Community and Public Health Nursing

"An extremely popular and valuable resource to students, practitioners and managers in community health care nursing" - Journal of Advanced Nursing

The fifth edition of Community and Public Health Nursing is an essential source of information for all those working in primary and community healthcare.  Comprehensive and accessible, it draws on the knowledge of a wide range of experts and conveys all the information and skills nurses working in modern primary care settings require. It includes material on policy developments, research perspectives, health visiting, practice and district nursing, team working, advanced nursing practice, non-medical prescribing, inter-professional practice, and user involvement.

• New edition of the definitive textbook on community healthcare nursing
• Covers learning disability nursing, caring for patients with mental health conditions, and community children’s nursing and school nursing
• Written by experts in the field – providing authority and insight
• 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.

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David Sines is Professor of Community Healthcare Nursing and Pro Vice Chancellor and Executive Dean for the Faculty of Society and Health at Buckinghamshire New University, Buckinghamshire, UK.

Sharon Aldridge-Bent is Senior Lecturer in Community Health Care Nursing at Buckinghamshire New University, Buckinghamshire, UK.

Agnes Fanning is Head of Academic Department of Primary Care and Public Health at Buckinghamshire New University, Buckinghamshire, UK.

Penny Farrelly is a Senior Lecturer in Specialist Community Public Health Nursing at Buckinghamshire New University, Buckinghamshire, UK.

Kate Potter is Senior Lecturer in Specialist Community Public Health Nursing at Buckinghamshire New University, Buckinghamshire, UK.

Jane Wright is a Senior Lecturer in Specialist Community Public Health Nursing at Buckinghamshire New University, Buckinghamshire, UK.

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

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