uest - University of Surrey

PAULJNE JEFFREE MSc.,RGN.,RM.,MTP.,Pip.N%%4.flOKdJVX,p, P^ac., Man,

VEPARTMENT OF EVUCATÎONAL S T U V I E S

U N I V E R S I T Y OF SURREY

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Ln tko. VQ,pafitmo,nt E d a a a tL o n a t StadJLn^,UnLvdfi^Lty SuLn.n.(iy,

Uov Q,mb<in., 1996

ProQuest N um ber: 27598776

INFORMATION TO ALL USERS The quality of this rep roduc t ion is d e p e n d e n t u p o n the quality of the copy subm itted .

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uestProQ uest 27598776

Published by ProQuest LLO (2019). C opyright of the Dissertation is held by the Author.

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THE EVUCATJON ANV T R A I N I N G WE E P S

P RA CT I CE NURSES

C O N T E N T S

ACKNOULEVGEHENTS

ABS T RACT

L I S T OF T ABLES

L I S T OF FIGURES

L I S T OF AFPENVI CES

CHAPTER ONE: P a g e Numbzn.

THE BACKGROUNV TO PR A C T I C E NURSING 1, 7 - 7 . 3 5

I n t ^ o d u a t L o n 7 . 7 - 7 . 4

H L ^ t o ^ J L c a t R e . u X e w 7 . 4 - 1 . 1 4

V z ^ L n L t j i o n o i V ^ a c t L c z N u ^ 6 Z a n d P ^ a c t L c z N u ^ ^ L n g 1 . 1 4 - 1 . 2 1

WHY I S PRACTI CE NURSING NECESSARY: 1 . 2 1 - 1 . 3 2

G o v z ^ n m z n t P o Z L c y 1 . 2 1 - 1 . 2 5

L z g L ^ l a t L o n a H z c t J i n g G z n z ^ a l P f i a z t J i a z 1 . 2 5 - 7 , 2 9

T h z V z v z l o p m z n t t h z O z z a p a t L o n a n d t h z N z z d

T ^ a L n Z n g Ion. P n . a c . t t c z Nun.6Z6 1 . 2 9 - 1 . 3 5

CHATTER TaO Vagz Numbzn.

THE VEUELOPHENT OF P R A C T I CE NURSING

ANV PREPARATI ON FOR P R A C T I CE 2 . 1 - 2 . 6 6

I n tn . 0 d u e t t o n and Bac.kgn.ound 2. 7 - 2 . 14

VARIOUS ISOLATEV EVUCATIONAL SCHEMES FOR PRACTICE NURSES: 2 . 1 4 - 2 . 23

Coun^z6 a n n a n gz d by G z n z n a t Pn.ac. t t t tonzn.6 2 . 1 4 - 2 . 1 5

Coun.6Z6 a n n a n g z d by LocaZ MzdtcaZ C o m m t t t z z ^ 2 . 1 6 - 2 .21

Pn.ogn.ammz6 a n n a n g z d by Vnug Compantz6 2 . 2 1 - 2 .2 2

I n - H o u ^ z T n a t n t n g 2 . 2 2 - 2 . 2 3

PROFESSIOANL ORGANISATIONS EVUCATIONAL INI TIATIVES 2 . 2 3 - 2 . 29

GOVERNMENT ANV STATUTORY BOVY INITIATIVES: 2 . 2 9 - 2 .51

V z p a n t m z n t o^ H za Zt k Fundtng o^ P n a z t t z z Nun^z E d u z a t t o n , 198811989;198911990 2 . 3 0 - 2 .31

V z v z Z o p m z n t o l a V t 6 t a n z z L za n n t n g P a z k a g z 2 . 3 1 - 2 . 3 5

E v a Z u a t t o n o^ E ng Zt ^h N a t t o na Z Boand P n a z t t z z Nun^z Coun6z 2 . 3 5 - 2 . 3 9

RevXew ojJ P n a z t t z z Nun^z Coan6Z6 2 , 4 0 - 2 ,51

SPECIFIC INI TIATIVES ESTABLISHEV BY PRACTICE NURSES: 2 . 5 1 - 2 . 51

E 6 t a b t t 6 h m z n t o l t k z A6thma T n a t n t n g C z n t n z IonP n a z t t z z Nun^z^ 2 . 5 2 - 2 .5 3

P n a z t t z z Nan^z I n t z n z ^ t Gnoap6 2 . 5 3 - 2 . 5 4

A J o u n n a t ^on P n a z t t z z Nun6z^ l o a n d z d 2 . 5 4 - 2 . 5 5

P n a z t t z z Nan^z T n a t n t n g P n a z t t z z ^ 2 . 5 5 - 2 . 5 1

FUTURE CHANGES ANV TRENVS IN PRACTICE NURSE EVUCATION 2 . 5 1 - 2 .6

C H A P T E R T H R E E P a g z N u m b z n

THE UNIQUE NATURE OF PRACTICE NURSING 3 . 7 - 3 . 2 2

I n t n o d u c t t o n 3. 7- 3. 5

Emzngz nzz t k z P n o ^ z 6 ^ t o n : 3. 5 - 3 . 1 4

StnuLztanaZ Ckangz6 3. 5- 3. 7

S z gmz nt a t J i on 3. 7- 3. 9

R z z n a t t m z n t 3. 9- 3 . 1 4

Body o l KnoujZzdgz: 3 . 1 4 - 3 . 2 2

S z n v t z z P z n ^ p z z t t v z 3 . 1 4 - 3 . 1 6

R z z o g n t t t o n 3 . 1 6 - 3 . 2 0

I m p t t z a t t o n ^ ^on z d u z a t t o n and t n a t n t n g 3 . 2 0 - 3 . 2 2

CHAPTER TOUR P a g z Ht i m b z n

EVUCATJON ANV T R A I N I N G ANV THE NEEVS

OF PR A CT I CE NURSES 4. 7 - 4 . 2 0

I n t n o d u e t t o n 4. 7 - 4. 3

THE UNIQUE FEATURES OF PRACTICE

NURSING ANV CONTINUING

PROFESSIONAL EVUCATION 4. 3- 4 . 2 0

C o n z z p t 0 ^ C o n t t n u t n g P n o ^ z ^ 6 t o n a t E d u z a t t o n 4. 3- 4. 6

C o n z z p t o l Cunn t z u t um and Pnognammz 4. 6- 4 . 1 2

Pnognammz P t a n n t n g 4 . 1 2 - 4 . 1 1

Thz Nzzd^ and Want^ o l P n o ^ z ^ ^ t o n a Z and Vzmand6 o^P n a z t t z z 4 . 1 1 - 4 . 2 0

CHAPTER F I V E P a g z N a m b z n

HETHOVOLOGV 5 . 7 - 5 . 5 7

I n t n o d u e t t o n 5 . 7 - 5 . 2

VESCRÏPTION OF THE SAMPLE: 5 . 5 - 5 . 1 0

S u n v z y S a m p t z 5 . 8 - 5 . 1 0

RESEARCH TOOLS: 5 . 1 0 - 5 . 3 3

V t 6 z u 6 6 t o n a b o u t t h z appnopnta t znz4>6 o^ t h z t o o t 6 5 . 1 2 - 5 . 1 6

Q u z ^ t t o n n a t n z dz6tgyi 5 . 1 6 - 5 . 1 8

T ypz 0 ^ quz6t tovL6 5 . 1 8 - 5 . 2 1

Fonmat o^ t h z q u z 6 t t o n n a t n z 5 . 2 1 - 5 . 2 7

P t t o t S t u d y 5 . 2 7 - 5 . 3 3

Data a n a t y 6 t 6 5 . 3 3 - 5 . 3 6

A d d t t t o n a t S u n v z y 5 . 3 6

C o n z t u 6 t o n 5 . 3 7

CHAPTER S I X P a g z N u m b z n

RESPONVENTS ANV T HEÏ R WORK

S I T U A T I O N 6 . 7 - 6 . 3 2

PERSONAL VETAÏLS 6 . 7 - 6 . 4

Gzndzn 6 . 2

Agz 0 ^ P n a z t t z z Nan6Z6 6 . 2 - 6 . 4

M a n t t a t 6tatu4> 6 . 4

PROFESSIONAL VETAILS 6 . 4 - 6 . 1 3

Pno ^ z 6 6 t o n a t q a a t t ^ t z a t t o n 6 6 . 5 - 6 . 1 0

Hotdzn6 UKCC Ptn Numbzn 6 . 7 7

I n d z m n t t y I n ^ u n a n z z 6 . 7 7 - 6 . 12

A z a d z m t z q a a t t ^ t z a t t o n ^ 6 . 7 2 - 6 . 1 3

WORKING ENVIRONMENT 6 . 7 3 - 6 . 2 4

T yp z 0 ^ P n a z t t z z pnzmt4>Z6 6 . 14

P n a z t t z z S t z z 6 . I B - 6 . 1 6

T n a t n t n g P n a z t t z z 6 6 . 17

G z n z n a t P n a z t t z z Sta^{, 6 . 1 7 - 6 . 2 2

G z n z n a t P n a z t t t t o n z n ^ 6 . 1 7 - 6 . 1 9

A t t a z h z d P n o ^ z 6 6 t o n a l 6 t a ^ ^ 6 . 2 0 - 6 . 2 1

Emptoyzd P n a z t t z z S t a ^ ^ 6 . 2 1 - 6 . 2 2

P n a z t t z z Nun6Z6 z o mb t n z d d a t t Z 6 6 . 2 2 - 6 . 2 4

EMPLOYMENT ARRANGEMENTS 6 . 2 4 - 6 . 3 0

C o n d t t t o n 6 EmpZoymznt: 6 . 2 4 - 6 .2 9

EmpZoyzn 6 . 2 4 - 6 . 2 5

C o n t n a z t 6 EmpZoymzntand Job V z 6 z n t p t t o n 6 6 . 2 5 - 6 . 2 7

Hou.n6 voonkzd 6 . 2 8 - 6 . 2 9

P zn^ onmanz z RzvtZM 6 . 2 9 - 6 . 3 0

P n a z t t z z M z z t t n g 6 6 .31

Conz Zu6 t on 6 . 3 1 - 6 . 3 2

C H A P T E R S E V E N P a g z N u m b z n

LEARNING OP PORT UNI TI ES ANV

LEARNING NEEVS 7 . 7 - 7 . 4 7

I n t n o d u e t t o n

L z a n n t n g O p p o n t u n t t t z 6 :

S t u d y t z a v z

I n - S z n v t z z T n a t n t n g

I n - H o u ^ z T n a t n t n g

?0 6 t - B a 6 t z E d u z a t t o n and t k z EngZt ^h N a t t o n a Z Boand P n a z t t z z Nun^z Coun^z

P n o ^ z 6 6 t o n aZ JounnaZ6

L z a n n t n g Nzzd^

I n t n o d u z t t o n

S p z z t ^ t z C Z t n t z a Z t a 6 k ^ and n u n6 t ng p n o z z d u n z 6

HzaZtk S u n v z t Z Z a n z z

C Z t n t z a Z Ex .amtnat ton6

Inv z4>t tga t ton6

C Zt n t z 6

C ktZdnz n

P n o ^ z6 6 to n aZ Up da t t ng

7- 7. 2

2- 7 . 7 7

3- 7. 6

7- 7 . 7 7

7 7- 7 . 7 2

73- 7 . 7 6

76 - 7 . 7 7

18- 7 . 4 7

18- 7 . 2 0

2 7 - 7 . 2 2

2 3 - 7 . 2 4

2 5 - 7 . 2 6

2 7 - 7 . 2 3

2 9 - 7 . 3 0

Managz m z n t 7 , 3 1 - 7 , 3 2

T z a z k t n g 7 . 3 3

Otkz n Conzznné 7 . 3 3 - 7 . 37

Ex. t zndzd n oZ z a z t t v t t y 7 . 3 7 - 7 . 38

V ta n y Rzzond6 7 . 3 9 - 7 . 40

A d d t t t o n a Z 6 a n v z y 7.41

ConzZu^Zon 7.41

C H A P T E R E I G H T P a g z N u m b z n

LEARNING NEEVS ANV THE RESPONVENTS*

PROFESSI ONAL BACKGROUNVS 8. 1- 8. 16

lYitnoduztJioyL 8. 7- 8. 2

S p z c t ^ t z C Z t n t z a Z t a ^ k 6 andn a n é t n g p n o z z d a n z ^ 8. 3- 8. 5

Hz aZtk S u n v z t Z Z a n z z 8. 5- 8. 8

C Z t n t z a Z E x a m t n a t t o n 8, 8 - 8. 9

I n v z 6 t t g a t t o n 6 8. 10

C Z t n t z ^ 8. 10- 8. 11

Ck tZ d nz n 8. 12- 8. 13

V n o l z 6 6 t o n a Z u p d a t t n g 8. 14

Managzmznt 8. 14- 8.1 5

T z a z k t n g 8. 15

O t kz n t o p t z 6 8. 15- 8 .1 6

C on zZu6t on 8. 16

C H A P T E R N I N E P a g z N u m b z n

LEARNING NEEVS ANV THE RESPONVENTS '

OCCUPATIONAL BACKGROUNV 9 . 1 - 9 . 4 3

I n t n o d u z t t o n 9. 1 - 9. 2

C Z t n t z a Z t a 6 k 6 and n u n ^ t n g p n o z z d u n z ^ 9. 2- 9. 9

C Z t n t z a Z z x a m t n a t t o n 6 9. 9 - 9 . 13

HzaZtk S u n v z t Z Z a n z z 9 . 1 4 - 9 . 16

I n v Z 6 t t g a t t o n 6 9 . 1 7 - 9 . 19

C Z t n t z 6 9 . 2 0 - 9 . 2 2

Ck t Zd nz n 9 . 2 3 - 9 .2 4

HzaZtk p n o m o t t o n and k z a Z t k z d u z a t t o n 9 . 2 5 - 9 . 28

T z a z k t n g 9 . 2 9 - 9 .31

' O t k z n ' 9 . 3 2 - 9 . 36

Managzmznt 9 . 3 7 - 9 . 39

E n v t n o n m z n t o^ P n a z t t z z l a z t o n ^ 9 . 4 0 - 9 .4 2

C H A P T E R T E N P a g z N u m b z n

VÏSCUSSÏON 10. 1 - 1 0 . 3 0

Jn t no d u e t t o n 10. 1 - 10 . 2

PART ONE 1 0 . 2 - 1 0 . 1 3

R z6 p o n d z n t 6 and t h z t n voonk 6 t t u a t t o n

PART TWO 1 0 . 1 3 - 1 0 . 2 0

R e s p o n d e n t s and t h e t n p n o l e s s t o n a t baz kgno und s

PART THREE 1 0 . 2 0 - 1 0 . 2 9

E d u z a t t o n and t n a t n t n g o p p o n t u n t t t e s and t e a n n t n g needs

C o n z t u s t o n 1 0 . 2 9 - 1 0 . 3 0

C H A P T E R E L E V E N P a g z N u m b z n

CONCLUSIONS ANV RECOHHENVATIONS

I n t n o d u z t t o n

T n a t n t n g and E d u z a t t o n

L z a n n t n g Nzzds

R z z o mm zn da t to ns

S t n z n g t h s and u j z a k n z s s z s o^ t k z s t u d y

P o t t z y

Nunsz R o t z V z v z t o p m z n t

E u n t k z n n z s z a n z k

C o n z t u s t o n

7 7 . 7 - 7 7 . 3 2

7 . 7 - 7 7 . 7

7 . 3 - 7 7 . 7 2

7 . 7 2 - 7 7 . 7 5

7 . 7 5 - 7 7 . 7 7

7 . 7 7 - 7 7 . 2 2

7 . 2 2 - 7 7 . 2 6

7 . 2 6 - 7 7 . 2 3

7 . 2 3 - 7 7 . 2 9

7 . 2 9 - 7 7 . 3 2

f o o t n o t e 7 7 . 3 2

B I BLI OGRAPHY

APPENVI CES

A C K N O W L E V G E U E N T S

1 am t n d e b t e d t o my T a t o n , V n o ^ e s s o n , V e t e n J a n v t s Head o^ V e p a n t m e n t , E d a e a t t o n a Z S t u d t e s , U n t v e n s t t y o{ Sanney voko k a s , M t t k muek p a t t e n e e , g a t d e d me t h n o u g h my s t a d t e s oven many y e a n s .

I am a l s o g n a t e ^ a t t o t h e V t n e e t o n s o i P n a e t t e e Nunse J o u n n a t ujho made an t d e a , some y ea ns ago, a n e a t t t y and s u p p o n t e d t k t s s t u d y .

I aeknovotedge a t s o t h e k e t p g t v e n by P e t e n Rudd a l e t t ovo n e s e a n e k Phd S t u d e n t a t t h e U n t v e n s t t y o^ Sunney u)ko, votth muek e o n s t d e n a t t o n , s k a n e d t k e t n t n a e a e t e s o^ t k e S t a t t s t t e a t Paekage ^on t k e S o e t a t S e t e n e e s eo mput en s y s t e m .

I a p p n e e t a t e a t t t k e t t m e , t n t e n e s t and e a n e t a k e n by p n a e t t e e n u n s e e o t t e a g u e s and s t u d e n t s wko p a n t t e t p a t e d t n t k t s n e s e a n e k .

T k t s s t u d y (Jüoutd n o t k a v e been p o s s t b t e M t t k o u t t k e s u p p o n t and eneounag ement o l Vn. K e n n e t k S e o t t and a t t my e o t t e a g u e s a t Etm House S u n g e n y .

A B S T R A C T

Tke atm t k t s s t u d y Mas t o ga tken as muek

tn^onmat ton as p o s s t b t e ^nom p n a e t t e e nunses tn

p o s t t n onden t o de tenmtne t k e t n pe n e e t v ed

ed uea t t on and t n a t n t n g needs .

V e t a t t Mas a s e e n t a t n e d Mttk negand t o pensona t

e k a n a e t e n t s t t e s , pn o^ e s s to n a t d e t a t t s and

o e e u p a t t o n a t n o t e . Tke a n a t y s t s o t k e da ta

t d e n t t l t e d t k a t p n a e t t e e nunses tn t k t s s t u d y Mene

a t t {,emate, t k e m a jo n t t y Monked p a n t - t t m e and t k a t

t k e gneat en pnopont ton o t k e nunses Mene aged

betMeen t k t n t y and l o n t y - n t n e yeans . Tke nange

0 p n o l e s s t o n a t q u a t t ^ t e a t t o n s Mas e o n s t d e n a b t e

and t k e o e e u p a t t o n a t n o t e Mktek t k e y undentook

d t v ense .

Tke nunses Monked t n a v a n t e t y o envtnonments

Mttk p n a e t t e e s betng e t t k e n punpose b u t t t on t k e

one kand on kavtng been dev e toped as a p n a e t t e e on

t k e o tken . One t k t n d o t k e p n a e t t e e s Mene

t n a t n t n g p n a e t t e e s , and t k t s kad t m p t t e a t t o n s { on

t k e nunse openat tng ^nom a t n a t n t n g p n a e t t e e .

Tke s t u dy k t g k Z t g k t e d t k a t nunses Monktng t n a

t n a t n t n g p n a e t t e e kad mone op po n t u n t t y t o punsue

s t u d t e s and t k e nunse m u s a t so mone t t k e t y t o kave

p n o t o e o t s t n p t a e e and be s a f e t y emptoyed. Tke

m aj o n t t y o i nunses t n t k e s t u d y Monked on t k e t n

oMn and a s e n s e o t s o t a t t o n Mas t d e n t t ^ t e d .

Tke p n a e t t e e nunses ' t eanntng needs Mene as

d t v e n s e as t k e t n n o t e . Cons tdenab te empkasts Mas

p t a e e d on s k t t t a b t t t t y and t k e need ^on t n a t n t n g

tn t k t s a s p e e t o t k e t n n o t e .

One o i t k e o b j e e t t v e s o i t k t s neseanek Mas t o s e e

Mketken a e e n tn a t eunnteutum on a modutan

pnognamme Mas b e s t s u t t e d ^on t k e t eann tng needs

0 p n a e t t e e nunses .

Tke nes eanek kas eon^tnmed t k a t a modutan

pnognamme t s b e s t s u t t e d ^on t k e t eanntng needs o

t k e s e nunses beeause t k e y Monk t n sm a t t p n a e t t e e s ,

h ave v a n y t n g oce up a t t o n a l n o t e s and k a v e d t ^ ^ e n e n t

p e n e e t v ed t e a n n t n g n e e d s . Tkene Mas a t s o g e n u i n e

e on ee nn t k a t p n a e t t e e n u n s e s n e e e t ^ ^ d e n e d t t ^on

p n o l e s s t o n a t e d u e a t t o n .

L I S T OF TABLES

P a g z N u m b z n

T a b t z 7. 7 Thz numbzn P n a z t t z z Nunszs t n Engl and and Wales 7 . 7 5

6 . 7 Age o l P n a e t t e e Nunses 6. 3

6. 2 UKCC R e e o n d a b l eq u a l t ^ t e a t t o n by yean 0 ^ q u a l t ^ t e a t t o n 6 . 1

6. 3 Otken n u n s t n gq u a l t ^ t e a t t o n s h e l d by n e s p o n d e n t s 6. 8

6. 4 Numben o l a ea de mt eq u a l t ^ t e a t t o n s 6 . 1 3

6. 5 P n a e t t e e s t z e a e e o n d t n g t o t h e numben o l n e g t s t e n e d p a t t e n t s 6 . 16

Numben o^ Female and Male Genena l P n a e t t t t o n e n s and P n a e t t e e Nunses n e l a t e d t o P n a e t t e e n e g t s t e n e d P a t t e n t I t s t s t z e 6 . 1 9

6. 7 Otken a s p e c t s o i t k eP n a e t t e e N u n s e ’s R o l e 6 . 2 3

6. 8 C o n t n a e t s o^ Employment and Job V e s e n t p t t o n s h e l d by R e s p o n d e n t s 6 . 26

6. 9 R e g t s t e n e d V a t t e n t L i s t s i z e and C o n t n a e t s o^ Employment and Job V e s e n l p t l o n s ■ on P n a e t t e e Nunses 6 , 2 7

6,10, Numben o^ P n a e t t e e Nunses Monktng ^ u l l - t t m e and p a n t - t t m e e o n n e l a t e d a g a i n s t n e g t s t e n e d p n a e t t e e p a t t e n t l i s t s t z e 6 . 2 9

7. 1 Counses a t t e n d e d by p n a e t t e e n u n s e s as t n - s e n v t e e t n a t n t n g 7 . 10

7. 2 d e t a i l s o^ t n - k o u s et n a t n t n g u n d e n t a k e n byt h e n e s p o n d e n t s 7 . 12

7. 3 T o p t e s I n c l u d e d t n t h e ENB P n a e t t e e Nunse e o u n s e Mkteh n e s p o n d e n t s e o n s t d e n e d had s u b s e q u e n t l y a ^ e e t e d p n a e t t s e 7 . 14

7. 4 L i s t e d t o p t e s M k t e k s h o u l d be I n c l u d e d t n s u b s e q u e n t ENB P n a e t t e e Nunse e o u n s es 7 . 15

7. 5 D e t a i l s o^ t k e j o u n n a l s nead by t k e n e s p o n d e n t s t o k e l p keepp n o l e s s t o n a l l y u p d a t e d 7 . 17

7. 6 Speet^te cltntaaZ tasks and nunstng pnocedunes ^on Mktek tke nespondents tdentt^ted edueatton and tnatntng needs 7 . 2 0

7. 7 H e a t t k s u n v e t t t a n e e andt k e t d e n t t l t e d e d u e a t t o n and t n a t n t n g needs o^ t k e n e s p o n d e n t s 7 . 2 2

7. 8 C t t n t e a t e x a m t n a t t o n s and t k e t d e n t t ^ t e d e d u e a t t o n and t n a t n t n g need s o^ t k e n e s p o n d e n t s 7 , 24

7. 9 Tke t n v e s t t g a t t o n s t d e n t t ^ t e d by t k e n e s p o n d e n t s i o n Mktek t k e y p e n e e t v e a need i o n i u n t k e n t n a t n t n g 7 ,26

7 . 7 0 C t t n t e s and t k e t e a n n t n gn eeds o i t k e n e s p o n d e n t s 7 , 28

7 . 7 7 C k t t d n e n and t k et d e n t t i t e d e d u e a t t o n and t e a n n t n g needs o i t k e n e s p o n d e n t s 7 , 30

7 2 Management and t d e n t t i t e d e d u e a t t o n a t and t n a t n t n g needs o i t k e n e s p o n d e n t s 7 , 32

7 . 1 3 Otken aneas o i e on ee nni o n M k t e k t k e n e s p o n d e n t sp e n e e t v ed a n eed i o ne d u e a t t o n and t n a t n t n g 7 . 3 5 - 7 . 36

7 . 7 4 P n a e t t e e p n o t o e o t s i o np n a e t t e e n u n s e e x t e n d e d n o t e a e t t v t t y 7 . 5 3

7 . 7 5 E i i e e t o i t h e Nevo GP C o n t n a e t (1990) - P n a e t t e e Nunse a e t t v t t y 7 . 40

8. 7 S p e e t i t e e t t n t e a t t a s k s and n u n s t n g p n o e ed u ne s i o n Mktek t k e n e s p o n d e n t s M t t k V t s t n t e t Nunse q u a t t i t e a t t o n and Mho k a v e a t t e n d e d an E n g t t s k N a t t o n a t Boand P n a e t t e e Nunse e o u n s e t d e n t t i y an e d u e a t t o n and t n a t n t n g n eed

8. 2 H e a t t k su nv e t t t a n e e andt k e t d e n t t i t e d e d u e a t t o n and t n a t n t n g need s by q u a t t i t e a t t o n and p o s t h a s t e pno i e s s t o n a t e d u e a t t o n

8. 3 C t t n t e a t e x a m t n a t t o n s and t k e t d e n t t i t e d e d u e a t t o n and t n a t n t n g n eeds o i t k e n e s p o n d e n t s M t t k p n o i e s s t o n a t q u a t t i t e a t t o n and knoMtedg e b aekgnound 8. 9

C k t t d n e n and t k e t d e n t t i t e d e d u e a t t o n and t n a t n t n g needs o i t k e n e s p o n d e n t s by p n o i e s s t o n a t q u a t t i t e a t t o n eompaned M t t k a t t n u n s e s u n d e n t a k t n g t k e v a n t o u s a s p e e t s o i e k t t d eane 3 . 7 5

9. 7 CttYLLdOit t a ^ k ^ and niin.^Lng pfioaQ,d 11 0,6 und o . ^ ta k tn by the, fi 0,6 pond a n t 6 ' and Â,do,ntÂ,^Â,o.d 6o , t ^ ’-po.K(LO.Â,ve.d o,du.c.atLon and tn.aX,nX,ng no,o,d6 9. 7 - 9. 9

9. 2 CZLnLaat o,xamX,natjion6u.ndo,fLtako,n by tko, fio,6pondo,nt6 ' and Â,do,ntX,^Â,o,d 6 o.t^-po.^c.o.X,v o,do.duc.atJion and tfLaX,nX,ng no,o,d6 9 , 1 2 - 9 ,1 3

9, 3 Ho.at th o.jLttanc.0.ando.^tako.n by tko,>io,6pondo,nt6 ' and Â,do.ntX,^o.do,dac.atLon and t f i a t n t n gno,o,d6 9 , 1 5 - 9 , 16

9, 4 Tko, l a i t fiango, a it n v 0,6 tJigatX,v 0, pfiOQ.o,dafio,6 u.ndo,Ktako,n by tko,^o,6pondo,nt6 ' and tko,Â,do,ntJi^Jio,d 6 o,t^-po.^c,o,Â,v o,do,duc,at ton and t ^ a t n t n gno,o,d6 9 , 1 8 - 9 , 19

9, 5 C t t n t c 6 { on, 6po,aX,aZpfLOC,o,dafLO,6, pH.obto.m6,t n v o , 6 t t g a t t o n 6 and d t 6 0,a6 0,manago,mo,nt t o t a t pH,ovt6tonand tko, H,o,6pondo,nt6 'po,H,ao,tvo.d o.duc,at ton andt f i a t n t n g no,o,d6 9 , 2 1 - 9 , 2 2

9, 6 C k t t d aatio, ac, t tvJi t to,6ando,H,tako.n by pH,ac.ttc,o, nuH.6 0,6 ’ and tko. nuH.6 0.6 ' po,H.ao,tvo.d o,duc.atton and tH,a tn tng no,o,d6 H,o,tato,d t o tko.6 0, a c , t t v t t t o , 6 9 , 24

9. 7 H d a t t k VfLomotJioYL and H z a t t k E d u c a t i o n pn,ogH,ammd6 ^on. ujktdk pH.ac.ttc.d nan.6d6 an.dH.d6pon6tbtd 6kowLng t k d nambdK and pd Hcdn t agd 0 ^ pHovt^JLon a g a t n 6 t t o t a t nambdfi o i H.d6ponddnt6 ' 9 , 2 6 - 9 ,2 8

9, 8 Td ad k t n g dommttmQ,nt6 and d d a a a t t o n and t n . a t n t n g nddd6 9 , 3 0 - 9,31

9, 9 'OtkdH,' a d t t o t t t d i voktdk^oH.m paf i t o{ t k d p n . ad t t dd naH,6d'6 i io td and 6 d t ^ -pdH,ddtv dd d d u d a t t o n and t n a t n t n g nddd6 9 , 3 3 - 9 , 36

9 , 1 0 ManagdH.tat H d 6 p o n 6 t b t t t t t d 6 and t k d a 6 6 0 d t a t d d t d v d t 0^ 6 d t ^ - p d H d d t v d d d d u d a t t o n and t n . a t n t n g nddd6 o l t k d H d 6 p o n d d n t 6 ' 9 , 3 8 9 , 39

F I G U R E S R a g e , UumbdH.

3 . 1 Tkd dtvdH,6d natuHdpH.adt tdd vLuH6tng andp o t d n t t a t knoujlddg dba6d 3 . 3

3 . 2 F t d l d 6 o i pfiadtJidd in.om ujhtdh pH-adt tdd nuH.6d6 m t g h t domd 3 . 4

L I S T OF AVVENVI CES

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TH.atntng nddd6 ?H.acttc.e. hlUH6d6 - RdpoHt o l t k d StddH.tng Gnoup, Ro y a lC o l l d g d 0 NuH.6tng 2 ,2 4

I t V K a d t t d d VLUH.6d t n . a t n t n g - O a t l l n d CuH.H.tculam t k d N a t i o n a l BoaH.d6 Ion. Eng l and , S c o t l a n d and Non.tkdn.n Jn.dland 2 ,2 4

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I v V n o i l l d o i V n a c t l d d Nun.6d6t a k i n g E n g l l 6 k N a t i o n a l BoandCoun.6d6, 198 8/ 198 9; 1 989/1 990 2 , 35

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v l d u d 6 t l o n n a l n . d , "Tkd E d u c a t i o n a lNddd6 0 ^ Pn . ac t l cd Nun.6d6" 5 ,21

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C H A P T E R OHE

THE BACKGROUND OP PRACTICE NURSING

Nanking ha6 mado. ovdn t k d ydan.6 a u n l q u d

d o n t n l b u t l o n t o p a t l d n t cand and t k d I n t r o d u c t i o n

o l p r a c t i c e n u r s i n g ka6 kad a s i g n i f i c a n t r o t d I n

t k d d d v d t o p m d n t o f p r i m a r y c a r d . T kd r d can bd

l l t t l d d o u b t , kowd vdr , t k a t t k d f o c u s o f p r i m a r y

k d a l t k c a r d I s c k a n g l n g . Many p d o p t d a r e l i v i n g

l o n g e r , many i v l t k d i s a b i l i t i e s a n d / o r c k r o n l c

d i s e a s e s . T k e r e a r e more r i s k f a c t o r s voklck can

be I d e n t i f i e d and m o d i f i e d by I m p r o v i n g

l i f e s t y l e . T k e r e I s a l s o a grouulng a toareness o f

t k d n eed n o t o n l y t o r e s p o n d t o I l l n e s s b u t a l s o

t o p r e v e n t d i s e a s e and t o p r o m o t e k e a l t k .

Tkd p r a c t i c e n u r s e and p r a c t i c e n u r s i n g does

a pp ea r t o k a v e a key r o l e t o p l a y I n t k e s e

c k a n ge s ( C k l e f N u r s i n g O f f i c e r , 1 989 ) , n o t o n l y

b e c a u s e c on sumers l i k e t o k a v e a p r a c t i c e n u r s e t o

vokom t k e y can r e f e r and vol tk ivkom t k e y can c o n s u l t

d i r e c t l y , ( H a r r i o t , 19S1) b u t a l s o b e c a u s e

p r a c t i c e n u r s e s a r e I d e n t i f i e d as h a v i n g a u n i q u e

o p p o r t u n i t y w i t h i n t h e g e n e r a l p r a c t i c e s e t t i n g

f o r making p l a n n e d and o p p o r t u n i s t i c h e a l t h

I n t e r v e n t i o n s , s c r e e n i n g p a t i e n t s and p r o m o t i n g

good h e a l t h . I n d e e d p r a c t i c e n u r s e s a r e I n a

p o s i t i o n b o t h o p p o r t u n i s t i c a l l y and t h r o u g h

p l a n n e d I n t e r v e n t l o n t o I n f l u e n c e t h e h e a l t h

s t a t u s o f t h e e s t i m a t e d 98% o f t h e g e n e r a l

p o p u l a t i o n who a r e r e g i s t e r e d w i t h a g e n e r a l

p r a c t i t i o n e r (Fowl er e t a l , 1 9 88) and " a t r i s k "

g r o u p s who a r e known t o c o n s u l t t h e g e n e r a l

p r a c t i t i o n e r f r e q u e n t l y , s u c h p a t i e n t s as t h o s e

w i t h l o n g t e r m s t r e s s r e l a t e d I l l n e s s e s ,

(NcCormlck and Rosenbaum, 1 989 ) . I t I s e s t i m a t e d

t h a t some 70% o f p a t i e n t s w i l l c o n s u l t e v e r y y e a r

and more t h a n 90% c o n s u l t w i t h i n f i v e y e a r s ,

( F u l l a r d e t a l , 1987) .

T h e r e r e m a i n , ho we v er , f u n d a m e n t a l q u e s t i o n s a b o u t

p r a c t i c e n u r s i n g w h i c h n eed t o be a n s w e r e d I f a

r o l e f o r t h e p r a c t i c e n u r s e I s t o be d e v e l o p e d .

Â r o t e w h i c h n o t o n l y m a x i m i s e s , t h r o u g h

a p p r o p r i a t e e d u c a t i o n a l p r e p a r a t i o n , t h e p o t e n t i a l

o f n u r s i n g , b u t a l s o alms t o I m p r o v e t h e q u a l i t y

o f p r i m a r y h e a l t h c a r e .

The m a j o r i t y o f p r a c t i c e n u r s e s h a v e e n t e r e d

p r a c t i c e n u r s i n g n o t o n l y f rom a v a r i e t y of

n u r s i n g b a c k g r o u n d s , b u t a l s o w i t h a w i d e and

v a r i e d k n o w l e d g e and s k i l l s b a s e . Jn s p i t e o f

t h i s d l v e r g e n c e and f r a g m e n t a t i o n , p r a c t i c e

n u r s i n g has emerged and become e s t a b l i s h e d as a

f i e l d o f p r a c t i c e . T h i s t h e s i s s e e k s t o

d e t e r m i n e n o t o n l y t h e r o l e o f p r a c t i c e n u r s e s b u t

a l s o t h e ' p e r c e i v e d e d u c a t i o n a l n e e d s o f t h o s e

n u r s e s who a r e u n d e r t a k i n g an I I I d e f i n e d r o l e f o r

w h i c h t h e r e I s no I n i t i a l t r a i n i n g or e s t a b l i s h e d

body o f k n o w l e d g e .

T h i s c h a p t e r w i l l f o c u s upon t h e g r o w t h o f

p r a c t i c e n u r s i n g o v e r t h e y e a r s and t h e v a r i o u s

f a c t o r s w h i c h have I n f l u e n c e d t h e emerg e n c e and

dev e l o p m e n t o f t h e p r a c t i c e n u r s e and p r a c t i c e

n u r s i n g .

The e a r l i e s t r e c o r d o f a n u r s e e m p l o y e d by a

g e n e r a l p r a c t i t i o n e r I s 1913. D o c t o r G r a n t , a

s i n g l e handed p r a c t i t i o n e r l i v i n g and p r a c t i s i n g

f rom h i s f a m i l y home I n E a s l n g t o n , N o r t h u m b e r l a n d

a m i n i n g t o wn , e m p l oy ed Nary Hannah Robson .

A c c o r d i n g t o Br own ' s p e r s o n a l c o m m u n i c a t i o n w i t h

f4lss Robson ( 1 9 S 7 ) , S i s t e r Ro bson ' s d u t i e s we r e

v a r i e d . She wo ul d a s s i s t Doc t or Gr a n t I n h i s

s u r g e r y , h e l p i n g w i t h d r e s s i n g s and d i s p e n s i n g o f

m e d i c i n e s . Jn a d d i t i o n , b e c a u s e s h e l i v e d I n t h e

p r a c t i c e h o u s e w i t h t h e Gr an t f a m i l y , her d u t i e s

a l s o I n c l u d e d t a k i n g r e q u e s t s f o r n i g h t home

v i s i t s . Her bedroom window o v e r l o o k e d t h e f r o n t

door so t h a t when t h e n i g h t b e l l rang s h e l e n t o u t

o f t h e window and t o o k t h e m e s s a g e . E v i d e n t l y

S i s t e r Robson u se d her d i s c r e t i o n w i t h t h e s e n i g h t

c a l l r e q u e s t s and I f s h e c o u l d d e a l w i t h t h e m , s h e

w e n t t o t h e p a t i e n t h e r s e l f . O t h er c a l l s w h i c h

s h e c o n s i d e r e d beyond h er c o m p e t e n c e , s h e p a s s e d

o n t o t h e d o c t o r . S i s t e r R o b s o n ’s o t h e r d u t i e s

I n c l u d e d v i s i t i n g t h e a mb u la nc e room a t t h e

l o c a l m i n e r s c o l l i e r y and d u r i n g t h e 1914- 1918 War

N l s s Robson a c t e d as t h e D o c t o r ’s s u r r o g a t e ,

v i s i t i n g p a t i e n t s I n n e a r b y v i l l a g e s who n e e d e d

her n u r s i n g s k i l l s .

U n t i l t h e p a s s i n g o f t h e N a t i o n a l H e a l t h S e r v i c e

A c t I n 1946 and t h e D o c t o r ’s C h a r t e r I n 1965 v e r y

l i t t l e dev e l o p m e n t I n p r a c t i c e n u r s i n g t o o k p l a c e

and b e f o r e t h e Sec on d World War, t h e g e n e r a l

p r a c t i t i o n e r wor ked l a r g e l y I n I s o l a t i o n . I t was

n o t u n t i l t h e r e c o m m e n d a t i o n s f rom t h e Dawson

R e p o r t ( 1920) wer e f i n a l l y I m p l e m e n t e d by t h e

dev e l o p m e n t o f h e a l t h c e n t r e s t h a t t h e c o n c e p t o f

p r i m a r y h e a l t h c a r e t e a ms became a c c e p t e d . The

m a j o r i t y o f g e n e r a l p r a c t i t i o n e r s r e l i e d upon

t h e i r w i v e s t o s u p p o r t them I n t h e r u n n i n g o f t h e

p r a c t i c e and o n l y a v e r y s m a l l number o f g e n e r a l

p r a c t i t i o n e r s e mp l oy ed t h e i r own n u r s e s , ( f r y ,

1988) . A l t h o u g h t h e N a t i o n a l H e a l t h S e r v i c e A c t

o f 1 946 c h a r g e d t h e N l n l s t e r o f H e a l t h w i t h t h e

r e s p o n s i b i l i t y o f e s t a b l i s h i n g a h e a l t h s e r v i c e

which, wo u l d I n c l u d e p r e v e n t i o n , d i a g n o s i s and

t r e a t m e n t o f I l l n e s s f o r a l l p a t i e n t s , f r e e of

c h a r g e a t t h e t i m e o f n ee d no p r o v i s i o n was made

w i t h i n t h e A c t f o r g e n e r a l p r a c t i t i o n e r s t o

d e v e l o p t h e i r s e r v i c e s by e m p l o y i n g p r o f e s s i o n a l

s t a f f t o s u p p o r t t h e m .

The o r g a n i s a t i o n w h ic h r e s u l t e d f rom t h e p a s s i n g

o f t h e NHS A c t was an a m a l g a m a t i o n o f e x i s t i n g

s e r v i c e s I n t o t h r e e main a r e a s , n amel y - p r o v i s i o n

f o r t h e s i c k I n I n s t i t u t i o n s , p r o v i s i o n f o r t h e

s i c k I n t h e communi ty and t h e p r e v e n t l o n o f

I l l n e s s . T h e s e d i v i s i o n s c o r r e s p o n d e d t o t h e

h o s p i t a l s e r v i c e , g e n e r a l p r a c t i t i o n e r s e r v i c e s

and t h e l o c a l a u t h o r i t y s e r v i c e s .

Wi th t h e e s t a b l i s h m e n t o f t h e NHS, g e n e r a l

p r a c t i t i o n e r s v i r t u a l l y r e p l a c e d t h e i r p r i v a t e

I ncome w i t h a s t a n d a r d c a p i t a t i o n f e e f o r each

p a t i e n t r e g i s t e r e d w i t h t h e d o c t o r . The g e n e r a l

p r a c t i t i o n e r , h o we v er , r e m a i n e d an I n d e p e n d e n t

c o n t r a c t o r r e s p o n s i b l e t o t h e E x e c u t l v e C o u n c i l

f o r prov ldJ ing G e n e r a l N e d l e a l S e r v i c e s t o t h e

p a t i e n t s r e g i s t e r e d w i t h t h e d o c t o r . The

E x e c u t l v e C o u n c i l became t h e f a m i l y P r a c t i t i o n e r

Co m mi t t e e I n 7 974 and became t h e f a m i l y H e a l t h

S e r v i c e s A u t h o r i t y I n 7 990.

The 7 965 C h a r t e r f o r G e n e r a l P r a c t i c e r e s u l t e d I n

maj or dev e l o p m e n t s I n g e n e r a l p r a c t i c e . The main

f e a t u r e s o f t h e l e g i s l a t i o n we r e t h e r e v i s e d Terms

of S e r v i c e f o r g e n e r a l p r a c t i t i o n e r s , t h e

I n t r o d u c t i o n o f v o c a t i o n a l e d u c a t i o n f o r d o c t o r s

w a n t i n g t o become g e n e r a l p r a c t i t i o n e r s and t h e

I n t r o d u c t i o n o f t h e c o s t r e n t s c h em e . The aim o f

t h e r e f o r m s was t o e ncour ag e d o c t o r s t o become

g e n e r a l p r a c t i t i o n e r s and f o r f a m i l y d o c t o r s t o

e x t e n d t h e i r p r a c t i c e f a c i l i t i e s and s e r v i c e s t o

p a t i e n t s by I m p r o v i n g p r a c t i c e f a c i l i t i e s and by

e m p l o y i n g a n c i l l a r y s t a f f . G e n e r a l p r a c t i t i o n e r s

wer e a l l o w e d a 70% s u b s i d y t o employ a n c i l l a r y

s t a f f t o work w i t h t hem I n t h e i r p r a c t i c e and each

d o c t o r was a l l o w e d t o employ two w h o l e - t i m e

e q u i v a l e n t members o f s t a f f . The s t a f f so

e mp lo ye d eo i i l d be e i t h e r r e c e p t i o n i s t s , c l e r k s ,

t y p i s t s or p r a c t i c e n u r s e s . Very f ew g e n e r a l

p r a c t i t i o n e r s , h o w e v e r . I n i t i a l l y t o o k a d v a n t a g e

of t h e s t a f f r e i m b u r s e m e n t sch eme , ( f r y , 1988) .

I t was I n t h e mid 1 960 ’s t h a t d e v e l o p m e n t s I n

g e n e r a l p r a c t i c e and p r a c t i c e n u r s i n g o c c u r r e d .

