The unique contribution of community clinical nurse specialists in rural Wales

Abstract

To date, quality indicators that have been developed for nursing tend to focus on acute, secondary care settings. It remains unclear whether such quality indicators are applicable to community settings, particularly in rural environments. This research aims to identify the consensus view among specialist nurses regarding their unique nursing contribution within their rural community. Identifying agreed aspects of the unique role within the rural community area will enable quality care metrics to be developed, allowing specialist nurses to measure their unique contribution to rural health care in the future. The research used the Delphi technique to identify a consensus view among a population of specialist community nurses working in a designated rural area in Wales. The strongest area of consensus related to clinical and teaching expertise, where participants perceive educational expertise as being at the forefront of their role. In terms of care for individuals, consensus was focused on four main areas: developing appropriate criteria for referral in to the service, collaborative working, education, and advocacy roles. The findings highlight similarities to models of care provision elsewhere. Specific quality indicators are required for clinical nurse specialists working in rural areas. Current quality indicators may not be applicable across all clinical settings. Further work is required to explore the nature of rural nursing practice.

How do they measure up? Differences in stakeholder perceptions of quality measures used in English community nursing

“…21 A specific concern is the fact that applying inappropriate indicators not only wastes valuable resources, but in doing so, may also actually diminish care quality. The consistency of our findings across the sites and with other research, 4,9,10,17,20 suggests the existence of deeply rooted issues which are unlikely to be amenable to short-term change, particularly in the ongoing economic climate. 26…”

“…Internationally, the drive to develop community-based collaborative care continues 27 along with an acknowledged need to develop suitable patient-centred care assessment processes 4,6,29 and nursing-sensitive indicators for community-based nursing care. 17,20 Additionally, it is known that applying unsuitable indicators can result in unintended consequences with concomitant problems for staff and service users. 9,10 In the absence of suitable measures, developing indicators tailored to individual patient outcomes may be helpful, as suggested by some study participants.…”

“…An American Nursing Association report 17 details the development of nursing-sensitive indicators for community care. Other papers present the validity and feasibility of purpose-designed community nursing quality indicators in England, 18,19 and competencies which nurses in Wales 20 and Northern Ireland 21 consider appropriate for quality assessment. In the Welsh study nurses expressed concern that indicators designed for hospital settings were being applied in the community.…”

“…In the Welsh study nurses expressed concern that indicators designed for hospital settings were being applied in the community. 20…”

Rural influences on the social network dynamics of district nursing services: A qualitative meta‐synthesis

“…This is in part because HCPs need to become generalists, healthcare services appear underfunded, operating in a context of poor infrastructure and services provided over long distances. 22 , 23 Furthermore, the lack of peer support paired with the diverse patient group that district nurses treat can cause stress and poor staff retention among the workforce, 23 , 24 all of which could impact on district nurses' ability to provide self‐management support in rural areas. There is some evidence to suggest that district nurses often live within, or near, the communities they serve, 4 which may offer an opportunity for drawing on existing relationships, shared values, and local embeddedness to provide a motivation to overcome rural challenges.…”