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Contents

Notes on Contributors xii 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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