Pages: 4

The aim of the book is to develop and support nurses to work safely and effectively in a range of community locations. The diverse range of nursing roles in the community, which meet the healthcare needs of individuals, families and communities across the lifespan, is introduced. The themes running through the text are person-centred care, evidence-based practice, reflection, inclusivity and diversity and current government policy drivers across the four UK countries. There are a range of chapters throughout the book to address contemporary topics related to community nursing that include case studies and activities to support the reader in applying key theories and concepts to practice.

Pages: 26

This chapter considers the environment within which community nurses practise, acknowledging its complex nature and explores definitions of community and ways in which the term is used. Systems and processes designed to organise and deliver community health and social care services are appraised. A range of factors influencing the delivery of community healthcare services is critically discussed. Key skills, knowledge and qualities required of the wide range of community nurses are identified as are the ways in which community nurses aim to tailor care to respond to the needs of people, families and communities.

Pages: 25

This chapter provides an overview of how to use research to inform evidence-based community nursing. It begins by providing an overview of the professional and policy research landscape across the four nations of the UK before identifying key research priorities for community nursing in light of the COVID-19 pandemic. The range and diversity of community nursing roles in supporting delivery and leading research are examined. Following this, specific research considerations are appraised, and their application within community nursing practice is debated. Methods, techniques and information related to the best ways to conduct, disseminate and support research are outlined, ensuring that the principles of equality, diversity and inclusion are adhered to. Finally, patient and public involvement as an integral part of the research process is discussed.

Pages: 23

This chapter introduces public health, health and wellbeing and identifies the factors that influence individuals and communities across their lifespans. Students will be able to discuss these and understand the relevance of community nursing and service demand and delivery. The application of theory to practice explores the opportunities nurses have to assess needs and promote the health of the populations across the lifespan. This is underpinned by understanding the relevance of policy, policy drivers, the National Strategy, legislation and guidance from professional regulatory bodies.

Pages: 22

This chapter explores the concepts of professionalism, professional standards, regulatory requirements and policies underpinning community nursing. It evaluates decision-making approaches and clinical expertise, relating to integrated working environments and diverse cultures. The importance of lifelong learning is examined and continuous professional development. Cultural awareness and emotional intelligence are reflected on in promoting equality, diversity and inclusivity. Wellbeing and self-care within professional practice are analysed. Recruitment and retention issues and the RePAIR model are considered, as well as an appraisal of the community nurse’s role in supporting student learning and widening participation and access. Overall, this chapter discusses the importance of professionalism and decision-making for community nurses working within integrated community environments and with diverse cultures. It also acknowledges the importance of lifelong learning, professional development and supporting students’ learning to maintain and sustain the professionalism of community nurses across communities.

Pages: 24

This chapter explores the potential risks encountered by community nurses and recommends ways to mitigate risks or to manage risks that materialise. The risks will be considered from the personal perspective of the community nurse and from a patient/service user perspective. The chapter will present some of the risks that community nurses may need to consider in respect of personal safety and how to minimise these risks. Risks to patients and service users will also be considered, including deterioration in health status leading to hospital admission and safeguarding issues. The importance of risk awareness is a focus of the chapter, as community nurses work with increased levels of autonomy and reduced access to immediate support that is available in in-patient settings.

Pages: 20

This chapter introduces the concept of safeguarding in the context of community nursing practice. A lifespan approach is taken to support the application of theory to practice to capture a broad audience. Key to enabling confidence in decision-making is the application of legislation and an evidence base; this chapter aims to provide a foundation for safe practice and discusses approaches applicable to the varied roles of the community nurse. The chapter uses case studies and vignettes to example multi-agency working and safe decision-making in caring for populations throughout the life course. In considering the case studies, the reader is given an opportunity to consider multi-agency working and apply safeguarding practice to varied populations where boundaries of nursing practice crossover and merge. This chapter provides an introduction for nurses to continue to build upon in their roles but will form the basis of safe decision-making.