Some g e n e r a l p r a c t i t i o n e r s v i e w e d t h e I n t r o d u c t i o n

o f t h e s t a f f r e i m b u r s e m e n t s c heme as t h e

o p p o r t u n i t y t o employ n u r s e s who wo u l d n o t o n l y

work a l o n g s i d e t hem and r e l i e v e t hem o f some o f

t h e l e s s demanding t a s k s b u t wo u ld a l s o h e l p

g e n e r a l p r a c t i t i o n e r s t o bro aden t h e s c o p e o f

s e r v i c e p r o v i s i o n w i t h i n t h e p r a c t i c e s , ( A n d e r s o n ,

1973) . The d e l e g a t i o n o f t a s k s f rom d o c t o r t o

n u r s e was e x p l i c i t l y e ncou rag ed a t t h i s t i m e w i t h

t h e r e v i s e d N a t i o n a l H e a l t h S e r v i c e Terms o f

S e r v i c e f o r f a m i l y d o c t o r s . T h e s e s t a t e d t h a t :

" I f r e a s o n a b l e s t e p s a r e t a k e n

t o e n s u r e c o n t i n u i t y o f t r e a t m e n t

t h e p r a c t i t i o n e r s h a l l be un der

no o b l i g a t i o n t o g i v e t r e a t m e n t

p e r s o n a l l y and s u c h t r e a t m e n t may

be g i v e n by . . . a p a r t n e r , a s s i s t a n t

or d e p u t y . . . or I f I t I s r e a s o n a b l e

I n t h e e l r e u m s t a n e e s t o d e l e g a t e

t o a member o f h i s s t a f f , b e i n g a

p e r s o n who I s c o m p e t e n t t o c a r r y

o u t s u c h t r e a t m e n t . . . "

B r i t i s h N e d l c a l A s s o c i a t i o n , "Â C h a r t e r f o r t h e

f a m i l y D o c t o r S e r v l c e " , B r i t i s h M e d i c a l J o u r n a l ,

18th March, 1965, No. 3138, p 89.

Dur ing t h e 1 9 6 0 ’ s v a r i o u s h e a l t h c a r e p r o f e s s i o n a l

s t a f f w e r e b e g i n n i n g t o work t o g e t h e r w i t h more

c o - o p e r a t i o n and m u t u a l r e s p e c t and d i s t r i c t

n u r s e s became f i n a l l y a t t a c h e d t o g e n e r a l

p r a c t i c e s . The l e g i s l a t i o n o f t h e H e a l t h S e r v i c e

A c t o f 1968 a l l o w e d d i s t r i c t n u r s e s t o s e e

p a t i e n t s I n t h e g e n e r a l p r a c t i t i o n e r ’s s u r g e r y or

h e a l t h c e n t r e and t h e s e c h a n g e s u n d o u b t e d l y h e l p e d

p r a c t i c e n u r s i n g t o e v o l v e b e c a u s e I t s o o n became

a p p a r e n t t o g e n e r a l p r a c t i t i o n e r s t h a t d i s t r i c t

n u r s e s c o u l d n o t m e e t I n d i v i d u a l p r a c t i c e needs

and c o n t i n u e t h e home n u r s i n g c a r e o f p a t i e n t s and

f o r t h i s r e a s o n some d o c t o r s began t o employ t h e i r

own n u r s e s t o work w i t h t he m I n t h e p r a c t i c e .

P r a c t i c e n u r s i n g , u n t i l r e l a t l v e l y r e c e n t l y ; has

been an o p t i o n f o r t h o s e n u r s e s r e t u r n i n g t o

n u r s i n g a f t e r a c a r e e r b r e a k , u s u a l l y o f f i v e

y e a r s or more , who w a n t e d p a r t - t i m e h o u r s t o s u i t

f a m i l y c o m m i t m e n t s b u t who e x p e c t e d no e d u c a t i o n a l

o p p o r t u n i t i e s , ( G r e e n f i e l d e t a l , 1987) . Whereas

t h e t r e n d I n more r e c e n t y e a r s has shown t h a t an

I n c r e a s i n g number o f n u r s e s h a ve c h o s e n p r a c t i c e

n u r s i n g v e r y e a r l y on I n t h e i r n u r s i n g

c a r e e r s . The d a t a t o s u p p o r t t h i s s p e c u l a t i v e

t e n d e n c y r e m a i n s a n e c d o t a l and t h e phenomenon has

y e t t o be t h o r o u g h l y r e s e a r c h e d . However , t h e

r e a s o n s I d e n t i f i e d by n u r s e s a t t e n d i n g t h e E n g l i s h

N a t i o n a l Board P r a c t i c e N u r s e C o ur s e d u r i n g t h e

p e r i o d 19 8 4- 19 88 f o r w h i c h t h e r e s e a r c h e r was

c o u r s e t u t o r , r a n g e d f r om p e r s o n a l on t h e one hand

1 . 1 0

t o pro f e s s l o n a t p r a c t l c e r e a s o n s on t h e o t h e r .

The n u r s e s I d e n t i f i e d t h e d e g r e e o f f l e x i b i l i t y

b o t h I n t h e t y p e o f work and hour s as b e i n g o f

m o s t s i g n i f i c a n c e so f a r as m e e t i n g t h e i r p e r s o n a l

f a m i l y c o mm i t m en t s wer e c o n c e r n e d and a number o f

t h e n u r s e s s t a t e d t h e y had c h o s e n p r a c t i c e

n u r s i n g b e c a u s e t h e y w a n t e d a c ha nge o f f o c u s f rom

I n t e n s i v e c a r e or c o r o n a r y c a r e w o r k . T h e s e

s t u d e n t s s t a t e d t h e y w a n t e d t o be p a r t o f p a t i e n t

c a r e a t a d i f f e r e n t end p o i n t and become an

I n t e g r a l t eam member I n p r i m a r y p r e v e n t i o n by

I n f l u e n c i n g l i f e s t y l e s and p r o m o t i n g h e a l t h I n t h e

p r i m a r y c a r e s e t t i n g o f g e n e r a l p r a c t i c e . The

g r o w t h I n t h e number o f n u r s e s becoming p r a c t i c e

n u r s e s c o n t i n u e s and t h i s g r o w t h has been

c o n s i d e r a b l e I n r e c e n t y e a r s as shown by Reedy ,

B . L . E . C . , e t a l , ( 1976) f o r t h e e a r l y y e a r s

d e t a i l s and t h e D e p a r t m e n t o f H e a l t h ( 1992) f o r

more r e c e n t f i g u r e s . The number o f g e n e r a l

p r a c t i t i o n e r s e m p l o y i n g p r a c t i c e n u r s e s has a l s o

I n c r e a s e d c o n s i d e r a b l y . I t has p r o v e d d i f f i c u l t

t o o b t a i n a c c u r a t e s t a t i s t i c s a b o u t t h e number o f

1 . 1 1

p r a c t i c e n u r s e s c u r r e n t l y e mp lo ye d b e c a u s e t h i s

I n f o r m a t i o n was n o t p a r t o f s t a f f r e t u r n s

s u b m i t t e d t o FHSAs and t h e D e p a r t m e n t o f

H e a l t h . The q u a r t e r l y r e t u r n s c o m p l e t e d by

g e n e r a l p r a c t i c e s o n l y g a v e d e t a i l s o f t h e t o t a l

numbers o f a n c i l l a r y s t a f f e mp l oy ed by g e n e r a l

p r a c t i t i o n e r s . S t a f f r e t u r n s became more

d e t a i l e d a f t e r t h e I m p l e m e n t a t i o n o f t h e New GP

C o n t r a c t o f 1990. The f i g u r e s o b t a i n e d f r om t h e

D e p a r t m e n t o f H e a l t h f o r 1984- 1990 do n o t show t h e

number o f ho u rs w o r k e d or t h e p r a c t i c e n u r s e s

q u a l i f i c a t i o n s . T a b l e 1.1 g i v e s t h e d e t a i l s o f

t h e p r a c t i c e n u r s e manpower s t a t i s t i c s .

1 . 1 2

Table. 7 . 7 The Number o f P r a c t i c e Nurses I n England

and Wales

Year: 1984 1985 1986 1987

W h o t c - t l m e n u r s e s 207 226 212 223

P a r t - t i m e n u r s e s 3846 4337 5002 5833

W h o l e - t l m e e q u i v a l e n t 2015 2326 2641 3150

1988 1989 1990

W h o l e - t l m e n u r s e s 267 - -

P a r t - t i m e n u r s e s 6975 10800 17000

W h o l e - t l m e e q u i v a l e n t s 3711 4645 7525

S o u r c e : D ep a r t m e n t o f H e a l t h , 7 9 9 2 .

The e s c a l a t i o n I n t h e r e c r u i t m e n t o f p r a c t i c e

n u r s e s was c o n s i d e r e d t o be I n p r e p a r t l o n f o r

t h e new c o n t r a c t u a l a r r a n g e m e n t s f o r g e n e r a l

p r a c t i t i o n e r s f rom A p r i l , 1990. However ,

p r a c t i c e n u r s e s . I n t e r m s o f w h o l e - t l m e

e q u i v a l e n t s r e m a i n s a s m a l l work f o r c e when

compar ing t h e i r numbers a g a i n s t o t h e r n u r s e s

w i t h i n t h e p r i m a r y h e a l t h c a r e s e t t i n g . P r a c t i c e

1 . 1 3

n u r s e s r e p r e s e n t a p p r o x i m a t e l y 20 p e r c e n t o f

a l l n u r s e s w o r k i n g I n p r i m a r y hea l t h , c a r e . The

f i g u r e s I n T a b l e 7 . 7 f rom t h e D e p a r t m e n t o f H e a l t h

( 1 992) show an I n c r e a s e o f some 29% w h o l e - t l m e

e q u i v a l e n t n u r s e s and 81% p a r t - t i m e n u r s e s and 84%

w h o l e - t l m e e q u i v a l e n t n u r s e s d u r i n g t h e p e r i o d

19 8 4 - 1 9 8 8 , w i t h an a c c e l e r a t e d p e r i o d o f e x p a n s i o n

I n 1 9 87- 1990 . T h i s g r o w t h I n p r a c t i c e n u r s e s I s

a p p a r e n t d e s p i t e t h e f a c t t h a t t h e r e I s t o d a t e no

c a r e e r s t r u c t u r e and no r e c o g n i s e d e d u c a t i o n a l

programme t o p r e p a r e t h e n u r s e or s u p p o r t t h e

p r a c t i c e n u r s e I n p r a c t i c e .

DETJNJTJON Of PRACTICE NURSE AND PRACTICE NURSING

P r a c t i c e n u r s i n g I s c h a r a c t e r i s e d by I t s l o c a t i o n

w i t h i n t h e p r a c t i c e s e t t i n g o f t h e g e n e r a l

p r a c t i t i o n e r ' s s u r g e r y or h e a l t h c e n t r e .

P r a c t i c e n u r s e s may, o f c o u r s e , work I n o t h e r

s e t t i n g s p r o v i d e d t h e y h a ve a c h i e v e d t h e - r e l e v a n t

c o m p e t e n c e s t h r o u g h a p p r o p r i a t e e d u c a t i o n and

t r a i n i n g . P r a c t i c e n u r s e s , a l t h o u g h a r e l a t l v e l y

1 . 1 4

new o c c u p a t i o n a l g r o u p f orm p a r t o f a

c o m p r e h e n s i v e n u r s i n g s e r v i c e . The r e l a t i o n s h i p

b e t we e n t h e o t h e r b r a n c h e s o f t h e n u r s i n g

pro f e s s l o n and p r a c t i c e n u r s e s r e m a i n s u n c l e a r

even when v a r i o u s members o f t h e p r i m a r y h e a l t h

c a r e t ea m a r e w o r k i n g t o g e t h e r w i t h i n t h e same

e n v i r o n m e n t .

T h e s e d i f f i c u l t i e s a r e p r o b a b l y compounded b e c a u s e

t h e p r a c t i c e n u r s e ' s r o l e , c l i n i c a l c o m p e t e n c e s

and e d u c a t i o n a l n eed s r e m a i n l l l - d e f l n e d . A

f u r t h e r r e a s o n m i g h t be t h e n a t u r e o f t h e

emp loymen t o f p r a c t i c e n u r s e s . P r a c t i c e n u r s e s ,

u n l i k e o t h e r n u r s i n g c o l l e a g u e s , a r e e m p l oy ed by

d o c t o r s and t h e management s t r u c t u r e w i t h i n a

g e n e r a l p r a c t i c e s e t t i n g I s v e r y S m a l l I n

c o m pa r l s on t o h o s p l t a l emp l oy me n t and manag e m e n t .

The e mp lo ymen t and management s t r u c t u r e w i t h i n t h e

p r a c t i c e a l l o w s f o r a c l o s e w o r k i n g r e l a t i o n s h i p

and r emoves t h e r e m o t e n e s s w h ic h some n u r s e s f e e l

happens w i t h i n t h e h o s p i t a l s e t t i n g .

1 . 1 5

P r a c t l c e n u r s i n g I s a t e r m u s e d t o d e s c r i b e a w i d e

r a n g e o f " n u r s i n g " a c t i v i t i e s w h i c h a r e u n d e r t a k e n

by p r a c t i c e n u r s e s . P r a c t i c e n u r s i n g

c h a r a c t e r i s t i c a l l y I s c o n s i d e r e d t o o c c up y a

' w a r d e n ' , ' s e l e c t i n g ' and ' g r a d i n g ' r o l e w i t h i n

t h e e n v i r o n m e n t o f p r a c t i c e w h e re t h e d e c i s i o n s

t h a t p r a c t i c e n u r s e s a r e empowered t o make by t h e

n a t u r e o f t h e i r e mp l o y m e n t a r e n o t a lways

c o n s i s t e n t w i t h t h e n u r s e ' s pro f e s s l o n a l

e d u c a t i o n , t r a i n i n g and e x p e r i e n c e .

By d e f i n i t i o n t h e p r a c t i c e n u r s e w i t h i n t h e

S t a t e m e n t o f f e e s and A l l o w a n c e s and t h e G e n e r a l

P r a c t i t i o n e r s Terms o f S e r v i c e I s d e s c r i b e d as :

"A p r a c t i c e n u r s e s h o u l d h o l d an

a p p r o p r i a t e q u a l i f i c a t i o n w h i c h I s

r e g i s t e r e d or r e c o r d e d on t h e

e f f e c t i v e p a r t o f t h e P r o f e s s i o n a l

R e g i s t e r m a i n t a i n e d by t h e U n i t e d

Kingdom C e n t r a l C o u n c i l f o r N u r s e s ,

M ld w l v e s and H e a l t h V i s i t o r s (UKCC).

1 . 1 6

T h i s w i l l n o r m a l l y be R e g i s t e r e d

G e n e r a l Nur se . Where a c t i v i t i e s

a r e u n d e r t a k e n f o r w h i c h a s p e c i f i c

q u a l i f i c a t i o n I s r e q u i r e d , f o r

I n s t a n c e h e a l t h v i s i t i n g , m i d w i f e r y

or d i s t r i c t n u r s i n g , t h e p e r s o n

w i l l be e x p e c t e d t o h o l d t h e

a p p r o p r i a t e q u a l i f i c a t i o n o f

R e g i s t e r e d H e a l t h V i s i t o r ,

R e g i s t e r e d M i d w i f e or a r e c o r d a b l e

q u a l i f i c a t i o n I n D i s t r i c t N u r s i n g .

Jn a d d i t i o n , t h e R e g i s t e r e d M i d w i f e

m u s t be a p r a c t i s i n g m i d w i f e as

d e f i n e d I n t h e UKCC Ml dwl ves R u l e s .

Where t h e p r a c t i c e n u r s e h o l d s t h e

q u a l i f i c a t i o n o f E n r o l l e d Nu rse

[ G e ne r a l ] o n l y and I s R e g i s t e r e d on

P a r t s 2 and 7 o f t h e UKCC P r o f e s s i o n a l

R e g i s t e r , t h e n he or s h e may o n l y

u n d e r t a k e a l i m i t e d r a n g e o f d u t i e s ,

h a v i n g due r e g a r d t o t h e s k i l l s o f

e n r o l l e d n u r s e c o n t a i n e d w i t h i n t h e

7. 7 7

n u r s e t r a i n i n g r u l e s o f t h e UKCC".

D e f i n i t i o n o f P r a c t i c e N u r s e D e p a r t m e n t o f H e a l t h

and Welsh O f f i c e : N a t i o n a l H e a l t h S e r v i c e G e n e r a l

M e d i c a l S e r v i c e s C o m m i t t e e S t a t e m e n t o f Fees and

A l l o w a n c e s Para. 5 2 . 2 3 ( 1 9 9 0 ) .

I t I s I n t e r e s t i n g t o n o t e t h a t t h e e mp h a s i s t h e

Ro y a l C o l l e g e o f N u r s i n g p l a c e s when d e f i n i n g a

p r a c t i c e n u r s e I s t h a t o f t h e n u r s e ' s e m p l o y e r and

t h e p l a c e o f work r a t h e r t h a n t h e r o l e :

" . . . a R e g i s t e r e d G e n e r a l Nur se who I s

e mpl oyed by t h e g e n e r a l p r a c t i t i o n e r t o

work w i t h i n t h e t r e a t m e n t room and I s a

member o f t h e t eam r e s p o n s i b l e f o r

t h e c l i n i c a l n u r s i n g c a r e o f t h e

p r a c t i c e p o p u l a t i o n . . . "

Ro y a l C o l l e g e o f N u r s i n g R e p o r t " T r a i n i n g Needs

f o r P r a c t i c e N u r s e s " , 19 84.

1 . 1 8

Jn o r d e r t o e l c L r l f y d e f i n i t i o n s I t wo u l d seem

a p p r o p r i a t e t k a t t h e r o l e o f t h e p r a c t i c e n u r s e I s

d e t e r m i n e d . The s t u d i e s w h i c h h a v e l o o k e d

a t t h e r o l e o f p r a c t i c e n u r s e s h a ve d e s c r i b e d

v a r i o u s a s p e c t s o f d e l e g a t i o n o f t a s k s , ( B o w l i n g ,

A, 1 9 85) . T h e s e s t u d i e s h a v e a l l been s m a l l I n

s i z e , u n d e r t a k e n by d o c t o r s and r e f l e c t a common

p e r c e p t i o n t h a t t h e work o f t h e p r a c t i c e n u r s e I s

r e a c t l v e t o m e d i c a l d i a g n o s i s and I n some

I n s t a n c e s I t has been shown t h a t d e l e g a t i o n o f

work has been e x t e n s l v e .

One e a r l y s t u d y , f o r e x a m p l e , l o o k e d a t t h e

e f f e c t s o f n u r s e s u n d e r t a k i n g home v i s i t s ,

( O Jes ton - Sml t h , J . Mo t t r am, E. M. , 1 967) w h i l e

a n o t h e r n o t e d t h a t some p r a c t i c e n u r s e s p e r f o r m e d

V e n e p u n c t u r e , s u t u r e d wounds g a v e s i m p l e

p h y s i o t h e r a p y and a s s e s s e d p a t i e n t s a t t e n d i n g t h e

s u r g e r y w i t h o u t an a p p o i n t m e n t , ( Hockey , L. 1984) .

More r e c e n t l y a s t u d y by G r e e n f i e l d e t a l (1987)

I d e n t i f i e d l a r g e v a r i a t i o n s I n work p a t t e r n s and a

c o n s i d e r a b l e e x t e n s i o n o f t h e t r a d i t i o n a l n u r s i n g

1 . 1 9

r o l e and t h a t many p r a c t i c e n u r s e s had an e x t e n d e d

r o l e , s i n c e o v e r 70% t o o k c e r v i c a l s m e a r s , 60%

exa mi ned p a t i e n t s ' b r e a s t s and 69% u n d e r t o o k

a u r o s c o p l c e x a m i n a t i o n o f t h e e a r s , n o s e and

t h r o a t . Only a f ew had e x t e n d e d t h e i r r o l e I n t o

conv e n t l o n a l m e d i c a l a r e a s w i t h 8% u s i n g a

s t e t h o s c o p e t o e xa mi n e t h e h e a r t and l u n g s and 4%

p e r f o r m i n g an a b d o m i n a l p a l p a t i o n . O v e r a l l 69%

o f n u r s e s wer e o f t h e o p i n i o n t h a t t h e i r r o l e was

e x t e n d e d beyond t h a t o f b a s i c t r a i n i n g , b u t t h e r e

were enormous v a r i a t i o n s I n t h e p a t t e r n o f work o f

p r a c t i c e n u r s e s h i g h l i g h t i n g t h e l a c k o f r o l e

d e f i n i t i o n . The s t u d y I n c l u d e d I n I t s d i s c u s s i o n

t h e n eed t o d e v e l o p t h e c l i n i c a l and I n

p a r t i c u l a r t h e c a r i n g a s p e c t o f n u r s i n g .

Jn t h e w i d e r pro f e s s l o n o f n u r s i n g t h e r e has been

some c o n c e r n a t t h e p o s s i b i l i t y t h a t t h e p r a c t i c e

n u r s e s ’ r o l e m i g h t be a b a n do n i ng t h e c a r i n g e t h i c

o f n u r s i n g I n f a v o u r o f a more m e d i c a l m o d e l ,

( Hockey , L . , 1984) . T h i s c o n c e r n I s compounded

by t h e l a c k o f r e s e a r c h I n t o t h e p r o c e s s and

1 . 2 0

outc.oïïit6 o l pKactJ^cQ, nu^6X,ng and the. Zaak

6 a t t a b Z z e.daaatZon Ion. pn.actZc.e. nun.ée.6,

WHY IS PRACTICE NURSING NECESSARY?

SZnce. the. de . lZnZtZon o l the. pn.actZc.e. nun.6e. Lh

n.e.Zate.d t o the. pZace. o^ e.mpZoyme.nt and the.

e.mpZoye.n. n.athe.n. t h a n t o nun.6Zng n.oZe. voZthZn

pn.Zman.y can.e. Z t ujouZd 6e.e.m appn.opn.Zate. t o l o a a ^

upon Ze.gZ6ZatZon vohZah ha6 Zn^Zue.nc.e.d the.

e.men.g e.nc.e. o^ the. pnac tZce . nan.6e. and pn.ac.tZc.e.

nun.6Zng .

Gov e.n.nme.nt VoZZcy

The.n.e. can be. ZZt tZe. d o u b t t h a t the. pn.e.6e.nt change.

Zn cmphaéZ^ t o pn.Zman.y and communZty can.c ^n.om

6 ccondan.y can.c ha6 majon. ZmpZZcatZon6 ^on. t h e

n.e.cZpZcnt6 o l he.aZth can.e, t h e CommZ6 6Zonen.6 and

t h e Vn.ovZden.6 . The Gov en .nmen t '6 pn.ogn.amme ^on.

"Jmpn.ovZng Vn.Zman.y HeaZth Can.e" decZan.ed Zn t h e

WhZte Vapen. "Pn.omotZng Bet ten. HeaZth^' ( 1 987)

1 , 2 1

" . . . t h e a e Z6 no 6 Z n g l e a Z g k t voay o^

on,ganZ6Zng 6en.vZc.e6 and t h e deeZ6Zon

a b o u t ujhat Z6 appn.opn.Zate Zn d Z H e a e n t

Z o eaZ Zt Ze6 n.emaZn6 one Ion, t h e HeaZth

Authon.Zty coneen.ned' ' (?an.a 7 . 7}

"?n.Zman.y ean.e Z6 b e 6 t ujhen pn.ovZded by a

n.ange o^ pn.o l e 66 Zo naZ 6 t a i l voon.kZng

t o g e t h e n . a6 memben.6 o^ a pn.Zman.y

h e a Z t h ean.e t e a m . . . E H e e t Z v e t e a m

won.kZng n.equZn.e6 a u}ZZZZngne66 among6t

aZZ t ea m memben.6 t o e o - o p e n . a t e and

eommunZeate weZZ, and t o a d o p t a

^ZexZbZe appn.oaeh vohZeh p u t 6 t h e

qu aZ Z ty o^ h e a Z t h ean,e pn.ovZ6Zon

t o t h e po pu Za tZ on 6en.ved a b ov e

pn. 0 l e6 6 Zo na Z 6 t a t u 6 and ^ u n e t Z o n " .

l?an.a 7 . 8 and 7 . 9}

"Tn.aZnZng Coun.6e6 Ion. ?n .ae tZee Uun , 6e6 . . .

7 . 2 2

t o Zncn.ea6e tKaZnZng oppon. tanZtZe6 . . .

Zn a voay t h a t n . e ^ l e c t 6 t h e n e ed l oa

gKeaten. a e e e 6 6 Z b Z l Z t y ^oa mon.e

nun.6e6 and {on. { Z e x Z b Z l Z t y o{

d e i Z g n " . {Van.a 1 . 14]

The HatZonaZ HeaZth Sen.vZee n.evZevo papen.6 "CJoakZng

{on. P a t Z e n t é " (Vepan. tment o{ HeaZth , 1 989 ) , t h e

CommunZty Can.e (iJhZte Papen. "Can.Zng {on. PeopZe" ,

( 1 989 ) and t h e Heu) Contn.aet {on. Genen.aZ

Pn.aetZtZonen.6, (Vepan. tment o{ HeaZth and WeZ^h

0 { { Z e e , 1 989 ) pn.opo6ed majon. c ha n ge s Zn t h e

on.ganZ6atZon o{ t h e HatZonaZ HeaZth Sen.vZee voZth

t h e Zntn. 0 d u e t Z o n o{ CommZ66Zonen.6 and Pn.ovZden.6,

t h e { on.matZon o{ HatZonaZ HeaZth Sen.vZee Tn.u6t6

and g enenaZ pn.aetZtZonen.6 managZng theZn. ovon

b u d g e t ojen.e d e ^ t Z n e d t o h a ve a 6 Z g n Z { Z e a n t Zmpaet

on t h e deZZv en.y o{ h e a Z t h ean.e.

T heée pn.opo6aZé u)en.e 6uppon. ted by t h e CommunZty

Can.e WhZte Papen. "Can.Zng {on. PeopZe*' ( 1 989 ) .

ThZ6 papen. 6tn .e66ed t h e n ee d {on. t h e Zn tn . od ue t Zon

1 . 2 3

o{ h e a l t h pn.omotZon and h e a l t h 6un.v e Z l l a n e e Zn

pn.Zman,y ean.e and t h e n.ole l o c a l authon.ZtZe6 voZll

need t o p l a y Zn t h e d e l Z v e a y o{ 6en.vZce6 Zn t h e

pn.Zman.y / communZty can.e 6 e t t Z n g ,

The CommunZty Hun.6Zng RevZeu)6 ( V e p a a t m e n t o{

H e a l t h , 1986, Wel6h 0 { { Z c e , 1989, S c o t t i s h Home

and H e a l t h Vepan. tment , 1 9 85 and t h e Hon.then.n

In .e land Boan.d {on. H e a l t h and S o c Z a l S e cu n .Z ty ,

1 986 } 6 tn .e66ed t h e n ee d {on. t h e u t Z l Z z a t Z o n o{

nun.6Zng and h e a l t h vZ^Z tZng 6 k Z l l 6 {on. t h e gaeaten.

e{ { e c t Z v ene66 o{ pn.Zman.y h e a l t h can.e vohZch can

b c 6 t be a c h i e v e d Zn pan. tnen.6hZp voZth t h e con6umen. .

Gn.Z{{Zth ( 1 983 ) a l 6 o empha 6l6 ed t h e n eed {on. a

commi t men t t o con6umen.l6m a6 a p Z v o t o{

p n . o du c t Zv Z t y and q u a l i t y and un.ged and encoun.aged

t h e nun.6lng pn.o { e 6 6 l o n t o t h i n k c n . Z t Z c a l l y a b o u t

t h e 6han.Zng o{ n . e6pon6ZbZlZtZe6 uoZth t h e

p a t i e n t I c l i e n t and h l 6 /hen . can.en.6 on. 6uppon. ten.6.

Thl6 pan.tnen.6hZp Zn can.e c h a l l e n g e6 t h e

t n . a d Z t Z o n a l n.ole o{ t h e nun.6e b e c a u 6 e Z t gZve6 a

hZghen. pn.o{Zle t o t h e n.ole o{ t h e nun.6e Zn

1 . 2 4

a66 e 6 6 l n g , dZagno6Zng and pn.e6c.n.ZbZng t h e nun.6tng

eafie pn.ogn.amme6, monZton.Zng and e v a l u a t i n g t h a t

pfLogaamme and t h e 6ub6 e q u e n t o u t co mes o{ nun.6lng

e a a e .

The I n t r o d u c t i o n o{ t h e tujo W h i t e Papers "Working

{ o r P a t i e n t é " [ V e p a r t m e n t o{ H e a l t h , 1989) and t h e

H e a l t h S e r v i c e s "Communi ty Care B i l l " ( 1989) haé

had a ma jor I m p a c t on t h e o r g a n i s a t i o n , p r o v i s i o n

and d e l i v e r y o{ h e a l t h c a r e I n t h e U n i t e d Kingdom.

The r e { o r m s h ave n o t o n l y a { { e c t e d t h e

emplo ymen t a r r a n g e m e n t s o{ n u r s e s , mldvulves

and h e a l t h v i s i t o r s b u t a l s o t h e t r a d i t i o n a l r o l e

b o u n d a r i e s and c o n t r a c t u a l o b l i g a t i o n s o{ t h e

pro { e s s l o n a l u j l th t h e p a t i e n t / c l i e n t .

L e g i s l a t i o n A { { e c t l n g G e n e r a l P r a c t i c e

As p r e v i o u s l y s t a t e d , t h e d o c t o r ' s C h a r t e r o{ 1965

r e a l l y ujas t h e I m p e t u s w h i c h moved g e n e r a l

p r a c t i t i o n e r s t o s e e t h e a d v a n t a g e s o{ e m p l o y i n g

t h e i r own n u r s e s t o work w i t h i n t h e p r a c t i c e

1 . 2 5

s e t t i n g and t o s h a r e I n t h e p r o { e s s l o n a l

r e s p o n s i b i l i t i e s w h i c h p r e s e n t w i t h i n t h e

p r a c t i c e . The G e n e r a l P r a c t i t i o n e r C o n t r a c t o{

1990 S u p p o r t e d t h e d e l e g a t i o n o{ t a s k s by m e d i c a l

p r a c t i t i o n e r s t o t h e i r p r a c t i c e n u r s e c o l l e a g u e s .

The G e n e r a l p r a c t i t i o n e r , h o we v er , has an

o b l i g a t i o n t o e n s u r e t h a t t h e p e r s o n t o whom t h e

d o c t o r has d e l e g a t e d t h e t r e a t m e n t or p r o c e d u r e

I s c o m p e t e n t t o c a r r y o u t t h e t r e a t m e n t a n d l o r

p r o c e d u r e . { G e n e r a l H e d l c a l C o u n c i l ,

" P r o f e s s i o n a l Conduc t and d i s c i p l i n e : F i t n e s s t o

P r a c t i c e " . A p r i l , 1981 and Terms and C o n d i t i o n s

of S e r v i c e f o r d o c t o r s I n G e n e r a l P r a c t i c e

d e p a r t m e n t o f H e a l t h and Welsh O f f i c e , Para 16,

7 9297 .

S i m i l a r l y , n u r s e s a r e r e q u i r e d by s t a t u t e t o

e x e r c i s e pro f e s s l o n a l a c c o u n t a b i l i t y and t o

a c k n o w l e d g e l i m i t a t i o n s o f p r a e t l c e and r e f u s e t o

a c c e p t d e l e g a t e d f u n c t i o n s u n t i l t h e n u r s e has

r e c e i v e d t h e n e c e s s a r y t r a i n i n g and has been

a s s e s s e d as c o m p e t e n t t o u n d e r t a k e e x t e n d e d r o l e

1 . 26

a c t i v i t i e s . (UKCC Code o f P r o f e s s l o n a l Conduc t

f o r t h e Hurse , H l d w l f e and H e a l t h V i s i t o r , 1984) .

T h e s e r e q u i r e m e n t s o f t h e n u r s e a r e s t a t e d :

"Each r e g i s t e r e d n u r s e , m i d w i f e and

h e a l t h v i s i t o r s h a l l a c t , a t a l l

t i m e s I n s u c h a manner as t o J u s t i f y

p u b l i c t r u s t and c o n f i d e n c e , t o

u p h o l d and e n h a n c e t h e good

s t a n d i n g and r e p u t a t i o n o f t h e

pro f e s s l o n , t o s e r v e t h e I n t e r e s t s

of s o c i e t y , and a b o v e a l l t o s a f e g u a r d

t h e I n t e r e s t o f I n d i v i d u a l p a t i e n t s

and c l i e n t s ,

Each r e g i s t e r e d n u r s e , m i d w i f e and

h e a l t h v i s i t o r I s a c c o u n t a b l e f o r

h i s or h e r p r a c t i c e , and. I n t h e

e x e r c i s e o f p r o f e s s i o n a l a c c o u n t a b i l i t y

s h a l l :

7 . 2 7

Ac k n o w l e d g e any l i m i t a t i o n s o f

c o m p e t e n c e and r e f u s e I n s u c h c a s e s

t o a c c e p t d e l e g a t e d f u n c t i o n s

w i t h o u t f i r s t h a v i n g r e c e i v e d

I n s t r u c t i o n I n r e g a r d t o t h o s e

f u n c t i o n s and h a v i n g been a s s e s s e d

as c o m p e t e n t " .

UKCC Code o f P r o f e s s i o n a l Conduc t f o r t h e Hurse ,

H l d w l f e and H e a l t h V i s i t o r , par a 4, 1984.

A Harp l an s u r v e y I n 1986 u n d e r t a k e n as p a r t o f t h e

co mmun i t y n u r s i n g r e v i e w " n e i g h b o u r h o o d Hu r s l n g -

a Focus f o r Care R e p o r t o f t h e Communi ty H ur s lng

Rev i ew Ch. J u l i a C um b er le ge , ( V e p a r t m e n t o f

H e a l t h , 1986] , I d e n t i f i e d t h a t s i x t y p e r c e n t o f

t h e s u r v e y p o p u l a t i o n a c t u a l l y p r e f e r r e d t o s e e a

n u r s e f o r c e r t a i n a s p e c t s o f t h e i r h e a l t h c a r e .

Of t h e s e s i x t y p e r c e n t , more t h a n h a l f

p r e f e r r e d t o s e e t h e n u r s e , b e c a u s e t h e y

c o n s i d e r e d t h e n u r s e t o be more s y m p a t h e t i c and

e a s i e r t o t a l k t o .

1 . 2 8

The Cumberleg e R e p o r t (1 986 ) a l s o p o i n t e d o u t t h a t

t h e r e was l i t t l e or no a p p r o p r i a t e e d u c a t i o n f o r

p r a c t i c e n u r s e s . The m a j o r i t y o f p r a c t i c e n u r s e s

we r e t r a i n e d by t h e i r e m p l o y e r - t h e g e n e r a l

p r a c t i t i o n e r - t o do a p a r t i c u l a r t a s k or t a s k s .

The V e v e l o p m e n t o f t h e O c c u p a t i o n and t h e Need f o r

T r a i n i n g f o r P r a c t i c e Nur ses

The f o r e g o i n g I l l u s t r a t e s t h e c om pl ex n e t w o r k o f

c h an ge f o r c a r e I n t h e c o m m u n i t y . T h e s e

c h a n g e s , a c c o r d i n g t o t h e A u d i t Commi ss ion ( 79 S 8 ) ,

b r i n g t o g e t h e r t h e r a n g e o f p r o f e s s i o n a l s k i l l s

a v a i l a b l e I n t h e commu ni t y so t h a t t h e u t i l i z a t i o n

o f r e s o u r c e s I s m a x i m i s e d f o r t h e b e n e f i t o f

p a t i e n t s / c l i e n t s , c a r e r s , s u p p o r t e r s and s o c i e t y

as a w h o l e .

The c h a l l e n g e f o r t h e pro f e s s i o n s I s t o e n s u r e

t h e s e c ha n g e s c o n t r i b u t e t o t h e a c h l e v ement o f t h e

World H e a l t h O r g a n i s a t i o n e x p e c t a t i o n s o f Pr i ma ry

H e a l t h Care by t h e y e a r 2000, n a me ly :

1 . 2 9

"VrJimary h e a l t h c a r e Jis e s s e n t i a l

h e a l t h c a r e , b a s e d on p r a c t i c a l ,

s c i e n t i f i c a l l y s o u n d and s o c i a l l y

a c c e p t a b l e me th od s and t e c h n o l o g y ,

made u n l v e r s a l l y a c c e s s i b l e t o

I n d i v i d u a l s and f a m i l i e s I n t h e

c o m mu n i t y t h r o u g h f u l l p a r t i c i p a t i o n

and a t a c o s t t h a t t h e co mmun i t y

and c o u n t r y can a f f o r d t o m a i n t a i n ,

a t e v e r y s t a g e o f t h e i r dev e l o p m e n t ,

I n t h e s p i r i t o f s e l f - r e l i a n c e and

s e l f d e t e r m i n a t i o n . I t f or ms an

I n t e g r a l p a r t b o t h o f t h e c o u n t r y ' s

h e a l t h s y s t e m , o f w h i c h I t I s t h e

c e n t r a l f u n c t i o n and main f o c u s , and

o f t h e o v e r a l l s o c i a l and econ omi c

d e v e l o p m e n t o f t h e c o m m u n i t y . I t

I s t h e f i r s t l e v e l o f c o n t a c t o f

I n d i v i d u a l s , t h e f a m i l y , and

c om mu ni t y w i t h t h e n a t i o n a l h e a l t h

s y s t e m , b r i n g i n g h e a l t h c a r e as c l o s e

as p o s s i b l e t o w h e r e p e o p l e l i v e and

1 . 3 0

work , and c o n s t i t u t e s t h e f i r s t

e l e m e n t o f a c o n t i n u i n g h e a l t h c a r e

p r o c e s s ".

The Alma At a D e c l a r a t i o n , 1918,

As p r a c t i c e n u r s i n g has e v o l v e d f rom v e r y s m a l l

b e g i n n i n g s , t h e p r o b l e m r e m a i n s t h a t t h e r e I s v e r y

l i t t l e e v i d e n c e t o I d e n t i f y wh at p r a c t i c e n u r s e s

do b e s t . An u n p u b l i s h e d s t u d y ( S t l l w e l l , B . ,

1981) showed t h a t p r a c t i c e n u r s e s we r e a p p r e c i a t e d

by p a t i e n t s f o r g i v i n g t i m e , l i s t e n i n g and showi ng

c a r e t h r o u g h g i v i n g e x p l a n a t i o n s . P a t i e n t s a l s o

f e l t t h e y c o u l d "pop I n " t o t a l k o v e r s e e m l n g l y

t r i v i a l p r o b l e m s w i t h t h e n u r s e . The a s s u m p t i o n

p e r h a p s can be made t h a t f o r t h o s e p e o p l e u s i n g

t h e n u r s i n g s e r v i c e I n t h i s way t h a t t h e q u a l i t y

o f t h e r e l a t i o n s h i p w h i c h t h e y e x p e c t t o be a b l e

t o e s t a b l i s h w i t h t h e n u r s e may be an I m p o r t a n t

m o t i v a t i n g f a c t o r . The p a t i e n t may f e e l more

c o m f o r t a b l e n o t o n l y when a t t e n d i n g f o r h e a l t h

s c r e e n i n g b u t a l s o when a s k i n g t r i v i a l q u e s t i o n s

1 . 3 1

and a d m i t t i n g t o an u n h e a l t h y l i f e s t y l e .

R e s e a r c h f rom No r th A m e r i ca shows t h a t n u r s e s h ave

e x c e l l e n t r e s u l t s I n h e l p i n g p e o p l e t o c h an ge

t h e i r l i f e s t y l e p r a c t i c e s . One s t u d y showed t h a t

p e o p l e c a r e d f o r by n u r s e p r a c t i t i o n e r s had b e t t e r

c o n t r o l l e d b l o o d p r e s s u r e t h a n when t h e p a t i e n t s

wer e c a r e d f o r by p h y s i c i a n s , (Ramsay, J . e t a l ,

1982) . A n o t h e r s t u d y f o u n d t h a t n u r s e s wer e

e f f e c t i v e a t h e l p i n g p e o p l e l o s e w e i g h t , keep

a p p o i n t m e n t s and compl y w i t h r e c o m m e n d a t i o n s ,

( W a l k i n g s , L. e t a l , 1 9 8 2 ) .

I t wo u ld seem a p p r o p r i a t e f rom t h e f o r e g o i n g t h a t

t h e r e I s a need t o d e t e r m i n e w ha t a r e t h e

p e r c e l v ed e d u c a t i o n a l n e e d s o f t h o s e who a r e

u n d e r t a k i n g an I I I d e f i n e d Job f o r w h i c h t h e r e I s

no c l e a r r o l e . In s p i t e o f t h e v a r i o u s

c r i t i c i s m s wh i ch h a v e been made a b o u t p r a c t i c e

n u r s i n g , p r a c t i c e n u r s i n g has become e s t a b l i s h e d

as a p r o f e s s l o n a l o c c u p a t i o n w h ic h I s r e c o g n i s e d

and r e s p e c t e d n o t o n l y by t h e p u b l i c , o t h e r

1 . 3 2

n u r s i n g c o l l e a g u e s b u t a l s o t h e Go ve r n m e n t .

P r a c t i c e n u r s e s a r e becoming more c o n f i d e n t a b o u t

t h e i r c o n t r i b u t i o n t o p r i m a r y h e a l t h c a r e . As

t h i s happens p r a c t i c e n u r s e s m i g h t f e e l more a b l e

t o be much more a s s e r t i v e a b o u t wha t t h e y c o n s i d e r

t o be t h e i r r o l e I d e n t i f y i n g wh at I s a p p r o p r i a t e

f o r t hem t o be d o i n g as n u r s e s I n g e n e r a l p r a c t i c e

and moving away f rom b e i n g d o c t o r ' s a i d s .

However, t h i s g r o w i n g w o r k f o r c e , w i t h a w i d e

v a r i a t i o n I n k n o w l e d g e and s k i l l s I s a l s o f a c i n g

t h e d i l emma o f c h a n g i n g r o l e s and r e s p o n s i b i l i t i e s

as g e n e r a l p r a c t i c e and p r i m a r y c a r e d e v e l o p .

The ne ed f o r e d u c a t i o n a l p r o v i s i o n t o m e e t t h e

d i s p a r a t e and c h a n g i n g n ee ds o f p r a c t i c e n u r s e s I s

as I s s u e w h ic h n eed s t o be a d d r e s s e d

I t I s r e c o g n i s e d t h a t t h e r e I s a n ee d f o r r e s e a r c h

t o d e t e r m i n e t h e p r o c e s s and o u tc om es o f t h e

p r a c t i c e n u r s e ' s wo rk , t h i s I n I t s e l f m i g h t

d e t e r m i n e t h e p r a c t i c e n u r s e ' s r o l e even t h o u g h I t

I s r e c o g n i s e d t h a t n u r s e s e n t e r i n g p r a c t i c e

n u r s i n g come f rom a v a r i e t y o f n u r s i n g b a c k g r o u n d s

1 . 3 3

with, a w i d e r a n g e o f pro f e s s l o n a l k n o w l e d g e ,

s k i l l s and c o m p e t e n c e s which. can I n f l u e n c e

t h e v a r i e t y and r a n g e o f n u r s i n g p r a c t i c e .

However , b e f o r e s u c h a s t u d y can be c o n t e m p l a t e d

I t wo ul d seem a p p r o p r i a t e t h a t p r a c t i c e n u r s e s be

a s k e d a b o u t t h e i r a c t i v i t i e s . T h i s s t u d y w i l l

d e t e r m i n e t h e d e t a i l s o f t h e p r a c t i c e s I n w h i c h

t h e p r a c t i c e n u r s e w o r k s , t h e n u r s e ’s o c c u p a t i o n a l

r o l e and t h e p r e p a r a t i o n . I f any , f o r t h a t r o l e

and t h e p e r c e l v ed l e a r n i n g n e ed s o f t h e p r a c t i c e

n u r s e u n d e r t a k i n g p r a c t i c e n u r s i n g a c t i v i t i e s .

