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With the move of care into the community, the role of nurses caring for older people is changing. However, nurses may not be adequately prepared to cope with this changing role, especially if their training and experience have been primarily hospital based. This study involves an educational needs analysis of registered nurses working in the care of older people in nursing homes and clients' own homes. It is based on focus groups with registered nurses and individual interviews with other professionals, as well as group discussions with older people. The aim of this project is to provide research-based input into the design of a new community care of older people module, to be offered at Napier University, Edinburgh from February 1998. The results presented here consist of three themes or patterns that have emerged from the interview data. The specialist/generalist theme concerns issues of role definition and gerontological specialism. The social/medical theme addresses the shift towards a social model of care when nurses move into the community settings. Finally, the physical health/mental health theme represents the need for greater integration of skills and knowledge from both mental health and general health nursing in the field of community care for older people. The results indicate the need for significant attitude changes and provide a major challenge to educationalists.

The White Paper, Towards a Healthier Scotland considerably widens the community nursing scope for health promotion, as it recognises that disadvantaged life circumstances as well as unhealthy lifestyles contribute to poor health. It has been shown that income and health are interrelated. This evidence has demonstrated that it is not how rich a nation is that determines the overall health of its inhabitants; it is how equitably its wealth is distributed that counts: countries that have narrow income differentials tend to have better health. Both the income and health divide in Britain widened considerably between 1980 and 1992. It is argued that increasing income inequality leads to social isolation and chronic stress, which can impact on psycho-social pathways and damages life expectancy. This paper suggests that community nurses can address adverse life circumstances by finding ways of improving the economic status of their most vulnerable clients, and that one way of doing this would be to ensure that clients claim their full quota of welfare entitlement, given that there is several billion pounds of social security benefits that remain unclaimed in Britain every year.

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