A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice

Abstract

The role and expectations of community nurses in carrying out needs assessments changed when an internal quasi-market was introduced to the British health service under the National Health Service (NHS) & Community Care Act 1990. This paper reports on a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment in the context of this legislation. A multiple case study design was utilized and four cases identified, incorporating the geographical variation in England. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (n=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. Participants were interviewed after the observation period (n=33 practitioners), to determine the extent of formality they attached to each assessment, and to elicit information about aspects which may be embedded in everyday practice. Single and multiple case analyses across the four cases used an iterative process of pattern-matching, replication logic and explanation building. The preliminary analysis yielded a descriptive 'taxonomy' which could serve as a basis for classifying the variants of needs assessment and help to clarify the whole phenomenon. When applied further to the data, this revealed the complex interactions between the different ideals (relating to policy, nursing and ascribed worth), the various types (purpose, formality/specificity and complexity) and timing (in relation to client, service and practice issues) within needs assessment.

An empowerment approach to needs assessment in health visiting practice

“…The central purpose of health visiting is to promote health; the goal is to focus on primary prevention. These aims have been achieved in the past through an integrative process where assessment of need is part of an ongoing pattern of care, with both need and care being intertwined (Cowley et al ., 2000). This approach has tended to leave much of the process implicit and therefore open to criticism because it could not be readily scrutinized by outside observers, managers or service commissioners.…”

A structured health needs assessment tool: acceptability and effectiveness for health visiting

“…2001). There is a growing literature about the processes embedded within health visitor needs assessment when professional judgement is the key mechanism for determining how much contact a client should be offered (Chalmers 1993, Williams 1997, Bryans & McIntosh 2000, Cowley et al. 2000, Appleton 2002).…”

Practice variation among home care nurses

“…The discussion about variation in needs assessments for home care is not unique to the Netherlands. Also in other countries, like England, attention has been paid not only to the different ways but also to the challenges of classifying and exploring needs assessments (Cowley et al ., 2000). …”