The r e s p o n d e n t s ’ v i e w s r e g a r d i n g t h e d e t a i l s o f

c o n t i n u i n g e d u c a t i o n w i l l be s o u g h t and p e r s o n a l

d e t a i l s r e l a t i n g t o q u a l i f i c a t i o n s a t t a i n e d ,

l e n g t h o f t i m e as a p r a c t i c e n u r s e w i l l be

r e q u e s t e d .

I t I s a n t i c i p a t e d t h a t t h e d a t a f rom t h i s s t u d y

w i l l h i g h l i g h t t h a t t h e m a j o r i t y o f p r a c t i c e

n u r s e s work I n I s o l a t i o n (Vamant , 1 99 0 ) , m o s t work

p a r t - t i m e and r e l a t l v e l y f ew ha ve e i t h e r Job

d e s c r i p t i o n s , C o n t r a c t s o f Employment or work t o

1 . 3 4

a g r e e d p r o t o c o l s or s t a n d a r d s . The d i v e r s i t y o f

t h e r o l e , I t I s e n v i s a g e d , w i l l become a p p a r e n t

as w i l l t h e amount o f t r a i n i n g c o m p l e t e d by t h e

n u r s e s i n c e becoming a p r a c t i c e n u r s e be v a r i a b l e

and I t I s a n t l c p a t e d t h a t t h e s t u d y w i l l show t h a t

t h e m a j o r i t y o f p r a c t i c e n u r s e s h av e p l a n n e d and

u n d e r t a k e n t h e i r own c o n t i n u i n g e d u c a t i o n .

The dev e l o p m e n t o f p r a c t i c e n u r s i n g t o g e t h e r w i t h

t h e e d u c a t i o n a l I n i t i a t i v e s w h ic h h ave emerged

o v er t h e y e a r s w i t h t h e dev e l o p m e n t o f p o l i c y

w i l l be c o n s i d e r e d I n t h e c h a p t e r w h i c h f o l l o w s .

1 . 3 5

CHAPTER TWO

THE VEVELOPHENT OF PRA CTI CE NURSING ANV

PREPARATI ON FOR PRACTI CE

P r a c t i c e n u r s i n g has dev e l o p e d and c o n t i n u e d t o

grow beyo nd a l l r e c o g n i t i o n f rom t h o s e e a r l y days

o f Mary Hannah Robson t h e f i r s t r e c o r d e d p r a c t i c e

n u r s e , t h e D o c t o r ’s C h a r t e r o f 1965 and t h e

v a r i o u s Gov e r n m e n t l e g i s l a t i o n w h i c h has f o l l o w e d ,

The e m p ha s i s has moved away f rom s e c o n d a r y c a r e t o

p r i m a r y c a r e and t h e g e n e r a l p r a c t i c e s e t t i n g .

The r a p i d I n c r e a s e I n w o r k f o r c e I s c o n s i d e r e d t o

be t h e r e s u l t o f n o t o n l y l e g a l and f i s c a l

a rr a n g emen t s I n t r o d u c e d I n 1 965 w i t h t h e

I n t r o d u c t i o n o f t h e 70% r e i m b u r s e m e n t s c h e m e w h i c h

e n a b l e d g e n e r a l p r a c t i t i o n e r s t o r e c l a i m s a l a r i e s

o f a n c i l l a r y s t a f f e mp lo ye d by t he m - I n c l u d i n g

p r a c t i c e n u r s e s - b u t a l s o due t o t h e I n a b i l i t y o f

communi ty n u r s e s t o m e e t t h e g r o w i n g demands o f

g e n e r a l p r a c t i c e .

The e o n t l n u e d e x p a n s i o n I n p r a c t i c e n u r s e numbers

p r o m p t e d t h e V e p a r t m e n t o f H e a l t h t o I s s u e a s t a f f

t r a i n i n g memorandum I n 1975. T h i s memorandum

acknoiv ledg ed t h a t c o n s i d e r a t i o n m i g h t n eed t o be

g i v e n t o l o n g t e r m t r a i n i n g f o r p r a c t i c e n u r s e s ,

I f , as an o c c u p a t i o n a l g ro up t h e y c o n t i n u e d t o

expand and I f t h e i r r o l e d e v e l o p e d . The

V e p a r t m e n t o f H e a l t h I s s u e d a f u r t h e r c i r c u l a r

S p e c i f i c a l l y f o r p r a c t i c e n u r s e s I n 1977. T h i s

d ocu men t a d d r e s s e d t h e I s s u e o f pro f e s s l o n a l

a c c o u n t a b i l i t y . Nu rse s wer e a l l e r t e d t o t h e i r

l e g a l r e s p o n s i b i l i t i e s I f t h e y u n d e r t o o k t a s k s f o r

whi ch t h e y were n o t c o m p e t e n t t o p e r f o r m . In

s p i t e o f t h e s e memoranda and t h e I m p l i e d a w a r e n e s s

of t h e e d u c a t i o n a l n eed s o f p r a c t i c e n u r s e s , no

a p p r o v e d e d u c a t i o n a l programme was f o r t h c o m i n g .

U n d o u b t e d l y , t h e work p r a c t i c e n u r s e s u n d e r t a k e I s

v a r i e d and t h e r a n g e and v a r i e t y o f work t h e

n u r s e s u n d e r t a k e I n e v i t a b l y w i l l r e l a t e n o t o n l y

t o t h e p r a c t i c e p h i l o s o p h y b u t a l s o t o t h e n u r s e s ’

c o m p e t e n c e . Some g e n e r a l p r a c t i t i o n e r s and

pr o Lc t l c e n u r s e s I d e n t i f i e d t h e a d v a n t a g e s o f (1)

e m p l o y i n g a p r a c t i c e n u r s e and (2) o f w o r k i n g

as a p r a c t i c e n u r s e .

(1) Some o f t h e a d v a n t a g e s o f e m p l o y i n g a p r a c t i c e

n u r s e :

* F l e x i b i l i t y : The p r a c t i c e n u r s e , b a s e d a t t h e

p r a c t i c e I s a v a i l a b l e f o r any e x t r a a c t i v i t y t h a t

m i g h t be r e f e r r e d or d e l e g a t e d t o h i m / h e r

( B o w l i n g , 19 8 1 ) .

* Complex n e g o t i a t i o n : The co mp lex n e g o t i a t i o n s

w h i ch t a k e p l a c e b e t w e e n g e n e r a l p r a c t i t i o n e r and

n u r s e manager when any c ha n g e s or d e v e l o p m e n t s I n

s e r v i c e p r o v i s i o n f rom d i s t r i c t n u r s e s or h e a l t h

v i s i t o r s I s r e moved , b e c a u s e t h e p r a c t i c e n u r s e I s

e m p l oy ed by t h e g e n e r a l p r a c t i t i o n e r and p l a n s f o r

c h an ge can be d i s c u s s e d more r e a d i l y as a p r a c t i c e

t eam and more e a s i l y I m p l e m e n t e d t h a n I s t h e c a s e

when n e g o t i a t i o n s h ave t o t a k e p l a c e b e t w e e n n u r s e

managers and a t t a c h e d s t a f f (Hockey , 19 8 4 ) .

* Time s a v i n g : Some o f t h e e a r l y s t u d i e s on

p r a c t i c e n u r s e s a t t e m p t e d t o m e a s u r e t h e c a p a c i t y

o f t h e n u r s e f o r s a v i n g t h e d o c t o r ’s t i m e ( Reed y ,

1 9 7 2 ) . The s t u d i e s w e r e l i m i t e d , h o w e v e r , and

m a i n l y l o o k e d a t t a s k s and n o t a t o u t c o m e s or

q u a l i t y . The r e s u l t s o f t h e s t u d i e s we r e

e q u i v o c a l . The m o s t I m p o r t a n t c o n c l u s i o n was

t h a t t h e d o c t o r has a number o f t i m e - c o n s u m i n g

t a s k s t a k e n f rom him by t h e n u r s e , who was

c o n s i d e r e d t o be t h e more a p p r o p r i a t e and

c o m p e t e n t p e r s o n t o u n d e r t a k e t h e t a s k s ( R ee dy ,

197 2) .

(2) A d v a n t a g e s f o r t h e p r a c t i c e n u r s e :

* C o n v e n i e n t h o u r s : Hours a r e n e g o t i a b l e w i t h

t h e g e n e r a l p r a c t i t i o n e r . However , t h e minimum

number o f h ou r s t h a t can be w o r ke d t o w a r r a n t r e

i m b u r s e m e n t I s f i v e h ou r s p e r w e e k . The

m a j o r i t y o f p r a c t i c e n u r s e s work p a r t - t i m e

a c c o r d i n g t o a r e c e n t n a t i o n a l c e n s u s o f p r a c t i c e

n u r s e s u n d e r t a k e n by A t k i n e t a l ( 1 9 9 3 ) .

* A d e g r e e o f au tonomy : The n u r s e I s o u t s i d e

n u r s i n g management s t r u c t u r e and has t h e p o t e n t i a l

f o r I n i t i a t i n g and r e g u l a t i n g her own wor k ,

* V a r i e d and I n t e r e s t i n g work: The s t u d i e s

I n d i c a t e d t h a t p r a c t i c e n u r s e s have a d i s l i k e o f

r o u t i n e .

* The p r a c t i c e n u r s e a c c e p t s d i r e c t p a t i e n t

r e f e r r a l s

C a r t w r i g h t e t a l I n 1961 I d e n t i f i e d t h r e e a r e a s o f

p r a c t i c e n u r s e ’s wor k . T h i s s t u d y I n v o l v e d two

p r a c t i c e s w h ic h c o m p r i s e d t h e U n i v e r s i t y

G e n e r a l P r a c t i t i o n e r T e a c h i n g U n i t . The f i r s t

I d e n t i f i e d a r e a o f p r a c t i c e n u r s e ’s work r e l a t e d

t o a c t i v i t i e s n o r m a l l y u n d e r t a k e n by

g e n e r a l p r a c t i t i o n e r s as p a r t o f g e n e r a l

m e d i c a l s e r v i c e s . Task s wer e d e l e g a t e d by t h e

g e n e r a l p r a c t i t i o n e r t o t h e p r a c t i c e n u r s e s

b e c a u s e t h e n u r s e s w e r e c o n s i d e r e d as t h e more

a p p r o p r i a t e and c o m p e t e n t p e o p l e t o u n d e r t a k e t h e

t a s k s . S e c o n d l y , p r a c t i c e n u r s e s wer e

u n d e r t a k i n g d i a g n o s t i c and t h e r a p e u t i c a c t i v i t i e s

w i t h i n t h e p r a c t i c e s e t t i n g . P r e v i o u s l y s u c h

a c t i v i t i e s m i g h t o t h e r w i s e h a ve been p e r f o r m e d I n

o t h e r p a r t s o f t h e h e a l t h s e r v i c e s u c h as t h e

h o s p i t a l or co mmun i t y s e t t i n g , and t h i r d l y by t h e

n u r s e a s s i s t i n g t h e d o c t o r b o t h t h e q u a l i t a t i v e

and q u a n t i t a t i v e p e r s o n a l c a r e g i v e n by t h e d o c t o r

was c o n s i d e r e d t o be e n h a n c e d . A n o t h e r l a t e r

s t u d y by J e f f e r y s e t a l ( 1 983 ) I n v o l v i n g f o u r

p r a c t i c e s came t o t h e same c o n c l u s i o n as

C a r t w r i g h t e t a l I n 1961. But I n t h i s s t u d y t h e

r o l e o f t h e p r a c t i c e n u r s e I n p r e v e n t l o n was

f u r t h e r e x t e n d e d and I n c l u d e d s c r e e n i n g and

c o u n s e l l i n g o f p a t i e n t s ’ and b e c a u s e p r a c t i c e

n u r s e s wer e becoming more aware o f p a t i e n t s ’ l i v e s

and f e e l i n g s t h e r o l e o f t h e n u r s e was b e g i n n i n g

t o e x t e n d I n t o e l e m e n t s o f p a t i e n t s ’ s o c i a l w e l l

b e i n g . A n o t h e r s t u d y u n d e r t a k e n I n 1980 by Reedy

e t a l compared t h e a c t i v i t i e s and o p i n i o n s o f

a t t a c h e d and e mp loy ed n u r s e s I n g e n e r a l p r a c t i c e .

I n t e r v i e w s t o o k p l a c e I n 113 g e n e r a l p r a c t i c e s

and 153 n u r s e s we r e I n t e r v i e w e d , The p r a c t i c e s

we r e s i t e d I n b o t h r u r a l and urban a r e a s . The

I n f o r m a t i o n f rom t h e I n t e r v i e w s I d e n t i f i e d 43

a c t i v i t i e s w h i c h w e r e c l a s s i f i e d a s : c a r i n g

a c t i v i t i e s , Such as bed b a t h s ; I n t e r m e d i a t e

a c t i v i t i e s f o r w h i c h n u r s e s and d o c t o r s a r e

t r a i n e d . Such as b l o o d p r e s s u r e m e a s u r e m e n t ;

t e c h n i c a l a c t i v i t i e s s u c h as I m m u n i s a t i o n s . The

l a t t e r h a v e been t r a d i t i o n a l l y c a r r i e d o u t by

d o c t o r s f o r l e g a l or s c i e n t i f i c r e a s o n s or b e c a u s e

o f t h e I m p l i c i t n eed f o r d i a g n o s i s . They I m p l y

t h e need f o r a d d i t i o n a l t r a i n i n g f o r t h e n u r s e .

A l t h o u g h t h e r e was l i t t l e d i f f e r e n c e I n each g r o u p

o f n u r s e s c a r r y i n g o u t I n t e r m e d i a t e a c t i v i t i e s ,

p r a c t i c e n u r s e s we r e much more I n v o l v e d w i t h

’t e c h n i c a l ’ a c t i v i t i e s . A p r a c t i c e n u r s e w o r k i n g

I n a t r e a t m e n t room p e r f o r m e d more ’t e c h n i c a l ’

a c t i v i t i e s and, t o a l e s s e r e x t e n t , more

’c a r i n g ’ a c t i v i t i e s as w e l l . The f i n d i n g s and

c o n c e r n s o f Hockey (1984) c i t e d I n t h e p r e v i o u s

c h a p t e r t e n d t o c o n f i r m t h e s t u d y f i n d i n g s o f

Reedy e t a l (19 8 0 ) .

However , t h e s t u d i e s o f t h e work o f p r a c t i c e

n u r s e s h a v e a l l c o n c e n t r a t e d on t h e t a s k s t h e

n u r s e p e r f o r m s . Only one s t u d y , Reedy e t a l

(1980) a p p e a r s t o h a v e l o o k e d a t t h e ’ e x p r e s s i v e ’

f u n c t i o n and t h i s was I n r e l a t i o n t o t h e n u r s e s ’

p e r c e p t i o n s . I t was n o t e d t h a t p r a c t i c e n u r s e s

wer e commonly c o n s i d e r e d t o be more a c c e s s i b l e and

e a s i e r t o c o m m u n i c a t e w i t h . A v i e w w h i c h I s

s u p p o r t e d by t h e e v i d e n c e g i v e n I n t h e Marplan

s u r v e y c o m m i s s i o n e d d u r i n g t h e Communi ty N u r s i n g

Rev i ew I n E n g l a n d , ( C u m b e r l e g e , 1 9 8 6 ) . The d e p t h

o f t h e i r p e r c e l v ed r e l a t i o n s h i p w i t h p a t i e n t s

c o r r e l a t e d w i t h t h e t i m e t h e n u r s e s had been

e mp lo ye d I n t h e p r a c t i c e .

Even b e f o r e t h e I n t r o d u c t i o n o f t h e New G e n e r a l

P r a c t i t i o n e r C o n t r a c t I n 1990, p r a c t i c e n u r s e s

we r e dev e l o p i n g a r o l e I n p r e v e n t a t l v e and

a n t i c i p a t o r y c a r e and becoming more I n v o l v e d I n

p r i m a r y c o n t a c t s . A d v a n t a g e s o f e m p l o y i n g a

p r a c t i c e n u r s e we r e I d e n t i f i e d as e a r l y as 1970,

p a r t i c u l a r l y f o r t h e p a t i e n t , b u t a l s o I n r e d u c i n g

t h e d o c t o r ’s w o r k - l o a d t h r o u g h p r i m a r y s c r e e n i n g

by t h e n u r s e {Wes ton S m i t h e t a l , 1 970 ) . One

r e s e a r c h e r o b s e r v e d t h a t , a l t h o u g h p r i m e r e f e r r a l

t o t h e n u r s e may l e a d t o l e g a l p r o b l e m s I n

r e l a t i o n t o d i a g n o s i s , d e l e g a t i o n and t r a i n i n g ,

n e v e r t h e l e s s n u r s e s w e r e d e f i n i t e l y s e e n by t h e

g e n e r a l p r a c t i t i o n e r s t o be c o m p e t e n t I n t h e f i e l d

o f s c r e e n i n g ( M a r r i o t t , 1981 ) .

The R o y a l C o l l e g e o f G e n e r a l P r a c t i t i o n e r s

s u p p o r t e d t h e r o l e o f t h e p r a c t i c e n u r s e I n h e a l t h

p r o m o t i o n and p r i m a r y c a r e p r e v e n t l o n and

f r e q u e n t l y I d e n t i f i e d a r o l e f o r t h e p r a c t i c e

n u r s e I n I t s s e r i e s o f r e p o r t s on h e a l t h and

p r e v e n t i o n I n p r i m a r y c a r e , ( R o y a l C o l l e g e o f

G e n e r a l P r a c t i t i o n e r s , 19 8 1 ) .

I t w o u l d a p p e a r t h a t p r a c t i c e n u r s e s p e r f o r m a

w i d e r a n g e o f t a s k s , f rom p r o - a c t i v e t o r e a c t i v e

and f rom d e l e g a t e d work t o t a k i n g r e s p o n s i b i l i t y

f o r g r o u p s o f p r a c t i c e p a t i e n t s I n r e l a t i o n t o age

a n d / o r d i s e a s e b u t as W a l t e r s e t a l (19 80)

I d e n t i f i e d w h i l e t h e r a n g e o f c l i n i c a l t a s k s

u n d e r t a k e n by p r a c t i c e n u r s e s I s I n c r e a s i n g t h e r e

I s no s u p p o r t l v e e v i d e n c e t o show how new s k i l l s

a r e b e i n g t a u g h t or by whom or how t h e n u r s e I s

a c q u i r i n g t h e k n o w l e d g e t o u n d e r t a k e e x t e n d e d r o l e

a c t i v i t i e s . At t h e p r e s e n t t i m e , many p r a c t i c e

n u r s e s a r e u n d e r t a k i n g a r o l e f o r w h i c h t h e y h ave

n o t been p r e p a r e d d u r i n g g e n e r a l n u r s e

t r a i n i n g .

As has a l r e a d y been m e n t i o n e d , m o s t p r a c t i c e

n u r s e s work p a r t - t i m e . In a s t u d y o f IBS n u r s e s

(Reedy e t a l 1980) , t h e s o c i a l and o c c u p a t i o n a l

c h a r a c t e r i s t i c s o f a t t a c h e d and g e n e r a l

p r a c t i t i o n e r e mp lo yed n u r s e s w e r e e x a m i n e d .

P r a c t i c e n u r s e s wer e f o u n d t o be o l d e r , we r e more

l i k e l y t o be m a r r i e d and h e l d I d e n t i c a l numbers o f

n u r s i n g q u a l i f i c a t i o n s a p a r t f rom t h e N a t i o n a l

D i s t r i c t Nu r s i n g c e r t i f i c a t e .

2 . 1 0

¥o K t y - Q , pe,K Q,Q,nt o i pA.actJicz nafi^o,^ had tKaLyiQ.d

a t t t a a k t n g k o 6 p J i t a l 6 , w/ ie- tea4 o n l y 1 8 %

a t t a c k e d n u ^ 6 t 6 had i i n d t K t a k t n tho,jin. t r a i n i n g I n

t e a c h i n g h o 6 p J i t a l 6 , P r a c t i c e , Mu%4&4 a l 6 o

te,nde.d t o b t I n v o l v e d I n le.64> ’ o r t h o d o x * ^o^m6 o i

n a f i ^ l n g . T h l ^ c o u l d go 4omc way t o e x p l a i n i n g

t hc l n . I n t c ^ c 6 t I n e x t e n d i n g the l * i K o l e . Â 4 w e l l

a4 b e i n g olden. , p r a c t i c e nun.6e^ wene mon.e l i k e l y

t o have t a k e n a bneak {nom n u n i l n g - one t h l n d had

been ' e c o n o m i c a l l y I n a c t i v e ' b e { o n e J o i n i n g t h e

p n a c t l c e .

The6e { l n d l n g 6 6 u g g e 6 t a p o 6 6 l b l e l o 6 6 o{

p n o { e 6 6 l o n a l c o n f i d e n c e and p r a c t i c a l 6 k l l l 6 and

h i g h l i g h t a p o ^ ^ l b l e n eed {on manda t ony e d u c a t i o n

and t n a l n l n g , e n a b l i n g p n a c t l c e n u n^ eé t o

I n c n e a ^ e t h e l n k n o w l e d g e , ^ k l l l 6 , c o m p e t e n c e

and n e é p o n ^ l b l l l t y ,

I t wo ul d appean , t h e n e f o n e , t h a t many p n a c t l c e

nun^e6 ane t a k i n g on a n o l e {on w h i c h t h e y h a ve

n o t been p n ep a ne d I n t h e l n g e n e n a l n u n i e t n a l n l n g

2 , 1 1

and n o t o n l y h ave t h e ^ e nan6e6 n o t n e e e l v e d t h e

n e a e 6 ^ a n y e d u c a t i o n and c l i n i c a l 4>k l l l i t n a l n l n g

I n g e n e n a l n u n ^ e p n e p a n a t l o n p n l o n t o

n e g l 6 t n a t l o n , b u t a ^ s i g n i f i c a n t numben o f p n a c t l c e

nu n^ e^ h a ve t a k e n a b ne ak fnom n u n ^ l n g . The

l e n g t h o f bneak t h e n u n ^ e m i g h t have t a k e n l 6 , o f

c o u n ^ e , v a n l a b l e b u t any gap I n 6 e n v l c e can

n e ^ u l t I n t h e n u n i e becoming o u t o f d a t e I n

p n a c t l c e , A4 a n e ^ u l t o f 6ome o f t h e ^ e f a c t o n 6 a

numben o f e d u c a t i o n a l I n i t i a t i v e s fnom a v a n l e t y

o f s o u n c e s h av e emenged,

k n o t h e n anea o f c o n c e n n I s n e l a t e d t o t h e

dev e l o p i n g n o l e o f p n a c t l c e n u n s e s I n

p nev e n t l o n and a n t l c l p a t o n y c a n e . A l t h o u g h

p n a c t l c e n u n s e s ane c o n s l d e n e d t o be t h e m os t

a p p n o p n l a t e gnoup t o u n d e n t a k e t h i s p n e v e n t a t l v e

n o l e , many o f t h e s e n u n s e s ane wonk l ng I n n e l a t l v e

I s o l a t i o n and w i t h u n c e n t a l n means t o c o n t i n u i n g

e d u c a t i o n . A l t h o u g h u n d o u b t e d l y p n a c t l c e

n u n s e s can and ane d e v e l o p i n g a n o l e I n t h e f i e l d

o f pn l ma ny c a ne w i t h i n g e n e n a l m e d i c a l p n a c t l c e

2 , 1 2

b e c a u s e t h e y ane e mp lo ye d by a n o t k e n p n o f e s s l o n

t h e l n p o s i t i o n I s p o t e n t i a l l y I n v i d i o u s , I t may

be t h a t t h e p n a c t l c e n u n s e ' s f u t u n e I d e n t i t y

d ep en ds upon t h e n e c o g n l t l o n o f a n u n s e ' s n o l e I n

g e n e n a l m e d i c a l p n a c t l c e and on n e l e v a n t and

a v a i l a b l e e d u c a t i o n and s k i l l s t n a l n l n g and

a s s e s s m e n t w h i c h I s e q u i t a b l e w i t h o t h e n o f hen

n u n s e c o l l e a g u e s ,

Cunnen t c h a l l e n g es I n pno f e s s l o n a l p n e p a n a t l o n

f on p n a c t l c e n u n s e s I n c l u d e t h e w i d e v a n l e t y o f

t h e l n wonk and l a c k o f n o l e d e f i n i t i o n , w i t h t h e

cons e q u e n t d i f f i c u l t y I n dev e l o p i n g a c u n n l c u l u m

t o m e e t t h e l e a n n l n g n e ed s o f t h e p n a c t l c e n u n s e .

T h i s c h a p t e n w i l l c o n s l d e n t h e v a n l o u s e d u c a t i o n

I n i t i a t i v e s t h a t h a ve e v o l v e d oven t h e y e a n s

I n c l u d i n g v a n l o u s l o c a l e d u c a t i o n a l s c he me s and

dev e l o p m e n t s fnom pno f e s s l o n a l o n g a n l s a t l o n s t h e

V e p a n t m e n t o f H e a l t h and t h e S t a t u t o n y n u n s l n g

B o d i e s , T hene h a ve been numenous I n n o v a t i o n s by

p n a c t l c e n u n s e s and t h i s c h a p t e n w i l l a l s o

c o n s l d e n t h e s e . I t I s a l s o n e l e v a n t t o c o n s l d e n

2 , 13

t h e f a t a n e as n u n s e e d u c a t i o n t a k e s a new

d l n e c t l o n ,

{/ARJOUS I S OLATEV EVUCATIONAL SCHEMES FOR

PRACTICE NURSES

Couns e s a n n a nged by Gen en a l P n a c t l t l o n e n s

The f l n s t n e p o n t e d t n a l n l n g c o u n s e f o n p n a c t l c e

n u n s e s was o n g a n l s ed by g e n e n a l p n a c t l t l o n e n s who

n e c o g n l s ed t h e n e ed f o n s p e c i a l t n a l n l n g t o e x t e n d

t h e k n o w l e d g e and s k i l l s o f p n a c t l c e n u n s e s

beyond t h o s e a c q u l n e d I n g e n e n a l n u n s e t n a l n l n g .

In 7 9 7 7, t h e Thames { / a l l e y F a c u l t y o f t h e R o y a l

C o l l e g e o f G en en a l P n a c t l t l o n e n s o n g a n l s e d a 10

day d i s c u s s i o n gnoup c o u n s e f on t n e a t m e n t noom

s l s t e n s and p n a c t l c e n u n s e s . The p n o j e c t a im ed

t o e x p l o n e and d e v e l o p t h e n u n s e s ' k n o w l e d g e a b o u t

t h e l n own n e l a t l o n s h l p w i t h t h e l n p n a c t l c e , wonk

and f u t u n e d e v e l o p m e n t s and compane t h e n e e d s o f

t h o s e who u s e d t n e a t m e n t nooms w i t h i n t h e

g u i d e l i n e s necommended by t h e V e p a n t m e n t o f H e a l t h

2 , 1 4

and S o c i a l S c n v l c c s . A f t c n t h e d i s c u s s i o n I t

was a g n ee d t h a t t h e n e was a need t o e s t a b l i s h some

fonm of s t a n d a n d t n a l n l n g ( H a s l en e t a l , 191î ) .

In 1 9 80 t h e E a s t A n g l i a F a c u l t y o f t h e Ro ya l

C o l l e g e o f Genena l P n a c t l t l o n e n s nan an e i g h t week

h a l f - d a y pen week n e l e a s e pnognamme, ( Mounl n , K.

1 980) . The o b j e c t i v e s o f t h e c o u n s e n e l a t e d t o

n u n s l n g t a s k s unden t h e main h e a d i n g s o f

pnev e n t l v e m e a s u n e s , d i a g n o s t i c t e s t s , p a t i e n t

t n e a t m e n t , p a t i e n t c a ne and t n e a t m e n t - n o o m

management . P a t i e n t c a n e was s e p a n a t e d fnom

p a t i e n t t n e a t m e n t b e c a u s e I t was c o n s l d e n e d t h a t

t h e fonmen n e q u l n e d e x t e n d e d on c o n t i n u i n g p a t i e n t

c o n t a c t and I n c l u d e d s u c h a s p e c t s as h l s t o n y -

t a k l n g and d l e t a n y I n s t n u c t l o n .

The pnognamme d i d n o t c l a i m t o be d e f l n l t l v e , b u t

was t h e b a s i s f on d i s c u s s i o n and e x p a n s i o n . The

n u n s e s who a t t e n d e d t h e c o u n s e , a p p a n e n t l y

c o n t i n u e t o m e e t as a gnoup and h a v e s e l e c t e d

t h e l n own fonm o f c o n t i n u i n g e d u c a t i o n .

2 . 1 5

C o u n s e s a n n a n g e d b y L o c a l M e d i c a l C o m m i t t e e s

L o c a l M e d i c a l C o mmi t t ee s h a ve a l s o n e c o g n l s ed t h e

n eed f o n some fonm o f t n a l n l n g f o n p n a c t l c e

n u n s e s . One s u c k I n i t i a t i v e was t h a t o f t h e

S t a f f o n d s h l n e L o c a l M e d i c a l C o m m i t t e e . A

q u e s t l o n n a l n e was s e n t t o a l l known p n a c t l c e

n u n s e s I n t h e anea a s k i n g t hem I f t h e y wo u l d be

w i l l i n g t o p a n t l c l p a t e I n an I n - s e n v l c e d a y -

n e l e a s e c o u n s e and t o I n d i c a t e t h e s u b j e c t s t h e y

w oul d l i k e I n c l u d e d I n s u c h a pnognamme. Fnom

t h e n e s p o n s es t h e f o l l o w i n g o b j e c t i v e s wene

f o n m u l a t e d :

"The p n a c t l c e n u n s e s h a l l d e m o n s t n a t e hen

I n c n e a s e d k n o w l e d g e o f :

(1) The n o l e of membens o f t h e pn l many

h e a l t h c an e t e am, I n c l u d i n g t e n ms and

c o n d i t i o n s o f s e n v l c e

(2) I m m u n i s a t i o n p n o c e d u n e s

(3) Common s k i n , ean, n o s e and

2 . 16

t k n o a t and e y e c o n d i t i o n s

(4) V n e s s l n g s , a p p l i c a t i o n s , and

e q u i p m e n t a v a i l a b l e t o hen

(5) The pnopen m e t ho d s o f c o l l e c t i n g

and h a n d l i n g l a b o n a t o n y s p e c i m e n s

(6) Common pn ob l ems a s s o c i a t e d w i t h

t h e t a k i n g o f t a b l e t s and m e d i c i n e

(7) The p u n p o s e and f u n c t i o n s o f " s p e c i a l "

c l i n i c s

(S) The m e d i c o - l e g a l a s p e c t s o f hen j o b

(9) J n t e n v l e w l n g s k i l l s

( 1 0 ) I n t e n p e n s o n a l n e l a t l o n s h l p s I n

hen wonk

{ l l j H e a l t h e d u c a t i o n I n t h e c o n t e x t

o f hen wonk

( 1 2 ) B e l n g p n o p e n l y t n a l n e d f on hen

v a n l o u s d u t i e s " .

Ros s , A.K. L e s s o n s l e a n n e d fnom a c o u n s e f on

P n a c t l c e hlunses - Counse O b j e c t i v e s , B n l t l s h

M e d i c a l J o u n n a l Volume 283, 413 - 415, 8 t h A u g u s t ,

2 . 1 7

F o l l o w i n g t h e s i x day c o u n s e t h e d i f f i c u l t i e s and

pnob lems a s s o c i a t e d w i t h t h e w i d e n an g e and

q u a l i t y o f d u t i e s u n d e n t a k e n by t h e p n a c t l c e n u n s e

wene I d e n t i f i e d and t h e c o u n s e s e n v e d t o u n d e n l l n e

t h e p nob l ems f a c i n g t h o s e who p l a n t h e c o n t i n u i n g

e d u c a t i o n o f t h i s g no up .

The f o l l o w i n g sugg e s t i o n s wene p u t f onwand f o n

c o n s l d e n a t l o n by t h e gnoup:

" ( 1) Numbens s h o u l d be k e p t l ow,

t o e n a b l e p n a c t l c a l d e m o n s t n a t l o n s

t o be o n g a n l s ed mone e a s i l y and t o

encounag e d i s c u s s i o n

(2) I n d u c t i o n c o u n s e s f o n p o t e n t i a l

and n ewl y a p p o i n t e d n u n s e s s h o u l d be

h e l d

(3) S p e c i a l i s e d c o u n s e s s h o u l d be

o n g a n l s ed f o n t h o s e w i s h i n g t o e x t e n d

t h e l n c l i n i c a l a c t i v i t i e s - f o n e x a m p l e

E l e c t n o c a n d l o g n a p h y , W e l l Woman S c n e e n l n g

and V l t a l o g n a p h y .

2 . 1 8

(4) R e f n e s h e n c o u n s e s s h o u l d be h e l d

y e a n l y as f o n dJ i s tnJ ic t n u n s l n g s l s t e n s

(5) A l t h o u g h d a y - n e l e a s e e x t e n d e d

pnognammes ane p n o b a b l y m o s t

p o p u l a n , p a n t l c u l a n l y w i t h mann l ed

n u n s e s , n e s l d e n t l a l c o u n s e s s h o u l d

be c o n s l d e n e d f o n t h o s e won k ln g

I n o u t l y i n g aneas

16) R e s p o n s i b i l i t y f o n t h e a d e q u a t e

f i n a n c i n g o f s u c h c o u n s e s m u s t be

a c c e p t e d by t h e V e p a n t m e n t o f H e a l t h

and S o c i a l S e c u n l t y . Counses

s p e c i f i c a l l y an nan ged f o n p n a c t l c e

n u n s e s ane now l a n g e l y e x c l u d e d

fnom t h e n e l m b u n s e m e n t s c h e m e " .

Ros s , A.K. L e s s o n s l e a n n e d fnom a c o u n s e f o n

p n a c t l c e n u n s e s . B n l t l s h M e d i c a l J o u n n a l Volume

283, 4 13 - 4 15, 8 t h A u g u s t , 1981 .

The p nob l ems o f f i n a n c i a l s u p p o n t ane n e l e v a n t .

The m a j o n l t y o f p n a c t l c e n u n s e s h a ve f i n a n c e d

2 . 1 9

t h e m s e l v e s t o a t t e n d c o u n s e s and veny many o f them

have p l a n n e d and u n d e n t a k e n t h e l n own c o n t i n u i n g

e d u c a t i o n pnognammes d u n l n g t h e l n days o f f on

a n n u a l l e a v e . U n f o n t u n a t e l y F am i ly H e a l t h

S e n v l c e A u t h o n l t l e s do vany I n t h e l e v e l o f

s u p p o n t t h e y w i l l g i v e t o g e n e n a l p n a c t l t l o n e n

s t a f f a t t e n d i n g f o n e l t h e n s t u d y days on c o u n s e s .

Some w i l l S u p p o n t t o t a l l y , o t h e n s w i l l pay f on

c o u n s e f e e s and n o t f o n t n a v e l l l n g on s u b s i s t e n c e .

Othen sug g e s t i o n s , p u t fonwand by t h e gnoup s u c h

as s p e c i f i c c l i n i c a l a c t i v i t i e s w h i c h t h e gnoup

c o n s l d e n e d n e e de d s p e c i a l i s e d c o u n s e s o f t n a l n l n g

have e l t h e n been a nnanged t h n o u g h dnug c o m pa n i es

on t h e n u n s e s has a t t e n d e d h o s p i t a l o u t - p a t i e n t s

t o g a i n k n o w l e d g e and s k i l l s .

Fon t h o s e n u n s es I n t h e gnoup who t n a v e l l e d some

68 m i l e s as a nound t n l p I n onden t o a t t e n d t h e

s t u d y days t h e a d v a n t a g e s o f a t t e n d i n g a c o u n s e

wh i ch I s n e s l d e n t l a l wo u ld seem t o be mone

a d v a n t a g e o u s . Most g e n e n a l p n a c t l t l o n e n s employ

2 . 2 0

one p n a e t l e e n u n s e . When t h a t n u n s e I s on l e a v e

f o n w h a t e v e n n e a s o n s h e I s n o t n e p l a e e d b e c a u s e

c u n n e n t l y t h e n e I s no p n a c t l c e n u n s e bank scheme

I n o p e n a t l o n . Not o n l y , t h e n e f o n e . I s t h e n e no

n u n s e t o s u p p o n t t h e p n a c t l c e b u t t h e f i n a n c i a l

I m p l i c a t i o n s t o t h e p n a c t l c e ane c o n s l d e n a b l e .

I t can be an gued , o f c o u n s e , t h a t t h e n u n s e who

a t t e n d s a c o n t i n u i n g e d u c a t i o n pnognamme w h e t h e n

I t be n e s l d e n t l a l on day n e l e a s e , w i l l n e t u n n t o

t h e p n a c t l c e veny o f t e n f n e s h l y m o t i v a t e d and w i t h

p n a c t l c e e n h a n c e d .

Pnognammes annanged by Vnug Companies

Othen s p e c i f i c e d u c a t i o n a l I n i t i a t i v e s may be

o f f e n e d by dnug c o mp a ni e s f o n s p e c i f i c a l l y

t a n g e t e d gnoups o f p a t i e n t s e l t h e n by age on

m e d i c a l p nob lem, s u c h as p a t i e n t s s u f f e n l n g fnom

D i a b e t e s on As thma. T h e s e pnognammes , s p o n s o n e d

by dnug c o m p a n i e s , u s u a l l y t a k e t h e fonm o f a

s t u d y day w h i ch I s h e l d nean t o t h e p n a c t l c e .

The s i t i n g o f t h e s t u d y day e n a b l e s t h e p n a c t l c e

2 . 2 1

n u n s e t o a t t e n d w i t h m i n i m a l c o s t I m p l i c a t i o n s

e l t h e n t o t h e p n a c t l c e on t h e n u n s e ,

In-HouS e T n a l n l n q

Gen ena l p n a c t l t l o n e n s h av e s u p p o n t e d t h e l n

p n a c t l c e n u n s e s by p n o v l d l n g I n - h o u s e t n a l n l n g

somewhat a l o n g t h e l i n e s o f an a p p n e n t l c e l e a n n l n g

on t h e ’ j o b ’ , f o n many p n a c t l c e n u n s e s t h i s has'

been t h e p n l n c l p l e on I n d e e d t h e o n l y means o f

o b t a i n i n g t n a l n l n g . Thene I s no d o c u m e n t e d

n e s e a n c h on e v i d e n c e a b o u t s u b j e c t m a t t e n , me t ho d

of t e a c h i n g and t h e n u n s e l e a n n l n g , a s s e s s m e n t on

e v a l u a t i o n . A t t h e p n e s e n t t i m e , t h e n e a ne o n l y

a ve ny s m a l l numben o f p n a c t l c e n u n s e s who h o l d

a l e c t u n e n p n a c t l t l o n e n p o s t and a l t h o u g h

o p p o n t u n l t l e s o f s h a n e d l e a n n l n g b e t w e e n o t h e n

communi ty wonkens wou ld be I d e a l t h e f e a s i b i l i t y

f on s h a n e d l e a n n l n g t o t a k e p l a c e p n e v e n t t h i s

fnom h a p p e n i n g . Not o n l y , t h e n e f o n e . I s t h e n e

t h e p nob lem o f t n y l n g t o I m p l e m e n t s h a n e d l e a n n l n g

w i t h o t h e n c o l l e a g u e s b u t a l s o p n a c t l c e n u n s e s

2 . 2 2

l i k e t h e l n d l s t n l e t n u n s e and h e a l t h v l s l t o n

c o l l e a g u e s n e c o g n l s e t h e ne ed f o n s p e c i a l i s t

t e a c h i n g I n p u t fnom t h o s e n u n s e s who h o l d t h e

n e l e v a n t q u a l i f i c a t i o n . A t t h e p n e s e n t t i m e f on

many n u n s e s , t h e o n l y way t o g a i n any c o n t i n u i n g

e d u c a t i o n I s t h n o u g h hen g e n e n a l p n a c t l t l o n e n

c o l l e a g u e s and l e a n n l n g on t h e j o b .

PROFESSIONAL ORGANISATIONS EDUCATIONAL I N I T I A T IVES

T n a l n l n g f o n p n a c t l c e n u n s e s n em al ns an ad hoc

a f f a l n b u t a l o n g - a w a i t e d n e p o n t p u b l i s h e d I n 1984

p n o m l s e d t o p n o v l d e a b l u e p n l n t f o n t h e f u t u n e .

Fon a l m o s t f o u n y e a n s an I n t e n - p n o f e s s l o n a l

wonk l ng p a n t y s e t up by t h e R o y a l C o l l e g e o f

Nuns lng s o u g h t t o d e t e n m l n e t h e t n a l n l n g n e e d s o f

p n a c t l c e n u n s e s , o f w h i c h t h e n e wene some 5 , 0 0 0

p n a c t l c e n u n s e s e m p l oy ed by g e n e n a l p n a c t l t l o n e n s

s e n v l n g I n t h e onden o f a p p n o x l m a t e l y 1 1 , 0 00

p n a c t l c e s a t t h e t i m e . The w o nk ln g gnoup

c o n c l u d e d t h a t p n a c t l c e n u n s e s n e e d e d f u n t h e n

p n e p a n a t l o n f o n t h e l n n o l e and necommended t h a t a

s t e e n l n g gnoup be fonmed w h i c h wo u l d e x a m i n e I n

d e t a i l t h e t n a l n l n g n e e d s o f p n a c t l c e n u n s e s and

n u n s e s e m p l o y e d t o wonk I n t h e t n e a t m e n t nooms o f

g e n e n a l p n a c t l c e on h e a l t h c e n t n e s .

The s t e e n l n g gnoup co mp nl s ed n e p n e s e n t a t l v es fnom

t h e R o y a l C o l l e g e o f N u n s l n g , R o y a l C o l l e g e o f

Gen en a l P n a c t l t l o n e n s , Ge n e n a l M e d i c a l S e n v l c e s

C o m m i t t e e , h e a l t h v i s i t o n s and d l s t n l c t n u n s e s .

The c o n c e n n o f t h e s t e e n l n g gnoup was t o d e s i g n a

p n o p e n l y s t n u c t u n e d pnognamme f o n t n a l n l n g t h a t

woul d p n e p a n e t h e p n a c t l c e n u n s e t o wonk as a

memben o f t h e pn l many h e a l t h c a ne t e a m . The

s t e e n l n g gnoup d e l l b e n a t e d f o n f o u n y e a n s and t h e

l o n g a w a i t e d n e p o n t e n t i t l e d " T n a l n l n g Needs o f

P n a c t l c e N u ns e s " was p u b l i s h e d I n O c t o b e n , 1984.

( A p p e n d i x I ) . The n e p o n t was f o l l o w e d by an

o u t l i n e c u n n l c u l u m p n o d u c e d by t h e N a t i o n a l Boands

f on N u n s l n g , Ml dw l f eny and H e a l t h V i s i t i n g

( A p p e n d i x I I ) . I t c o v e n s a bnoad b a s e d

c u n n l c u l u m unden t h e h e a d i n g s : p n o f e s s l o n a l n o l e

2 . 2 4

d e v e l o p m e n t ; p n o c e d u n e s and t e c h n i q u e s t o be u s e d

I n t h e t n e a t m e n t noom and manag ement o f t h e

t n e a t m e n t noom. The w h o l e p u n p o s e o f necommendlng

a c u n n l c u l u m w h i c h was n o t n e s t n l c t l v e,

a c c o n d l n g t o Yvonne V a v l d s o n C ha l n p e n s o n o f

t h e s t e e n l n g gnoup , ( V a v l d s o n , Y . , ? e n s o n a l

Co mmun ica t i on , 19 84) was t o e nc ou na ge f l e x i b i l i t y

and make I t p o s s i b l e f o n mo du le s o f t n a l n l n g t o be

added s u b s e q u e n t l y .