Pages: 33

This chapter aims to help readers develop a critical understanding of therapeutic relationships in the context of community nursing. It encompasses multiple perspectives of community nurses who support people across the lifespan and highlights the underpinning principles of therapeutic relationships, whilst considering people as partners. The features of therapeutic relationships are considered, exploring interpersonal connections with self and people that community nurses support. The key features of a therapeutic relationship and how those might be nurtured are outlined. Influential factors in forming therapeutic relationships are explored, acknowledging the power balance, the need for self-wellbeing and the community context of these relationships. This chapter concludes with a valuable opportunity for readers to critically analyse the key principles of forming, progressing, maintaining and concluding therapeutic relationships and considers how these theories and principles might be applied to their own practice.

Pages: 24

This chapter explores the concept of a lifespan approach to healthcare that considers growth and development from childhood to older age. Changes in biopsychosocial aspects of health that occur normally at different stages of the lifespan, and how these are influenced by their interaction with other factors including life experience, social norms, culture, health status and the environment, are explored through a multi-generational family. To enable the community nurse to adopt a truly holistic approach to the delivery of care, a sound understanding of the factors that influence growth and development across the lifespan is required. The changes in physiology, psychology and behaviour that occur normally at different stages of the lifespan: child, adolescent, adult, middle age, older adult and perceptions of death and how people’s lifestyle choices impact their concept of health are explored. The promotion of health across the lifespan is an essential role for every community nurse, and strategies to support healthy behaviour and lifestyle demonstrate how this is at the heart of improving people’s quality of life.

Pages: 21

The aim of this chapter is to examine community nursing assessment and information gathering framed by the nursing process, by defining terminology and identifying what constitutes a person-centred assessment. Information gathering is based on the concept of need and is explored using a range of contemporary assessment and improvement tools that have been developed to support the decision-making for a range of community nursing disciplines to meet the wide range of situations that exist within a community setting. The importance of communication is then discussed, with an opportunity to reflect on current practice by using a case study to consolidate the learning from this chapter.

Pages: 26

There is a strong relationship between physical and mental health. In order to deliver effective quality care to people in their own homes and their carers, community nurses need an awareness of mental health challenges in order to support individuals they are visiting as well as signpost services and on occasion facilitate referral and access to mental health services. This chapter provides an overview of the role of the community nurse in mental health assessment and examines some mental health skills that can be used in practice by community nurses. By developing an awareness of these issues community nurses are better able to engage in effective interprofessional working, collaborative care and referral to specialist services to meet the complex needs of people with complex physical and mental health needs.

Pages: 16

This chapter defines what is meant by the term carer in relation to children, young people, young adults and adults in the UK before going on to examine the role of informal carers within the context of current UK national health and social care policy. The chapter further critically discusses some of the many emotional, physical, financial and practical needs and risks associated with being a young carer/carer. The final section of the chapter focuses on appraising the future challenges confronting carers in response to the post-pandemic socio-economic challenges and changes facing the UK.

Pages: 23

This chapter is concerned with the concept of spirituality in the care provided by nursing professionals. Reference is made to some of the relevant research and literary reviews which offer a useful context for this complex subject area. Some definitions of spirituality are outlined and the place of spirituality within community nursing is considered. The consequent implications in terms of spiritual assessment and possible interventions are discussed. The need for self-awareness and its development in nurses is explored. Finally, the competence of nurses to deal with the spiritual aspects of care is considered together with the importance of observational skills and communication, essential tools in the repertoire of all nursing professionals.

Pages: 22

The authors explore the definition of collaborative working in the context of community nursing. They consider the political drivers influencing collaborative working within the health and social care environment. Frameworks for collaborative practice will be explored. The knowledge, skills, attitudes and behaviours required for successful collaboration are discussed at both the micro level (clinical) and the meso level (organisational). Activities will be utilised throughout the chapter to enable readers to develop their understanding of how relationships and processes can contribute to effective outcomes for citizens in their community.

