‘Now More Than Ever’An International
Perspective
Professor Barbara Parfitt CBE PhD MSc
MCommH RGN RM FNP
Inverse Care Impoverishing Care Fragmented Care Unsafe care Misdirected care
Service Delivery Reforms
Leadership Reforms
Universal coverage Reforms
Public Policy Reforms
Family Physician
Family Health
Nurses / Midwives
Public health
approaches to
protecting the public
Multi-disciplinar
y and multi-
agency team
working
Integrated care approach
Community participation
Meeting the health needs of communities
Supporting anticipatory care
Working directly with individuals and their carers
Supporting self care
Co-ordinating services
Guided by:• WHO Europe
definition• NHS Education
Scotland Competency framework
• learning from all pilot countries
Characteristics:• based on a generalist
model• Advanced nursing
practice • combines clinical care
with health improvement
• works at 3 levels individual, family & community
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Family Health Nurse (WHO Euro model
Scotland & Tajikistan)
Community Health Nurse (RoNIC model Scotland)
Different Geographies Health needs Different support
systems
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NHS WesternIsles
NHS Highland
NHSOrkney
StirlingUniversity
Robert GordonUniversity
NHS Argyll & Clyde
NHS Glasgow
Glasgow CaledonianUniversity
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Varsob
Medical CollegePost graduate Institute
Qurghonteppe
Kulob
Tajikistan site locations
To test the FHN model as a way of delivering community nursing services to remote & rural areas (phase1) and urban areas (phase 2)
To develop and test the educational preparation of FHN
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Scottish Executive (2006) The WHO Europe Family Health Nursing Pilot in Scotland, Final Report. Edinburgh: Scottish Executive. http://www.scotland.gov.uk/Publications/2006/10/31141146/0
To evaluate the contribution of Family Health Nurses towards the National Health Reform Programme
To review the learning outcomes achieved by community nurses following completion of the four year curriculum and the six month re training programme.
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Improved patient and family experience Identification of problems at an early
stage Reduced need for hospitalisation Improving outcomes of care Increasing organisational efficiency Larger pilot required, implementation of
development sites and full evaluation to test a generic advanced community nursing role
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Community based curriculum
for all nurse education pre-qualifying programmes (4 Med colleges & 9 Schools)
Reduction in infant deaths and childhood malaria cases
Timely interventions Improved access to health
services 1000 new Family Health
Nurses 300 community nursing
bags supplied Raised self esteem of nurses
• Benefits– Intervention for those who might ‘fall through the cracks’
– First point of contact and accessibility
– Early detection and prevention of high risk health threats
– Integrated team approach at community level
– Empowerment and role modeling
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– Community Dependency– Possible time issues / 24 hour on
call– Financial un-sustainability– Change of status and position for
nurses (HV’s, DN,s)– Non engagement by the team– Focus on acute intervention rather
than public health
Interface with other services Workforce modelling Change management Generic vs specialist model
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INPUTS CARE CONTEXT OUTPUTS
Education,training culture
Integrated team network
Advanced nursing Expertise
•Country specific Primary Health Care Model
•Accessibility
•Tackling MDG’s
•Cost effective
Family centred health care
Measurable outcomes
Data from 8 countries using questionnaires
Similar concepts in role across Europe Improved communication in team when
shared focus Move towards clinical disease & public
health Further work on role clarity and
sustainability Education programmes differed due to
in-country system & resources
WHO Europe (2006) Report on the Evaluation of the WHO Multi-country Family Health Nurse Pilot Study, Copenhagen: WHO Europe http://www.euro.who.int/document/e88841.pdf
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Patient and carer needs Scotland’s population profile and
health care needs Health and social policy Nursing, health and social care
workforce issues
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Increasing numbers of older people
Health is worse than either the rest of Great Britain or Europe on a range of indicators, from premature deaths to dental health among children
Within this, substantial inequalities between different parts of Scotland and between different groups within the population
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• Diminishing number of work-age adults
• The age profile of community nurses different from nurses in the acute sector
• Increasing demand on health care services– Modernisation agenda with increased
delivery of health care in primary care.– Maintenance of current levels of
service in the face of recruitment and retention problems
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Individuals, carers, families and communities
Individuals, carers, families and communities
Community Health Nurse(CHN)
Clinical Team Leader/Advanced PractitionerNurse Consultant
Community staff nurseHealth care support worker
Primary Health Care Team, including GP.
practice nurses, pharmacists,
maternity services etc
Acute SectorCommunity Hospitals Local AuthorityTeams
Nursing Service Model
Nurses working in the community
Working directly with people
Meeting health needs
Public health / Protecting the public
Supporting Anticipatory
care
Multi disciplinary Team working
Supportingself care
Co-ordinating services
• Four development sites identified• Project Director appointed• Four Project leads in each development site appointed• Competencies identified for the new Role• Educational programmes developed
Educational transition taking place
Base Line Study Completed
New teams in place
Full evaluation commencing July 2009
Experienced workforce Community Nursing teams with varied
organisation Engagement = confidence The ‘invisible nurse’ Mid range levels of satisfaction Mixed views about proposed changes Rural areas seen to fit the new model
Staff, patient, client, carers perceptions and satisfaction levels
Time and cost of the implementation (value for money)
Team working / roles responsibilities Patient outcomes Impact measures
Short time span for implementation prior to evaluation. Possible distortion of results
Variance between different development sites
Difficulty in separating net versus gross outcomes
Number of variables within each situation
Does everyone understand what we are trying to do?
Did we manage the implementation effectively?
Have we achieved our objectives? Have we made any impact on the problems
that gave rise to the implementation of the project in the first place?
Do we understand the contribution that Community Health Nurses and the RoNIC model can make towards improving the health of our communities?
Health systems that maximise the skills and expertise of nurses are more likely to achieve the Millennium Development Goals.
Nurses are key players in providing an effective primary health service for our communities.
Appropriate community based education and advanced levels of competence are necessary for nurses to undertake this role.