The s t e e n l n g gnoup necommended t h a t c o u n s e s s h o u l d

be p l a n n e d I n c o l l a b o n a t l o n w i t h l o c a l g e n e n a l

p n a c t l t l o n e n s and h e l d whene p o s s i b l e I n c o l l e g e s

o f h l g h e n on f u n t h e n e d u c a t i o n . S t u d e n t s s h o u l d

be encounag ed t o l e a n n w i t h s t u d e n t s h a v i n g

s l m l l a n needs s u c h as d l s t n l c t n u n s e s , h e a l t h

v i s i t o n s , p n a c t l c e managens and g e n e n a l

p n a c t l t l o n e n s . The n e p o n t a l s o s t a t e d t h a t I f

p n a c t l c a l e x p e n l e n c e I n t e c h n i q u e s c o u l d n o t be

o f f e n e d t o t h e n u n s e I n h e n f h l s own s u n g e n y , t h e n

annang ement s s h o u l d be made t o o b t a i n t h i s

e x p e n l e n c e e l s ewhene; a c h e c k l i s t o f p n o c e d u n e s

2 . 2 5

and t a s k s s h o u l d be a g n e e d as a b a s i s f o n d e c i d i n g

l e a n n l n g n e e d s . T h i s l a t t e n n e c o m m e n d a t l o n was

p n o b a b l y t h e f l n s t I n d i c a t i o n o f t h e n e e d f o n a

n e g o t i a t e d a ppn oach t o c u n n l c u l u m d e s i g n and

c o n t e n t f o n p n a c t l c e n u n s e s . The f l n s t c o u n s e was

p i l o t e d and s u b s e q u e n t l y ap pn ov ed by t h e E n g l i s h

N a t i o n a l Boand a t t h e Unlv e n s l t y o f S un n ey I n 19 86

and s i n c e t h a t t i m e o t h e n c o u n s e s m o u n t e d I n

c o l l e g e s o f h l g h e n and f u n t h e n e d u c a t i o n and

u n l v e n s l t l e s h a v e been appnov ed so t h a t each

n e g l o n w i t h i n En gl an d now has a t l e a s t one

a ppn ov ed p n a c t l c e n u n s e c o u n s e . S i n c e a t t e n d a n c e

a t t h e c o u n s e o n l y a t t n a c t s a s t a t e m e n t o f

a t t e n d a n c e , f l g u n e s t o I d e n t i f y how many n u n s e s

have c o m p l e t e d t h e c o u n s e s u c c e s s f u l l y an e n o t

n e c o n d e d .

An I n i t i a t i v e by t h e R o y a l C o l l e g e o f G e n e n a l

P n a c t l t l o n e n s G e n e n a l Pun pos es C o m m i t t e e I n 1988

was t o s e t up a T ask P onc e . One o f t h e n e a s o n s

f on t h e e s t a b l i s h m e n t o f t h e Task Ponce was t o

n e s p o n d t o t h e c o n c e n n e x p n e s s ed by g e n e n a l

p n a c t l t l o n e n s and p n a c t l c e n u n s e s a b o u t t h e

a p p n o p n l a t e n e s s and t h e e d u c a t i o n a l q u a l i t y o f a t

l e a s t some o f t h e e x i s t i n g p n a c t l c e n u n s e c o u n s e s .

In an a t t e m p t t o o b t a i n f a c t u a l I n f o n m a t l o n a

l e t t e n was s e n t t o a l l t h e c o l l e g e s and

I n s t i t u t i o n s appnov ed by t h e E n g l i s h N a t i o n a l

Boand t o nun p n a c t l c e n u n s e c o u n s e s . The l e t t e n

s o u g h t f a c t u a l I n f o n m a t l o n a b o u t c o u n s e c o n t e n t ,

t h e c o n s t i t u t i o n o f t h e c o u n s e p l a n n i n g t eam and

any o t h e n I n f o n m a t l o n w h i c h m i g h t be u s e f u l . A

l a n g e numben o f I n s t i t u t i o n s f a i l e d t o n e p l y and

t h e Task Eonce fonmed t h e v i e w t h a t t h o s e c o l l e g e s

who d i d n e p l y wene mone l i k e l y t o be s a t i s f l e d

w i t h t h e l n c o u n s e . The o b j e c t i v e o f t h e Task

Eonce was t o s e e k ways I n w h i c h t h e c o l l e g e m i g h t

a s s i s t p n a c t l c e n u n s e s I n t h e l n e d u c a t i o n a l n e e d s .

The R o y a l C o l l e g e o f Gen en a l P n a c t l t l o n e n s

n e c o g n l s ed t h a t p n a c t l c e n u n s e s n e e d e d t o d e f i n e

t h e l n own e d u c a t i o n a l o b j e c t l v e s , t n a l n l n g and

c o n t i n u i n g e d u c a t i o n b u t t h a t t h e c o l l e g e s h o u l d

be p n e p a n e d t o o f f e n h e l p and a d v i c e when

n e q u e s t e d and n e c o g n l s ed t h a t g e n e n a l

2 . 2 7

p n a c t l t l o n e n s as e m p l oy en s o f p n a c t l c e n u n s e s had

a n e s p o n s l b l i l t y t o e n s u n e t h a t t h e l n e mp l o y e e s

wene c o m p e t e n t I n p n a c t l c e . The T ask f o n c e

membensh lp n e p n e s e n t e d g e n e n a l p n a c t l t l o n e n s and

p n a c t l c e n u n s e s fnom d l f f e n e n t p a n t s o f t h e U n i t e d

Kingdom and t h e Task f o n c e was h e l p e d I n I t s

d e l l b e n a t l o n s by h a v i n g d i s c u s s i o n s w i t h

n e p n e s e n t a t l v es fnom t h e n u n s e s ’ S t a t u t o n y Bod i es

and t h e n u n s e s ' p n o f e s s l o n a l o n g a n l s a t l o n .

The Task f o n c e I d e n t i f i e d aneas o f c o n c e n n w h i c h

ane t h e same co n ce nn s as t h o s e p n e v l o u s l y n a l s e d

n a me l y , f u n d i n g o f p n a c t l c e n u n s e s t o a t t e n d

c o u n s e s , t h e need f o n p n a c t l c e n u n s e s as

e d u c a t o n s , and e q u a l t n a l n l n g o p p o n t u n l t l e s f o n

p n a c t l c e n u n s e s and t h e Task f o n c e made d e t a i l e d

n ec om m e n d a t l o n s I n I t s R e p o n t . ( A p p e n d i x I I I ) .

B e c a us e many p n a c t l c e n u n s e s wonk I n p n o f e s s l o n a l

I s o l a t i o n t h e I n i t i a t i v e o f c n e a t l n g l i n k s w i t h

l o c a l c o l l e a g u e s by f o n ml n g t h e ms e l v es I n t o

p n a c t l c e n u n s e gnoups has h e l p e d t o o vencome t h i s

2 . 2 8

p n o f e s s l o n a l I s o l a t i o n . Some o f t h e g no up s h a ve

fonmed membensk l p w i t h t h e V n a e t l e e Nunse fonum o f

t h e Roy a l C o l l e g e o f Nuns lng w h i ch a l s o h e l p s I n

w i d e n i n g t h e n e t w o n k s u p p o n t . Some f a c u l t i e s o f

t h e Roya l C o l l e g e o f G e ne na l P n a c t l t l o n e n s h ave

s u p p o n t e d t h e dev e l o p m e n t o f n e g l o n a l

o n g a n l s a t l o n s o f p n a c t l c e n u n s e s and t h e n e I s , f o n

exa mp le , an a c t i v e n e g l o n a l e d u c a t i o n c o m m i t t e e o f

p n a c t l c e n u n s e s I n t h e Wes t Mi d l an ds R e g i o n . The

P n a c t l c e Nunse Fonum a t t h e Roy a l C o l l e g e - o f

Nuns lng now o f f e n s s t u d y days fnom t i m e t o t i m e

b u t t h e s e ane o n l y open t o t h o s e n u n s e s who ane

membens o f t h e c o l l e g e and a t t e n d a n c e does

n o t a t t n a c t e d u c a t i o n a l c u n n e n c y .

GOVERNMENT ANV STATUTORY BOW I N I T I A T I VES

The Task Fonce n e c o g n l s ed t h a t many o f I t s

n e c o m m e n d a t l o n s had f i n a n c i a l I m p l i c a t i o n s . Some

o f wh i ch wene t h e d l n e c t n e s p o n s l b l i l t y o f t h e

em pl o y i n g g e n e n a l p n a c t l t l o n e n b u t o t h e n s wene . I n

t h e v i ew o f t h e T ask Fonce, p n o p e n l y t h e

2 .2 9

n e s p o n s l b l l L t y o f t h e V e p a n t m e n t o f H e a l t h . The

V e p a n t m e n t o f H e a l t h and t h e Genena l M e d i c a l

S e n v l c e s C o m m i t t e e e n t e n e d I n t o d i s c u s s i o n I n

onden t o make t h e n e c e s s a n y a l t e n a t l o n s t o t h e

S t a t e m e n t o f Tees and A l l o w a n c e s wh ich w o u l d a l l o w

f o n f u n d i n g t h e c o n t i n u i n g e d u c a t i o n a l n e e d s o f

p n a c t l c e n u n s e s .

Vep a n t m ent o f He a l t h Fu n d i ng o f P n a c t l c e Nunse

E d u c a t i o n , 1 9 8 8 /1 9 89 ; 198 9 / 1 990

The Gov ennment was c o m m i t t e d t o e x t e n d i n g t h e

a n n a n ge me n t s f o n d l n e c t n e l m b u n s e m e n t t o c o v e n t h e

t n a l n l n g o f p n o f e s s l o n a l s t a f f , d e m o n s t n a t l n g I t s

I n t e n t i o n by p n o v l d l n g t h e sum o f £150, 000 f o n

p n a c t l c e n u n s e e d u c a t i o n I n t h e yean e n d i n g 3 1 s t

Manch, 19 89. The E n g l i s h N a t i o n a l Boand a g n e e d t o

f u n c t i o n as an a g e n c y I n t h e a l l o c a t i o n o f t h e

f u n d s and t h e V e p a n t m e n t o f H e a l t h d e c i d e d t h a t

£1 00, 000 wou ld be u s e d f o n t h e p ay m e n t o f c o u n s e

f e e s f o n p n a c t l c e n u n s e s a t t e n d i n g an a p p n o v e d

p n a c t l c e n u n s e c o u n s e w i t h t h e n e c o m m e n d a t l o n t h a t

2 . 3 0

p n l o n l t y be g i v e n t o t h o s e p n a c t l c e n u n s e s who had

been e m p l o y e d I n g e n e n a l p n a c t l c e f o n two y e a n s on

l e s s . The I n i t i a t i v e was , t h e n e f o n e , s e e n t o be

f o n t h e I n i t i a l p n e p a n a t l o n o f p n a c t l c e n u n s e s f o n

t h e l n p n a c t l c e n u n s l n g n o l e . I t was I n t e n d e d t h a t

some f i v e hundned p n a c t l c e n u n s es w o u l d e n t e n and

c o m p l e t e t h e c o u n s e d u n l n g t h e y e a n . The f i n a l

t o t a l was some s i x hundned and t h l n t y s e v e n

p n a c t l c e n u n s e s who had c o m p l e t e d t h e c o u n s e and

t h e p n o j e c t was c o n s l d e n e d t o have been a g n e a t

s u c c e s s . ( V e p a n t m e n t o f H e a l t h , T990) .

Vev e l o pme n t o f a V l s t a n c e L e a n n l n g Package

The n e m a l n l n g £ 5 0 , 0 0 0 was a l l o c a t e d f o n t h e

dev e l o p m e n t o f an open l e a n n l n g e d u c a t i o n a l

p a c k a g e w i t h t h e p n o v l s o t h a t s p e c i a l a t t e n t i o n be

g i v e n t o t h e s u b j e c t o f h e a l t h p n o m o t l o n and

c e n v l c a l c y t o l o g y as I t was a n t i c i p a t e d t h a t t h i s

woul d fonm t h e p n l n c l p l e t a s k s t h e p n a c t l c e n u n s e

woul d be u n d e n t a k l n g w i t h t h e I m p l e m e n t a t i o n o f

t h e New G e ne na l P n a c t l t l o n e n C o n t n a c t I n 1990.

The V e p a n t m e n t o f H e a l t h e s t a b l i s h e d a m u l t i -

d l s e l p l l n a n y s t e e n l n g gnoup I n 1 988 t o move t h i s

p n o p o s a l f on wa nd . T h i s gnoup I n c l u d e d

n e p n e s e n t a t l v es o f t h e n u n s l n g and m e d i c a l

pno f e s s i o n s S t a t u t o n y B od i e s and pno f e s s l o n a l

o n g a n l s a t l o n s . The s t e e n l n g gnoup necommended

t h a t a wo nk l ng p a n t y be s e t up t o d e v e l o p t h e

d i s t a n c e l e a n n l n g pnognamme. The membens o f t h e

wonk l ng p a n t y wene n o m i n a t e d by t h e V e p a n t m e n t

of H e a l t h and I n c l u d e d n e p n e s e n t a t l v es o f t h e

n u n s l n g and m e d i c a l pno f e s s i o n s , t h e S t a t u t o n y

Bod ies and p n o f e s s l o n a l o n g a n l s a t l o n s . The n e m l t

of t h i s gnoup was:

'To d e v e l o p a pnognamme o f d i s t a n c e

l e a n n l n g m a t e n l a l s a p p n o p n l a t e t o

t h e e d u c a t i o n and t n a l n l n g n e ed s

o f p n a c t l c e n u n s e s , e n c o m p a s s i n g

h e a l t h p n o m o t l o n I n pn lmany h e a l t h

c a n e , w i t h p a n t l c u l a n n e f e n e n c e

t o c e n v l c a l s c n e e n l n g ' .

Wonklng Gnoup R e mi t e s t a b l i s h e d by t h e S t e e n l n g

Gnoup, 1988,

2 . 3 2

The open l e a n n l n g e d u c a t i o n a l p a c k a g e e n t i t l e d

"Heal th. Pnomot l on I n Pnlmany H e a l t h Cane",

I n c l u d e d a v i d e o p n o d u c e d I n c o l l a b o n a t l o n w i t h

t h e B n l t l s h S o c i e t y f o n C l i n i c a l C y t o l o g y , T h i s

d i s t a n c e l e a n n l n g p a c k a g e was l a u n c h e d I n 1989

a f t e n s i x months d e l l b e n a t l o n s by t h e won kl ng

p a n t y . The n e a s o n f o n t h e d e a d l i n e was

t o t n y t o m e e t t h e e d u c a t i o n a l n e e d s o f

p n a c t l c e n u n s e s who wene b e i n g n e c n u l t e d I n l a n g e

numbens b e f o n e t h e I m p l e m e n t a t i o n o f t h e New

Genena l P n a c t l t l o n e n ' s C o n t n a c t I n k p n l l , 1990,

The New C o n t n a c t I n t n o d u c e d t a n g e t s w h ic h

p n a c t l c e s wo ul d n eed t o m e e t I n onden t o s e c u n e

t h a t p a n t o f t h e l n I n c o m e , One o f t h e t a n g e t s

was c e n v l c a l s c n e e n l n g o f women ag ed b e t w e e n

t w e n t y - f i v e and s i x t y f o u n y ea ns and w i t h t h e

I n c n e a s e d vo l ume o f wonk w h ic h t h e Gen en a l

P n a c t l t l o n e n ' s C o n t n a c t u n d o u b t e d l y w o u l d b n l n g ,

t h e g e n e n a l p n a c t l t l o n e n s ' wene o f t h e o p i n i o n

t h a t t h e l n p n a c t l c e n u n s e was an I d e a l p e n s o n t o

penf onm t h i s s c n e e n l n g . W h i l s t t h e g e n e n a l

p n a c t l t l o n e n ' s m i g h t h av e been n i g h t I n f o nm l ng

2 , 3 3

t h i s o p i n i o n , w ha t was n o t c o n s l d e n e d was

w h e t h e n t h e n u n s e was c o m p e t e n t t o u n d e n t a k e t h e

n o l e . Hence t h e dev e l o p m e n t o f t h e d i s t a n c e

l e a n n l n g pnognamme,

A f u n t h e n Gov ennment I n i t i a t i v e I n t h e yean

19 8911990 was f i n a n c i a l s u p p o n t f o n p n a c t l c e

n u n s e s , Counse f e e s wene p a i d f o n p n a c t l c e

n u n s e s t o a t t e n d an a p pn ov ed p n a c t l c e n u n s e

c o u n s e .

Again t h e u p t a k e was oven and a bove t h a t w h i c h had

been t a n g e t e d and, as p n e v l o u s l y , a sum was

s e t a s i d e t o p n o d u ce a n o t h e n d i s t a n c e l e a n n l n g

pnognamme. The pnognamme t h i s t i m e was t a n g e t e d

a t s c n e e n l n g and h e a l t h p n o m o t l o n f o n e l d e n l y

p a t i e n t s . The s c n e e n l n g o f p a t i e n t s oven t h e age

of s e v e n t y - f i v e y e an s was a n o t h e n s t a t u t o n y

n e q u l n e m e n t I n t n o d u c e d w i t h t h e New Gen en a l

P n a c t l t l o n e n ' s C o n t n a c t (1990) and t h e s c n e e n l n g

pnognamme had t o be u n d e n t a k e n and c o m p l e t e d each

y e a n . Aga i n t h e p n a c t l c e n u n s e was c o n s l d e n e d t o

2 , 3 4

be t h e p e n s o n m o s t s u i t e d t o u n d e n t a k e t h i s n o l e ,

Veny f ew p n a c t l c e n u n s e s , howeven , h a ve t h e

knowledg e on s k i l l s t o u n d e n t a k e t h e a s s e s s m e n t o f

p a t i e n t s w i t h i n t h e l n own homes and t h e n e was an

u n g e n t n ee d t o a d d n e s s t h i s gap I n t h e p n a c t l c e

n u n s e ’s e d u c a t i o n I f s h e was g o i n g t o be

u n d e n t a k l n g t h i s n o l e .

Ev a l u a t i o n o f E n g l i s h N a t i o n a l Boand Pn a c t l c e

Nunse Counse

Be c aus e t h e n e h ave been ve ny l i t t l e n e c o n d e d d a t a

a b o u t p n a c t l c e n u n s e s and t h e l n a c t i v i t i e s , t h o s e

e d u c a t i o n a l I n s t i t u t i o n s appnov ed t o h o l d p n a c t l c e

n u n s e c o u n s e s wene a p p n o a c h e d and t h e d e t a i l s o f

t h e n u n s e s a t t e n d i n g t h e c o u n s e s t h n o u g h

Gov ennment I n i t i a t i v e mo n ie s wene o b t a i n e d ,

A pp e n d i x I v I n d i c a t e s t h e d l s p a n a t e n a t u n e o f

p n a c t l c e n u n s e s ' w h i c h u n d o u b t e d l y has

c o n s e q u e n c e s f o n t h e s t n u c t u n e and c o n t e n t o f

c o u n s e s and t h e t e a c h i n g me th o ds e m p l o y e d . The

m a j o n l t y o f t h e n u n s e s t a k i n g t h e ENB c o u n s e

2 . 3 5

1 9 891 1 990 a g t d b z t u j t z n 30 - 50 yo.a^6, mo6t

pa^t - tJ ime, uDOKkÀ,ng b t t u j t t n 1 0 - 3 0 hoan.^ p e t

weefe and the, m a j o a t t y o i nuK6e,6 had be,e,n p a a c t t a e ,

6ome, 1 - 5 ye,a^6. Mo t e t h a n h a t i o i tho^e ,

p a o i t l e . d a t t e , n d t n g the, ENB aoaaie, duKtng

the, pe,Ktod 1 98911 990 he, td othe,a nua- i tng

q u a Z t i t c a t t o n ^ othe,^ t h a n He,gjiite,Ktd Ge,ne,^âZ Wu t a e

vutth Re,gt6te,ae,d Mtduot i t be,Lng the, mo6t i n , t q a e , n t t y

he,td qaaZX,iJLc.at ton,

The, Ve.pafitme,nt o i He,al th, a-6 Me.lt a6 a l l o c a t i n g

monle,^ ion, p n a c t l c c nun^e, t n . a l n l n g and the, uon,lt lng

and p n o d u c l n g o i d l i t a n c c l e , ann ln g pn,ogn.ammc6,

a l 6 o 6 p c c l i l c a l l y 6Ct a^ lde , a 6 m a l l 6um o i money

w h i ch wa-4 t o be a ^e d ion, t h e e v a l u a t i o n o i t h e

E n g l i s h U a t l o n a l Boand V a a c t l c e nun,6e c o u n é e ^

e s t a b l i s h e d some ioun, y e a n s p n e v l o u s l y . The

e v a l u a t i o n was u n d e n t a k e n by p n a c t l c e n u n s e s ,

c o u n s e l e a d e n s and l e c t u n e n s . Some g e n e n a l

p n a c t l t l o n e n s wene a l s o g i v e n t h e o p p o n t u n l t y t o

comment on c o m p l e t e a q u e s t l o n n a l n e b u t t h e n e was

a ven y poon n e s p o n s e. T h o s e g e n e n a l

2 , 36

p n a c t l t l o n e n s who d i d n e p l y made comment a b o u t t h e

d l l i l c u t t l e s o i n e t e a s l n g a p n a c t l c e n u n s e inom

Sungeny c o m m i t m e n t s .

The n e p o n t , ( A p p e n d i x v ) , I d e n t l i l e d a n e as o i

c o n c en n w i t h i n t h e s t n u c t u n e o i t h e c o u n s e s , t h e

c o n t e n t and a s s e s s m e n t p n o c e d u n e . The

n e g u l a t l o n s o i t h e E n g l i s h N a t i o n a l Boand p n a c t l c e

n u n s e c o u n s e s t a t e t h a t t h e l e n g t h o i t h e c o u n s e

s h o u l d be a minimum o i t e n days e x c l u s l v e o i

a n n u a l l e a v e , A numben o i n u n s e s wene o n l y

a b l e t o a t t e n d t h e c o u n s e , howeven , d u n l n g days

o i i on a n n u a l l e a v e and mo s t n u n s e s i o u n d I t

d l i i l c u l t t o be away inom t h e p n a c t l c e on h a v e

s u i i l c l e n t t i m e t o u s e t h e l l b n a n y on s t u d y a

s u b j e c t I n d e p t h . As i a n as t h e c o n t e n t was

c o n c e n n e d , a numben o i s t u d e n t s commented on t h e

l a c k o i e m p h a s i s on p n a c t l c a l s k i l l s , Counse

l e a d e n s i o u n d d l H l c u l t l e s I n s t n u c t u n l n g t h e

c o u n s e t o m e e t I n d i v i d u a l n ee ds b e c a u s e o i t h e

w i d e v a n l a t l o n n o t o n l y I n t h e p n a c t l c e n u n s e ' s

k n o w l e d g e and e x p e n l e n c e as a p n a c t l c e n u n s e b u t

2 , 3 7

a l s o I n t h e l e n g t h o i t i m e s i n c e n e g l s t n a t l o n .

The v a n l a t l o n I n t e a c h i n g and l e a n n l n g me t hods

u s e d I n t h e c o u n s e s a l s o b n o u g h t m i x e d n e s p o n s e s ,

Howeven, t h e m o s t c o n s i s t e n t me t hod o i t e a c h i n g

w h ic h t h e s t u d e n t s i o u n d t o be b e n e i l c l a l was

l e c t u n e s g i v e n by d o c t o n s , gnoup d i s c u s s i o n s ,

I n i o n m a l d i s c u s s i o n s w i t h p eens and c l i n i c a l

w o n k s h o p s , V n a c t l c e n u n s e s o b t a i n e d t h e l n

p n a c t l c a l e x p e n l e n c e a t t h e l n p l a c e s o i wonk

b a se d on I d e n t l i l e d s t u d e n t n e e d s . A s s e s s m e n t o i

p n a c t l c e v a n l e d and I n c l u d e d t h e I n v o l v e m e n t o i

c o u n s e t u t o n s , s t u d e n t s e l i a s s e s s m e n t , g e n e n a l

p n a c t l t l o n e n s on e x p e n l e n c e d p n a c t l c e n u n s e s .

Some o i t h e e x p e n l e n c e d p n a c t l c e n u n s e s a l s o t o o k

on t h e n o l e o i m e n t o n s . The s t u d e n t s a t t e n d i n g

t h e c o u n s e s made l i t t l e comment a b o u t p n a c t l c a l

ass e s s m e n t .

Counse wonk t o o k t h e ionm o i t h e p n e p a n a t l o n o i

pno j e c t s , p n e p a n a t l o n and p n e s e n t a t l o n o i s e m l n a n s

and t h e m a j o n l t y o i s t u d e n t s i o u n d I t d l H l c u l t t o

c o m p l e t e I n s u c k a t i g h t t i m e s c a l e s a y i n g t h a t

t h e s h o r t n e s s o i t h e c o u n s e , home c o m m i t m e n t s and

wonk c omm i t me n t s ven y c o n s t n a l n l n g .

G e n e n a l l y s p e a k i n g t h e s t u d e n t s w e l co m ed t h e

o p p o n t u n l t y t o a t t e n d s u c h a c o u n s e b e c a u s e I t

g a v e t he m a s e n s e o i I n c n e a s ed c o n i l d e n c e , t h e

n u n s e s i e l t l e s s I s o l a t e d b e c a u s e t h e y wene a b l e

t o s e t up n e t w o n k s . The c o u n s e l e a d e n s wene

unani mous I n s t a t i n g t h a t t h e y i o u n d t h e p n a c t l c e

n u n s e s a m o t i v a t e d and e n t h u s i a s t i c gno up .

( E n g l i s h N a t i o n a l Boand Uepont on t h e Re v i ew oi

V n a c t l c e Nunse Coun ses , En gl and , 1989)

In t h e l i g h t o i t h e n e v l e w I t was necommended

t h a t i u n t h e n d i s c u s s i o n s s h o u l d t a k e p l a c e b e t w e e n

t h e S t a t u t o n y Body i o n n u n s l n g , t h e V e p a n t m e n t o i

H e a l t h , p n a c t l c e n u n s e s and g e n e n a l p n a c t l t l o n e n s

and I t was necommended t h a t a won k ln g p a n t y be s e t

up i o n t h i s p u n p o s e .

2 . 39

Rev i ew o j Tn a c t l c e Nun s e Counses

A n e v l e w o i p n a e t l e e n u n s e c o u n s e s was

c o m m i s s i o n e d by t h e E n g l i s h N a t i o n a l Boand i o n

N u n s l n g , m d w l i e n y and H e a l t h V i s i t i n g I n

c o l l a b o n a t l o n w i t h t h e N a t i o n a l Boands i o n

S c o t l a n d , (JJales and No n th en n I n e l a n d and t h e

U n i t e d Kingdom C e n t n a l C o u n c i l i o n N u n s l n g ,

N l d w l i e n y and H e a l t h V i s i t i n g . The t e n ms o i

n e i e n e n c e wene a g n ee d by t h e E n g l i s h N a t i o n a l

Boand and n a t l i l e d by t h e V l s t n l c t Nunse J o i n t

C o m m i t t e e and H e a l t h V i s i t i n g J o i n t C o m m i t t e e , as

i o l l o w s :

"To n e v l e w t h e e d u c a t i o n and t n a l n l n g

n e e d s o i p n a c t l c e n u n s e s . I n c l u d i n g

t h e n o l e and i u n c t l o n o i t h e p n a c t l c e

n u n s e and c o u n s e e n t n y n e q u l n e m e n t s ,

To e v a l u a t e t h e c u n n e n t p n a c t l c e

n u n s e c o u n s e p n o v l d e d by t h e N a t i o n a l

Boands , t a k i n g I n t o a c c o u n t o t h e n

2 . 4 0

n e l e v a n t c o u n s e s .

To make n ec o m m e n d a t l o n s t o t h e Boand" .

Eng I t s h N a t i o n a l Boand i o n Nu n s l n g , N l d w l i e n y and

H e a l t h V i s i t i n g V n a c t l c e Nunse Counse Re v ie w,

Oct o be n , 1989.

The E n g l i s h N a t i o n a l Boand was ke en t o a p p o i n t

p e n s o n s t o t h e n e v l e w gnoup who c o u l d n e p n e s e n t

t h e main aneas o i I n t e n e s t I n p n a c t l c e n u n s l n g and

t h e n e b y p n o v l d e e x p e n t a d v i c e inom a n a n g e o i

d l i i e n e n t p e n s p e c t l v es so t h a t t h e c o m pl e x I s s u e s

o i c on t em pon any p n a c t l c e c o u l d be c o n s l d e n e d I n

t h e l i g h t o i t h e l n I m p l i c a t i o n s i o n e d u c a t i o n and

t n a l n l n g . A p n o j e c t o U l c e n was a p p o i n t e d t o

S t e e n t h e n e v l e w and e x p e d i t e t h e wonk o i t h e

gnoup and t h e t l m e s c a l e i o n c o m p l e t i o n o i t h e

p n o j e c t was s i x m o n t h s .

The n e v l e w p n o c e s s u s e d t h e v a n l o u s p e n s p e c t l v es

b n o u g h t t o t h e gnoup by I t s membens and

I n v o l v e d i l v e s t a g e s . Each s t a g e o i t h e n e v l e w

t o o k a c c o u n t o i t h e p n c s c n t s i t u a t i o n and known

i u t u n c d e v c l o p m c n t s , n ame l y :

" ( I ) The c o n t e x t o i t h e Rev iew

( I I ) The c o n t e x t o i p n a c t l c e n u n s l n g ;

wha t n eed s t o be done?

( I I I ) What do PSls do?

( I v ) J d e n t l i l c a t l o n o i t h e n o l e s ,

i u n c t l o n s and c o m p e t e n c e s I n

p n a c t l c e n u n s l n g .

(v) The e v a l u a t i o n o i e x i s t i n g

N a t i o n a l Boand a pp noved

?N c o u n s e s and o t h e n

n e l e v a n t c o u n s e s " .

E n g l i s h N a t i o n a l Boand i o n Nu n s l n g , Mld wl i eny and

H e a l t h V i s i t i n g V n a c t l c e Nunse Counse Rev i ew

Re po nt Vana 4, Vage ( I v ) 1990.

The gnoup ionmed t h e v i e w t h a t , any c u n n l c u l a n

dev e l o p m e n t s h o u l d o n l y be dnawn up w i t h i n t h e

c o n c e p t u a l inamewonk o i p n a c t l c e n u n s l n g . The

c o n c e p t u a l inamewonk dev e l o p e d by t h e gnoup i o n

2 . 42

t h e p a n p o s e o i t h e n e v l e w was i o u n d e d upon t h e

b e l l e i t h a t p n a e t l e e n u n s l n g I s :

"a c o n c e p t w h i c h d e m o n s t n a t e s

a c om mi t me n t t o t h e pno i e s s l o n a l

v a l u e s and c o n d u c t I m p l i c i t

w i t h i n t h e Code o i

Vnoi e s s l o n a l Con duc t i o n Nu ns es ,

N l d w l v e s and H e a l t h V i s i t o n s

(UKCC, 1984) ;

a c o l l a b o n a t l v e p n o c e s s t h n o u g h

w hi ch I n d i v i d u a l s and i a m l l l e s

w i t h i n t h e p n a c t l c e p o p u l a t i o n

ane a s s i s t e d t o n e c o v e n y , on

t o c o pe w i t h , on t o p n e v e n t

t h e s t n e s s o i I l l n e s s on

s u i i e n l n g

a v a l u e w h i c h I s I n h e n e n t w i t h i n

t h e p h i l o s o p h y and o b j e c t i v e s

o i pn l many h e a l t h c a n e

2 .4 3

(WonZd H e a l t h O n g a n l s a t l o n

The A l m a - A t a V e e l a n a t l o n , 1978)

a e l l n l e a l l y b a s e d d i s c i p l i n e ,

whose t h e o n y gnows o a t o i ,

and I s t e s t e d I n p n a c t l c e ;

w h i c h C O n t n l b a t es t o n e s e a n c h

and u s e s n e s e a n c h i l n d l n g s .

an I n t e g n a l p a n t o i communi t y

n u n s l n g and t h e n e i o n e t h e

e d u c a t i o n a l n ee ds o i p n a c t l c e

n u n s e s ane p e n c e l v e d as a p o s t

n e g l s t n a t l o n dev e l o p m e n t ;

a d yn ami c a ge n c y i o n ch ang e

w i t h i n t h e new p nlmany h e a l t h

c an e s y s t e m ; c o n s i s t e n t w i t h

t h e e t h o s o i V n o j e c t 2000

(UKCC, 1986) w h i c h n e g a n d s :

2 , 4 4

h e a l t h as a v a l u e w h i c h I s

I m p l i c i t w i t h i n t h e c o n c e p t

and p n a c t l c e o i n u n s l n g ,

m l d w l i eny h e a l t h v i s i t i n g ;

a s i n g l e p n e p a n a t l o n as no

l o n g e n b e i n g a b l e t o s e n v e

a l l i e t l m e o i p n a c t l c e ;

t h e n eed t o p n e p a n e p e o p l e

i o n c ha n g e , t o g i v e them t h e

i o u n d a t l o n on w h i c h t o b u i l d

and t h e c o n i l d e n c e and.

m o t i v a t i o n t o en gag e I n

pno i e s s l o n a l dev e l o p m e n t

as a mone i e a s l b l e g o a l

t h a n t o s e e k t o I d e n t l i y

i u t u n e needs w i t h p n e c l s l o n ;

t h e u l t i m a t e g o a l o i

p n o i e s s l o n a l e d u c a t i o n and

t n a l n l n g as t h e p n o d u c t l o n

2 . 4 5

o i a. i l e x l b t e p n a c t l t l o n e n

who w i l t h ave t h e e o n i l d e n e e

and n e a d l n e s s i o n c h an ge I n

t h e i a c e o i u n c e n t a l n t y " .

E n g l i s h N a t i o n a l Boand i o n Nu n s l n g , N l d w l i e n y and

H e a l t h V i s i t i n g P n a c t l c e Nunse Counse Rev iew

Re po nt pana 2 . 4 , 1990.

T h i s n e v l e w o i p n a c t l c e n u n s e e d u c a t i o n was a t a

t i m e o i u n p n e c e d e n t e d c h an g e i o n b o t h t h e

N a t i o n a l H e a l t h S e n v l c e , t h e h e a l t h pno i e s s l o n s

and t h e S t a t u t o n y B od i es and t h e n e v l e w gnoup

necommended t h a t I m m e d i a t e a t t e n t i o n n e e d e d t o be

g i v e n t o t h e e d u c a t i o n and t n a l n l n g o i p n a c t l c e

n u n s e s b o t h t h o s e who wene n ewl y e m p l o y e d , o i

w hi ch t h e n e wene an e s c a l a t i n g numben, and t h o s e

n u n s e s who wene e x p e n l e n c e d I n p n a c t l c e n u n s l n g .

As p n e v l o u s l y s t a t e d , t h e n e I s ven y l i t t l e

e v i d e n c e w i t h negand t o t h e n o l e s , i u n c t l o n s and

c o m p e t e n c e s o i p n a c t l c e n u n s e s and t h a t w h i c h I s

a v a i l a b l e c o n s i s t s o i a i ew I s o l a t e d s t u d i e s w h i c h

2 . 46

have t a k e n p l a c e . I t was e q u a l l y d l i i l c u l t i on

t h e n e v l e w gnoup t o d e t e n m l n e t h e n o l e o i t h e

p n a c t l c e n u n s e and necommended t h a t t h e e d u c a t i o n

and t n a l n l n g o i p n a c t l c e n u n s e s s h o u l d be h o l i s t i c

I n ap pnoach and unden t h e p n o c e s s e s I d e n t l i l e d by

t h e gnoup w h ic h u n d e n p l n p n a c t l c e n u n s l n g .

E d u c a t i o n p n o v l s l o n s h o u l d n o t o n l y be h o l i s t i c I n

appnoach b u t s h o u l d a l s o e q u i p t h e p n a c t l c e n u n s e

t o i u n c t l o n e i i e c t l v e l y w i t h i n t h e inamewonk o i

t h e pn lmany h e a l t h c a n e t e a m .

The i o l l o w l n g i o n m a t o i e d u c a t i o n and t n a l n l n g i on

p n a c t l c e n u n s e s was necommende d . E l n s t l y t h a t

t h e n e s h o u l d be an I n d u c t i o n pnognamme

e s t a b l i s h e d by t h e e mp l o y e n s o i p n a c t l c e n u n s e s .

T h i s I n d u c t i o n pnognamme s h o u l d ionm t h e I n i t i a l

p n e p a n a t l o n i o n t h e p n a c t l c e n u n s e . T hene I s no

do cu m e n t e d e v i d e n c e t o show how i a n t h i s

n e c o m m e n d a t l o n has been I m p l e m e n t e d . Heansay

e v i d e n c e s u g g e s t s t h a t some p n a c t l c e s p n o v l d e an

o n l e n t a t l o n pnognamme w h i l e some F am i ly H e a l t h

S e n v l c e A u t h o n l t l e s p n o v l d e an I n d u c t i o n

2 . 4 7

pnognamme. Not o n l y I s t h e n e no a n l ^ o n m l t y I n

p n o v l s l o n b u t a l s o I t I s n o t a s t a t u t o n y

n e q u l n e m e n t t o p n o v l d e on t o a t t e n d s u c h a

pnognamme.

S e c o n d l y , t h e n e s h o u l d be a c o u n s e i o n p n a c t l c e

n u n s e s w h i c h s h o u l d e n s u n e a n e c o n d a b l e

q u a l l i l c a t l o n on s u c c e s s i u l c o m p l e t i o n . The

q u a l l i l c a t l o n wou l d be s u c h t h a t e n t n y wo u ld be

n e c o n d e d on t h e p n o i e s s l o n a l n e g l s t e n m a i n t a i n e d

by t h e UKCC and t h e gnoup h e l d t h e v i e w t h a t t h e

c o n t e n t o i t h e c o u n s e s h o u l d be s u c h t h a t I t wou l d

be c a p a b l e o i be in g awanded a c a de mi c c n e d l t . The

e d u c a t i o n a l p n o v l s l o n i o n p n a c t l c e n u n s e s , I n l i n e

w i t h e d u c a t i o n a l p n o v l s l o n i o n o t h e n s p e c i a l i s t

n u n s e s , s h o u l d be t h a t w h i c h I s c a p a b l e o i b e i ng

awanded a ca d em ic c n e d l t b o t h a t c e n t l i l c a t e ,

d i p l o m a , d e g n e e and h l g h e n d e g n e e l e v e l . Nany o i

t h e u n i t s o i l e a n n l n g c o u l d be t h o s e a l n e a d y u s e d

by o t h e n bnanches o i t h e n u n s l n g and h e a l t h

v i s i t i n g p n o i e s s l o n s . The gnoup n e c o g n l s e d t h e

I m p o n t a n c e o i a c c n e d l t l n g p n l o n l e a n n l n g and a

S y s t e m n e e d e d t o be d e v i s e d n o t o n l y i o n a n a l y s i n g

t h e n a n s e ' s p n l o n l e a n n l n g a c h i e v e m e n t s b u t a l s o a

s y s t e m n e e d s t o be I n p l a c e w h ic h wo u l d a n a l y s e

and p n e d l c t t h e t n a l n l n g n e e d s o i p n a c t l c e n u n s e s

so t h a t c o n t i n u i n g e d u c a t i o n can a l ways be I n l i n e

w i t h c u n n e n t t n e n d s and c h an g es and w o u l d a l l o w

i o n a s t n a t e g y i o n t h e s t a n d a n d l s a t l o n o i p n a c t l c e

n u n s e e d u c a t i o n and t n a l n l n g .

The gnoup ionmed t h e v i e w t h a t t h e way i onwand i o n

s t a n d a n d l s a t l o n wo u l d be i o n a l l p n a c t l c e n u n s e s

commencing emp l oy me n t t o u n d e n t a k e an I n d u c t i o n

pnognamme. Fnom an a g n e e d d a t e a l l p n a c t l c e

n u n s e s w i t h i n one y ea n o i e mp l oymen t s h o u l d

c o m p l e t e t h e p n a c t l c e n u n s e c o u n s e . Fon t h o s e

n u n s e s a l n e a d y I n p o s t , b u t who want t o o b t a i n a

n e c o n d a b l e q u a l l i l c a t l o n s h o u l d be g i v e n t h e

o p p o n t u n l t y t o do s o . The amount o i a s s e s s e d

s t u d y s h o u l d be I n d i v i d u a l l y t a l l o n e d t o m e e t t h e

s t a n d a n d l s e d n e q u l n e m e n t i o n q u a l l i l c a t l o n and

d e t a i l e d e x p e n l e n c e and p n l o n l e a n n l n g s h o u l d be

n e c o n d e d I n t h e n u n s e s p n o i e s s l o n a l p n o i l l e .

2 . 4 9

The gnoup a l s o necomm e n de d t h a t s u i t a b l y q u a l l ^ l e d

p n a e t l e e n u n s e s s h o u l d be a p p o i n t e d as

' c o n s u l t a n t s ' on ' s e s s i o n a l ' t e a c h e n s t o t h e

c o u n s e w h i l s t n e m a l n l n g I n c l i n i c a l p n a c t l c e .

Some c e n t n e s h a v e a d o p t e d t h i s a ppnoach and employ

l e c t u n e n i p n a c t l t l o n e n s i o n s p e c i a l t y I n p u t .

B e ca us e o i t h e ven y n e a l p n o b l em o i I s o l a t i o n , t h e

gnoup necommended t h a t a s y s t e m o i m e n t o n s h l p be

e s t a b l i s h e d n o t o n l y t o g i v e s u p p o n t and a d v i c e t o

t h e p n a c t l c e n u n s e b u t a l s o t o i a c l l l t a t e t h e

p n a c t l c e n u n s e s t u d e n t ' s a b i l i t y t o I n t e g n a t e

t h e o n y and p n a c t l c e I n t h e p n a c t l c a l s e t t i n g .

The Impnov ement o i a c c e s s t o e d u c a t i o n and

t n a l n l n g a p p n o p n l a t e t o t h e n ee ds o i p n a c t l c e

n u n s e s n e e d e d i u n t h e n c o n s l d e n a t l o n and t h e gnoup

wene c o n s c i o u s t h a t p n a c t l c e n u n s e s wene I n

d l i i l c u l t y when s e e k i n g t o be n e l e a s e d inom

p n a c t l c e l i a c o u n s e was some d i s t a n c e away. The

met hod o i ' s a t e l l i t i n g ' was a d o p t e d by some

c e n t n e s and t h e u s e o i d i s t a n c e l e a n n l n g n e e d e d t o

be i u n t h e n e x p l o n e d . The i u n d l n g o i e d u c a t i o n

2 . 5 0

and t n a l n l n g s h o u l d be t a k e n I n t o a c c o u n t by t h e

R e g i o n a l H e a l t h A u t h o n l t l e s when d e t e n m l n l n g t h e l n

n e s o u n c e a l l o c a t i o n s .

The wo nk l ng gnoup c o m p l e t e d t h e n e v l e w w i t h i n t h e

t i m e s c a l e and p n e s e n t e d t h e n e p o n t t o . t h e

V e p a n t m e n t o i H e a l t h t h e UKCC and N a t i o n a l Boands ,

The S t a t u t o n y B o d i e s wene I n v i t e d t o c o n s l d e n t h e

n e c o m m e n d a t l o n s c o n t a i n e d w i t h i n t h e n e p o n t .