Pages: 25

This chapter provides a contemporary overview of acute care in the community and the essential role of the community nurse in delivering and influencing community care provision. This chapter encourages the reader to consider what is meant by acute care in the community and explores the range of options available across the UK to support patients to remain at home and avoid hospital admission where appropriate. This chapter details the knowledge, skills, assessment strategies and leadership that community nurses require to manage these episodes of care to meet the needs of the patient. The importance of person-centred care across the lifespan are discussed in relation to all disciplines of community nursing, providing examples and activities to strengthen the reader’s understanding of acute care in the community.

Pages: 33

The purpose of this chapter is to explore the impact of long-term conditions across the lifespan. It considers the role of community and primary care nurses in delivering healthcare services to this vulnerable group of patients, their carers and their families. The relevant health policy agendas of the devolved government administrations across the UK are explored in the context of the assessment and management of patients with long-term conditions within the wider healthcare agenda. The key identified themes focus on the delivery of person-centred care across the lifespan, the assessment and case management approaches and the role of community and primary care nurses in supporting patients to engage in self-management and behaviour-change activities. Long-term health conditions are known to be complex and are impacted negatively by health inequalities, along with social and environmental factors. These issues form an underlying theme throughout the chapter.

Pages: 24

The term end-of-life care (EOLC) has been used for nearly two decades in England, since the EOLC programme was launched in 2005, which followed the NICE ‘Supportive and Palliative Care for Adults with Cancer’ guidelines. This was the point where to provide good palliative care in the community, a more structured approach was adopted. This period may last years, months, weeks or days. The point is not trying to have a firm prediction but to enable active planning ahead rather than reactive care, which is not helpful to anyone, and optimise quality of life with a focus on living rather than dying. The main framework in the community and primary care settings is the Gold Standards Framework (https://www.goldstandardsframework.org.uk/), with a focus on advance care planning, training and other useful tools. Prognostic Indicator guidelines are also provided for different disease trajectories. NHS England also set out Ambitions for Palliative and End of Life Care, to work alongside various NICE guidelines and NHS England’s Long Term Plan.

Pages: 24

The use of community services in the UK rose significantly during the COVID-19 pandemic while capacity and demand issues have worsened. With nursing in the community setting being seen as varied, complicated and challenging, it is important to bring order to the chaos when dealing with the demands on these services. This chapter explores the dynamic and constantly changing care environment, demand and capacity and strategies for managing workload and caseloads in this context. With practitioners needing to be responsive to routinely fluctuating workload demands as well as less predictable crises such as epidemics, the discussion centres on being able to practically apply tools or methods for care organisation and the minimisation of risk. Topics relating to the organisation and management of care covered in this chapter include work organisation in the community setting, service design and referral criteria; skill mix, educating for competence; and caseload/workload management.

Pages: 25

The aim of this chapter is to support nurses working in community settings to recognise their own leadership and their role in promoting person-centred ways of working. Within the chapter, the author encourages readers to explore their personhood and explore contemporary leadership models that promote person-centred practices and cultures. Theories around person-centredness and leadership are introduced, and frameworks that will be helpful in practice are offered. Throughout, learning activities are included. Nurses working in community settings will be supported in their leadership development.

Pages: 23

This chapter explores digital healthcare in the context of nursing in the community. First, some terminology is explored, considering some more contemporary language such as digital transformation. The suitability of technology is then considered, looking at strengths and challenges. Some specific examples are explored such as the use of mobile apps in the context of community nursing. Professional and ethical issues are explored with consideration of access to information, eRostering, equity and access to services and the use of social media. Finally, the educational needs of community nurses are examined.

Pages: 15

This final chapter of the book summarises the main content of the book and appraises the complexity of nursing in the community. The impact of the policy agenda across the UK is considered. The chapter also explores contemporary issues impacting community nursing going forward. The development of advanced practice is explored, and sustainability is appraised. Finally, the wide range of skills and knowledge required in community nursing is discussed.