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

3 AIMS AND OBJECTIVES

3.1 The original aims the study were to:

• Evaluate the impact of the new model of practice on both staff and patients (including carers),
• Provide evidence to inform a future decision on the use of the CHN in Scotland.

3.2 The original objectives were:

A. To identify the impact to date that the CHN role has made in:

• Working directly with individuals and carers throughout the lifespan
• Adopting public health approaches
• Co-ordinating services
• Supporting self care
• Working effectively within a multi disciplinary and multi agency team
• Meeting the health needs of the communities
• Supporting anticipatory care

B. To determine the positive or negative aspects of the implementation of the role on practice, in particular:

• Organisation of teams and workload
• Services delivered compared to those previously delivered
• The identification of service gaps
• Staff satisfaction with their new role
• Views of staff and their clients on the new model of community nursing
• Comparison with non-transitioning teams within the Pilot areas
• Identify common lessons from the teams transitioning in terms of what works and what doesn't, and where appropriate disseminate these lessons to each of the pilot sites as the work progresses.

3.3 Why were these aims and objectives changed? Early indications from our field work up to March 2011 suggested a strong sense of inertia around the new role. There was a strongly held view among nurses that in many instances it was not implemented and in the few places where it had been implemented the effect had dissipated. We were obliged by our contract to report any potential risk of the study and we did so at the next available advisory group meeting. The risk in this instance was not being able to demonstrate the impact of the new role on nursing practice and patient experience.

3.4 We thought there would be strong grounds for enhancing the other parts of the study which examined the implementation of the new role and there was still a need to provide evidence which informed a future decision on the use of the CHN in Scotland. The resulting evidence would provide insight into the underlying issues which explain uptake of the role such as managerial support, education, professional identity and professional boundaries. We also thought it wise to provide a more complete data set thus avoiding the risk of reporting part of the picture. For example there was some evidence in our early data of the potential importance of staff nurses in developing the role and thus merit in gathering their views.

3.5 An agreement was reached with the Advisory Group in June 2011 to set out our plans (including costs) which involved removing the parts of the study which assessed the impact of the new nursing role on patient experience.

3.6 Revised aims

• Provide insight into the structural and other issues which affect the uptake and implementation of the Community Health Nurse role
• Provide evidence to inform a future decision on the use of the CHN in Scotland.