The d e v e l o p m e n t s w h i c h h a v e t a k e n p l a c e s i n c e t h i s

n e p o n t has been w n l t t e n w i l l be d i s c u s s ed when

c o n s l d e n l n g t h e c h a n g e s and i u t u n e t n e n d s I n n u n s e

e d u c a t i o n l a t e n I n t h i s c h a p t e n ,

SPECIFIC I N I T I ATI VES ESTABLJSHEV BY PRACT ICE

NURSES

Some o i t h e I n n o v a t i o n s e s t a b l i s h e d by p n a c t l c e

n u n s es h a v e a l n e a d y been m e n t i o n e d I n t h e

i o n e g o l n g , Howeven, o t h e n p n a c t l c e n u n s e

I n i t i a t i v e s a ne w o n t h y o i m e n t i o n i n g , Whe then I t

was I n a n t i c i p a t i o n o i t h e New G en e n a l

V n a c t l t l o n e n C o n t n a c t (1 990) on p a n t o i pnactJLce

n u n s l n g e v o l u t i o n I t was n o t l o n g b e i o n e

n a t i o n w i d e t h e n e was t h e emeng enee o i a s t n u c t u n e

o i p n a c t l c e n u n s e i a c l l l t a t o n s , o t h e n w l s e known as

pnlmany c a n e n u n s e i a c l l l t a t o n s \ E l a i n e E u l l a n d

p l o n e e n e d t h e n o l e I n t h e Oxiond V n e v e n t l o n o i

Meant A t t a c k and S t n o k e P n o j e c t inom 19 87. The

main t a s k o i t h e i a c l l l t a t o n I n i t i a l l y was t o h e l p

e s t a b l i s h s c n e e n l n g c l i n i c s w i t h i n g e n e n a l

p n a c t l c e h e l p i n g t h e p n l many h e a l t h c a n e t eam oi

t h e p n a c t l c e t o d e s i g n a pnognamme i on a n t e n l a l

d i s e a s e p n e v e n t l o n . Many Fami l y H e a l t h S e n v l c e

A u t h o n l t l e s p e n c e l v e d t h e n u n s e i a c l l l t a t o n ' s n o l e

as one o i w o nk ln g c l o s e l y w i t h t h e p n a c t l c e n u n s e

by a d v i s i n g t h em on pnev e n t l v e c a ne ( F u l l a n d

e t a l , 1987] and saw t h e b e n e i l t s o i e m p l o y i n g

s u c h a p e n s o n .

Est ab l i s h m e n t o i t h e As thma Tnal n l n g Cent n e j o n

P n a c t l c e Nunses

A i u n t h e n I n i t i a t i v e was t h e e s t a b l i s h m e n t o i t h e

2 . 5 2

A s t h m a S o c i e t y T n a l n l n g C e n t n e i o n p n a c t l c e

n u n s e s . T h i s c e n t n e e s t a b l i s h e d I n S t n a t i o n d -

upo n- Avo n by a p n a c t l c e n u n s e I n 1 987 o U e n s a

d i s t a n c e l e a n n l n g p a c k a g e i o l l o w e d by a s t u d y day

a t t h e c e n t n e and i l n a l a s s e s s m e n t . The

pnognamme I s now l i n k e d t o t h e R o y a l C o l l e g e o i

Genena l V n a c l t l o n e n s . The l e v e l o i s t u d y t o

a t t n a c t e d u c a t i o n a l c u n n e n c y I s c u n n e n t l y unden

n e g o t i a t i o n b u t I t I s a n t i c i p a t e d t h a t s u c h a

c o u n s e wo u ld a t t n a c t c n e d l t a c c u m u l a t i o n a t

d i p l o m a l e v e l .

V n a c t l c e Nunse I n t e n e s t Gnoups

P n a c t l c e n u n s e s t h n o u g h o u t t h e U n i t e d Kingdom h ave

i onmed t h e m s e l v e s I n t o p n a c t l c e n u n s e I n t e n e s t

g n o u p s . The p u n p o s e o i t h e s e I s n o t o n l y t o m ee t

t o g e t h e n b u t a l s o t o p n o v l d e a ionum whene

d i s c u s s i o n can t a k e p l a c e and e d u c a t i o n a l t o p i c s

n e l a t e d t o p n a c t l c e n u n s l n g can be p n e s e n t e d .

T h e s e gnoups ane now i u n c t l o n l n g t h n o u g h o u t e v e n y

R e g i o n a l H e a l t h A u t h o n l t y and e v e n y F am i l y H e a l t h

2 . 53

S e n v l c e A u t h o n l t y g e o g n a p h l c a l anea , a l t h o u g h n o t

a l l ane a U l l l a t e d t o t h e R o y a l C o l l e g e o i

N u n s l n g . Some o i t h e n u n s e s t o g e t h e n w i t h

p n a c t l c e n u n s e i a c l l l t a t o n s h a ve e s t a b l i s h e d

p n a c t l c e n u n s e t n a l n l n g i on u ms . T h e s e ionums

m e e t n e g u l a n l y I n onden t o a g ne e and s e t alms and

ob j e c t l v es and s h o n t and l o n g t enm p l a n s i o n t h e

p n a c t l c e n u n s e s w i t h i n t h e l n I m m e d i a t e a ne a .

A J o u n n a l i o n V n a c t l c e Nunses i o u n d e d

The p n a c t l c e n u n s e j o u n n a l was i o u n d e d I n 1987 I n

onden t o s u p p o n t p n a c t l c e n u n s e s , many o i whom

wene won kl ng I n I s o l a t i o n . J t was c o n s l d e n e d

i l t t l n g t h a t t h e p u b l i s h i n g company w h i c h a l n e a d y

p n o du c e d a numben o i m e d i c a l j o u n n a l s , many o i

w h i c h wene s p e c l i l c a l l y i o n g e n e n a l p n a c t l t l o n e n s ,

be a ppn o ac he d w i t h t h e p n o p o s a l o i e s t a b l i s h i n g a

j o u n n a l i o n p n a c t l c e n u n s e s . T h i s p u b l i s h i n g

company was b as ed nean t h e U n l v e n s l t y o i Sun ney

whene t h e i l n s t U n l v e n s l t y b a s e d p n a c t l c e n u n s e

c o u n s e was e s t a b l i s h e d and h e l d . The

2 . 54

n e g o t l a t l o n s I n v o l v e d t h e i l n s t gnoup o i p n a e t l e e

n u n s e s t u d e n t s a t t h e U n l v e n s l t y .

The p n o p o s a l was a c c e p t e d and t h e j o u n n a l became

e s t a b l i s h e d ; t h e main aim o i w h ic h has been t o

p n o v l d e t h e p n a c t l c e n u n s e w i t h e d u c a t i o n a l t o p i c s

w h i c h wou ld e n a b l e t h e n u n s e t o keep u p d a t e d .

O n l g l n a l l y t h e j o u n n a l was p u b l i s h e d m o n t h l y now

I t I s c l n c u l a t e d e v e n y two w e e k s , w i t h Fami ly

H e a l t h S e n v l c e A u t h o n l t l e s d l s t n l b u t l n g c o p i e s t o

g e n e n a l p n a c t l t l o n e n sung e n l e s so t h a t a copy I s

a v a i l a b l e w i t h i n e v e ny p n a c t l c e i o n t h e p n a c t l c e

n u n s e t o a c c e s s . Manket n e s e a n c h c a n n l e d o u t by

t h e m a n k e t l n g boand o i t h e p u b l i s h i n g company I n

1 9 93 I d e n t l i l e d t h a t some n i n e t y - t w o pen c e n t

oi p n a c t l c e n u n s e s nea d t h e p n a c t l c e n u n s e j o u n n a l

and nead t h e m a g a z i n e as t h e l n i l n s t c h o i c e .

Thene I s a s t n o n g e d l t o n l a l boand, t h e memb en sh lp

oi w h ic h I s p n e d o m l n a n t l y p n a c t l c e n u n s e s .

2 . 55

y n a c t L c e Nuns e T n a l nl n g Pnac.t l c.es

P n a e t l e e n u n s e t n a l n l n g p n a e t l e e s h a v e a l s o been

l a u n c h e d and E n f i e l d and Hanl ngey F am i ly H e a l t h

S e n v l c e A u t h o n l t y was t h e i l n s t I n 1 992. They

p n o p o s e d t o i u n d a numben o i n u n s e t n a l n l n g

p n a c t l c e s w h i c h wou l d be j o i n t l y a c c n e d l t e d by t h e

FHSA and a c o l l e g e o i n u n s l n g on h l g h e n e d u c a t i o n ,

( Pe a c h e y , 1992 p e n s o n a l c o m m u n i c a t i o n ) .

E n i l e l d and Hanl ngey FHSA e n v i s a g e d d e s i g n a t i n g

some s i x t e e n p n a c t l c e s as t n a l n l n g p n a c t l c e s .

Each p n a c t l c e wo ul d employ an a p p n o p n l a t e l y

q u a l l i l e d on e x p e n l e n c e d p n a c t l c e n u n s e t n a l n e n

(no m e n t i o n I s g i v e n as t o wh at t h e a p p n o p n l a t e

q u a l l i l c a t l o n wo ul d be) and t h i s p n a c t l c e n u n s e

woul d t a k e n e s p o n s l b l l l t y i o n t h e s t u d e n t

p l a c e m e n t . Fon t h e i l n s t yean p n a c t l c e s wo u l d

n e c e l v e one hundned pen c e n t ne lm b u n s e m e n t o i a

p n a c t l c e n u n s e t n a l n e n ' s s a l a n y , and t h e n n i n e t y

pen c e n t I n t h e s e c o n d and s u b s e q u e n t y e a n s . The

p n a c t l c e s so d e s i g n a t e d as t n a l n l n g p n a c t l c e s

woul d p n o v l d e c l i n i c a l t n a l n l n g i o n p n a c t l c e

2 . 56

n u n s e s and P n o j e c t 2000 s t u d e n t s .

FUTURE CHANGES ANV TRENVS IN PRACTICE NURSE

EVUCATION

In 19 89 t h e E n g l i s h N a t i o n a l Boand n e a c h e d a new

a g n e e m e n t w i t h t h e C o u n c i l i o n N a t i o n a l Academi c

Awands t h n o u g h I t s c n e d l t a c c u m u l a t i o n and

t n a n s i e n s cheme b e i o n e t h e CNAA was d i s b a n d e d .

The a g n e e m e n t , w h ic h has now been I m p l e m e n t e d ,

means t h a t n u n s e s , m l d w l v e s and h e a l t h v i s i t o n s

ane a b l e t o g a i n a c a d e m i c as w e l l as p n o i e s s l o n a l

c n e d l t i o n some o i t h e p n o i e s s l o n a l q u a l l i l c a t l o n s

t h e y a l n e a d y h o l d . R e t n o s p e c t l v e l y , t h e

a g n e e m e n t b e t w e e n t h e CNAA and t h e ENB wou l d

e n a b l e t h o s e n u n s e s , m l d w l v e s and h e a l t h v i s i t o n s

who had c o m p l e t e d c o u n s e s l e a d i n g t o n e g l s t n a t l o n

as a i l n s t l e v e l n u n s e and many e s t a b l i s h e d p o s t

n e g l s t n a t l o n q u a l l i l c a t l o n s t o c o u n t i o n a c a d e m i c

c n e d l t t ow an ds a d e g n e e . In a d d i t i o n , any n u n s e ,

m l d w l i e on h e a l t h v l s l t o n who o b t a i n e d t h e s e

q u a l l i l c a t l o n s and who w i s h e d t o p u n s u e i u n t h e n

2 .5 7

a ca de mi c s t u d y e l t k e n I n n u n s l n g on n e l a t e d

Sub j e c t s , wo ul d be a b l e t o u s e t h e l n q u a l l i l c a t l o n

t o g a i n e x e m p t i o n inom o t h e n s t u d y . T h i s was

I n t e n d e d t o be t h e I n c e n t l v e i o n n u n s e s , m l d w l v e s

and h e a l t h v i s i t o n s t o p u n s u e i u n t h e n s t u d i e s . The

i a c l l l t y t o a c c u m u l a t e c n e d l t s I s now p o s s i b l e

t h n o u g h I n d i v i d u a l a c a de mi c b oa n ds .

The U n i t e d Kingdom C e n t n a l C o u n c i l i o n N un ses ,

Mldwl ves and H e a l t h V i s i t o n s w h i c h I s t h e

n e g u l a t l n g body i o n t h e n u n s l n g , m l d w l i eny

h e a l t h v i s i t i n g p n o i e s s l o n s t h n o u g h o u t t h e U n i t e d

Kingdom has a p n l n c l p a l d u t y t o I m p n o v e t h e

s t a n d a n d s o i e d u c a t i o n and t n a l n l n g , p n a c t l c e and

c o n d u c t I n t h e I n t e n e s t o i t h e p u b l i c . To I m p n o ve

s t a n d a n d s o i cane i o n p a t i e n t s and c l i e n t s , t h e

C o u n c i l has dev e l o p e d new p o l i c i e s i o n e d u c a t i o n

and p n a c t l c e i o l l o w l n g n e g l s t n a t l o n w h i c h ane

d e s i g n e d t o m a i n t a i n and I m p n o ve t h e p n o i e s s l o n a l

k n o w l e d g e and c o m p e t e n c e o i n u n s e s , m l d w l v e s and

h e a l t h v i s i t o n s . T h i s a g n e e m e n t has i o l l o w e d a

i l v e yean g e s t a t i o n w i t h t h e UKCC s e t t i n g new

2 . 5 8

s t a n d a n d s i o n a l l n u n s e s , m l d w l v e s and h e a l t h

v i s i t o n s d e s i g n e d t o I m pno ve p a t i e n t and c l i e n t

c a n e and t o mat ch n eed w i t h i l e x l b l e , n e s p o n s l v e

e d u c a t i o n p n o v l s l o n . The s t a n d a n d s n e l a t e t o

m a i n t a i n i n g an e H e c t l v e n e g l s t n a t l o n and p o s t -

n e g l s t n a t l o n e d u c a t i o n .

The summany o i t h e c ha nge s as t h e y n e l a t e t o t h e

n u n s e and p n a c t l c e n u n s e s ane as i o l l o w s . A l l

membens o i t h e p n o i e s s l o n ane n e q u l n e d t o m a i n t a i n

and d e v e l o p p n o i e s s l o n a l k n o w l e d g e and c o m p e t e n c e

and I n a d d i t i o n , n u n s e s , m l d w l v e s and h e a l t h

v i s i t o n s w i l l be n e q u l n e d t o c o m p l e t e a minimum o i

i l v e s t u d y days ev en y t h n e e y e a n s . T h i s has

majon I m p l i c a t i o n s i o n p n a c t l c e n u n s e s n o t o n l y

may t h i s n e q u l n e m e n t l i m i t s t u d y l e a v e i o n

p n a c t l c e n u n s e s b u t a l s o has t h e p o t e n t i a l o i

nemov l ng t h e a b i l i t y o i p l a n n i n g l o n g t enm

e d u c a t i o n a l pnognammes i o n t h e p n a c t l c e n u n s e .

Each pno i e s s l o n a l gnoup w i l l be n e q u l n e d inom t h e

1 s t A p n l l , 1995 t o c o m p l e t e a n o t l i l c a t l o n o i

p n a c t l c e ionm on a t h n e e y e a n l y b a s i s . T h i s

2 . 5 9

ionm g i v e s d e t a i l s o i q u a l l i l c a t l o n and anea o i

p n a c t l c e and when I n i t i a l l y n e g l s t e n e d , T h i s

ionm m u s t a l s o be c o m p l e t e d n o t o n l y a t

n e g l s t n a t l o n b u t a l s o when n e t u n n l n g t o p n a c t l c e

a i t e n i l v e y ea ns on mone on c h a n g i n g an anea o i

p n a c t l c e , w h ic h e n t a i l s p n a c t l s l n g unden a

d l i i e n e n t n e g l s t e n a b l e q u a l l i l c a t l o n , J t w i l l

a l s o become a s t a t u t o n y n e q u l n e m e n t t o c o m p l e t e an

a pp noved n e t u n n - t o - p n a c t l c e pnognamme i o n t h o s e

n u n s e s who ane w a n t i n g t o n e t u n n t o n u n s l n g

p n a c t l c e a i t e n a bneak I n n u n s l n g s e n v l c e o i i l v e

y ean s on mone. T h e s e b a c k - t o - n u n s l n g c o u n s e s ane

I n t e n d e d t o bn ln g t h e p n a c t l t l o n e n up t o d a t e and

e n s u n e c o m p e t e n c e , s k i l l s and c o n i l d e n c e . Each

p n o i e s s l o n a l I s now n e q u l n e d t o c o m p l e t e a

p e n s o n a l p n o i e s s l o n a l p n o i l l e w h ic h wo u ld I d e n t l i y

p e n s o n a l and p n a c t l c e n e l a t e d s t u d y n e e d s and

n e l e v a n t a c t i v i t y t o m e e t n e e d s .

Newly q u a l l i l e d n u n s e s ane n e q u l n e d t o c o m p l e t e a

p e n l o d o i a p p n o x l m a t e l y i o u n mont hs unden t h e

g u i d a n c e o i a p n e c e p t o n , t o e n s u n e t h e new n u n s e

2 . 6 0

doz6 n o t t o o mack f i t ^ p o n ^ t b t i t t y , t o o 6oon

on. t n a p p n o p n t a t t l y , a l t h o u g h nun,6e,6 an.0.

ac.c. 0 u n t a b l e , ^on. t h t t n . ocvn pn.ac.ttae. ^n.om the.

mome,nt o^ n . e .g t6tn ,at ton\

l ^ t t h n.e.gan.d t o aommunt ty he.al th-aan.e. nun.4tng

the. n.e,qutn.tme,nt4> ane. {on. e . duaa t t on t o be. an.n.ange.d

anound a aommon aon.e. o{ no mon.a t h a n tujo t h t n d é o{

t h a t o t a l t a u g h t pn.ogn.amma. Tha pn.ogn.amma t 6

t n t a n d a d t o a p p l y thaon.y t o p n . a a t t a a w t t h t n a

i > p a a t a l t 6 t anaa o{ aommunt ty nun.6tng. S p a a t a l t é t

modular {on. 6 p a a t { t a anaa6 o{ p n a a t t a a uoould

t h a n ba b u t l t o n t o t h a aommon aon.a t o {on.m an

t n t a g n a t a d ujhola. Tha n a l a v a n t 6 p a a t a l t 6 t

q u a l t { t a a t t o n and anaa o{ p n a a t t a a voould ba

a n t a n a d on t h a p n a a t t t t o n a n ’ 6 nama on t h a UKCC

n a g t ^ t a n , A l l t h a 6 p a a t a l t 6 t q u a l t { t a a t t o n 6

Mould ba o{ a qua l s t a n d i n g and l a v a l and n a q u t n a

t h a 6ama l a n g t h o{ p n a p a n a t t o n . I t t ^ n o t

t n t a n d a d t h a t aaah anaa o{ a l t n t a a l p n a a t t a a

s h o u l d ba a t t g h t and n t g t d aompant mant b u t n a t h a n

{ l a x t b l a and a o l l a b o n a t t v a t n n a t u n a . Tha

2 . 6 7

6 p a c t a l J i 6 t anaa6 o{ p n a a t t a a d a { t n a d by t h a UKCC

* g a n a n a t p n a a t t a a nun-ôtng

* aommunt t y m a n t a l h a a t t h n u n ^ t n g

* aommunt t y a h t t d n a n * 6 n u n i t n g

* p u b l t a h a a t t h n u n ^ t n g ( h a a t t h v t 6 t t t n g ,

o a a u p a t t o n a t h a a t t h n u n ^ t n g , d t ^ t n t a t

n u n ^ t n g , c a h o o t n u n à t n g ] ,

Tha a d u a a t t o n a l pnognamma^ s h o u l d ba a^ { l a K t b t a

a6 p o 6 6 t b t a and may ba d a t t v a n a d t n d t { { a n a n t

t n a t u d t n g d t 6 t a n a a and opan t a a n n t n g .

OJhanavan p o ^ 6 t b t a t h a UKCC 4 t t p u t a t a , t h a

a d u a a t t o n a l pnognamma s h o u l d a o n t a t n a aommon aona

o{ p n a p a n a t t o n 6hanad M t t h o t h a n pnognamma^ o{

n a l a t a d p n a a t t a a and a l a m an t ^ 6 p a a t { t a t o an

t n d t v t d u a l ' ^ anaa6 o{ p n a a t t a a . S t u d a n t 6 who

6 u a a a 6 ^ { u l l y a o m p l a t a t h a p n a ^ a n t b a d a d u a a t t o n a l

pnognamma s h o u l d n a a a t v a a q u a l t { t a a t t o n , uohtah

maat6 t h a C o u n a t l ’ -6 4 t a n d a n d 4 , ha6 baan a p p n ov ad

by a N a t i o n a l Boand and t 6 I t n k a d t o a h t g h a n

2 . 6 2

a d u a a t t o n a c a n a d l t a t l o n Tha p n a a t t t t o n a n

s h o u l d a l à o ba g t v a n a n a d t t {on a p p n o p n t a t a

pnavlou4> t a a n n t n g g a t n a d {nom a x p a n t a n a a and

g a t n a daapan u n d a n ^ t a n d t n g o{ an anaa on anaa6 o{

nun-ôa p n a a t t a a , a6 M a t t a<6 6 p a a t { t a modu l ar t {

t n d t a a t a d . P n a p a n a t t o n M t t t ba {oun kay a n a a ^ ,

namaty - a t t n t a a t n u n ^ t n g p n a a t t a a , aana and

pnognamma manag a ma n t , a t t n t a a t p n a a t t a a

dav a t o p m a n t and a t t n t a a t p n a a t t a a t a a d a n ^ h t p .

Nan6a6 Manttng to andantaka advanaad nun^tng

pnaattaa Moutd ba axpaatad to hava aanntad out

6uah tavat6 o{ aaadamta 6tudy a6 M O u t d ba

a66oatatad Mtth a Na^tan’6 dagnaa.

Taaahan6 o{ nun6a-6 ana naqutnad t o ba a na d t b t a

a t t n t a a t t y and knoMtadgaabta about aontamponany

p n a a t t a a . Any nunia taaahan Moutd a t than naad

ba a gnaduata on hold a 6 p a a t a t t 6 t nun^tng on a

aommuntty haat th aana nun^tng q u a t t { t a a t t o n

naaondad on th a Couna t t '6 n a g t 6 t a n . Tha

t n d t v t d u a t Manttng t o t aaah nun6a6 sh ou ld at6o

2 . 6 3

hold an appnopntata taacktng quatt^tcatton.

Vt6ciu66ton6 a b o u t t naJ i n t ng and a d u a a t t o n a l naad6

do n o t oaaun w t t h t n a vaauum and mu6t a l 6 o l o o k

a t n o t a d a { t n t t t o n among aommunt ty nun6a6 . Tha

{ a a ^ t b t l t t y o{ t a t l o n t n g a d u a a t t o n and t n a t n t n g t o

t h a a xp a n d t n g n o l a o{ p n a a t t a a nun6a6 n a t 6a 6

t m p o n t a n t t 6 6 u a i a b o u t n o t a d a { t n t t t o n and t h a

p a n a a t v a d a d u a a t t o n a l naad6 o{ t h a p n a a t t t t o n a n

u n d a n t a k t n g t h a t n o t a . C a n t a t n q u a 6 t t o n 6 ^uah

a 6 , t 6 t t t h a a p p n o p n t a t a n a m t t o{ t h a p n a a t t a a

nunàa t o ba u n d a n t a k t n g 6uah a l t n t a a l pnoaaduna6

a6 o p t h a l m o i a o p t a and 6 t a t h o 6 a o p t a a x a m t n a t t o n ?

S h o u l d t h a p n a a t t a a n un^a ba v t 6 t t t n g p a t t a n t 6 a t

homa {on a66a^6 ma nt on t o o { { a n t n a a t m a n t ?

An t ^ ^ u a wht ah a l ^ o naad6 t o ba d t 6 a u 6 6 a d ti> how

p n a a t t a a nunéa^ n a l a t a t o t h a n o l a 6 o{ h a a l t h

v t ^ t t o n à and d t ^ t n t a t n u n ^ a ^ . Tha H a t t o n a l

H a a l t h S a n v t a a Nanag amant E x a a u t t v a t n t a d t o add

aohananaa t o t h t 6 d a b a t a by 4ugg a-ôttng t h a t

ahanga6 a4 a n a q u i t o{ t h a N a t i o n a l H a a l t h

2 . 6 4

S a n v t c a na{onm6 w t t l t n a n t a é a t h a o p p o n t u n t t y {on

p n a a t t a a nun^a^ t o t n a n a a ^ a t h a t n ^ k t l l 6 " . . . %of

o n l y t n n a t a t i o n t o d t n a a t p a t t a n t aana b u t t n

h a a l t h naad a66 a ^ ^ m a n t , h a a l t h p n o m o t t o n ,

t n a a t m a n t p n o t o a o l 6 , aana managamant and t h a

p n o v t ^ t o n o{ a g n a a t a n nanga o{ n a h a b t l t t a t t v a ,

p a l l t a t t v a and 6 p a a t a l t 6 t é a n v t a a - à " . (UHS

Uanagamant E x a a u t t v a , 1 993) . Tha NHSME.,

aon a l u da 6 t h a t t h a n a l 6 a o n ^ t d a n a b l a 6aopa {on

p n a a t t a a nun^a^ t o d a v a l o p t h a t n n o l a .

V o l t a y makan^ and 6 a n v t a a p l a n n a n6 w i l l naad t o

a o n é t d a n a a n a { u l l y t h a o n g a n t ^ a t t o n and n o l a o{

aommunt ty n u nà tn g b a{ ona a d u a a t t o n and t n a t n t n g

ba a l a a n l y t d a n t t { t a d , I t wou ld 6aam t m p a n a t t v a

t h a t t h a n o l a o{ t h a p n a a t t a a nun^ta and t h a

p a n a a t v ad a d u a a t t o n a l naad6 o{ t h t 6 gnoup o{

nun6a6, who ana a u n n a n t l y u n d a n t a k t n g an t l l -

d a { t n a d n o l a , naad t o ba d a t a n m t n a d . Suah an

a66 a66mant s h o u l d hava { u l l nagand t o t h a a o 6 t

a { { a a t t v a n a 6 6 o{ any dav a l o p m an t and s h o u l d ba

n a l a v a n t t o t h a h a a l t h aana naad6 o{ t h a p n a a t t a a

2 . 6 5

p o p u l a t i o n and c o n t n l b u t a o v a n a l l t o q u a l i t y c a m .

The. c h a p t a n w h i c h { o l l o w 6 w i l l d l 6 c u 6 6 the. va n lo u 6

t n a d l t l o n a l mode.l6 o{ pno { e . 6 6 l o n a l l ^ a t l o n o{ a new

o c c u p a t i o n a6 the.y ne. late. t o p n a c t l c e . n u n ^ l n g .

2 . 6 6

C H A P T E R T H R E E

THE U N IQ U E NATURE OF P RA CT I CE NURSI NG

I n t r o d u c t i o n

P r a c t i c e n u r s i n g l 6 d l { { c r c n t {rom many o{ t h e

o c c u p a t i o n s d i s c u s s ed I n t h e l i t e r a t u r e r e l a t i n g

t o an o c c u p a t i o n p r o f e s s i o n a l i s i n g . The

d i f f e r e n c e l i e s I n how t h e o c c u p a t i o n emerged and

t h e way p r a c t i c e n u r s e s dev e l o p e d t h e i r own u n i q u e

body o f k n o w l e d g e and s k i l l s f rom t h e i r v a r i e d

n u r s i n g b a c k g r o u n d s . I t was g e n e r a l

p r a c t i t i o n e r s who n o t o n l y we r e t h e f i r s t t o

r e c o g n i s e t h e b e n e f i t s o f e m p l o y i n g t h e i r own

n u r s e t o s u p p o r t t hem I n p r a c t i c e , b u t t h e d o c t o r s

a l s o a p p r e c i a t e d t h a t some n u r s e s n e e d e d e x t r a

t r a i n i n g I n o r d e r t o u n d e r t a k e some o f t h e work

t h e y we r e d e l e g a t i n g t o t hem and I n i t i a t e d

a p p r o p r i a t e I n - s e r v i c e t r a i n i n g .

P r a c t i c e n u r s i n g has c o n t i n u e d t o d e v e l o p and

r e s p o n d t o t h e c ha n ge s I n h e a l t h c a r e p r o v i s i o n ,

n o t o n l y as a r e s u l t o f g e n e r a l p r a c t i t i o n e r s

r e c r u i t i n g n u r s e s f rom d i f f e r e n t n u r s i n g

s p e c i a l t i e s b u t a l s o b e c a u s e p r a c t i c e n u r s e s have

u t i l i z e d t h e k n o w l e d g e and s k i l l s t h e y p o s s e s s I n

p r a c t i c e . I t c o u l d be s a i d , t h e r e f o r e , t h a t

p r a c t i c e n u r s i n g I s d e t e r m i n e d by t h e k n o w l e d g e ,

s k i l l s and n u r s i n g e x p e r i e n c e n u r s e s e n t e r i n g

p r a c t i c e n u r s i n g p o s s e s s and u t i l i z e I n t h e i r r o l e

and by t h e a c t i v i t i e s g e n e r a l p r a c t i t i o n e r s

d e l e g a t e t o t h e i r n u r s e s . P r a c t i c e n u r s i n g

I s n o t b a s e d on a s p e c i f i c or I n i t i a l body o f

kno wledg e, w h i c h C a r r - S a u n d e r s s u g g e s t s I s t h e

b a s i s o f a p r o f e s s i o n and s t a t e s , " . . . a p r o f e s s i o n

may p e r h a p s be d e f i n e d as an o c c u p a t i o n b a s e d upon

S p e c i a l i s e d I n t e l l e c t u a l s t u d y and t r a i n i n g , t h e

p u r p o s e o f w h i c h I s t o s u p p l y s k i l l e d s e r v i c e and

a d v i c e t o o t h e r s f o r a d e f i n i t e f e e or s a l a r y . . . "

( 1 9 2 8 : 4 ) . The d i a g ra m s w h i c h f o l l o w I l l u s t r a t e

t h e s e p o i n t s .

Registered Sick Chiidren's Nurse

R e g is te r e d M idw ife R e g is t e r e d M en tai N u r s e

R e g is te r e d H eaith V is ito r

P r a c t ic e N u rse- ► M -

(G en era l N u r se T rained)E n ro iied N u r se

D istr ic t N u rsin g C er tif ic a te

C o m m u n ity P s y c h ia tr ic N u r se

F e v e r N u r se

F ig . 3 .1 Diagram t o U L t a s t r a t e t h e d i v e r s e n a t u r e o f p r a c t i c e n u r s i n g and p o t e n t i a l k n o w led g e b a s e

Note: Some r e c r u i t s t o p r a c t i c e n u r s i n g h e l dt h e E n r o l l e d Nur s e q u a l i f i c a t i o n ,(Vamant , 1990) and A t k i n s and L u n t , 1993)

Community Midwife

CommunityPsychiatric

NurseHeaith Visitor

PracticeNurse

Registered Sick Chiidren's NurseDistrict Nurse

Fjig . 3 , 2 VLoLgKam ^hom Lng t h e , £ j i e , t d 6 o i p ^ a c t t d e .iKom oshJLdh pfLacttce, nu^6e6 mLght come.

Tht6 chapten. u j t l t con^Jide,^ a6pdc. t6 o l the, na ture .

0 ^ pfLacitJidd n u ^ ^ t n g w h i c h make t h l 6 new o c c u p a t i o n

d l l l e n , e n t l^iom t h e t r a d i t i o n a l model6 o^

p r o l e 6 6 l o n a l l 6 a t l o n . The ^ e a t u r e 6 w h i c h make

p r a c t i c e n u r s i n g u n i q u e r e l a t e t o how t h e

o c c u p a t i o n emerged , r e c r u i t e d and s e l e c t e d l t 6

members , f o r m u l a t e d l t 6 own b o d i e s o f kno wl ed g e

and 6 k l l l 6 , r e c o g n i s e d and r e s p o n d e d t o p a t i e n t

s e r v i c e n ee ds and became a c c e p t e d as a c r e d i t a b l e

pro f e s s l o n a l o c c u p a t i o n ,

The t r a d i t i o n a l mo de l s o f p r o f e s s i o n a l i s a t i o n o f

an o c c u p a t i o n a l l m e n t i o n t h e s t r u c t u r a l c ha ng es

w hi ch need t o t a k e p l a c e w i t h i n an o c c u p a t i o n , t h e

need f o r t r a i n i n g and a s p e c i f i c body o f t h e o r y as

t h e f o u n d a t i o n o f a new and emer ging p r o f e s s l o n a l

g r o u p . For e xa m p l e , Caplow, (1954) s u g g e s t s t h a t

an o c c u p a t i o n w i l l n ee d t o c ha n g e I t s t i t l e , f o u n d

a s p e c i f i c a s s o c i a t i o n w h i c h w o u l d h a v e t h e

a u t h o r i t y t o r e g u l a t e a d m i s s i o n and d e t e r m i n e t h e

s c o p e o f p r a c t i c e . W l l e n s k y , (1964) s i m i l a r l y

I d e n t i f i e s t h e c ha nge s w h i c h n eed t o t a k e p l a c e

and s u g g e s t s t h a t can o n l y happen o n ee an

o c c u p a t i o n has become f u l l - t i m e and e s t a b l i s h e d a

t r a i n i n g s c h o o l l i n k e d w i t h a u n l v e r s l t y and

Greenwood, (1966) a l on g w i t h o t h e r s , s t a t e s t h a t a

p r o f e s s i o n ' s ' k e r n e l o f u n i q u e n e s s and c r u c i a l

d i s t i n c t i o n ' I s t h e body o f t h e o r y w h i c h f orms t h e

b a s i s o f t h e p r o f e s s i o n ' s I n t e r e s t and p r a c t i c e .

But t h e s e f e a t u r e s w o u l d a p p ea r t o be more

r e l e v a n t t o t h e v a r i o u s I n d i v i d u a l s e g m e n t s ,

w hi ch make up p r a c t i c e n u r s i n g t h a n t h e y do t o t h e

w h o l e o c c u p a t i o n as I t c u r r e n t l y e x i s t s .

But I f each o f t h e s e f e a t u r e s a r e c o n s i d e r e d I n

t h e c o n t e x t o f p r a c t i c e n u r s i n g . I t w i l l be

a p p r e c i a t e d t h a t t h e s t r u c t u r a l c ha n g e s w h i c h form

p a r t o f t h e p r o f e s s i o n a l i s a t i o n p r o c e s s c a n n o t

a p p l y t o t h i s p a r t i c u l a r g r o u p . In t h e f i r s t

I n s t a n c e , t h e t i t l e ' p r a c t i c e n u r s e ' r e l a t e s t o

t h e p l a c e o f e mp l o y m e n t , ( R o y a l C o l l e g e o f

N u r s i n g , 1984] and n o t t o a u n i q u e body o f t h e o r y ,

a l t h o u g h p r a c t i c e n u r s i n g I s dev e l o p i n g I t s own

body o f knowledg e. S e c o n d l y , t h e s t a t u t o r y

b o d i e s f o r n u r s i n g , m i d w i f e r y and h e a l t h v i s i t i n g

f u l f i l an o b l i g a t o r y f u n c t i o n o f r e g u l a t i n g

a d m i s s i o n t o t h e p r o f e s s i o n , and a p p r o v i n g

e d u c a t i o n and t r a i n i n g , a l l o f w h i c h a r e l i n k e d

w i t h I n s t i t u t e s o f h i g h e r e d u c a t i o n , and d e f i n i n g

t h e s c o p e o f p r o f e s s l o n a l p r a c t i c e . Jn a d d i t i o n ,

p r a c t i c e n u r s i n g I s p r e d o m i n a n t l y a p a r t - t i m e

o c c u p a t i o n , ( A t k i n s and L u n t , 1 9 93 ) . A p a r t f rom

t h e f a c t t h a t a number o f p r a c t i c e n u r s e s

have c h o s e n p r a c t i c e n u r s i n g b e c a u s e t h e y can

work f l e x i b l e p a r t - t i m e h o u r s , t h e n u r s e s have

a l s o c o m p l e t e d I n i t i a l g e n e r a l n u r s e t r a i n i n g .

As t h i s o c c u p a t i o n has emerged , p r a c t i c e n u r s i n g

wo ul d a p p ea r t o be l i k e t h e mode l d e s c r l b ed by

Bucher and S t r a u s s , " . . . p r o f e s s i o n s a r e l o o s e

a m a l g a m a t i o n s o f s e g m e n t s p u r s u i n g d l f f e r e n t

o b j e c t i v e s I n d i f f e r e n t manners and more or l e s s

d e l i c a t e l y h e l d t o g e t h e r u nd er a common name a t a

p a r t i c u l a r p e r i o d I n h i s t o r y . . . " ( Bu ch er and

S t r a u s s , ( C i t e d I n l /o l l me r and N l l l s , 1 966 : 86 ) .

I t I s f rom t h e s e l o o s e a m a l g a m a t i o n s t h a t a

s i n g l e o c c u p a t i o n I s s l o w l y b e g i n n i n g t o emerge .

Bucher and S t r a u s s (1966) b a s e d t h e i r d i s c u s s i o n

a b o u t t h e c o n c e p t o f p r o f e s s i o n s on m e d i c i n e as a

p r o t o t y p e t o I l l u s t r a t e t h e i r p o i n t s , a l t h o u g h

t h e y c l e a r l y s t a t e o t h e r pro f e s s i o n s m i g h t h ave

been c h o s e n f o r t h e d i s c u s s i o n . T he y , ( 1 9 6 6 : 8 6 )

p o i n t o u t , " . . . t h e g r e a t d i v e r g e n c y o f e n t e r p r i s e

and e n d e a v o u r t h a t mark t h e pro f e s s l o n , t h e

c l e a v a g e s t h a t e x i s t a l o ng w i t h i n t h e d i v i s i o n o f

l a b o u r ; and t h e I n t e l l e c t u a l and sp e c l a l l s t

mov emen t s t h a t o c c u r w i t h i n t h e broad r u b l e c a l l e d

' o r g a n i s e d m e d i c i n e ' . . . " . Bucher and S t r a u s s

s u g g e s t t h a t w i t h i n any p r o f e s s i o n s p e c i a l i s m

o c c u r s . The a p p l i c a t i o n o f t h i s t h e o r y t o

n u r s i n g m i g h t mean t h a t g e n e r a l n u r s i n g , as a

p r o f e s s i o n , c o u l d be t h e a l l e mb ra c i ng u m b r e l l a

t e r m or 'common n a me ’ w h i c h I s ' d e l i c a t e l y h o l d i n g

t o g e t h e r ' t h e v a r i o u s s e g m e n t s w h i c h c u r r e n t l y

make up t h i s p r o f e s s i o n , s u c h as d i s t r i c t n u r s i n g ,

communi ty p s y c h i a t r i c n u r s i n g and o t h e r s .

I f p r c L c t l c e n u r s i n g I s c o n s i d e r e d as b e i n g made up

of a number o f s e g m e n t s , w i t h t h e n u r s e s

r e c o g n i s e d f o r t h e i r l o c a t i o n o f p r a c t i c e r a t h e r

t h a n f o r any S p e c i f i c body o f kn owl ed g e t h e y

p o s s e s s , I t c o u l d be s a i d t h a t t h e v a r i o u s

s t r u c t u r a l c ha nge s w h i c h form p a r t o f t h e p r o c e s s

o f p r o f e s s l o n a l l s t l o n a r e n o t a p p l i c a b l e t o

t h i s p r o f e s s i o n a l g r ou p b e c a u s e t h e y h a v e a l r e a d y

go n e t h r o u g h t h e pro f e s s l o n a l l s a t l o n p r o c e s s

b e c a u s e each n u r s e I s q u a l i f i e d as a g e n e r a l

n u r s e .

But t h e n u r s e s who we r e r e c r u i t e d t o s u p p o r t t h e

g e n e r a l p r a c t i t i o n e r s w i t h t h e p r o v i s i o n o f

g e n e r a l m e d i c a l s e r v i c e s , a s s i s t w i t h any

p r o c e d u r e s and h e l p w i t h d e v e l o p i n g s e r v i c e s

w i t h i n t h e p r a c t i c e f o r t h e p a t i e n t s w e r e n o t

n e c e s s a r i l y r e c r u i t e d f o r t h e i r kno wl ed g e and

s k i l l s . A c c o r d i n g t o Re edy , e t a l 11976) t h o s e

n u r s e s whom t h e d o c t o r s c o n s i d e r e d w o u l d f i t I n t o

t h e p r a c t i c e p h i l o s o p h y r a t h e r t h a n n u r s e s w i t h

s p e c i f i c k n o w l e d g e and s k i l l s w e r e s e l e c t e d .

A l s o , A t k i n s and L u n t , (1993) f o u n d t h a t g e n e r a l

p r a c t i t i o n e r s we r e t e n d i n g t o employ n u r s e s who

wer e I n t h e o l d e r age g r o u p , who had t h e b e n e f i t

o f l i f e e x p e r i e n c e t o b r i n g and u s e I n p r a c t i c e .

But as Vamant , (1990) p o i n t s o u t t h e m a j o r i t y o f

n u r s e s r e c r u i t e d t o p r a c t i c e n u r s i n g d u r i n g t h e

t i m e when t h e r e was c o n s i d e r a b l e g r o w t h I n numbers

wer e p r i n c i p a l l y n u r s e s who we r e r e t u r n i n g t o

p r a c t i c e a f t e r a gap I n s e r v i c e o f f i v e y e a r s or

more. Not o n l y , t h e r e f o r e , w e r e g e n e r a l

p r a c t i t i o n e r s n o t s e l e c t i n g n u r s e s f o r t h e i r

knowl edg e and s k i l l s b a s e , b u t a l s o t h e y we r e

a p p o i n t i n g n u r s e s who we r e p o s s i b l y n o t u p d a t e d

w i t h k n o w l e d g e and s k i l l s . T h i s p r o b l e m has now

been a d d r e s s e d w i t h t h e I n t r o d u c t i o n o f ' R e t u r n t o

P r a c t i c e ' c o u r s e s , a t t e n d a n c e a t w h i c h I s a

m an d a t o r y r e q u i r e m e n t I f a n u r s e has had a gap I n

n u r s i n g p r a c t i c e o f f i v e y e a r s or more , (UKCC,

19 86 ) . I t I s p e r h a p s I n t e r e s t i n g t o r e f l e c t ,

h o we v er , t h a t I f a n u r s e has had an I n t e r r u p t i o n

I n n u r s i n g p r a c t i c e and I s r e t u r n i n g t o p r a c t i c e

3 . 1 0

n u r s i n g , t h a t t h e r e I s no s p e c i f i c e d u c a t i o n and

t r a i n i n g r e l a t e d t o n u r s i n g I n g e n e r a l p r a c t i c e

f o r t h e n u r s e t o u p d a t e h i s / h e r k nowl edg e and

s k i l l s .

T h e r e h ave been a number o f o t h e r c o n t r i b u t o r y

f a c t o r s I n t h e g r o w t h o v e r t h e y e a r s I n t h e number

o f n u r s e s becoming p r a c t i c e n u r s e s , and t h e number

of g e n e r a l p r a c t i t i o n e r s e m p l o y i n g p r a c t i c e n u r s e s

w hi ch r e l a t e n o t o n l y t o Gov e r n m e n t p o l i c y b u t

a l s o l e g i s l a t i o n a f f e c t i n g g e n e r a l p r a c t i c e .

T h i s g r o w t h I n numbers I s s u p p o r t e d by

e v i d e n c e I n T a b l e 7 . 7 . The c o n s i d e r a b l e

I n c r e a s e I n t h e number o f p r a c t i c e n u r s e s s i n c e

1987 c o n f i r m s t h e I m p a c t o f t h e 1990 New G e n e r a l

P r a c t i t i o n e r C o n t r a c t and t h i s I s s u b s t a n t i a t e d

by R o b i n s o n e t a l ( 1 993 ) who f o u n d t h a t 51% o f

g e n e r a l p r a c t i t i o n e r s had c r e a t e d a new p o s t

w i t h i n t h e p r a c t i c e s t a f f e s t a b l i s h m e n t I n o r d e r

t o s u p p o r t a p r a c t i c e n u r s e t o f u l f i l t h e

r e q u i r e m e n t o f t h e New G e n e r a l P r a c t i t i o n e r

C o n t r a c t o f 1 990 . But t h e main f o c u s o f t h e

3 . 1 1

C o n t r a c t was upon a n t i c i p a t o r y c a r c , hea l th ,

p r o m o t i o n , h e a l t h e d u c a t i o n , s c r e e n i n g and

r e a c h i n g t a r g e t s f o r c h i l d r e n ' s I m m u n i s a t i o n s and

c e r v i c a l c y t o l o g y f o r w h i c h n u r s e s I n g e n e r a l were

n o t t r a i n e d , and t h i s p r o m p t e d e d u c a t i o n a l

I n i t i a t i v e s by t h e D e p a r t m e n t o f H e a l t h t h e d e t a i l

o f w h i c h has been d e s c r i b e d I n c h a p t e r t w o .

