence which highlighted the students' achievement. Students were required to link theory to practice and record personal and professional growth over time. The portfolios were assessed by the host HEI and verified by an external examiner.

Evaluation

2.6 The Scottish Government commissioned two research studies to help inform the development of the Review of Nursing in the Community. The first was a literature review conducted by Kennedy et al (2008) which identified the contribution made by nurses in the community in shifting the balance of care identified in the Kerr Report (SEHD 2005a) and Delivering for Health (SEHD 2005b). Little evidence was found which directly indicated the effectiveness of different models of community nursing. The second was a baseline study conducted by Kennedy et al (2009) which indicated that whilst nurses worked along fairly traditional lines there was some evidence that their teams possessed the right balance to work across areas such as child protection, coordinating services on behalf of those with complex needs, and addressing health inequalities.

2.7 Following discussions between the Scottish Government and the relevant trade unions, a new approach was announced in 2009 to modernise community nursing in Scotland. This focused on all parties working together to modernise community nursing within team settings throughout NHS Scotland. The new approach no longer centred on the generic community health nurse model, however the CHN role continue to be piloted in: NHS Borders, NHS Highland, and NHS Tayside. It is this evaluation which appears in the present report.

2.8 In 2010 the Scottish Government commissioned the research team to conduct the evaluation. It was envisaged that the results of this research would help to inform the development of future policy for the provision of community-based healthcare services and practice in relation to community nursing in Scotland.

This report

2.9 Chapter Two of this report provides details of the aims, objectives and key questions addressed in the evaluation study. Chapter Three details the design and methods. The findings are reported in Chapter Four. The final Chapter, Five, identifies conclusions from the study.