Approaches to community needs assessment: a literature review

In the light of the growing awareness of professionals in the community of the need to undertake health needs assessments of the population, this literature review sets out to explore, delineate and critically analyse the various approaches to community needs assessment, to facilitate a greater understanding of their strengths and weaknesses The review commences by highlighting its complex nature, and attempting to define what is meant by 'needs assessment' from the differing perspectives of three dominant approaches, namely sociology, epidemiology and health economics It continues by putting forward an argument for the use of the community health profile, being a multi-focal approach to needs assessment, combining quantitative with qualitative data, and proceeds with a discussion of strengths and weaknesses related to its compilation, in particular factors relating to reliability and validity of data sources The consumer perspective is also reviewed, as are issues surrounding the ethics of data collection and problems concerning aggregation of the numerous data sources into meaningful policy Throughout the review, issues are discussed with reference to the current political context in the United Kingdom Equally important is the community nurse perspective, which is integrated into the arguments where appropriate     

Adult children of parents with mental illness: Dehumanization of a parent – ‘She wasn't the wreck in those years that she was to become later’

Children who have lived with parental mental illness experience long‐standing reduced health and social outcomes, alongside ongoing personal distress. While there has been some dialogue regarding interventions to support children who are living with parental mental illness, there remains a paucity of knowledge regarding adult children's experiences and potential needs. Given this, the aim of the present study was to establish parenting narratives of adult children who had experienced childhood parental mental illness. This included their experiences of being parented alongside their own subsequent parenting roles. Three men and 10 women, ranging from 30 to 78 years old, met individually with a researcher to tell their stories. Narratives were thematically analysed to establish themes. The findings of the study demonstrated that individuals who have lived with childhood parental mental illness dehumanized their parent with mental illness. The authors argue that all mental health services should be underpinned with a whole of family assessment and care philosophy. There is also a need for all mental health services to consider how policies and procedures might inadvertently dehumanize clients who are parents, which could contribute to familial dehumanization. This could prevent the dehumanization of parents who experience mental illness to preserve parental and child relationships.     

Implementing new health visiting services through action research: an analysis of process

Implementing new health visiting services through action research: an analysis of process An action research project based in a single fundholding practice on the South Coast of England aimed to identify needs relevant to families with resident children, then to use the contracting system to redirect health visiting practice to meet those needs. The naïvety of this plan was well recognised, so the processes that occurred during implementation of the proposed changes were recorded throughout. An analysis of these participant observation data revealed various organisational constraints and facilitators that arose during contract negotiations. Two new full time health visiting posts were established, each with an innovative and somewhat controversial focus. One health visitor was employed to establish a community development project in an underserved area of the town, while the other was to provide a home visiting service for the families of school aged children. The processes involved in structuring decisions about ‘health needs’ and how these are best met are analysed for each of the two new posts. The analysis reveals powerful influences that affect the implementation of new health visiting services.     

What do nurses do? An observational survey of the activities of nurses on acute surgical and rehabilitation wards

Aim  The subject of the study described in this article is an activity analysis of nursing care given on an acute surgical ward at a District General Hospital as compared to that given on a rehabilitation ward at a Community Hospital.
Methods  Obtaining a global overview of nursing activities on the two study wards was a focal issue. The project consisted of undertaking in excess of 60 h of observation with 10 registered nurses (RNs) of various grades in the two settings.
Findings It was found that both sets of nurses undertook similar types of activities. Overall more indirect care activities than direct care occurred on both wards. These findings are similar to the findings of other studies where the majority of RNs' activities are said to relate to the co-ordinating and management aspects of patient care.
Conclusion  It is concluded that the 'glue function' or maintaining a holistic overview of patient care given by all members of the health care team is an important part of nursing care delivery.     

Evaluating a preceptorship programme in South West Ireland: perceptions of preceptors and undergraduate students

Aim  The study sought to evaluate stakeholder perspective of preceptor preparation and attributes.
Background  In Ireland, undergraduate students are supported by a named preceptor on clinical placement. A preceptor is a registered nurse who has completed a teaching, assessment and preceptorship programme. Preceptor preparation is costly in terms of facilitation and staff release/replacement. To date, in Ireland, research has not explored the effectiveness of preceptor preparation.
Method  An utilization-focussed approach was adopted incorporating a two-phase research process; Phase 1 being exploratory while Phase 2 aimed to validate inductions derived from the previous stage.
Results  The programme is effective in meeting its learning outcomes. The findings are categorized into four theme areas: the importance of preceptor characteristics, the demonstration of these characteristics, knowledge demonstrated by the preceptors and the skills demonstrated by the preceptor.
Conclusion(s)  Preceptors, to be effective within the preceptor/student relationship, need to integrate both their professional and personal attributes to effectively socialize students to the profession of nursing.
Implications for nursing management  The preceptor role is invaluable within nurse education. This study supports the release of registered nurses to attend preceptor preparation programmes. It highlights the importance of nursing management in preceptor selection, release, support and monitoring in order to create an effective clinical learning environment.     

Evaluating the purpose and benefits of continuing education in nursing and the implications for the provision of continuing education for cancer nurses

In the light of increasing emphasis upon mandatory continuing education in nursing, the need for cancer nurses to update and improve their knowledge and skills is heightened. The challenges lie in how to keep nurses up-to-date, broaden their outlook and ensure that patients benefit. In this paper the literature on the purpose and benefits of continuing education is reviewed, and the implications of the Post-Registration Education and Practice Project (PREPP) for cancer nurses are addressed. Arguments about a definition of 'continuing learning' rather than 'continuing education' are discussed, since outcomes vary depending upon the definition adopted. Inconsistencies between the benefits claimed and those measured are highlighted. Attention is drawn to the inconclusive nature of the studies that have measured impact; some of the problems encountered in the provision of adequate education and its accessibility to nurses; and the continuing discrepancy of perceived need between nurse and manager. Specific impact evaluation studies relating to continuing education in cancer nursing are reviewed. Recommendations for providing education with measurable outcomes are drawn from the literature, while a case is made for the alternative perspective of lifelong learning where outcomes are neither specific nor measurable. In conclusion, the questions of who should be responsible for education and the need for further development of impact evaluation tools are addressed.     

'The Awful Rowing Toward God': therapeutic conversations with a woman following major surgery

'The Awful Rowing Toward God': therapeutic conversations with a woman following major surgery ¶ Listening is a complex event requiring skills and competencies that encompass the personhood of the listener. This paper explores a clinical conversation with a woman experiencing serious illness. The ideas of Klein offer the theoretical means for understanding exchanges. Reflexivity is addressed through exploring the writer's thoughts and feelings in response to significant events. The benefits of supervision, as support and guidance, are discussed in context. The discussion concludes with the suggestion that although many layers of interpretation are possible, and can be informed by various ways of knowing, the act of listening offers potential benefits.