But t h e r e may, h o w e v e r , be o t h e r f a c t o r s w hi ch

have a f f e c t e d t h e r e c r u i t m e n t and d e v e l o p m e n t o f

p r a c t i c e n u r s i n g . E l l i o t t , (1911) f o r e x am pl e ,

s a y s t h e emer g en ce o f a new o c c u p a t i o n a l g ro up

may a t t r a c t o t h e r s t o I t . E l i o t t , (1972) was

r e f e r r i n g t o a p r o f e s s l o n ' s p e r f o r m a n c e and

r e l a t e d s t a t u s and I d e o l o g y . His n o t i o n m i g h t

S u p p o r t t h e r e a s o n s g i v e n by p r a c t i c e n u r s e s f o r

c h o o s i n g p r a c t i c e n u r s i n g , t h a t t h e y w a n t e d t o be

p a r t o f p r e v e n t a t l v e c a r e and e n a b l i n g p a t i e n t s t o

c h an ge l i f e s t y l e s r a t h e r t h a n a t t h e o t h e r end

p o i n t o f I n t e n s l v e c a r e and p e r h a p s n o t b e i n g a b l e

t o make any I m p a c t on a p a t i e n t ' s f u t u r e

w e l l - b e i n g , (Vamant , 1 9 9 0 ) . S i m i l a r l y , J n k e l e s

3 . 12

e t a l , (1956) s t a t e t h a t t h e r e I s c o n s i d e r a b l e

e v i d e n c e t o s u g g e s t t h a t s o c i a l s y s t e m s r e c r u i t

I n d i v i d u a l s who a l r e a d y s h a r e a t t i t u d e s t y p i c a l o f

members o f t h e s y s t e m . Newcombe, (1957) h o l d s

t h e v i e w t h a t I n d i v i d u a l s a r e s h a p e d by wh a t t h e y

wo ul d l i k e t o be and s y s t e m s t e n d t o r e c r u i t

I n d i v i d u a l s who m e e t t h e r e q u i s i t e s o f t h e s y s t e m

n o t o n l y I n t a l e n t s and e q u i p m e n t b u t I n g e n e r a l

o u t l o o k and o r i e n t a t i o n as w e l l . Bucher and

S t r a u s s ( 1 96 6 : 1 9 4 ) a l s o s u p p o r t t h e s u g g e s t i o n

d i s c u s s e d by o t h e r w r i t e r s t h a t " . . . s e g m e n t s

c h o o s e c a n d i d a t e s I n t h e i r own I m a g e . . . " .

P r a c t i c e n u r s i n g has emerged as a r e s u l t o f

Gov e r n me n t and g e n e r a l p r a c t i t i o n e r s s u p p o r t and

has s ub s e q u e n t l y grown and d e v e l o p e d b e c a u s e o f

t h e s e and o t h e r o u t s i d e p r e s s u r e s .

Nany p r a c t i c e n u r s e s , h ow e v e r , h a v e c h o s e n

p r a c t i c e n u r s i n g b e c a u s e o f t h e o p p o r t u n i t i e s o f

w o r k i n g f l e x i b l e h o u r s , b e i n g an I n t e g r a l member

o f a p r i m a r y h e a l t h c a r e t ea m and h a v i n g c l o s e

w o r k i n g r e l a t i o n s h i p s w i t h i n a s m a l l manag ement

3 . 13

s t r u c t u r e . P r a c t i c e n u r s e s a l s o commented on t h e

d i r e c t p a t i e n t c o n t a c t a p p r o a c h and a l t h o u g h t h e r e

wer e t h e d i s a d v a n t a g e s o f wo r k i n g I n I s o l a t i o n ,

t h e r e we r e a l s o t h e o p p o r t u n i t i e s f o r a u t o n o m y ,

t h e work was v a r i e d and I n t e r e s t i n g and r a n g e d

f rom b e i n g p r o a c t l v e t o r e a c t i v e f rom d e l e g a t e d

t o t a k i n g r e s p o n s i b i l i t y , (Vamant , 1 990 ) .

R e c r u i t m e n t , h o we v er . I s n o t t h e o n l y f e a t u r e

w h ic h I s d i f f e r e n t w i t h t h i s emer g i ng o c c u p a t i o n .

An e a r l y s t a g e o f pro f e s s l o n a l l s a t l o n o f an

o c c u p a t i o n , a c c o r d i n g t o E l l i o t t , (1971) I s t h a t

t h e members o f t h e o c c u p a t i o n r e c o g n i s e a s o c i a l

need p e r s p e c t l v e and t h i n k t h e s e r v i c e s t h e y

p r o v i d e a r e v a l u a b l e and n e c e s s a r y f o r t h e w e l l

b e i n g o f s o c i e t y . The p r a c t i c e n u r s e s who we r e

t h e e a r l y p i o n e e r s o f p r a c t i c e n u r s i n g , a l t h o u g h

e n t e r i n g t h e o c c u p a t i o n f rom a v a r i e t y o f r o u t e s ,

w i t h a f o u n d a t i o n o f a t l e a s t t h e k no wl ed g e

a s s o c i a t e d w i t h g e n e r a l n u r s i n g w o u l d p r o b a b l y

h ave had a s o c i a l n ee ds p e r s p e c t l v e w i t h a

c o m m o n a l i t y o f c o n c e r n and p u r p o s e , na me l y t o

3 . 1 4

m e e t t h e n ee ds o f p a t i e n t s w i t h i n t h e p r i m a r y

e a r e s e t t i n g o f g e n e r a l p r a c t i c e . The

n o t i o n t h a t a l l pro f e s s l o n a l I n d i v i d u a l s a r e

c o m m i t t e d t o s h a r e d c o n c e r n s and t h e common good

of S o c i e t y t h e y s e r v e I s a v i t a l c o m p o n e n t o f a l l

pro f e s s i o n s and I n s t i t u t i o n s I n I n d u s t r i a l

s o c i e t y , a c c o r d i n g t o P a r s o n s , ( 1 9 3 9 ) ,

T h i s ' s e r v i c e o r i e n t a t i o n ' d e s c r i b e d by Goode,

(1913) I s f o r t h e p r o t e c t i o n and w e l l b e i n g o f t h e

I n d i v i d u a l , s o c i e t y as a w h o l e , t h e pro f e s s l o n and

pro f e s s l o n a l c o l l e a g u e s . Halmos, ( 1 966 ) s u g g e s t s

t h a t t h e pro f e s s l o n a l s h a r e d c o n c e r n f o r p e o p l e ' s

h e a l t h and c o n t e n t m e n t o r i g i n a t e d I n pro f e s s i o n s

s u c h as m e d i c i n e and s o c i a l work , and has a l way s

been a t t h e f o r e f r o n t o f n u r s i n g p r a c t i c e and t h i s

e t h i c o f p e r s o n a l s e r v i c e has s u bs e q u e n t l y s p r e a d

t o I n f l u e n c e t h e s e l f - i m a g e o f o t h e r

p r o f e s s i o n a l s , and t h e d e c i s i o n s a pro f e s s l o n a l

m i g h t make f o r a c l i e n t wo ul d be b a s e d on t h a t

p e r s o n ' s need w i t h t h e u l t i m a t e r e s p o n s i b i l i t y f o r

any d e c i s i o n r e s t i n g w i t h t h e pro f e s s l o n a l ,

3 , 1 5

(Mars h a l l , 1 939 ) ,

But an e s s e n t i a l f e a t u r e o f t h e s e r v i c e

p e r s p e c t l v e I s t h a t I t I s b as e d on t h e k n o w l e d g e

h e l d by t h e p r o f e s s i o n a l g r o u p , Bucher and

S t r a u s s , ( C i t e d I n V o l l m e r and M i l l s , 1966)

S u g g e s t t h a t w i t h i n any pro f e s s l o n d i v i s i o n s and

s u b - d l v l s l o n s o f s p e c i a l i s t p r a c t i c e o c c u r .

S e g m e n t a t i o n and s p e c i a l i s a t i o n I n p r a c t i c e

n u r s i n g I s due , n o t o n l y t o t h e knowl edg e and

s k i l l s t h e n u r s e s p o s s e s s , b u t a l s o how t h e

p r a c t i t i o n e r has u t i l i z e d t h i s b a c k g r o u n d

I n f o r m a t i o n t o d e v e l o p a s p e c i f i c f i e l d o f

p r a c t i c e t o m ee t p a t i e n t s n e e d s . Tor e x a m p l e ,

n u r s e s w i t h s p e c i a l i s t k n o w l e d g e I n f a m i l y

p l a n n i n g h ave dev e l o p e d n ur s e - r u n f a m i l y p l a n n i n g

c l i n i c s w i t h i n g e n e r a l p r a c t i c e , o t h e r n u r s e s w i t h

s i c k c h i l d r e n ' s n u r s i n g k n o w l e d g e and e x p e r t i s e

have dev e l o p e d nu rs e - r u n s u r g e r l e s s p e c i f i c a l l y

f o r s i c k c h i l d r e n , F u r t h e r s p e c i a l i s a t i o n m i g h t

o c c u r I n e i t h e r o f t h e s e e x a m p l e s . For I n s t a n c e

some n u r s e s m i g h t h a ve p a r t i c u l a r I n t e r e s t and

3 , 1 6

knowledg e I n c o n t r a c e p t i o n f o r t h e young

a d u l t and n u r s e s with. s i c k c h i l d r e n ’s

n u r s i n g e x p e r t i s e m i g h t h ave a p a r t i c u l a r

I n t e r e s t I n p a e d i a t r i c a c c i d e n t and emergency

work and p a t i e n t ' s u s e t h e s e f a c i l i t i e s

b e c a u s e as Greenwood, ( C i t e d I n V o l l m e r

and M i l l s , 1966) s u g g e s t s a p r o f e s s i o n a l

g r o u p ' s c r e d i b i l i t y comes f rom t h e

layman r e c o g n i s i n g t h e a u t h o r i t y o f

knowledg e an I n d i v i d u a l or pro f e s s l o n a l

g r o up h o l d s . S i m i l a r l y , C a r r - S a u n d e r s ,

( C i t e d I n V o l l m e r and M i l l s , 1966) s t a t e s

t h a t m a s t e r y o v e r an a r e a o f k n o w l e d g e

g i v e s an a u t o m a t i c d e g r e e o f po wer t o

t h e p r a c t i t i o n e r s who h a ve a c q u i r e d

t h i s k n o w l e d g e , and Caplow, (1954) s u g g e s t s

p u b l i c r e c o g n i t i o n I s r e s e r v e d f o r t h o s e

who a r e q u a l i f i e d and r e g i s t e r e d t o

p r o f e s s i o n a l l y p r a c t i c e ,«

P r a c t i c e n u r s e s , h ow e v e r , do n o t c u r r e n t l y h a ve a

s p e c i f i c body o f t h e o r y or I d e n t i f i e d s k i l l s

3 , 1 7

t r a i n i n g so I t I s d i f f i c u l t t o s e c how s o c i e t y can

r e c o g n i s e p r a c t i c e n u r s i n g u s i n g t h e s e m o d e l s .

But a c c e p t a n c e o f p r a c t i c e n u r s i n g as a

c r e d i t a b l e p r o f e s s i o n a l o c c u p a t i o n has come o v e r a

number o f y e a r s as h e a l t h c a r e p r o v i s i o n and

e mp h as i s has cha n ge d f o c u s . Consumers s u p p o r t e d

p r a c t i c e n u r s i n g and p r a c t i c e n u r s e s I n a 1986

Marplan s u r v e y by I d e n t i f y i n g t h a t t h e y p r e f e r r e d

t o s e e t h e p r a c t i c e n u r s e f o r c e r t a i n a s p e c t s o f

h e a l t h c a r e , and l i k e d t h e av a l l a b l l l t y ,

a c c e s s i b i l i t y and f l e x i b i l i t y o f t h e s e r v i c e

p r a c t i c e n u r s e s p r o v i d e d ,

T h i s c h a p t e r has e xa mi ne d some o f t h e u n i q u e

f e a t u r e s o f p r a c t i c e n u r s i n g . By c o n s i d e r i n g t h e

n a t u r e o f p r a c t i c e n u r s i n g I t has shown t h a t t h e

t r a d i t i o n a l mode l s o f pro f e s s l o n a l l s a t l o n a r e n o t

v a l i d when t h e y a r e a p p l i e d t o p r a c t i c e n u r s i n g

and cons e q u e n t l y t h e a p p r o a c h t o pro f e s s l o n a l

knowl edg e and e d u c a t i o n m u s t a l s o be d i f f e r e n t .

The h i s t o r y o f p r a c t i c e n u r s e e d u c a t i o n d e t a i l e d

3 , 1 8

I n c h a p t e r two I d e n t i f i e d v a r i o u s e d u c a t i o n a l

I n i t i a t i v e s w h ic h dev e l o p e d o v e r t h e y e a r s on an

ad hoc b a s i s . J t was g e n e r a l p r a c t i t i o n e r s who

f i r s t r e c o g n i s e d t h e e d u c a t i o n a l and t r a i n i n g

n eed s o f t h e i r p r a c t i c e n u r s e s and e n d e a v o u r e d t o

m e e t t h e s e n eed s by s e t t i n g up d i f f e r e n t

e d u c a t i o n a l programmes , s t u d y days and u n d e r t a k i n g

I n - h o u s e t r a i n i n g . The g e n e r a l p r a c t i t i o n e r s

who o r g a n i s e d t h e s e v a r i o u s e d u c a t i o n a l

I n i t i a t i v e s r e c o g n i s e d t h e need f o r s p e c i a l i s t

t r a i n i n g t o e x t e n d t h e knowledg e and s k i l l s o f

p r a c t i c e n u r s e s t o m e e t t h e demands o f p r a c t i c e .

A l l t h e c o u r s e s we r e s h o r t and we r e p l a n n e d as a

' t o p p i n g u p ' o f I n i t i a l t r a i n i n g r a t h e r t h a n

I n i t i a l t r a i n i n g and t h e y wer e p r a c t i c e o r i e n t a t e d

and p r a c t i c e d r i v e n . C o n s e q u e n t l y p r a c t i c e

n u r s i n g has dev e l o p e d I n a r a t h e r d i f f e r e n t way t o

t h a t Sugg e s t e d by t h e t r a d i t i o n a l m o de l s of

emerg i ng p r o f e s s i o n s .

As t h i s new pro f e s s l o n has emerged w i t h i n n u r s i n g ,

p r a c t i c e n u r s e s . I n l i n e w i t h t h e i r o t h e r

3 . 1 9

d o m m u n t t y c . o l l e . a g u d 6 , now ^ddkJing thdJiK own

I d a n t I t y , T/ie u n t q u d ^ d a t u ^ d 6 o l p^ac . t t c . d

n u K ^ t n g dd6c.n.Jib dd Jin thJi6 c k a p t d ^ Ji66ud^

a b o u t t h d n a t u K d o l p ^ d p a ^ a t t o n (on. p ^ a a t t d d ^04.

t h t 6 p a ^ t t d u l a K g ^ o u p o i n u ^ 6 d 6 . To p f i o d u t d a

6 t n g Z d t ^ a d t t t o n a t m o dd t dun .Ktdutum {^on. tkt4>

d t v d K ^ d p K o I d ^ ^ L o n a l g ^ o u p w o u l d bd I n a p p ^ o p ^ l a t d ,

unldJi6 p f i a d t l d d n u K ^ l n g bdc.omd-6 d l ^ d c t d n t ^ y &4

p a ^ t o l a ndw b ^ an a h o l n u K 6 l n g , Thd R o y a l

C o l l d g d o l h lu ^ ^ l n g , ( 1 9 84 ) 6 p d n t many ydaK^ t r y i n g

t o p ^ o d u d d a dUKKldulum w h l d k w o u l d bd K d l d o a n t

loK a l l p ^ a d t l d d nun.6d^ and {^ound t k l 6 d l ^ ^ l d u l t

t o a d h l d v d .

V ^ a d t l d d n u K ^ d i dntdn. p f i a d t l d d nun.6lng a l K d a d y

t n . a l n d d , F^om t k d l f i o a K l d d b a d k g ^ o und6 and

d x p d ^ l d n d d w h l d k t h d y u t l l l z d I n p f i a d t l d d , nuf i6d6

aKd g f i a d u a l l y ^ o f i m u l a t l n g t h d l f i own u n l q u d body o^

p f i a d t l d d n u f i 6 l ng t h d o f i y and f i d l a t d d 4> k l l l 6 ,

V f i a d t l d d nuf i6d6 , howdvdf i , wofik I n d l ^ d f i d n t

g d n d f i a l p f i a d t l d d 6 d t t l n g 6 and eac/i nuf i6d w i l l h a v d

a f iangd o f i d 6 p o n 6 l b l l l t l d 6 and u n d d f i t a k d

3 , 2 0

d l l l d f i d n t a d t l v I t l d à d t p d n d l n g upon daah

^ufig d-fildé p h i l o s o p h y a b o u t SdfLvlcd p r o v i s i o n . So

t h a t , n o t o n l y w i l l nuKSdS havd t h d l f i own body o^

t h do f i y and s k i l l s w h i c h t h d y afid u t i l i z i n g I n

cuf i f idnt p f i a d t l d d , b u t a l s o t h d y w i l l havd

othdf i I n d i v i d u a l d d u c a t l o n and t f i a l n l n g n d d d s ,

wa n ts and ddmands f i d l a t d d t o I n d i v i d u a l gdn df ia l

p f i a d t l d d ddv d l o p m d n t s ,

Ond way t o mddt t h d nddds ol t h i s dlvdf iSd gfioup

oi nufiSdS would appdafi t o bd t o ' t o p up* on t h d

nufiSdS I n i t i a l dduc a t l on and t f i a l n l n g , Thd

' t opp i ng up' coul d bd modulafi In s t f iuctuf id and

nddd not bd t a u g h t ^ a c d - t o - ^ a c d , but by d l s t a n c d ,

Thd nufiSdS coul d S d l d d t fiom a menu ol modules .

S u b j e c t s which would not onl y b u i l d on t h e

nufisds pf idvlous knowledge base but a l s o meet t h e

demands o cufifient ■■ p f i a c t l c e , Jn a d d i t i o n ,

because o{, t h e pf i esent economic phenomenon, t h e

doctof i s would have some f ieassufiance t h a t

thdl f i nufiSdS would not be away fiom t h e

pf i adt l dd iofi l ong pef i lods oi s t u d y . I t

a l s o means, t h a t whtfie a p f i ae t l e e has two 0 4 mon.e

pf i a e t l e e nufises In p o s t t h a t t h e s e nufises coul d

s t u d y one ok mon.e modules t og etheK as a s ma l l

gKoup OK choose t o s t u d y on t h e l K own as

I n d i v i d u a l s , El theK o p t i o n oUeKS a s y s t e m

which I s { f l e x i b l e In d e s i g n and appKoach,

The loKegolng has Ka l s e d a numbeK oi I s s u e s

which need t o be exploKed and d i s c u s s ed In t h e

c o n t e x t oi c o n t i nu i ng educ a t i on p Ko v l s l o n ioK t h i s

d l v c Ks e p K o i e s s l o n a l gKoup oi nuKses , The

chapteK which i o l l o w s w i l l d i s c u s s t h e uni que

i ea t uKe s oi p K a c t l c e nuKSlng as t h e y K e l a t e t o

pKo i e s s l o n a l knowledge and e duc a t i on p K o v l s l o n ,

3 , 2 2

C H A P T E R FOUR

EVUCATJON ANV T R A I N I N G ANV THE NEEVS OF PR A C T I C E

NURSES

JntKodu.c. t lon

The pKevl oas ehapteK I d e n t l i l e d a s p e c t s w i t h i n t h e

natuKe oi p K a c t l c e nuKSlng which make I t d l H e K e n t

iKom otheK pKo i e s s l o n a l o c c u p a t i o n s . The unique

i ea t uKe s about p K a c t l c e nuKSlng which wckc

I d e n t l i l e d have I m p l i c a t i o n s ioK c o n t i n u i ng

educ a t i on p Ko v l s l on ioK t h i s paKt l c u l aK gKoup oi

nuKses, not only because p K a c t l c e nuKses come iKom

a d l v e K S l t y oi nuKSe backgKounds and aKe

pKedoml nant l y geneKal nuKse t Ka l n e d , but a l s o

because t h e nuKses woKk w i t h i n d l H eKent t y p e s oi

p K a c t l c e s wheKe t h e d e l e g a t e d woKk iKom t h e

doctoKS and s e K v l c e p Ko v l s l o n ioK t h e p a t i e n t s

w i l l vaKy and wheKe K e l e a s e ioK s t u d y l e a v e I s

d l i i l c u l t t o o b t a i n because oi t h e s ma l l

management s t Kuc t uKes oi geneKal p K a c t l c e w i t h i n

which t h e nuKses aKe employed p K o h l b l t s t h i s .

The pKO i e s s l o n a l e duc a t i on and t Ka l n l ng

pKepaKat lon ioK t h i s gKoup oi nuKses, a t t h i s

moment oi t i m e and a t t h i s s t a g e oi de ve l opment oi

p K a c t l c e nuKSlng, would be InappKopKl a t e t o be

e l t heK I n i t i a l In appKoach because t h e nuKSes a l l

have backgKound knowledge and s k i l l s , Uel theK

would I t be appKopKl at e ioK t h e appKoach t o be

pKe-s e Kv l ce because p K a c t l c e nuKses aKe alKeady

In p o s t . Any e d uc a t i o n p Ko v l s l o n , t hc Ke i oKe ,

would need t o be l n~s e Kv l ce and K e l a t e d t o what

t h e nuKses i e e l t h a t t h e y need ioK

compe t ent p K a c t l c e t a k i n g I n t o account t h e unique

i ea t uKe s oi p K a c t l c e nuKSlng d i s c u s s e d p K e v l o u s l y ,

But because oi t h e d l v e Ks e natuKe oi p K a c t l c e

nuKSlng, and t h e nuKses' d l H e K e n t backgKounds, I t

Is not known p K e c l s e l y what t h e nuKSes i e e l t h a t

t h e y need In t h e way oi e d uc a t i o n and t Ka l n l n g

p Ko v l s l o n , hence t h e Keason ioK t h i s KeseaKch,

This chapteK w i l l d i s c u s s t h e unique i e a t u Ke s oi

p K a c t l c e nuLKSlng and t h e p K a c t l c a l knowledge needs

oi I t s membeKS w l t h l n t h e c o n t e x t oi c o n t i n u i n g

p K o i e s s l o n a l e d uc a t i o n pKepaKat lon and p K o v l s l o n .

Taking I n t o account no t onl y t h e i e l t needs oi t h e

p K a c t l c e nuKses but a l s o t h e n e c e s s i t y t o

Ke c ogn l s e t h a t t h e demands oi t h e maKket economy

KequlKe an appKoach which I s i l e x l b l e In d e s i g n ,

a t t K a c t l v e and maKket abl e t o t h e puKchaseKS oi

e d u c a t i o n . The d e t a i l w i l l I n c l u d e t h e c o n c e p t

oi c o n t i n u i n g p K o i e s s l o n a l educ a t i on as I t K e l a t e s

t o cuKKlculum t heoKy , pKogKamme p l anni ng and

mo d ul a Kl s a t l o n , In a d d i t i o n t h e needs and wants oi

t h e p Ka c t l t l o n e KS and t h e demands oi p K a c t l c e w i l l

be cons l de Ked and t h e maKket economy and e d u c a t i o n

p Ko v l s l o n K e l a t e d t o p K a c t l c e nuKSlng d i s c u s s e d .

THE UNIQUE FEATURES OF PRACTICE hlURSJNG AMV

CONTINUING PROFE S SI ONAL EVUCATION

Conc e p t o j c o n t i n u i n g p K o i e s s l o n a l e d u c a t i on

The natuKe oi p K a c t l c e nuKSlng does not i l t I n t o

t h e t K a d l t l o n a l models oi an o c c u pa t i o n

pKoi e s s l o n a l l s l n g and nel then. does I t meet t h e

KequlKements oi t h e c onc e p t o i c on t i n u i ng

pKoi e s s l o n a l e duc a t i on model , l i I t I s a c c e p t e d

t h a t c o n t i n u i ng e duc a t i on I s beyond I n i t i a l In t h e

v o c a t i o n a l s e n s e , ( JaKv l s , 1995) . I n i t i a l

e d uc a t i o n and pKepaKat lon ioK t h i s gKoup oi

nuKses, t heKe i oKe , would be t h e s t u d y oi a

s p e c l i l c body oi knowledge upon which t h e

pKo i e s s l o n would be based and Kecognl s ed, t h e

s e K v l c e p e KSpe c t l v e e s t a b l i s h e d and iKom which,

on c o mp l e t i o n oi s t u d y i n g t h e body oi t heoKy and

acqul Klng K e l a t e d s k i l l s , t h e membeKS would be

Ke cKul t ed , KatheK t han I n i t i a l geneKal nuKse

t Ka l n l n g which a l l t h e p K a c t l c e nuKses have

undeKtaken and ioK which t h e y p o s s e s s t h e

Kecognl s ed q u a l l i l c a t l o n .

TheKe aKe pKoblems a s s o c i a t e d w i t h t h i s

d e i l n l t l o n . PKac t l c e nuKses have dev e l ope d

I n d i v i d u a l bod i es oi knowledge and s k i l l s iKom

t h e l K vaKled nuKSe backgKounds which t h e y a l Keady

p o s s e s s and u t l t t l z e d t h e s e In p K a e t l e e . The

body oi theoKy and s k i l l s which cuKKent l y

makes up p K a c t l c e nuKSlng, t he Ke i oKe , I s

I n d i v i d u a l , K e l a t e d t o each p K a c t l c e

nuKse' s backgKound knowledge and expeKl ence

and de t eKmlned by t h e demands oi p K a c t l c e ,

t h e woKk which I s d e l e g a t e d t o t h e nuKSe and

p o s s i b l y a l s o t o t h e I n t e K e s t s oi t h e nuKses.

Any c on t i n u i ng e duc a t i on p Ko v l s l o n , t heKe i oKe ,

would need t o be t a l l o K e d t o I n d i v i d u a l

need and b u i l d on t h e I n d i v i d u a l segment s oi

knowledge which cuKKent l y make up p K a c t l c e

nuKSlng. But even l i p K a c t l c e nuKSlng

dev e l op e d I t s own I n i t i a l ok pKe~s eKvl ce

e d uc a t i on and t K a l n l n g , any c o n t i n u i ng

p K o i e s s l o n a l e d uc a t i on p Ko v l s l o n would s t i l l

need t o t a k e I n t o account t h e s p e c i a l i s t

s e g me n t a t i o n and s u b - s e g m e n t a t l o n s p e c i a l i s a t i o n

t h a t can o c c u k and which I s de s c Kl b e d by BucheK

and St Kauss , ( C i t e d In VollmeK and H i l l s , 1966)

and d i s c u s s ed In t h e pKevl ous chapt eK.

To a t t e m p t t o { I t t h e e o m p t ex L t l e s o{ t h e IeatuKes

oi p K a e t l e e nuKSlng I n t o t h e c o n t e x t u a l iKamewoKk

oi cuKKlculum and pKogKamme I s d l H l c u l t , no t onl y

because theKe I s c o n i u s l o n oveK t h e use o i t h e

teKms but a l so because o i t h e changes which aKe

occuKKlng In e d u c a t i o n , which c a l l I n t o account

t h e con cep t o i cuKKlculum.

Co nce p t o j CuKKlculum and PKogKamme

PoK example, Lawton, (1973] s t a t e s t h a t cuKKlculum

emphasis ed t h e c o n t e n t o i a t e a c h i n g pKogKamme and

K e l l y , ( 19 7 7 : 3 ) s u g g e s t s t h a t I t I s necessaKy

" . . . t o d i s t i n g u i s h t h e use o i t h e woKd t o den o t e

t h e c o n t e n t o i a pa Kt l cu la K s u b j e c t ok aKea oi

s tu dy iKom t h e use o i I t t o KeieK t o t h e t o t a l

PKogKamme oi an e d u c a t i o n a l I n s t i t u t i o n . . . " . The

concep t can, theKe ioKe , be used t o Imply t h e

c o n t e n t o i a s u b j e c t ok aKeas o i s t u d y , wheKeas

when used In t h e wldeK s e n s e t h e c o n t e n t can

IncoKpoKate a l l t h e p K l n c l p l e s which und eK l l e t h e

s p e c i a l a s p e c t s o i a pa Kt l c u l a K s u b j e c t ok aKea oi

s tu dy as t o t a l p r o v i s i o n o i an I n s t i t u t i o n .

This no t i o n o i S p e c l i l c as w e l l as t o t a l p r o v i s i o n

has been l l l u s t K a t e d by J a K v l s , (1 995) . Jn t h e

d i s c u s s i o n t h e teKm has been employed t o In c l u d e

not onl y t h e t o t a l p r o v i s i o n o i a leaKnlng

I n s t i t u t i o n but a l s o t h e s u b j e c t matten. o i a

paKt lcu laK couKse oi s t u d y , and can a l s o . In c l u d e

t h e In t e n de d and un in t ended t o t a l leaKnlng

expeKlences . The pKogKamme In t h i s s e n s e ,

becomes e l theK t h e o v e K a l l e d u c a t i o n a l pK o v l s l o n ,

OK KeieKS t o a numbcK oi couKSes w i t h i n a

pKogKamme, any oi which could be s t u d i e d by an

I n d i v i d u a l ok a sm a l l gKoup whetheK I t be t eacheK

l e d OK s e l i - d l K e c t e d l ea Kn lng .

The c o nc e p t , t he Ke i oKe , accoKdlng t o JaKv l s ,

( 1995: 190) can K e l a t e " . . . t o both t h e known and

t h e I n t e n d e d , t h a t I s , t h e e d u c a t i o n a l

oKga n l s a t l o n and p K o v l s l o n , o k t o t h e unknown and

u n q u a n t l i l a b l e , t h a t I s t h e l eaKnlng

e x p e K l e n c e s . . . " . I t can be a p p Ke c l a t e d iKom

t h e ioKegolng how t h e co n i us lo n In t h e use oi t h e

teKm has a r i s e n not onl y because o i t h e a i i l n l t y

oi t h e teKms t o each otheK, but a l s o because oi

t h e InteKchang e a b l e meaning and natuKe oi t h e

I n i t i a l s t u d i e s oi cuKKlculum concen tKated

on compulsoKy educ a t i on p K ov l s l o n and

K e i l e c t e d t h e contKo l e lement oi s e l e c t i o n

oi e d u c a t i o n a l p Ko v l s l on and I t s c o n t e n t

by e l theK a p K o i e s s l o n a l body ok t eacheKS.

T h i s a s p e c t o i t h e co ncep t o i cuKKlculum

i l t s In t o t h e c l a s s i c a l cuKKlculum model

wheKe cuKKlculum c o n t e n t I s s e l e c t e d and

t a u g h t by teacheKS and t h e s t u d e n t s leaKn

t h e t o t a l c o n t e n t . WheKeas In a d u l t

educa t i on t h e emphasis Is on s t u d e n t

p a K t l c l p a t l o n . LeaKneKS have t h e oppoKtun l t y

t o t a k e Kes pons l b l i l t y ioK I d e n t l i y l n g

th e lK own s e l e c t i o n about what t h e y wish

t o be t a u g h t , s t u d y and l eaKn. The

d e c i s i o n s t h e s t u d e n t s make w i l l be K e l a t e d

t o I n d l v l d u a t a s p l K a t l o n s and t eaKnlng

needs . Jn t h i s appKoaeh, known as t h e Komantle

euKKleutam, t h e s t a d e n t s ' o w n K e c o g n l t l o n oi

I n t e r e s t s , wants and leaKnlng needs aKe o i most

s l g n l i l e a n e e when cons ldeKlng leaKneKS ' n e e d s ,

t e a c h i n g e x p c K t l s e and t o t a l e duc a t i on p K o v l s l o n .

This no t i on oi t h e peKce l ved needs oi leaKneKS and

t h e s t u d e n t centKed appKoach t o edu ca t i on

pK ov l s l on I s o i paKt lcu laK s l g n l i l e a n e e so iaK as

p K a c t l c e nuKses and p K a c t l c e nuKSlng aKe

conceKned. The teKm pKogKamme, theKe ioKe , can

seen t o be one which KeieKS t o t h e t o t a l numbeK oi

couKSes a v a i l a b l e w i t h i n any one e d u c a t i o n a l

I n s t i t u t i o n and I s a woKd which can s l g n l i y t h e

c o n t e n t oi a pKosp ec tus . The use o i t h e teKm

pKogKamme, howeveK, does not g i v e d e t a i l about how

t h e c o n t e n t I s s e l e c t e d , ok t h e d e t a i l o i t h e

c o n t e n t I t s e l i , ne l theK does I t de sc K lb e t e a c h i n g

and l eaKnlng methods which aKe going t o be

emplo y e d .

To l l l u s t K a t e t h e d l H l c u l t l e s o i dev e l o p i n g a

c e n t f L a t t y p t a n n e d cuKKJicatam d i s c u s s i o n w i l t i o c u s

upon s u c h a. cuKKl cu t um ion. p n a c t l c c nuKScs w h i c h

was d e v i s e d I n 1984 by an I n t en.’■ p K o i e s s l o n a l

wonk l ng p a n t y e s t a b l i s h e d by t h e R o y a l C o l l e g e o i

hluKSlng, who d e l l b e n a t e d i o n some iouK y e a n s

b e i o n e i l n a l l y p n o d u c l n g an o u t l i n e cuKKl cu l um

w hi ch was a c c e p t e d by t h e N a t i o n a l Boands i o n

N u n s l n g , M l d w l i e n y and H e a l t h i / l s l t l n g . The

cuKKl cu l um, bnoad basz.d, s i t e d I n I n s t i t u t e s o i

h l g h e n e d u c a t i o n was p l a n n e d on a b l o c k and day

K e l e a s e b a s i s . The c u n n l c u l u m so d e v i s e d was

ba sed on t h e mode l d e s c n l b e d by Taba, [1962] w h i c h

I n c o n p o n a t e s w i t h i n I t alms and o b j e c t i v e s .

S u b j e c t m a t t e n , m e t h o d s , o n g a n l s a t l o n and

e v a l u a t i o n .

The p no b le m a s s o c i a t e d w i t h d e v i s i n g a c u n n l c u l u m

u s i n g a lms and o b j e c t l v es I s t h a t I t I s I m p l i e d

t h a t I n d i v i d u a l s ane g o i n g t o b e h a v e I n a c e n t a l n

way on c o m p l e t i o n o i t h e l n s t u d i e s . k n o t h e n

pnob l em a s s o c i a t e d w i t h t h i s ap noach I s t h a t I t I s

I m p l i e d t h a t t h e t e a c h e n s w i l l a d o p t c e n t a l n

4 . 1 0

p a t t e n n s o i t e a c k l n g sugg e s t l n g an a u t h o K l t a n l a n

appKoack . As J a n v l s , ( 1 9 9 5 : 1 9 4 ) s a y s , " . . . a n y

appKoach t o t e a c h i n g t h a t d e s i g n a t e s how a t e a n n e n

w i l l b e h a v e as a n e s u l t o i u n d e r g o i n g t h e t e a c h i n g

and l e a r n i n g p r o c e s s u n d e r m i n e s t h e d i g n i t y o i t h e

l e a r n e r , and c o n s e q u e n t l y , t h e p r o c e s s o i t e a c h i n g

and l e a r n i n g i a l l s s h o r t o i t h e h i g h I d e a l s o i

e d u c a t i o n . . . " .

To I m p o s e a c u r r i c u l u m I n t h i s way, e s p e c i a l l y

when r e l a t e d t o p r a c t i c e n u r s i n g , m i g h t be

I n a p p r o p r i a t e b e c a u s e n o t o n l y do p r a c t i c e n u r s e s

h ave d l i i e r e n t k n o w l e d g e b a s es b u t a l s o t h e

n u r s e s a r e u n d e r t a k i n g a v a r i e d o c c u p a t i o n a l

r o l e .

The p r o b l e m s a s s o c i a t e d w i t h d e v i s i n g a

c o u r s e b as e d w i t h i n e d u c a t i o n a l I n s t i t u t i o n s

Xn t h e i l r s t I n s t a n c e , p r e c l u d e d many

p r a c t i c e n u r s e s i rom a t t e n d i n g . The n u r s e s

we r e u n a b l e t o be r e l e a s e d i rom

p r a c t i c e , p r i n c i p a l l y b e c a u s e t h e r e was no

4 . 1 1

one t o c o v e r t h e i r d u t i e s . Vamant , (1990)

h i g h l i g h t e d t h i s d i l emma I n t h e R e p o r t , "A Review

o i E d u c a t i o n and T r a i n i n g i o r P r a c t i c e N u r s i n g ".

The R e p o r t a l s o h i g h l i g h t e d t h e I n a p p r o p r i a t e n e s s

o i t h e c e n t r a l l y p l a n n e d p r a c t i c e n u r s e c o u r s e

c u r r i c u l u m . Jn some p r a c t i c e n u r s e c o u r s e s t h e

s u b j e c t m a t t e r was n e g o t i a t e d b e t w e e n t h e t u t o r

and t h e s t u d e n t s , ( M a r t i n , 1 98 8) . T h i s g a v e t h e

o p p o r t u n i t y i o r t h e s t u d e n t s t o c o n s i d e r and

I d e n t l i y t h e i r own l e a r n i n g n e ed s r e l a t e d t o t h e i r

knowl edg e and s k i l l s and t h e n e ed s o i p r a c t i c e .

Programme P l a n n i n g

V e v e l o p i n g and d e s i g n i n g an e d u c a t i o n a l programme

I s c o m pl e x and m u l t l i a c a t e d . D i s c u s s i o n a b o u t

t h e s u b j e c t as I t r e l a t e s t o p r a c t i c e n u r s i n g w i l l

i l r s t o i a l l i o c u s on t h e p r o c e s s o i programme

p l a n n i n g and s u b s e q u e n t l y upon p l a n n i n g

r e s p o n s i b i l i t y .

4 . 1 2

The Pr o c e s s o j Programme P l a n n i n g

Houl e , (1972) w e l l known i o r h i s w r i t i n g I n

Am er i ca on t h e s u b j e c t o i t h e d e s i g n o i e d u c a t i o n ,

r e c o g n l s ed n o t o n l y t h e c o m p l e x i t y o i d e s i g n i n g an

e d u c a t i o n a l programme b u t a l s o t h e p r o b l e m

a s s o c i a t e d w i t h t h e v a r i e t y o i d l H e r e n t

e d u c a t i o n a l s i t u a t i o n s I n w h i c h a programme may be

d e s i g n e d and he I d e n t l e s i o u r ma jo r c a t e g o r i e s

o i e d u c a t i o n a l d e s i g n s i t u a t i o n s w h i c h he

c o n s i d e r e d we r e o i s l g n l i l e a n e e , ( H ou le , 1972:44

C i t e d I n J a r v i s , 1 9 9 5 ) 2 0 3 ] . The c a t e g o r i e s

r e l a t e t o t h e I n d i v i d u a l , g r o u p . I n s t i t u t i o n

and t h e mas s . I t I s p o s s i b l e , u s i n g H o u l e ' s

programme p l a n n i n g me th o d , i o r e x a m p l e , i o r

I n d i v i d u a l s t o d e s i g n t h e i r own e d u c a t i o n a l

a c t i v i t i e s or i o r t e a c h e r s t o d e s i g n an a c t i v i t y

i o r a g r o u p . The p l a n n e r ' s r o l e wo u l d be t o

d e t e r m i n e I n t o w h ic h o i t h e e l e v e n c a t e g o r i e s o i

e d u c a t i o n a l d e s i g n s i t u a t i o n s t h e p r o p o s e d

l e a r n i n g a c t i v i t y b e l o n g s .

4 . 13

A c c o r d l n g t o C er v e r o and W i l s o n , ( 1 9 9 3 : 1 8 ) ,

" . . . e d u c a t o r s o i a d u l t s become e x p e r t p l a n n e r s by

dev e l o p i n g and b e i n g aware o i t h e i r own c r i t e r i a

i o r making d e c i s i o n s . R a t h e r t h a n a p p l y i n g

s t a n d a r d p r i n c i p l e s , t h e n a t u r a l i s t i c v i e w p o i n t

p l a c e s p r i m a r y e mp h a s i s on t h e p l a n n e r ' s a b i l i t y

t o make j u d g ement s I n a s p e c l i l c c o n t e x t and t o

j u s t l i y t h e m . . . " Ho u le , (1972) w h i l s t d i s c u s s i n g

each o i t h e e l e v e n c a t e g o r i e s o i e d u c a t i o n a l

d e s i g n s i t u a t i o n s do es n o t d e s c r i b e t h e p r o c e s s

w h i c h u n d e r l i e s t h e e d u c a t i o n a l s i t u a t i o n s w h i c h

he u s e s I n h i s i r a m e w o r k i o r programme p l a n n i n g .

Houle , ( 1 9 72 :4 7 C i t e d I n J a r v i s , 1 9 9 5 : 2 0 4 ) ,

howev er does go on t o I d e n t l i y dihe d e c i s i o n

p r o c e s s as an a p p r o a c h w h i c h he s u g g e s t s can be

u s e d I n programme p l a n n i n g . The d e c i s i o n making

p r o c e s s I n c l u d e s s u c h I s s u e s as t h e

" . . . I d e n t l i l c a t l o n o i p o s s i b l e e d u c a t i o n a l

programme; d e c i s i o n t a k e n t o p r o c e e d ;

I d e n t l i l c a t l o n o i o b j e c t i v e s ; d e s i g n i n g t h e

i o r m a t ; c o n t e x t u a l l s l n g t h e i o r m a t ; p u t t i n g t h e

p l a n I n t o o p e r a t i o n ; m e a s u r i n g t h e r e s u l t s and

4 . 1 4

e v a l u a t i n g t h e r e s u l t s . . , " , Hou le , [1972:47

C i t e d I n J a r v i s , 1 9 9 5 : 2 0 5 ) , a l s o r e c o g n i s e d t h e r e

wer e o t h e r f e a t u r e s w h i c h n e e d e d t o be t a k e n I n t o

a c c o u n t when p l a n n i n g a programme. T h e s e

f e a t u r e s I n c l u d e d , " r e s o u r c e s , l e a d e r s , m e t h o d s ,

s c h e d u l e , s e q u e n c e , s o c i a l r e l n i o r c e m e n t .

I n d i v i d u a l i s a t i o n , r o l e s and r e l a t i o n s h i p s ,

c r i t e r i a i o r e v a l u a t i o n , c l a r i t y o i d e s i g n " . Jn

a d d i t i o n Houle , ( 1 972 ) , h e l d t h e v i e w t h a t

couns e l l l n g , H i e s t y l e , i l n a n c e s and

I n t e r p r e t a t i o n s s h o u l d be c o n s i d e r e d by programme

p l a n n e r s .

B r o o k i l e l d , (19 8 6 : 2 4 5 ) , h o w e v e r , u r g e s e d u c a t i o n a l

programme p l a n n e r s t o u s e t h e i r I n t u i t i o n when

making d e c i s i o n s a b o u t wh a t t o do I n s p e c l i l c

s i t u a t i o n s , a t a s k w h i c h he s a y s , " . . . t h e n e a t l y

c o n c e i v e d mode l s o i p r a c t i c e i o u n d I n manua l s and

t e x t b o o k s a r e I n a d e q u a t e . . . " . Knox, ( 1 9 8 2 : ) go es

on t o e x p l a i n a b o u t t h e d e c i s i o n making p r o c e s s :

" . . . A l t h o u g h c h o o s i n g among a l t e r n a t i v e c o u r s e s o i

a c t i o n seems t o be t h e i o c u s , t h e p r o c e s s I n c l u d e s

4 . 1 5

a t t e n t i o n t o t h e c o n t e x t I n w h i ch d e c i s i o n s a r e

made and I m p l e m e n t e d , m a s t e r y o i t e c h n i c a l

p r o c e d u r e s , I n t e r p e r s o n a l r e l a t i o n s , c o n s i d e r a t i o n

o i b o t h I n d i v i d u a l and o r g a n i s a t i o n a l v a l u e s and

c o n c e p t s a b o u t o r g a n i s a t i o n and a d m i n i s t r a t i o n . . . "

A n o t h e r a p p r o a c h t o programme p l a n n i n g I s one

d e s c r i b e d by Merner , ( 1 9 6 4 ) , who b a s e s h i s

p l a n n i n g on a n e ed s m e e t i n g a p p r o a c h . He

s e p a r a t e s programme p l a n n i n g i rom programme

a d m i n i s t r a t i o n and managing t h e l e a r n i n g

e x p e r i e n c e . \ J e r n e r ' s mo de l I n c o r p o r a t e s e l e m e n t s

o i c u r r i c u l u m t h e o r y , b u t he does n o t d e v e l o p I t

I n t o one w h i c h I s a l l e m b r a c i n g . V e r n e r , (1964)

o m i t s t h e l e a r n i n g p r o c e s s I n h i s m o d e l .

However, t h e n eeds m e e t i n g a p p r oa ch t o programme

p l a n n i n g w h i c h n eeds i u r t h e r c o n s i d e r a t i o n b e c a u s e

so i a r as p r a c t i c e n u r s i n g I s c o n c e r n e d , I t I s

t h e n u r s e s who a r e d o i n g t h e Job , who come i rom

d l i i e r e n t n u r s e b a c k g r o u n d s , w i t h a w i d e r a n g e o i

knowl edg e and s k i l l s who a r e I n t h e b e s t p o s i t i o n

t o I d e n t l i y t h e i r e d u c a t i o n and t r a i n i n g n e e d s .

4 . 1 6

The Needs and Wants o i P r a c t i t i o n e r s and t h e

Demands o i P r a c t i c e .

Needs I s a t r a d i t i o n a l e d u c a t i o n a l t e r m and has

been a t e r m f r e q u e n t l y u s e d I n t h e p a s t as t h e

b a s i s f o r c u r r i c u l u m p r o v i s i o n . To some e x t e n t

t h e meaning o f t h e t e r m I s d e p e n d e n t upon t h e

c i r c u m s t a n c e s I n w h i c h I t I s u s e d . For e xa m p l e ,

Bradshaw, ( 7 9 7 7 ] d e s r l b e d f o u r t y p e s o f s o c i a l

n eed s o f w h i ch s o c i a l w o r k e r s s h o u l d be aware .

H i r s t and P e t e r s , ( 1 9 7 0 ) , I d e n t i f y a number o f

ways I n w h ic h t h e t e r m can be u s e d t o I l l u s t r a t e

t h e p r o b l e m s a s s o c i a t e d w i t h u s i n g t h e ' n e e d s '

a p p r o a c h t o c u r r i c u l u m p r o v i s i o n . Halmos , (1978)

I d e n t i f i e d p r i m a r y and s e c o n d a r y n e e d s . The

f i r s t r e l a t i n g t o body f u n c t i o n i n g n e e d s and

l e a r n e d and a c q u i r e d n e ed s w h i c h a r e a dded on.

The r e a s o n f o r d i s c u s s i n g t h e a p p r o a c h o f ' n e e d s '

so f a r as p r a c t i c e n u r s i n g I s c o n c e r n e d I s t h a t I f

p r a c t i c e n u r s e s do h a ve n e ed s t h e n e e d s t h a t

t h e y f e e l t h e y h ave w i l l r e l a t e t o e d u c a t i o n and

t r a i n i n g p r o v i s i o n t o m e e t t h e r e q u i r e m e n t s o f

4 . 77

prcLctlce,

The n e e d s . I n t e r e s t s and demands o f p r a c t i c e

r e l a t e , t h e r e f o r e , t o t h e u n i q u e f e a t u r e s o f

p r a c t i c e n u r s i n g . Such as t h e p a r t - t i m e

n a t u r e o f t h e o c c u p a t i o n , t h e v a r i a t i o n

I n t h e knowl edg e t h e n u r s e s p o s s e s and a c t u a l l y

u t i l i s e I n t h e i r v a r i e d r o l e , and t h i s w i l l be

d i f f e r e n t f o r each p r a c t i c e n u r s e . The demands

o f p r a c t i c e w i l l a l s o v a r y b e t w e e n p r a c t i c e s , and

t h e a s p i r a t i o n s o f t h e p r a c t i c e n u r s e may be

d i f f e r e n t t o t h o s e o f h er employ e r . Bu t some

n u r s e s h a v e d i f f i c u l t y I n b e i n g r e l e a s e d f rom

p r a c t i c e b e c a u s e o f t h e s m a l l manag emen t s t r u c t u r e

w i t h i n w h i c h t h e y wor k , and a l t h o u g h s t u d y l e a v e

may be p a r t o f t h e n u r s e s c o n t r a c t o f e m p l o y m e n t ,

as A t k i n s and L u n t , {1993) f o u n d v e r y f ew n u r s e s

a c t u a l l y t a k e t h e i r a l l o c a t e d s t u d y l e a v e .

Mar ke t Economy

Any e d u c a t i o n p r o v i s i o n p r e v i o u s l y has been more

4 . 1 8

d o m i n a t e d by t h e p r o v i d e r s t h a n t h e p a r e h a s e r s o f

e d u c a t i o n . But any e d u c a t i o n a l p r o v i s i o n w i l l

need t o t a k e I n t o a c c o u n t t h e u n i q u e f e a t u r e s

o f p r a c t i c e n u r s i n g p r e v i o u s l y d i s c u s s e d . The

p r a c t i c e n u r s e ' s e m p l o y e r I s more l i k e l y t o

S u p p o r t t h e n u r s e who s t u d i e s a s u b j e c t t h r o u g h a

modu lar a p p r oa ch w h i c h I s d i r e c t l y r e l a t e d t o

p r a c t i c e needs t h a n t h e n u r s e who I s away f rom

p r a c t i c e f o r l o n g p e r i o d s o f t i m e . Jn a d d i t i o n

t h e n u r s e s f o l l o w i n g t h e m o d u l a r , d i s t a n c e

l e a r n i n g me t hod n e ed n o t be away f rom p r a c t i c e

and wo ul d be a b l e t o r e l a t e t h e o r y t o p r a c t i c e and

I n c r e a s e t h e i r k n o w l e d g e , (Tough, 1972} w i t h i n t h e

w o r k p l a c e . An e d u c a t i o n a l a pp r o a c h d e s i g n e d

I n t h i s way o f f e r s b o t h f l e x i b i l i t y and

a c c e s s i b i l i t y t o b o t h e m p l o y e r and e m p l o y e e and

so f a r as p r a c t i c e n u r s e s a r e c o n c e r n e d , o f f e r s

t h e o p p o r t u n i t y f o r t h e n u r s e s t o b u i l d on t h e

knowledg e and e x p e r t l s e t h e y a l r e a d y p o s s e s s . J t

was Boone, (1985) who r e c o g n i s e d t h e n e c e s s i t y t o

r e l a t e and l i n k programme p l a n n i n g w i t h

e d u c a t i o n a l o r g a n i s a t i o n s and t h e p u b l i c . By

4 . 1 9

o f f e r i n g a. menu o f mod ul es f rom w h i c h n u r s e s can

c h o o s e t o s t u d y w o u l d a p p ea r t o b r i d g e t h e gap

b e t w e e n e d u c a t i o n a l I n s t i t u t i o n s and t h e n e e d s o f

t h e p r o f e s s i o n a l s .

T r a d i t i o n a l l y a d u l t e d u c a t i o n has s e e n I t s e l f as

r e s p o n d i n g t o s t u d e n t s ' n eeds b u t w i t h i n t h e

p r o f e s s i o n a l l i t e r a t u r e , t h e r e was a c r i t i q u e o f

t h e I d e a o f n ee d . I n as much as a d u l t e d u c a t i o n

d i d n o t do t h e m a r k e t r e s e a r c h . J t o f f e r e d

c o u r s e s and p r a c t i t i o n e r s we r e t a u g h t w ha t t h e y

t h o u g h t t h e y n e e de d or w a n t e d . What t h i s r e s e a r c h

I s s e e k i n g t o do I s t o f i n d o u t w ha t p r a c t i c e

n u r s e s f e e l t h a t t h e y n eed I n t h e v a r i e t y o f

p r a c t i c e s w i t h i n w h i c h t h e y work and f rom t h e

b a c k g r o u n d k n o w l e d g e f r om w h i c h t h e y come w h i c h

may b e g i n t o p o i n t t h e way t o t h e t y p e o f m od u l a r

s t r u c t u r e and t h e c o n t e n t o f t h e m o du l e s t h a t

e d u c a t i o n p r o v i d e r s can o f f e r . The c h a p t e r

w hi ch f o l l o w s d e s c r i b e s t h e r e s e a r c h m e t ho ds w h i c h

wer e d e s i g n e d t o d i s c o v e r t h e n ee ds o f p r a c t i c e

n u r s e s .

4 . 2 0

CHAPTER F I V E

NETHOVOLOGy

The p r e v i o u s c h a p t e r s h ave I d e n t i f i e d how p r a c t i c e

n u r s i n g emerged and dev e l o p e d , and I s c u r r e n t l y

t h e l a r g e s t n u r s i n g w o r k f o r c e I n t h e c o m m u n i t y ,

and I s t h e o n l y b r an ch o f n u r s i n g w h i c h I s

c o n t i n u i n g t o a t t r a c t n u r s e s f rom a l l f i e l d s o f

p r a c t i c e , ( A t k i n s and L u n t , 1993) , The u n i q u e

n a t u r e o f p r a c t i c e n u r s i n g I s e s s e n t i a l l y b a s e d on

t h e f a c t t h a t t h e n u r s e s , p r i n c i p a l l y g e n e r a l

n u r s e t r a i n e d , have f o r m u l a t e d t h e i r own body o f

k n o w l e d g e and s k i l l s w h i c h I s I n d i v i d u a l t o t h e

n u r s e and r e l a t e d t o t h e n eeds o f t h e p r a c t i c e

w i t h i n w h ic h t h e n u r s e w o r k s . J t I s d i f f i c u l t

f o r t h e s e n u r s e s t o g e t t i m e o f f f rom work b e c a u s e

o f t h e n a t u r e o f t h e i r p a r t - t i m e h o u r s , b e c a u s e

t h e y work I n a s m a l l manag ement s t r u c t u r e and t h e

m a j o r i t y s h a r e d u t i e s w i t h one o t h e r n u r s e

col l eoLgue. A c o m b i n a t i o n o f t h e s e f a c t o r s

p r o h i b i t t h e n u r s e f r om h a v i n g any s u b s t a n t i a l

s t u d y l e a v e .

I t I s hoped t h a t t h i s r e s e a r c h w i l l I d e n t i f y any

c o m m o n a l i t y o f f a c t o r s w h i c h may a f f e c t t h e

p r o v i s i o n o f c o n t i n u i n g p r o f e s s l o n a l e d u c a t i o n f o r

t h i s g r o up o f n u r s e s . The d e t a i l w i l l I n c l u d e

t h e p e r s o n a l and p r o f e s s l o n a l b a c k g r o u n d o f t h e

r e s p o n d e n t s , t h e c h a r a c t e r i s t i c s and t h e

e n v i r o n m e n t o f p r a c t i c e , t h e o c c u p a t i o n a l r o l e o f

t h e p a r t i c i p a n t s and t h e n u r s e s p e r c e l v ed

e d u c a t i o n and t r a i n i n g n e ed s r e l a t e d t o p r a c t i c e .

T h i s c h a p t e r w i l l d e s c r i b e and d i s c u s s t h e s t e p s

w hi ch wer e t a k e n t o c o l l e c t t h i s I n f o r m a t i o n and

t h e c o n s t r a i n t s a s s o c i a t e d w i t h t h i s r e s e a r c h .

V E S C n J V T ï O h l O F T H E S A M P I E

Tko, dJiHJiQ.aZty e ,ncounte , ^ td ^ c Z a t t d t o

l o c a t i n g a ^e .p^Q,6e.ntat tv z ^ a m p t z o l p ^ a c t t c z

YivLK^z^ who c o a t d pan . tJLz t pa t z Jin t k z ^ t ^ z a K z h ,

UzJithzfi t k z V z p a ^ t m z n t H z a Z t k , S t a t u t o r y B od t z ^

on. FamJily H z a l t h S z K v t c z Aa t ho n . t t J i z6 , a t t h z t t m z

o{, t h z 6 t u d y , vjznz a b t z t o ^ a p p l y t h t 6

t n ^ o n m a t t o n , Thz V z p a n t m z n t o^ H z a t t h o n l y had

d z t a t t ^ i ^h t zh n . z t a t z d t o t h z numbzn. o^ ancJLt tany

^ t a l l M t t h t n z a z h F a m t t y H z a t t h Szn.vJizz k a t k o n . t t y

ion. u j k t zk n. z tmban.6zmznt wa4 madz. BzzaU' i z t k z n z

t 6 no KZzondabZz q uaZJ i iJ i za t t on ion. p n . a z t Z z z

nun.6Zng, t k z UnZtzd KZngdom Cz nt naZ CounzZZ ion.

h!un.6Z6, MZduoZvz^ and H z a Z tk i/Z4Zton.6 dZd n o t k a v z

n z z o n d z d d z t a Z Z é n. zZatZng t o p n a z t Z z z nun.6Z6»

Tkz EngZZ^k NatZonaZ Boan.d ion. Nun.6Z6, MZduoZvz^

and Hz aZtk VZ6Zton.6 onZy k z p t d z t a Z Z i o i nan.^z6

u)ko had z o m p Z z t z d an z d u z a t Z o n a Z pn.ogn.ammz t vkznz

6 u z k a zoun.^z m z n Z t z d a z z n . t Z i Z z a t z o i z o m p z t z n z z ,

b a t 4>uzzz66iaZ z o m p Z z t Z o n o i t k z p n . a z t Z z z nan.6Z

zoan.^z onZy ga Zn zd a ^ t a t z m z n t o i a t t z n d a n z z

and W&4 n o t n z z o n d a b t z .

Tkz “Roya l C o l l z g z o i Nun.6lng uja6 a p o 6 6 l b l z i o a n z z

oi Z n io n m a t Z o n i Z n c z Z t Z6 t k z p n o i z 6 6 Z o n a t

o ng an Z ^ a t Z o n Zn vokZzk t k z m a j o n Z t y o i nan.6Z6 Zn

t k z UnZt zd KZngdom é z z k mzmb zn.6kZp and l o o k ion.

pno i z 6 6 Z o n a l a d v Z z z , g u Z d a n z z and u p d a t i n g , Tkz

Z n io nm at Z on k z p t by t k z R o y a l C o l l z g z o i H un t i n g

w aa , o i zoun.6z, z o n i Z d z n t Z a l and t k z n z i o n z n o t

a z z z 6 ^ Z b l z , V n a z t Z z z nun.6z Z n t z n z 6 t gnoup6 voznz

bzZng i o u n d z d t k n o u g k o u t t k z UnZt zd KZngdom and

4)0mz uiznz 4 z z kZ n g a H Z l Z a t Z o n ujZtk t k z Ro y a l

C o l l z g z o i hJunéZng t k n o u g k ZtJ> Communi ty Uun^Zng

Fonum. Tk l 6 d z v z l o p m z n t uoa6 v z n y muck Zn Z t 6

Z n i a n z y a t t k z t Z m z , and a l t k o u g k t k z nz6 z a n z k z n

mZgkt k a v z acc . e44 t o t k z 6Zzn.ztan.Zz6 o i t k z 6 z

gn.oup6, 6 uz k a 6 am p l z uoould bz I Z m Z t z d and t k z

nz6 zanzkzn. woul d bz n z l Z a n t upon t k z gnoup

6 zzn.ztan.Zz6 t o d Z 6 6 zm Z na t z d z t a Z l 6 o i t k z 6 t u d y

and t k z n z wz nz t o o many unknown i a z t o n 6 wkZzk

z o u l d a i i z z t t k z p n o j z z t Z i t k l 6 n o u t z w z n z t o bz

i o l l o w z d ,

A n o t k z n way o i making c o n t a c t w i t h p n a c t l c z nan6Z6

m i g h t h ave been t k n o a g h t h e v a n l o u 6 z d a c a t l o n a l

I n s t i t u t i o n s I n t h e U n i t e d Kingdom w h i c h h e l d

a p p r o v e d p n a c t l c e n u n s e c o u n s e s . Such

e s t a b l i s h m e n t s s h o u l d h o l d n ec o n d s o i s t u d e n t s who

had a t t e n d e d i o n a c o u n s e . I t was a p p n e c l a t e d

t h a t s u c k I n i o n m a t l o n was c o n i l d e n t l a l and

p e n m l s S i o n wou l d n eed t o be o b t a i n e d I n onden t o

make c o n t a c t w i t h t h e p n a c t l c e n u n s e s , Howeven,

even l i t h e e d u c a t i o n a l I n s t i t u t i o n s wene

a p p n oa ch ed , t h e n e was no g u a n a n t e e t h a t t h e

I n i o n m a t l o n t h e y h e l d was up t o d a t e , and a i t e n

c a n e i u l c o n s l d e n a t l o n t h i s me t ho d was n o t

p u n s u e d .

A i u n t h e n p o s s i b i l i t y was t o a ppno ach Fa mi l y

H e a l t h S e n v l c e A u t h o n l t l e s d l n e c t l y I n onden t o

s e e k t h e l n p e n m l s s l o n t o d l s t n l b u t e t o a l l g e n e n a l

p n a c t l t l o n e n s w i t h i n t h e l n g e o g n a p h l c a l a n e a s , v i a

t h e w e e k l y I n t e n n a l m a i l i n g s y s t e m , I n i o n m a t l o n

a b o u t t h e p n o p o s e d s t u d y t h a t t h e d o c t o n s on t h e l n

managens c o u l d d i s s e m i n a t e t o t h e l n p n a c t l c e

n a n s e s . Ont o i t h e majon pnobZtms w i t h t h i s

met ho d was t h a t t h e n e wo u l d be v en y l i t t l e e o n t n o l

oven t h e e l n e u l a t l o n o i t h e I n i o n m a t l o n b o t h t o

and w i t h i n g e n e n a l p n a c t l c e s u n g e n l e s . The

n e s e a n c h e n abandoned t h i s m e t h o d , b e c a u s e I t was

n o t p o s s i b l e t o ha ve s u H l c l e n t e o n t n o l oven t h e

e a n l y s t a g e s o i t h e s t u d y ,

k n o t h e n o p t i o n wou l d be t o m a l l t o p n a c t l c e n u n s e s

t h n o u g h t h e P n a c t l c e Nunse J o u n n a l , t h e i o u n d a t l o n

o i w h i c h had been I n i t i a t e d by t h e n e s e a n c h e n , and

a l t h o u g h I t was I n I t s I n i a n c y , t h e s u b s c n l b e n s

wene known t o t h e p u b l l s h e n s . The e d l t o n and

d l n e c t o n s o i t h e J o u n n a l wene a p p n o a c h e d and veny

k i n d l y a g n e e d t o m a l l t h n o u g h t h e J o u n n a l , a t no

c o s t , b o t h a l e t t e n and a q u e s t l o n n a l n e and n e t u n n

s t a m p e d and a d d n e s s e d e n v e l o p e . The J o u n n a l a l s o

a gn ee d t o i o l l o w - u p any n o n - n e s p o n d e n t s a t no

e x t n a c o s t . The s u b j e c t s w o u l d n o t be known t o

t h e n e s e a n c h e n and o n l y t h e m a i l i n g o U l c e wou l d

be I n v o l v e d I n t h e p a c k a g i n g and u l t i m a t e p o s t i n g .

The managing d l n e c t o n s o i t h e p u b l i s h i n g company,

b e c a u s e an e dJL t on l a t boand was s t J i t t I n t h e

p n o c e s s o i b e i n g a p p o i n t e d , a l s o a g n e e d t o p u b l i s h

I n t h e J o u n n a l d e t a i l s a b o u t t h e s t u d y .

Thene wene a numben o i d i s a d v a n t a g e s l i t h i s

me th o d o i q u e s t l o n n a l n e e l n e u l a t l o n wene_ t o b e

p u n s u e d , na me l y - t h e n e s e a n c h e n w o u l d h a v e no

k n o w l e d g e t o whom q u e s t l o n n a l n e s w o u l d h a v e been

s e n t and wo u l d be t o t a l l y n e l l a n t upon t h e s t a H

t o c l n c u l a t e t h e q u e s t l o n n a l n e s I n t h e J o u n n a l .

T o t a l d e p e n d e n c e on t h e d i s p a t c h s t a H w o u l d a l s o

be n e c e s s a n y when i o l l o w l n g up any non-

n e s p o n d e n t s . The s t u d y m i g h t b i a s t h e n e s p o n s e

inom t h e p a n t l c l p a n t s s i n c e t h e p n o j e c t m i g h t be

p e n c e l v ed as b e i n g p a n t o i t h e J o u n n a l by h a v i n g

t h e q u e s t l o n n a l n e I n c o n p o n a t e d I n I t s c o n t e n t s .

In a d d i t i o n t h e n e was no g u a n a n t e e t h a t a l l

s u b s c n l b e n s t o t h e J o u n n a l wene p n a c t l c e

n u n s e s .

S un vey Sample

The n e s e a n c h e n , a ^ t e n c a n e ^ a l c o n s l d e n a t l o n o i a l l

t h e v a n l o u s n o a t e s t h a t c o u l d be t a k e n t o

I d e n t l i y a n e p n e s e n t a t l v e gnoup o i p n a c t l c e

n u n s e s , d e c i d e d t o u s e t h e P n a c t l c e hlunse J o u n n a l .

In t h e o p i n i o n o i t h e nes eanchen t h e J o u n n a l

a p pe a ne d t o be t h e m o s t n e l l a b l e v e h i c l e i o n

making c o n t a c t w i t h p n a c t l c e n u n s e s . I t was n o t

p o s s i b l e t o I d e n t l i y p n a c t l c e n u n s e s I n d i v i d u a l l y

n e l t h e n was I t p o s s i b l e t o s a m p l e inom a t o t a l

p o p u l a t i o n b u t I t was hoped t h a t t h e s u b j e c t s

c o n t a c t e d t h n o u g h t h e P n a c t l c e hlunse J o u n n a l wo ul d

be a s u i i l c l e n t l y n e p n e s e n t a t l v e s a m p l e .

I n e v i t a b l y t h e I n i o n m a t l o n w h i ch t h e p n a c t l c e

n u n s e s wou ld be g i v i n g would^ n e l a t e t o t h e l n

e x p e n l e n c e I n p n a c t l c e n a t h e n t h a n t o t h e l n

e d u c a t i o n a l needs measuned a g a i n s t c u n n l c u l u m

c o n t e n t . E x p e n l e n c e , howeven . I s a u s e i u l t o o l

upon w h i c h an I n d i v i d u a l can dnaw b e c a u s e I t

I n c l u d e s a l l t h o s e e v e n t s and a c t i v i t i e s w h i c h

k a v e e n a b l e d t h e I n d i v i d u a l t o a e q u l n e new

k n o w l e d g e and s k i l l s ( t ^ou ly , 1 978} and i o n many

p n a e t l e e n u n s e s ' l e a n n l n g on t h e J o b ' has been t h e

o n l y m et hod o i a e q u l n l n g new k n o w l e d g e and

l e a n n l n g new s k i l l s .

The c o l l e c t i o n o i d a t a inom p n a c t l c e n u n s e s a b o u t

t h e l n p e n c e l v ed e d u c a t i o n a l n ee ds n e l a t e d t o

e x p e n l e n c e I n p n a c t l c e wo u l d be e s s e n t i a l

I n i o n m a t l o n , t h e n e i o n e , when t n y l n g t o d e t e n m l n e

t h e p e n c e l v ed e d u c a t i o n a l and t n a l n l n g n e e d s o i

t h i s p a n t l c u l a n gnoup o i n u n s e s . I t I s p enha ps

s l g n l i l c a n t t o n o t e t h a t n e c o g n l t l o n o i p n l o n

e x p e n l e n t l a l l e a n n l n g has now been n e c o g n l s ed I n

e d u c a t i o n a l t en ms as a v a l u a b l e l e a n n l n g p n o c e s s

and a c c n e d l t l n g e x p e n l e n c e has dev e l o p e d I n

e d u c a t i o n I n n e c e n t y e a n s , (Long, 1978 ) .

Ton n e s e a n c h p u n p o s e s , h oweven , e x p e n l e n c e I s

c o n s l d e n e d t o be s u b j e c t i v e and n e e d s t o be

c h e c k e d a g a i n s t o b j e c t i v e n e a l l t y as Cohen e t a l

s t a t e , ( 1 9 8 9 ) . K e n l l n g e n (1969) s l m l l a n l y

comments t h a t e x p e n l e n c e n e l a t e s t o e v e n t s w h ic h

can ocean I n a h ap haz an d f a s h i o n , wheneas n e s e a n c h

m e t h o d o l o g y I s s y s t e m a t i c and c o n t n o l l e d and I s

b a s e d upon an I n d u c t i v e - d e d u c t i v e mode l and I t

I s t h e nes eanchen who n e ^ e n s t o e x p e n l e n c e I n

onden t o v a l i d a t e n e s e a n c h f i n d i n g s . Thene I s a

n e e d , t h e n e i o n e , i o n d e t a i l b o t h a b o u t e x p e n l e n c e

and c o n t n o l l e d n e s e a n c h I n onden t o d l s c o v en t h e

t n u t h a b o u t a s u b j e c t ,

RESEARCH TOOLS

In onden t o d e t e n m l n e t h e n o l e p e n s p e c t l v e and

p e n c e l v e d e d u c a t i o n a l n e ed s o i p n a c t l c e n u n s e s a

numben o i m e t h o d o l o g l c a l appno a c h e s e o u l d have

been u s e d . Wi t h some o i t h e d l H l c u l t l e s

I n I d e n t l i y I n g a n e p n e s e n t a t l v e s a m p l e o i p n a c t l c e

n u n s e s , I t seemed t h a t t h e mos t n e l l a b l e way

o i c o l l e c t i n g t h e I n i o n m a t l o n wo ul d be t o u s e a

s e l i a d m l n l s t e n e d q u e s t l o n n a l n e s e n t o u t t h n o u g h

t h e j o u n n a l and n e t u n n e d by p o s t t o t h e

n e s e a n c h e n .

5 . 1 0

Thene wene a numben o i e o n s t n a l n t s a t t h e e a n l y

s t a g e s o i t h e s t u d y w h i c h n e e d e d t o be c o n s l d e n e d .

The p n o j e c t was a s e l i i u n d e d one and t h e n e

wene l i m i t e d n e s o u n c e s . The p n a c t l c e , whene t h e

n es ea nchen was e mp l oy ed i u l l - t l m e as b o t h managen

and s e n l o n p n a c t l c e n u n s e s u p p o n t e d t h e n e s e a n c h

and s u p p l i e d s t a t l o n e n y and p a i d i o n t h e

p n e p a n a t l o n o i t h e q u e s t l o n n a l n e s . The t y p i n g o i

t h e l e t t e n s , q u e s t l o n n a l n e and t h e c o s t o i t h e

p o s t a g e was t h e n e s p o n s l b l l l t y o i t h e n e s e a n c h e n .

A i u n t h e n c o n s t n a l n t was t h e q u e s t i o n o i t i m e t o

u n d e n t a k e t h e s t u d y . As a i u l l - t l m e e m p l o y e e ,

t h e o n l y t i m e a v a i l a b l e wo u l d be t h a t w h i c h c o u l d

be a l l o c a t e d a t w e e k e n d s , a n n u a l l e a v e and a i t e n

wonk l ng h o u n s . I t was n e c o g n l s e d t h a t i u n t h e n

c o n s t n a l n t s w i t h neg a nd t o t i m e wo u ld n e s u l t as

t h e p n a c t l c e e x p a nd ed and t o o k on o t h e n

n e s p o n s l b l l l t l e s s u c h as p n e p a n l n g i o n an

a d d i t i o n a l d o c t o n , t h n e e o t h e n p n a c t l c e n u n s e s and

o t h e n s u p p o n t s t a H t o j o i n t h e p n a c t l c e and t h e

a d d i t i o n a l n e s p o n s l b l l l t y o i t h e p n a c t l c e b ec om in g

5 . 1 1

a i l n s t wave iand ho ld ing p n a e t l e e ion which t h e

nes eanchen would have, In a d d i t i o n t o othen

d u t i e s , t h e n e s p o n s l b l l l t y o i s u p e n v l s l n g . The

neseanchen ne c og n l se d t h e need t o p lan a d e t a i l e d

wonk s c h e d u l e and t h i s pnognamme was d i s c u s s e d

w i th t h e s e n lo n pantnen o i t h e p n a c t l c e . . T u l l

Suppont t o undentake a pnolong ed neseanch p n o j e c t

was g i v e n by t h e p n a c t l c e and t i m e In t h e ionm oi

s t u dy l e a v e was made a v a i l a b l e when c o n v e n i e n t t o

t h e p n a c t l c e .

D i s c u s s i o n a b o u t t h e a p p n o p n l a t e n e s s o i t h e t o o l s

I d e a l l y , w i t h o u t t h e a i o n e m e n t l o n e d c o n s t n a l n t s ,

t h e u s e o i I n t e n v l e w s t o g a t h e n t h e d a t a wo u l d

h a ve been a d v a n t a g e o u s . One o i t h e b e n e i l t s o i

u s i n g t h e I n t e n v l e w me thod o i c o l l e c t i n g d a t a I s

t h a t a s k i l l e d I n t e n v l e w e n can e n s u n e t h a t t h e

n e s p o n d e n t has i u l l y compnehended t h e n a t u n e o i

t h e q u e s t i o n and t h e i u l l e x t e n t o i t h e n e s e a n c h .

The n e s e a n c h e n can a l s o u s e t h e o p p o n t u n l t y ,

unden c o n t n o l l e d c o n d i t i o n s , t o p n o b e p a n t l c u l a n

5 . 1 2

answens and t o c t a s s J i i y t h e answens I m m e d i a t e l y .

A i u n t h e n a d v a n t a g e u s i n g t h e I n t e n v l e w me t hod

i o n d a t a c o l l e c t i o n I s t h a t I t I s p o s s i b l e t o n o t

o n l y e s t a b l i s h b u t a l s o m a i n t a i n t h e I n t e n e s t and

n e s p o n s l v e n e s s o i t h e n e s p o n d e n t t h n o u g h o u t t h e

c o m p l e t i o n o i t h e I n t e n v l e w , wheneas a s u b j e c t can

c o m p l e t e a q u e s t l o n n a l n e I n any on den , a t any t i m e

and t h e s e i a c t o n s , unknown t o t h e n e s e a n c h e n ,

c o u l d s l g n l i l c a n t l y b i a s t h e I n i o n m a t l o n and

a i i e c t t h e o u t co me o i t h e s t u d y .

The nes eanchen was awane t h a t l i t h e I n t e n v l e w

n o u t e t o g a t h e n t h e d a t a had been t a k e n t h a t t h e n e

wene a numben o i i a c t o n s w h i c h m i g h t h a ve

I n i l u e n c e d t h e n e s p o n d e n t s ' a n s w e n s . Ton e x a m p l e ,

t h e n es ea nchen m i g h t h a v e been known by some o i

t h e s u b j e c t s and t h e p a n t l c l p a n t s n e s p o n s e s m i g h t

h a v e been t h o s e t h a t t h e y c o n s l d e n e d t h e

n e s e a n c h e n w a n t e d and e x p e c t e d , (Oppenhe l m, 19 8 6 ) .

The me t hod o i c o l l e c t i n g t h e d a t a was i u n t h e n

c o n s l d e n e d a t t h e p l a n n i n g s t a g e s o i t h e s t u d y and

5 . 1 3

t h e d e c i s i o n made t o u s e t h e s e l i a d m l n l s t e n e d

q u e s t l o n n a l n e , s e n t o u t t h n o u g h t h e P n a c t l c e Hunse

j o u n n a l and n e t u n n e d d l n e c t l y t o t h e n e s e a n c h e n .

T h e s e m e t h o d s wo u ld k e e p c o s t s t o t h e minimum

b e c a u s e c o m p l e t i o n o i t h e q u e s t l o n n a l n e w o u l d n o t

n e q u l n e t n a l n e d s t a H i o n I t s a d m l n l s t n a t l o n w hi ch

I m m e d i a t e l y nemoves t h e e x p e n s e o i t n a v e l l l n g and

m a i n t e n a n c e c o s t s . The e x p e n s e s I n c u n n e d as a

n e s u l t o i u s i n g a s e l i a d m l n l s t e n e d q u e s t l o n n a l n e

n e l a t e s t o t h e c o s t o i p l a n n i n g , p i l o t wonk,

s t a t l o n e n y , p o s t a g e , i o l l o w - u p o i n o n - n e s p o n d e n t s

and t h e p n o c e s s l n g and a n a l y s i s o i t h e

q u e s t l o n n a l n e s on t h e l n n e t u n n ,

A s e l i a d m l n l s t e n e d q u e s t l o n n a l n e d o e s , howeven ,

nemove t h e p e n s o n a l I n t n o d u c t l o n o i t h e

ne s e a n c h e n , T h i s can be p a n t l a l l y ovencome by t h e

c a n e i u l l y c o n s t n u c t e d l e t t e n w h i c h a c c o m p a n i e s

t h e q u e s t l o n n a l n e . The n e s e a n c h e n , howeven , was

known by some p n a c t l c e n u n s e s n o t o n l y t h n o u g h

t e a c h i n g a numben o i p n a c t l c e n u n s e s on c o u n s e s on

s t u d y days b u t a l s o by n e p n e s e n t l n g c o l l e a g u e s on

v a n l o u s c o m m i t t e e s and wonk l ng p a n t i e s and by

v l n t u e o i b e i n g t h e i o a n d e n memben o i t h e P n a c t l c e

Nunse j o u n n a l and a p n a c t l c e n u n s e . I t was hoped

t h a t t h e s e i a c t o n s wo u ld h e l p nemove some o i t h e

p o t e n t i a l n e m o t e n e s s o i t h e nes e a n c h e n ,

As an e x t e n s i o n o i t h i s s t u d y t h e n e s e a n c h e n

d e c i d e d t o a s k p n a c t l c e n u n s e s t u d e n t s a t t e n d i n g

t h e E n g l i s h N a t i o n a l Boand p n a c t l c e n u n s e c o u n s e

some s i x months a i t e n t h e I m p l e m e n t a t i o n o i t h e

New Gen en a l P n a c t l t l o n e n C o n t n a c t o i 1990 t o keep

one week d l a n y e n t n l e s o i p n a c t l c e n u n s l n g

a c t i v i t y . Two s e t s o i t w e n t y s t u d e n t s each

u n d e n t o o k t h i s e x e n c l s e , t h e p u n p o s e o i w h i c h was

t o a n a l y s e t h e d l a n y e n t n l e s I n onden t o

d e t e n m l n e w h e t h e n t h e n e was any n o t i c e a b l e c h an ge

I n t h e na nge o i a c t i v i t i e s p n a c t l c e n u n s e s wene

u n d e n t a k l n g s i n c e t h e I m p l e m e n t a t i o n o i t h e New

Genena l P n a c t l t l o n e n C o n t n a c t , 1990. A l l t h e

s t u d e n t s c o m p l e t e d one w e e k ' s d l a n y e n t n y o i

p n a c t l c e n u n s l n g a c t i v i t y .

5 . 1 5

Thene ane a numben o i p nob l ems a s s o c i a t e d w i t h

c o l l e c t i n g d a t a I n t h i s way, [ H l m m e l we l t , e t a l

1 9 5 8 : 7 2 - 1 5 ] , One d l H l c u l t y o i w h i c h I s t h a t

n e s p o n d e n t ' s I n t e n e s t I n k e e p i n g d l a n y e n t n l e s can

become m o d l i l e d oven a p e n l o d o i t i m e and t h e

e n t n l e s may n o t be a t n u e n ep n es e n t a t l o n o i t h e

n e s p o n d e n t ' s wonk. Ton t h i s n e a s o n , t h e s u b j e c t s

wene encounag ed t o c o m p l e t e t h e l n d l a n y n e c o n d l n g s

a t l e a s t a i t e n each p e n l o d o i d u t y . I d e a l l y

i o l l o w l n g each a c t i v i t y , . I n onden t o e n s u n e

a c c u n a c y o i n e c o n d l n g t h e d e t a i l . Kn ot hen p no bl em

I s t h e d l i i l c u l t y o i c o d i n g t h e d l a n y e n t n l e s ,

(Oppenhelm, 1 986 ) . To h e l p w i t h t h i s p n o c e s s t h e

d e s i g n o i t h e e n t n y was d i s c u s s ed w i t h t h e

p a n t l c l p a n t s and a i o n m a t a g n e e d . Each n e s p o n d e n t

was g i v e n an e x e n c l s e book I n w h i c h t o n e c o n d t h e

I n i o n m a t l o n a g a i n s t d a t e , t i m e o i day and a c t i v i t y

u n d e n t a k e n . T h e s e d a t a , i o l l o w l n g a n a l y s i s , w i l l

s u bs e q u e n t l y pnes e n t e d .

5 . 1 6

Q u e s t l o n n a l n e D es ign

C a n e i u l c o n s l d e n a t l o n n e e d e d t o be g i v e n t o t h e

q u e s t l o n n a l n e d e s i g n and q u e s t i o n c o n s t n u c t l o n l i

m e a n i n g i u l d a t a wene g o i n g t o be c o l l e c t e d . The

n e s e a n c h e n was m l n d i u l t h a t p a n t l c l p a t l o n I n

c o m p l e t i n g q u e s t l o n n a l n e s I s v o l u n t a n y and any

n e s p o n d e n t who I s I n c l u d e d I n t h e s u n v e y s h o u l d ,

by t h e veny n a t u n e o i t h e q u e s t l o n n a l n e d e s i g n and

i o n m a t , be encounag ed t o c o - o p e n a t e and p n o v l d e

a c c u n a t e I n i o n m a t l o n . To h e l p w i t h t h i s p n o c e s s ,

t h e n e s e a n c h e n dev e l o p e d a q u e s t l o n n a l n e i l o w

c h a n t u s i n g t h e i e a t u n e s d e s c n l b e d by Cohen e t a l

( 1 9 8 9 : 1 0 7 ) , T h i s t e c h n i q u e h e l p e d w i t h p l a n n i n g

and c l a n l i l c a t l o n o i s u c h I s s u e s as q u e s t i o n

c o n t e n t , w o nd l ng , i o n m a t o i t h e n e s p o n s e ,

d e c i s i o n s a b o u t t h e s e q u e n c e o i t h e q u e s t i o n s and

o v e n a l l pnes e n t a t l o n o i t h e q u e s t l o n n a l n e .

B e i o n e c o n s t n u c t l n g t h e q u e s t l o n n a l n e , t h e

nes eanchen had some I d e a t h e p a t t e n n t h e n e s e a n c h

w oul d i o l l o w , t h e s i z e o i t h e s a m p l e , t h e

5 . 1 7

a n t i c i p a t e d n e s p o n s e n a t e and p o s s i b l e answens and

ou tc om es o i t h e s t u d y . I t was inom t h e s e

c o n c l u s i o n s t h a t t h e main v a n l a b l e s wene

I d e n t l i l e d , t h e s e q u e n c e o i t h e q u e s t i o n s was

c o n s l d e n e d and t h e c n o s s t a b u l a t i o n s b e t w e e n

d l i i e n e n t v a n l a b l e s p l a n n e d . The b u i l d up o i t h e

q u e s t i o n s and t h e onden w i t h i n each s e q u e n c e

was c a n e i u l l y c o n s l d e n e d w i t h t h e a i d o i t h e

i l o w c h a n t .

Type o i Q u e s t i o n s

The q u e s t l o n n a l n e was d i v i d e d I n t o v a n l o u s

s e c t i o n s and t h e onden o i t h e q u e s t i o n s i u n t h e n

c o n s l d e n e d . The d e c i s i o n was made t o s t a n t

w i t h i a c t u a l q u e s t i o n s w h i c h c o u l d n e a d l l y

be answened a l t h o u g h I t was n o t a ssu med t h a t t h e

n e s p o n d e n t n e c e s s a n l l y had t h e I n i o n m a t l o n

I m m e d i a t e l y a v a i l a b l e . The c l a s s l i l c a t l o n t y p e

oi i a c t u a l q u e s t i o n s s u c h as age , s e x and m a n l t a l

s t a t u s wene l e i t t o t h e end o i t h e q u e s t l o n n a l n e .

The i u n n e l appnoach was n o t u s e d I n t h e

5 . 1 8

s t u d y as t h e n e was no I n d i c a t i o n t o p o s e a

b n o a d l y b a s e d q u e s t i o n w h i c h n e e d e d t o become

p n o g n e s s l v e l y mone s p e c i f i c . Howeven, t h e

i l t t e n t e c h n i q u e was u s e d I n some p a n t s o i t h e

q u e s t l o n n a l n e w h i c h g a v e t h e n e s p o n d e n t s t h e

o p p o n t u n l t y t o be e x c l u d e d inom some p a n t s o i t h e

q u e s t l o n n a l n e s e q u e n c e . Nany o i t h e q u e s t i o n s

p o s e d wene o p e n - e n d e d I n s p i t e o i t h e i a c t o i t h e

d l i i l c u l t y I n c o d i n g and a n a l y s i n g t h e d e t a i l .

Howeven, as much I n i o n m a t l o n as p o s s i b l e a b o u t

p n a c t l c e n u n s e s was w a n t e d and t h e n e s e a n c h e n

h e l d t h e v i e w t h a t t h e n e s p o n d e n t s s h o u l d be g i v e n

as much i needom as p o s s i b l e t o e x p n e s s t h e l n v i e w s

and g i v e t h e l n n e s p o n s e s . Oppenhelm c o n s l d e n s

t h a t t h e " . . . c h l e i a d v a n t a g e o i t h e open q u e s t i o n

I s t h e i needom t h a t I t g i v e s t o t h e n e s p o n d e n t .

Once he has u n d e n s t o o d t h e I n t e n t o i t h e q u e s t i o n ,

he can l e t h i s t h o u g h t s noam i n e e l y , unencumb ened

by a p n ep an ed s e t o i n e p l l e s . . . " ( 1 9 8 6 : 4 1 ) .

C l o s e d q u e s t i o n s , on t h e o t h e n hand, nemove t h e

s p o n t a n e i t y and t h e o p p o n t u n l t y i o n t h e

5 . 1 9

n e s p o n d e n t s t o e x p n e s s t h e l n o p i n i o n s , J t

e o u l d be angaed t h a t by s e l e c t i n g t h e p o s s i b l e

answens t h e n e s p o n d e n t s ane e x p e c t e d t o make t h a t

an e l e m e n t o{ b i a s I s b e i n g I n t n o d a c e d I n t o t h e

I n i o n m a t l o n n e t n l e v a l . In a d d i t i o n , c l o s e d

q u e s t i o n s can be I n n l t a t l n g t o some n e s p o n d e n t s ,

e s p e c i a l l y l i t h e s e q u e n c e o i answens do es n o t

a d e q u a t e l y co ve n t h e v i e w s o i t h e p a n t l c l p a n t s .

T h i s a g g n a v a t l o n may n e s u l t I n t h e s u b j e c t s

i a l l l n g t o c o m p l e t e t h e q u e s t l o n n a l n e and t h e l o s s

oi n a p p o n t b e t w e e n n e s p o n d e n t s and ne s e a n c h e n ,

The q u e s t l o n n a l n e , as a n e s e a n c h t o o l , n e e d s t o be

n e l l a b l e I n I t s c o n s i s t e n c y and v a l i d I n t h a t I t

measunes wha t I t I s s u p p o s ed t o m e a s un e . Each

q u e s t i o n how I t I s pnes e n t e d and t h e I n s t n u c t l o n s

wh i c h accompany I t can be c n u c l a l i a c t o n s w h i c h

can m o t i v a t e n e s p o n d e n t s t o c o n t i n u e and c o m p l e t e

t h e q u e s t l o n n a l n e . I t I s I m p e n a t l v e t h a t

t h n o u g h o u t t h e w h o l e o i t h e n e s e a n c h t o o l t h a t t h e

p a n t l c l p a n t s ane s e e n t o be t n e a t e d w i t h n e s p e c t

and made awane t h a t t h e I n i o n m a t l o n t h e y a ne g o i n g

5 . 2 0

t o d i s c l o s e I s o i v i t a l s l g n l i l c a n c e and t h e

s u b j e c t s s h o u l d be i u l l y awane o i wha t w i l l

u l t i m a t e l y happen t o t h e d a t a . The p a n t l c l p a n t s

s h o u l d be n e a s s u n e d o i t o t a l a n o n y m i t y . Ton a

copy o i t h e q u e s t l o n n a l n e and t h e a cc om p an y i n g

l e t t e n s e e ( A p p e n d i c e s v l l and v l l l )

Fonmat o i t h e Q u e s t l o n n a l n e

The q u e s t l o n n a l n e was d i v i d e d I n t o t h e i o l l o w l n g

s e c t i o n s and s e q u e n c e s . J t was hoped t h a t t h e

onden wou ld p n o v l d e a l o g i c a l p n o g n e s s l o n i o n t h e

n e s p o n d e n t t o i o l l o w .

A P n a c t l c e P n o i l l e

The n e s e a n c h e n d e s i g n e d t h e q u e s t i o n s i o n t h i s

s e c t i o n w i t h o u t i o nml ng any a s s u m p t i o n s . The

i l n s t s e c t i o n was so p l a n n e d I n onden t o h e l p t h e

n e s p o n d e n t s become a c c u s t o m e d t o t h e q u e s t l o n n a l n e

and t o encounag e t hem t o c o m p l e t e I t , and t h e

I n i o n m a t l o n n e q u e s t e d w o u l d be t h a t w h i c h w o u l d be

n e a d l l y a v a i l a b l e .

T hi s s e c t i o n u s e d a v a n l e t y o i m et ho ds t o c o l l e c t

t h e d a t a and t h e n e a s o n i o n t h i s ap pnoa ch was I n

onden t o h e l p t h e p a n t l c l p a n t s i e e l mone

c o m i o n t a b l e w i t h c o m p l e t i n g t h e q u e s t l o n n a l n e as

I t dev e l o p e d . The answens n e q u e s t e d wene i a c t u a l

ones and no c o n i l d e n t l a l on e m b a nn a ss ln g

I n i o n m a t l o n was b e i n g s o u g h t n e l t h e n wene t h e

q u e s t i o n s l i k e l y t o c a u s e o U e n c e .

The i l n s t s e c t i o n o i t h e q u e s t l o n n a l n e was d e v o t e d

t o t h e e n v l n o n m e n t and t h e c h a n a c t e n l s t l c s o i t h e

p n a c t l c e s whene t h e n e s p o n d e n t s wene e m p l o y e d .

I t was hoped t h a t t h e s e d a t a w o u l d p n o v l d e a

p n o i l l e o i t h e p n a c t l c e s whene t h e p a n t l c l p a n t s

wonked a g a i n s t w h i c h t h e p n a c t l c e n u n s e s

o c c u p a t i o n a l n o l e and e d u c a t i o n and t n a l n l n g n e ed s

c o u l d be c o n n e l a t e d . D e t a i l s a b o u t p n a c t l c e

l i s t s i z e , t n a l n l n g p n a c t l c e s , numben o i d o c t o n s

and s u p p o n t s t a H I n p n a c t l c e and t ea m m e e t i n g s

wene some o i t h e q u e s t i o n s a s k e d I n t h i s s e c t i o n .

5 . 2 2

B O c c u p â t I o n a t R o t e

T h i s s e c t i o n o i t h e q u e s t l o n n a l n e was d e v o t e d t o

t h e p n a c t l c e n u n s e ' s n o t e . The q u e s t i o n s I n t h i s

s e c t i o n wene o p e n - e n d e d . To h e l p t h e n e s p o n d e n t s

c o m p l e t e t h i s p a n t o i t h e q u e s t l o n n a l n e t h e

s e c t i o n was c a t e g o n l s e d . The onden I n c l u d e d

c l i n i c a l t a s k s and n u n s l n g p n o c e d u n e s ,

c l i n i c a l e x a m i n a t i o n s , I n v e s t i g a t i o n s , h e a l t h

s un v e l l l a n c e , n e p e a t p n e s c n l p t l o n w n l t l n g ,

n e c e p t l o n wonk, a n s w e n l n g t e l e p h o n e q u e n l e s ,

n e s e a n c h and a u d i t , s p e c i a l c l i n i c s , h e a l t h

p n o m o t l o n , h e a l t h e d u c a t i o n , c o u n s e l l i n g , t e a c h i n g

and management .

C L e a nn l ng Needs

T h i s s e c t i o n was s t n u c t u n e d t o h e l p t h e

n e s p o n d e n t s t o c a t e g o n l s e t h e l n p e n c e l v e d

l e a n n l n g n eed s a g a i n s t o c c u p a t i o n a l n o l e .

The s e c t i o n was d e s i g n e d u s i n g t h e i o l l o w l n g

s e c t i o n s : c l i n i c a l t a s k s and n u n s l n g p n o c e d u n e s ,

5 . 2 3

c . t i . Y L lQ . a . 1 e x a m i n a t i o n s , I n v e s t i g a t i o n s , h e a l t h

s unv e l l l a n c e , n e p e a t p n e s c n l p t l o n w n l t l n g ,

n e c e p t l o n wonk, a n s w e n l n g t e l e p h o n e q u e n l e s ,

n e s e a n c h , s p e c i a l c l i n i c s , h e a l t h p n o m o t l o n ,

h e a l t h e d u c a t i o n , c o u n s e l l i n g , t e a c h i n g and

management . The n u n s e s wene a l s o a s k e d t o

I d e n t i f y t h o s e p n o c e d u n e s i o n w h i c h t h e y had

p n o t o c o l s .

V I n - S e n v l c e T n a l n l n g

The p a n t l c l p a n t s wene n e q u e s t e d t o d o cu me n t t h e

I n - h o u s e t n a l n l n g t h e y had n e c e l v e d as p n a c t l c e

n u n s e s . In a d d i t i o n t h e s u b j e c t s wene a s k e d t o

d e t a i l t h e s t u d y d a y s , c o n i e n e n c e s and c o u n s e s

t h e y had a t t e n d e d , T h i s I n i o n m a t l o n wo u ld

I n d i c a t e t h e e d u c a t i o n and t n a l n l n g s u p p o n t t h e

n e s p o n d e n t s had n e c e l v e d and t h e s e d a t a c o u l d be

c n o s s n e i e n e nc ed a g a i n s t o c c u p a t i o n a l n o l e ,

l e a n n l n g n e e d s , pno i e s s l o n a l q u a l l i l c a t l o n s and

t y p e o i p n a c t l c e . T h i s s e c t i o n wo u l d e n h a n c e t h e

I n i o n m a t l o n a l n e a d y g a t h e n e d a b o u t l e a n n l n g n e ed s

5 . 2 4

and wo ul d I n d i c a t e a d e g n e e o i l e a n n l n g

o p p o n t u n l t l e s .

E Employment D e t a i l s

T h i s s e c t i o n n e q u e s t e d d e t a i l a b o u t t h e

n e s p o n d e n t s ' e m p l o ym en t a n n a n g e m e n t s . The n u n s e s

wene a s k e d t o I d e n t l i y t h e l n employ en. I n d i c a t e

w h e t h e n t h e y had s i g n e d c o n t n a c t s o i e mp l o y m e n t

and j o b d e s c n l p t l o n s . The s u b j e c t s wene a l s o

a s k e d t o s t a t e t h e l n s t u d y l e a v e a l l o w a n c e .

J t wou l d app ea n , t h a t a numben o i p n a c t l c e n u n s e s

ane u n d e n t a k l n g mone t h a n one n o l e , s u c h as

p n a c t l c e n u n s e ! p n a c t l c e managen and t h i s d e t a i l

was a l s o s o u g h t .

The q u e s t i o n s I n t h i s s e c t i o n wene b o t h open and

c l o s e d . T h e s e d a t a w o u l d be n e i e n e n c e d a g a i n s t

o t h e n v a n l a b l e s s u c h as d l H e n e n c e s b e t w e e n

e mp lo ymen t annang emen t s I n s m a l l and l a n g e n

p n a c t l c e s and t n a l n l n g p n a c t l c e s , a l s o

g e o g n a p h l c a l d l H e n e n c e s b e t w e e n p n a c t l c e n u n s e s

5 . 2 5

emp l oy ed I n t h e N on t k o i England and S o u t h o i

En g la n d .

F V n o i e s s l o n a l D e t a i l s

The n e s p o n d e n t s wene a s k e d I n t h i s s e c t i o n t o g i v e

t h e l n pno i e s s l o n a l d e t a i l s w h i c h n e l a t e d t o

n u n s l n g as w e l l as a ca d e m i c q u a l l i l c a t l o n s . The

n e s p o n d e n t s wene a l s o a s k e d t h e yean t h e y became a

p n a c t l c e n u n s e and w h e t h e n t h e y wene c u n n e n t l y

n e g l s t e n e d w i t h t h e U n i t e d Kingdom C e n t n a l C o u n c i l

i on N u n s e s , Mldwlves and H e a l t h V i s i t o n s . T h e s e

d a t a w o u l d be c n o s s n e i e n e n c e d w i t h t h e d a t a

a b o u t o c c u p a t i o n a l n o l e and l e a n n l n g n e e d s .

G P e n s o n a l D e t a i l s

The i l n a l s e c t i o n o i t h e q u e s t l o n n a l n e d e a l t w i t h

p e n s o n a l d e t a i l s a b o u t t h e n e s p o n d e n t s so i a n as

g e n d e n , a ge and m a n l t a l s t a t u s was c o n c e n n e d .

T h e s e c l a s s l i l c a t l o n q u e s t i o n s wene l e i t t o t h e

end o i t h e q u e s t l o n n a l n e . T h e s e q u e s t i o n s wene o i

5 . 2 6

S p e c i a l I m p o n t a n c e b e c a u s e t h e y s t n a t l i y t h e

s a m p l e and as Oppenhelm s t a t e s t h a t by coming

n i g h t a t t h e end I t I s hoped t h a t by t h i s

t i m e , " . . . w e can hope t o h ave c o n v i n c e d t h e

n e s p o n d e n t t h a t t h e I n q u l n y I s g e n u i n e . . . " ,

( 1 9 8 6 : 5 7 .

P i l o t S t u d y

The q u e s t l o n n a l n e so p l a n n e d was p i l o t e d . The

gnoup u s e d t o c o m p l e t e t h e q u e s t l o n n a l n e s wene

known t o t h e n e s e a n c h e n . The n e s p o n d e n t s t w e n t y

s t u d e n t s who had c o m p l e t e d an E n g l i s h N a t i o n a l

Boand s t a t e m e n t o i a t t e n d a n c e c o u n s e i o n p n a c t l c e

n u n s e s i o n whom t h e n e s e a n c h e n had been t h e c o u n s e

t u t o n . The p n a c t l c e n u n s e s who had c o m p l e t e d t h e

c o u n s e wene n e t u n n l n g some t h n e e mont hs a i t e n

c o m p l e t i n g t h e c o u n s e i o n i o l l o w - u p e v a l u a t i o n .

The i a c t t h a t t h e gnoup wene known t o t h e

nes eanchen can , o i c o u n s e , I n i l u e n c e how t h e

q u e s t i o n s ane a nswened s i n c e t h e n e s p o n d e n t s m i g h t

be w a n t i n g t o p n o v l d e t h e I n i o n m a t l o n w h i c h t h e y

5 . 2 7

pz.n,Q.Q,Jiv t t k z 2.6 za^ahe,^ X,6 Mantling, On t k z otkzn.

hand, t h z dz taJ i tzd &%4w&%4 t k z %&4&a%cb&% waa

fizqiiz^tJing vooatd bz p^ovJLdJLng nzuj JinlofimatJion and

Jit ujoutd bz da ta anknovon t o t h z K z ^ z a a z k z a ,

Thz qaz6tJionnaJiaz wa-6 a t i o t z 6 t z d on t u j z n t y

6 t u d z n t 6 Mho Mzaz i a z ^ h t y u n d z a t a k t n g t h z Eng t L^h

Ha tL o na l Boaad p a a z t L z z n u a ^ z z o i i a ^ z , Tht6

t z 6 t t n g t o o k p t a z z on t h z ^tKi^t day o^ t h z coa%4&

and t h t 6 Jin t t ^ z l ^ mJight h a v z t n t a o d a z z d 6 X a 4 .

Such b ta6 m t g h t h a v z b z z n t h z 6 t a z 6 6 o l a t t z n d t n g

t h z I t a ^ t day o{, a z o u a ^ z , t h z -&tn,z66 a z l a t z d t o

a z t a a l t y u n d z a t a k t n g ^ u a t h z a z d u z a t t o n a t 6 t a d t z 6 ,

m z z t t n g nzM p z o p t z , z n t z ^ t n g a nZM z nvJ i ^onmznt ,

Z K p z z t a t t o n 6 b o t h by t h z 6 t u d z n t o^ t h z zoaa-&z and

o{) othzA. z o a ^ 4 z mzmbza^ a-6 w z t t a-6 pZKzzJio zd

z x . p z z t a t t o n 6 o^ t h z z o a a 6 z t a t o a and t h z

a d d i t i o n a l 6 t ^ Z 66 o l p o 6 6 l b l y I z a v l n g ^ a m l l l z 6 and

Moak and t a a v z l l l n g t o a nzvo v z n t u K Z , f i n a l l y ,

M l t h l n t h z p i l o t Moak, ^otia o t h z a n ua 6z ^ vozaz

a 6 k z d t o z o m p l z t z t h z q i i z 6 t l o n n a l ^ z and t h z 6 z vozaz

p f i a z t l z z n u a ^ z z o l l z a g a z 6 a t t h z p a a z t l z z vohzKZ

5 , 2 8

t h z Kz fi ZdfLzhzfL woKkzd, Thz t o t a l nambza o^

p a a z t l z z nua6Z6 a 6 k z d t o p i l o t t h z 6 t u d y vooak,

t h z ^ z ^ o a z , MZfLZ l o K t y - ^ o a a and I t voa6 h o p z d t h a t

t h l 6 4>amplz Ma6 a z p a z 6 z n t a t l v z o i K Z6 pon dz n t 6 Mho

Mould bz p a a t l z l p a t l n g I n t h z ^ u l l 6 z a l z 6 t u d y ,

Thz a z i p o n d z n t ^ p a a t l z l p a t l n g I n t h z p i l o t 6 t u d y

a l 6 o tz^&tzd t h z p a o p o 6 z d I z t t z K Mhlzh Mould

azzompany t h z q u z i t l o n n a l ^ z and mzkz a ^ k z d t o makz

zommznt6 and a z c o m m z n d a t l o n ^ ,

Thz I m p o r t a n t { z a t u ^ z ^ a b o u t p i l o t Moak I d z n t l ^ l z d

by Oppznhz lm (1 986 ) mzkz u ^ z d a6 a z h z z k l l 6 t .

Thz d z t a l l I n z l u d z d àu zh ^za tuKZ6 a i q u z i t l o n

M o l d i n g , c o l o u r o{, p apz a and p o i n t i n g , i l z z o l

p a p z a , t h z o^dzK o i t h z q u z i t l o n i and t h z l ^ t y p z ,

t h z I z n g t h o^ t l m z t h z a z i p o n d z n t i t o o k t o

z o m p l z t z t h z q u z i t l o n n a l a z and t h z i u b i z q u z n t z a i z

o l z o d l n g t h z d a t a and t h z a z l a t l v z z a i z o l

a n a l y s i n g t h z ^ I n d l n g i , I t Mai I m p o r t a n t a t t h l i

i t a g z o l p i l o t i n g t h a t t h z { u l l p o t z n t l a l o i t h z

q u z i t l o n n a l ^ z and p a z z l i l o n o^ d a t a mz kz a z a l l i z d

and a d j u i t m z n t i madz t o g l v z g az a t z n . o v z a a l l

5 , 2 9

c l a r i t y , i c o p z and d l mz n i l on t o t h z i t u d y .

Ai a fLZiu.lt 0 t h z p i l o t i t u d y , a d j u i t m z n t i vozaz

madz both t o t h z I z t t z a and t o t h z q u z i t l o n n a l K Z ,

T hz i z changz i I n z l u d z d t h z a i i u a a n z z t h a t t h z

i l n d l n g i fiom t h z i t u d y Mould bz madz knoMn to

p f i a z t l z z nuf i i z i Mlth t h z a z i u l t i b z lng p u b l l i h z d

In t h z V f ia z t l z z hlufiiz Jouanal , Somz paf i t i o t h z

q u z i t l o n n a l f i z Mhzfiz i a z z t zx . t Mai u i z d Mzaz

a l t z f i z d t o bzzomz moKZ i t a u z t u a z d ^oa t h z puKpoiz

ol av o id in g am b igu i t y and a l i o t o h z lp In

i u b i z q u z n t zodlng and a n a l y i l i .

Subi zquzn t ma i l ing o t h z q u z i t l o n n a l f i z i

azzompanlzd by a I z t t z a i t a t l n g t h z

pufipoiz o l t h z i t u d y and thank ing t h z

KZipondzn t i { oa t h z l a iu p p o a t t o g z t h z f i Mlth a

l l n . i t z l a i i i t ampzd and addn.zi i zd z n v z l o p z

Mzn.z p o i t z d In Maac/i, 1 989 , Thz t im i n g o^

t h z iuKvzy Mai an Impor ta n t ^azton. t o

t o z o n i l d z K , To a v o id Chal i tmai t l m z , h o l i d a y

p z f i l o d i , and t o a v o id p o i t l n g a t t h z b zg lnn lng o i

t k z weefe on. ion, M zz k zn d z o m p l t t l o n . I t ujai

a n t i c i p a t e d , a i p n . t v l o ( i i l y m e n t i o n e d t h a t t h e

f i e i p o m e n.ate wo ul d be ven,y h i g h , i l n c e p r a c t i c e

n u K i z i an.z h i g h l y m o t i v a t e d gn.oup and t h z

n,zi zan.chzn. i o n , m u l a t zd t h z v i e w t h a t p a a z t l z z

n u a i z i wo u l d wan t t o u i z t h e o p p o r t u n i t y t o

I d z n t l i y t h z l n , p z r c z l v z d l e a r n i n g n z z d i n o t o n l y

a i a r z i u l t b i t h z a d d i t i o n a l r z i p o n i l b l l l t l z i t h z

n u n z i we r e a l r e a d y u n d e r t a k i n g b u t a l i o w i t h t h z

p o t z n t l a l r o l e Z K t z m l o n w i t h t h z I m p l e m e n t a t i o n

o i t h z new G e n e r a l P r a c t i c e C o n t r a c t o i 1 990 .

(iJlth t h z I m p l e m e n t a t i o n o i t h z G e n e r a l

P r a c t i t i o n e r C o n t r a c t I m m i n e n t , t h z t i m i n g o i t h l i

i u r v z y wai c r u c i a l and p r o b a b l y i z r v z d a i a

m o t i v a t i o n a l i a c t o r i o r an u l t i m a t e l y h i g h

r a t e o i c o m p l e t e d q u z i t l o n n a l r z i . E v z r y o n z ’ i

i z n i z o i n e ed i o r t r a i n i n g and e d u c a t i o n wai

h z l g h t z n z d a t t h l i t l m z I n o r d e r t o m e e t t h z

dzmandi o i t h z new I z g l i l a t l o n . Thz l e t t e r w h i c h

a c c o m p a n i e d t h z q u z i t l o n n a l r z i t a t z d t h e p u r p o i z

o i t h z i u r v z y and t h z p r a c t i c e n u n z j o u r n a l

c a r r i e d a i z a t u r z a l e r t i n g t h z n u n z i o i t h z

I m p z n d l n g i t u d y . C o n i l d z n t l a Z l t y t h r o u g h o u t t h z

p r o z z i i o i z i t a b l l i h l n g , I m p l z m z n t l n g and r u n n i n g

t h z i t u d y w a i , o i z o u r i z , r z a i i u r z d .

Thz r z i z a r z h z r , a i a p r a z t l z z n u n z , wai v z r y

z o n i c l o u i t h a t a number o i p r a z t l z z n u r i z i

r e c e i v i n g t h z q u z i t l o n n a l r z m i g h t b z w o r k i n g I n

l i o l a t l o n and I t wai madz q u i t e c l e a r t h a t l i any

p r a c t i c e n u n z w a n t e d t o make p z n o n a l c o n t a c t I n

o r d e r t o i l n d o u t d z t a l l i o i l o c a l p r a c t i c e n u n z

I n t z r z i t g r o u p i , t h e n t h z r z i z a r z h z r w o u l d bz

p l z a i z d t o o i i z r i u c h I n i o r m a t l o n . Any p z n o n a l

c o n t a c t , I t wai madz q u i t e c l e a r , wo u l d bz q u i t e

i z p a r a t z i rom t h z i t u d y . A number o i p r a c t i c e

n u n z i r z i p o n d z d t o t h l i o U z r and t h z I d z n t l i l z d

l i o l a t z d n u r i Z i w e r e p u t I n t o u c h w i t h

o t h e r c o l l z a g u z i w i t h i n t h z l r l o c a l l t l z i and

w i t h t h z l r l o c a l p r a c t i c e n u n z I n t z r z i t

g r o u p .

Thz number o i q u z i t l o n n a l r z i i z n t o u t t h r o u g h t h z

P r a c t i c e N u n z j o u r n a l wai 474 I n t h z J u n e

5 . 3 2

l i i a z , 1989 o i t h e j o u r n a t . I t wai n o t p o i i J i b l z ,

t h z r z i o r z , t o h a v e any c o n t r o l o v e r t i m i n g o i

m a i l i n g o a t t h e q u e i t l o n n a l r e . The j o u r n a l a t

t h a t t i m e wai c i r c u l a t e d t o i u b i c r l b e n on a

m o n t h l y b a i l i , i l n c e 1993 t h e c i r c u l a t i o n h a i

I n c r e a i e d t o t w i c e m o n t h l y . By t h e end o i J u n e ,

1989, 466 c o m p l e t e d q u z i t l o n n a l r z i had b z z n

r e t u r n e d w h i c h wai a r z i p o n i z r a t e o i 98.31% and

i o u r o t h e r u n c o m p l e t e d q u z i t l o n n a l r z i w e r e

r e t u r n e d t o g e t h e r w i t h I z t t z n w h i c h e x p l a i n e d t h z

r z a i o n i o r t h z q u z i t l o n n a l r z n o t b z l n g c o m p l e t e d .

Thz i o u r r e t u r n e d q u z i t l o n n a l r z i w e r e I n i a c t

m a i l e d t o e d u c a t i o n a l z i t a b l l i h m z n t i . T a k i n g

I n t o a c c o u n t t h z i o u r I z t t z n w h i c h w e r e a l i o

r e c e i v e d t h z o v e r a l l r z i p o n i z r a t e wai 99.15%.

i o l l o w - u p o i n o n - r z i p o n d z n t i wai u n n z c z n a r y and

a i p r e d i c t e d t h z l e v e l o i i u p p o r t wai way b e y o n d

any p o n l b l z p r e d i c t i o n or e x p e c t a t i o n .

Va t a k n a l y i l i '

Thz n e x t i l x m o n t h i w e r e i p z n t by t h z r z i z a r c h z r

5 . 3 3

c o d i n g t h e q u e i t l o n n a l r e and t h e r e t u r n e d d a t a

o n t o c o d i n g i h e e t i r e a d y i o r e n t r y o n t o t h e

U n l v e n l t y c o m p u t e r i y i t e m , u i l n g t h e S t a t l i t l c a l

Package i o r t h e S o c i a l S c l e n c e i i y i t e m , t h e d a t a

wai i t o r e d on i p o o l i . k n a l y i l i o i t h e d a t a u i l n g

t h e Unlv e n l t y c o m p u t e r i y i t e m , I n t h e e a r l y

i t a g e i o i t h l i i t u d y , wai o n l y p o i i l b l e a t b oo ke d

i e a l o n i and m o i t o i t h e a n a l y i l i wai u n d e r t a k e n

d u r i n g h o l l d a y i or e v e n l n g i . C o u n e i w e r e

a t t e n d e d a t t h e Unlv e n l t y I n o r d e r t o u n d e n t a n d

t h e S t a t l i t l c a l Package i o r S o c i a l S c l e n c e i i y i t e m

o i d a t a a n a l y i l i .

A i c h e d u l e t o c o m p e t e t h e r e i e a r c h wai o u t l i n e d

b u t i e v e r a l a d j u i t m z n t i had t o b z madz t o t h z i z

p l a n i . T h z i z c h a n g z i w e r e due t o t h z v o l u m e o i

work w i t h i n t h z r z i z a r c h z r ' i own p r a c t i c e . Thz

number o i i t a H o i t h e p r a c t i c e had I n c r z a i zd t o

i o u r t y - t w o , new d o c t o n w e r e n e e d i n g o r i e n t a t i o n

and - w i t h d z v z l o p m z n t i I n G over nmen t I z g l i l a t l o n ,

many i t a t u t o r y r z q u l r z m z n t i w e r e n e e d i n g t o b z

I m p l e m e n t e d . In a d d i t i o n , t h z number o i

5 . 3 4

r z g l i t z r z d p a t l z n t i o i t h e p r a c t i c e had i t e a d l t y

I n c r e a i e d t o o v e r 13 , 000 and t h e p r a c t i c e on t h e

n a t i o n a l i c e n e and a t D e p a r t m e n t o i H e a l t h l e v e l

had a v e r y h i g h p r o i l l e . T h e i e c h a n g e i , t o g e t h e r

w i t h t h e r e i e a r c h e r b e i n g I n v i t e d t o i l t on a

number o i w o r k i n g p a r t l e i and c o m m l t t e e i r e l a t i n g

t o p r a c t i c e n u n l n g and p r i m a r y c a r e , r e i u l t e d I n

t h e c h a n g e i t o p l a n n e d t l m e - t a b l l n g o i t h l i

r e i e a r c h . I n e v i t a b l y , b e c a u i e o i t h e t i m e

c o n i t r a l n t i , t h e m a j o r i t y o i t h e d a t a I n i t i a l l y

had t o be a n a l y i e d w i t h o u t t h e u i e o i t h e

Unlv e n l t y c o m p u t e r .

F u r t h e r a n a l y i l i o i t h e d a t a u i l n g t h e S t a t l i t l c a l

Package i o r t h e S o c i a l S c l e n c e i i y i t e m wai

e n e n t l a l and b e c a u i e t h e Unlv e n l t y had c ha n g e d

t h e c o m p u t e r i y i t e m , a c c e n t o p r e v l o u i l y i t o r e d

d a t a wai n o t a v a i l a b l e n e i t h e r wai I t p o i i l b l e t o

t r a n i i e r t h e d a t a t o t h e new i y i t e m w i t h o u t

i r e i h l y e n t e r i n g t h e I n i o r m a t l o n . The d a t a we r e

r e - c o d e d and e n t e r e d I n t o t h e SPSS i o r

Wlndowi , r e i e r e n c e i wai made t o t h e SPSS i o r

5 . 3 5

ùJlndowi Nanuat ( F i e l d i n g , 7 995 ) . The d a t a wer e

p r i n t e d and c h e e k e d i o r a c c u r a c y . V a r l a b l e i

r e l a t e d t o c o l u m m I n d a t a i l l e and v a l u e l a b e l i

we r e added t o t h e i y i t e m and t h e d a t a wai r e a d

and a n a l y i e d u i l n g t h e v a r i a b l e n a m ei , v a l u e

l a b e l i and c r o m t a b u l a t l o n and r e - c o d l n g

i a c l l l t l e i w i t h i n t h e SPSS i y i t e m .

A d d i t i o n a l S u r v e y

Ai an a d d i t i o n t o t h e main i t u d y a i u b i e q u e n t

i u r v e y v i a t h e P r a c t i c e N u n e J o u r n a l wai

u n d e r t a k e n I n A p r i l , 7 995 I n o r d e r t o d e t e r m i n e

t h e l e v e l o i I n t e r e i t p r a c t i c e n u n e i m i g h t h ave

l i a d l i t a n c e l e a r n i n g m o d u l a r programme we r e t o

be e i t a b l l i h e d , w h i c h w o u l d be a d m l n l i t e r e d

t h r o u g h t h e j o u r n a l and v a l i d a t e d by t h e

Unlv e n l t y o i S u r r e y and t h e E n g l l i h N a t i o n a l

Board i o r N u n l n g , M l d w l i e r y and H e a l t h { / l i l t i n g .

The d a t a i rom t h l i a d d i t i o n a l i t u d y w i l l be

p r e i e n t e d I n a i u b i e q u e n t c h a p t e r , and i o r a copy

o i t h e q u e i t l o n n a l r e i e e , ( A p p e n d i x v l l l ) .

5 . 3 6

Conc l u i l o n

I t w i l l be i e e n i rom t h e i l z e o i t h e p i l o t i t u d y ,

t h e l a r g e i a m p l e , t h e d l a r l e i and t h e a d d i t i o n a l

i u r v e y u n d e r t a k e n t h r o u g h t h e P r a c t i c e N u n e

j o u r n a l , t h a t a g r e a t d e a l o i I n i o r m a t l o n h a i been

g a t h e r e d a b o u t p r a c t i c e n u n e i , t h e i r r o l e and

t h e i r I d e n t l i l e d p e r c e i v e d l e a r n i n g n e e d i . The

i o l l o w l n g c h a p t e n c o n t a i n t h e a n a l y i e i o i t h e i e

d a t a .

5 . 3 7

C H A P T E R S I X

RESPONDENTS AND T H E IR WORK S I T U A T I O N

In o r d e r t o comprehend and c o n t e x t u a l L i e t h e d a t a ,

Jit l i n e c e a a r y t o u n d e n t a n d who ha i p r o v i d e d I t ,

i o t h a t t h l i c h a p t e r p r o v l d e i t h e d e t a i l o i t h e

p e n o n a l and p r o i e n l o n a l c h a r a c t e r l i t l c i o i t h e

p r a c t i c e n u n e i , I n i o r m a t l o n a b o u t t h e i r

w o r k i n g e n v i r o n m e n t and emp loymen t a r ra n g e m e n t i

and l i m a i n l y d e i c r l p t l v e g i v i n g i l m p l e

i r e q u e n c l e i and c r o n - t a b u l a t l o n i . I t l i d i v i d e d

I n t o i o u r i e c t l o m w i t h each i e c t l o n h a v i n g a

number o i i u b - d l v l i l o n i ,

PERSONAL DETAILS

T h l i i e c t l o n p r o v l d e i t h e d e t a i l o i t h e

r e i p o n d e n t i ' p e n o n a l p r o i l l e and I n c l u d e i

I n i o r m a t l o n a b o u t g e n d e r , age o i t h e i u b j e c t i and

m a r i t a l i t a t u i .

Gender

V r a e t l e e n u n l n g l i p r e d o m i n a n t l y a f e m a l e

o c c u p a t i o n w i t h i ome 98% o i n u n e i w o r k i n g I n

p r i m a r y h e a l t h c a r e b e i n g women (PH, 1991) . In

g e n e r a l n u n l n g t h e number o i women l i o n l y i ome

90% o i t h e t o t a l w o r k i o r c e ( Be a r d i h a w and

K o b l n i o n , 1990) . A t t h e t i m e o i t h e main i t u d y ,

a l l t h e r e i p o n d e n t i w e r e i e m a l e . The a d d i t i o n a l

r e l a t e d i t u d y d i d n o t i e e k t h l i I n i o r m a t l o n .

Age o i P r a c t i c e N u n e i

The a ge o i p r a c t i c e n u n e i I n t h l i i u r v e y , r a n g e i

i rom 11 y e a n t o 62 y e a n w i t h t h e g r e a t e i t number

o i i u b j e c t i b e i ng w i t h i n t h e ag e r a n g e o i 40 y e a n

- 49 y e a n . The t o t a l number o i p r a c t i c e n u n e i I n

t h l i a ge band wai 1 77 ( 37. 9%) o i t h e t o t a l

r e i p o n d e n t i . The m a j o r i t y o i p r a c t i c e n u n e i . I n

t h e i t u d y w e r e aged b e t w e e n 30 - 49 y e a n , 340

( 72. 9%) w i t h one I n t h i r t y i l v e o i p r a c t i c e n u n e i

b e i n g ag ed 20 - 29 y e a n and one I n t h i r t y e i g h t

aged 60 y e a n and o v e r . The mean age i o r t h l i

i a m p l e o i p r a c t i c e n u n e i wai 46 y e a n . The a ge

band d e t a l l i o i t h e a ge o i t h e p r a c t i c e n u n e i

w i t h i n t h l i i t u d y a r e I d e n t l i l e d I n T a b l e 6 . 1 .

T a b l e 6 , 1 : Age o i P r a c t i c e N u n e i

Ag e_________________________________ 1_20 - 29 13 2 .7

30 - 39 163 3 4 . 9

40 - 49 177 37 . 9

50 - 59 101 21 . 6

O Z ii-É Ê ___ 1 1 ____________________

W = 466

Nean: 46 . 2

S t a n d a r d D e v i a t i o n : 9 . 1 7

T h e r e l i an a p p a r e n t r e g i o n a l v a r i a t i o n I n a ge

d l i i e r e n c e w i t h p r a c t i c e n u n e i I n t h e i o u t h o i

England b e i n g o l d e r t h a n t h o i e I n t h e n o r t h o i

En gland . From t h e i e d a t a I t wou l d a p p e a r t h a t

n u n e i emp l oyed I n t h e S o u t h E a i t , S o u t h (nJeit,

O x i o r d , E a i t A n g t l a and OJenex r e g l o n i a r e on

a v e r a g e aged 43 y e a n , w h e r e a i p r a c t i c e n u n e i

w o r k i n g I n N o r t h e r n , N o r t h W e i t e r n , M e n e y r e g l o n i

a r e on a v e r a g e t h r e e y e a n y o u n g e r . T h e i e d a t a

a l i o I d e n t i f y t h a t t h e r e a r e a g r e a t e r number o i

p r a c t i c e n u n e i u n d er t h e ag e o i 30 y e a n I n t h e

N e n e y and No r th E a i t Thamei r e g l o n i , and S o u t h

E a i t and S o u t h bJei t Thamei h a v e t h e g r e a t e r number

o i p r a c t i c e n u n e i aged 60 y e a n and o v e r .

M a r i t a l S t a t u i

The m a j o r i t y o i r e i p o n d e n t i ' 406 ( 87. 1%) wer e

m a r r i e d and o n l y 17 (3. 6%) w e r e i l n g l e .

A d d i t i o n a l l y , t h e r e w e r e 23 widowed (4. 9%) and t h e

r e m a i n i n g p a r t l c l p a n t i w e r e e i t h e r i e p a r a t e d or

d i v o r c e d . f i v e i u b j e c t i d i d n o t p r o v i d e t h l i

I n i o r m a t l o n .

PROFESSIONAL DETAILS

T h l i i e c t l o n o i t h e d a t a a n a l y i e i and I d e n t l i l e i

t h e p a . r t l e l p a . Y i t i ' p r o i e n l o t i a t quat l i J iea tJ ioYLi , and

a e a d e m l e a eh J i eveme nt i and w h e t h e r t h e y a r e e n t e r e d

on t h e V r a e t l i l n g R e g l i t e r o i t h e U n i t e d Kingdom

C e n t r a l C o u n c i l i o r N u n e i , M l d w l v e i and H e a l t h

V l i l t o n . The p r a c t i c e n u n e i w e r e a i k e d t o

I d e n t l i y w h e t h e r t h e y had I n d e m n i t y I m u r a n c e

c o v e r , l i t h e y w e r e m e m b e n o i t h e R o y a l

C o l l e g e o i N u n l n g P r a c t i c e N u n e Forum and

a t t e n d e d t h e i r l o c a l P r a c t i c e N u n e I n t e r e i t Group

[ O p p o r t u n i t y i o r t h o i e n u n e i who we r e n o t m e m b e n

o i t h e i r l o c a l P r a c t i c e N u n e I n t e r e i t Group t o be

p u t I n t o u c h w i t h t h e i r I d e n t l i l e d g r o u p ' i

i e c r e t a r y and a i m a l l number r e i p o n d e d t o t h l i

o i i e r ) , P r a c t i c e n u n e i wer e a l i o a i k e d

t o I d e n t l i y t h e y e a r t h e y became a p r a c t i c e n u n e .

Pro i e n l o n a l Q _ u a l l i l c a t l o n i

P r a c t i c e n u n e i h o l d a w i d e r a n g e o i pro i e n l o n a l

q u a l l i l c a t l o m many o i w h i c h a r e r e c o r d a b l e on t h e

U n i t e d Kingdom C e n t r a l C o u n c i l ' i Pro i e n l o n a l

R e g l i t e r . R e g l i t e r e d g e n e r a l n u n e l i t h e m o i t

commonly h e l d UKCC r e g l i t r a t l o n : 440 ( 94. 4%) o i

t h e r e i p o n d e n t i had o b t a i n e d t h l i q u a l l i l c a t l o n .

T we l v e r e i p o n d e n t i (2. 5%) wer e r e g l i t e r e d e n r o l l e d

n u n e i and i l x i u b j e c t i (1. 2%) d i r e c t e n t r y

m l d w l v e i . E i g h t r e i p o n d e n t i ( 1. 7%) we r e b o t h

r e g l i t e r e d e n r o l l e d n u n e i and r e g l i t e r e d

mldwl v e i .

More t h a n h a l i o i t h e r e i p o n d e n t i h e l d more t h a n

one q u a l l i l c a t l o n , 277 ( 59 . 4%) . The m o i t common

c o m b i n a t i o n wai r e g l i t e r e d g e n e r a l n u n e and

r e g l i t e r e d m l d w l i e , 106 ( 22 . 7%) , 21 (4. 6%) wer e

q u a l l i l e d d l i t r l c t n u n e i and 14 (3. 0%) wer e

r e g l i t e r e d h e a l t h v l i l t o n o i w h i c h 5 (4.2%)

h e a l t h v l i l t o n we r e a l i o r e g l i t e r e d m l d w l v e i , and

14 (53. 8%) o i t h e r e g l i t e r e d e n r o l l e d n u n e i had

i u c c e n i u l l y c o m p l e t e d c o n v e n l o n c o u n e i and

become r e g l i t e r e d g e n e r a l n u n e i . T a b l e 6 . 2

d e t a l l i t h e UKCC r e c o r d a b l e q u a l l i l c a t l o m h e l d by

t h e r e i p o n d e n t i by t h e y e a r o i q u a l l i l c a t l o n .

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U j A U - CO C J CO CO :5

On a v e r a g e , p r a c t i c e n u n e i o b t a i n e d t k e l r i l n t

q u a l l i l c a t l o n 19 y e a n ago. The e a r l l e i t r e c o r d

o i o b t a i n i n g a n u n l n g q u a l l i l c a t l o n i rom t h l i

i a m p l e wai 1942 and t h e m o i t r e c e n t , 1992. The

m a j o r i t y o i t h e r e i p o n d e n t i ' o b t a i n e d t h e i r

q u a l l i l c a t l o n l e a t h a n 30 y e a n ago.

More t h a n h a l i o i r e i p o n d e n t i had a t t e n d e d an

E n g l l i h N a t i o n a l Board P r a c t i c e N u n e c o u n e , 244

(52. 4% and 152 (32. 6%) had a t t e n d e d t h e c o u n e

p r i o r t o p r a c t i c e . Oi t h e t o t a l , 272 ( 58. 4%)

c o n i l d e r e d a t t e n d a n c e i h o u l d be m a n da t or y p r i o r t o

becoming a p r a c t i c e n u n e and o i a l l r e i p o n d e n t i

who had c o m p l e t e d i u c h a c o u n e , 219 ( 44. 9%) h e l d

t h e v i e w t h a t c o m p l e t i o n o i t h e c o u n e had

i u b i e q u e n t l y a H e c t e d t h e i r p r a c t i c e . The

r e m a i n i n g r e i p o n d e n t i d i d n o t know w h e t h e r t h e i r

p r a c t i c e had been a H e c t e d .

T h e r e a r e a number o i d l i t l n g u l i h l n g i e a t u r e i

w hi ch r e l a t e t o t h o i e n u n e i who had a t t e n d e d a

p r a c t i c e n u n e c o u n e a i o p p o i e d t o t h o i e who had

n o t . The d a t a ihow t h a t p r a e t L e e n u n e i w o r k i n g

I n t r a i n i n g p r a e t l e e i a r e i l g n l i l e a n t Z y more

l i k e l y t o h a ve a t t e n d e d i u e h a e o u n e 139 151.8%)

t h a n t h o i e w o r k i n g I n n o n - t r a l n l n g p r a e t l e e i , 133

( 4 8 . 8%) . More t h a n two t h l r d i o i t h e

r e i p o n d e n t i w o r k i n g I n t h e N o r t h o i E n g l an d , Wale i

and M e n e y r e g l o n i had a t t e n d e d a p r a c t i c e n u n e

c o u n e compared t o l e a t h a n one t h i r d I n t h e

r e g l o n i I n t h e S o u t h o i E n g l a n d . T h o i e i u b j e c t i

w i t h i n t h e i t u d y who h e l d e i t h e r a h e a l t h v l i l t o r

or d l i t r l c t n u n e q u a l l i l c a t l o n had n o t a t t e n d e d

a p r a c t i c e n u n e c o u n e .

T h e r e a r e i l m l l a r d l i t l n g u l i h l n g i e a t u r e i w h i c h

r e l a t e t o t h o i e p r a c t i c e n u n e i who h o l d a i a m l l y

p l a n n i n g c e r t l i l c a t e . More t h a n two t h l r d i o i

P r a c t i c e n u n e i w o r k i n g I n t r a i n i n g p r a e t l e e i ,

h e l d a i a m l l y p l a n n i n g c e r t l i l c a t e , 21 (67. 7%)

and p r a c t i c e n u n e i h o l d i n g e i t h e r a m l d w l i e r y or

h e a l t h v l i l t o r q u a l l i l c a t l o n w e r e a l i o

i l g n l i l c a n t l y more l i k e l y t o h o l d a i a m l l y

p l a n n i n g q u a l l i l c a t l o n .

6 . 1 0

H o l d e n o j UKCC PIN No.

The i u b j e c t i we r e a i k e d t o I d e n t l i y w h e t h e r t h e y

wer e on t h e p r a c t l i l n g r e g l i t e r o i t h e U n i t e d

Kingdom C e n t r a l C o u n c i l , 459 (98. 5%) we r e on t h e

c u r r e n t p r a c t i c e r e g l i t e r o i t h e C o u n c i l ,

2 (0. 4%) i a l d t h e y we r e n o t , and 5 (1. 0%) g a v e

no a n i w e r t o t h l i q u e i t l o n .

I n d e m n i t y I m u r a n c e

J u i t o v e r t h r e e - q u a r t e n o i t h e r e i p o n d e n t i had

I n d e m n i t y I m u r a n c e c o v e r , 350 ( 75. 1 %) t h r o u g h

t h e Ro y a l C o l l e g e o i N u n l n g . T h l i h i g h l e v e l o i

m e m b e n h l p l i i l m l l a r t o t h e i l n d l n g i r e p o r t e d by

G r e e n i l e l d e t a l , ( 1 9 87) ; E v a m , ( 1 992) and

k t k l m and L u n t , ( 1 9 9 3 ) . Oi t h e r e m a i n i n g 116

(24. 9%) t h e i e i u b j e c t i had I n d e m n i t y I m u r a n c e

c o v e r t h r o u g h t h e M e d i c a l V e i e n c e Uni on . T h l i

o r g a n l i a t l o n ha i e i t a b l l i h e d a d e p a r t m e n t i o r

p r a c t i c e n u n e i and o U e n n o t o n l y l e g a l , e t h i c a l

i u p p o r t t o t h e p r a c t i c e n u n e i b u t a l i o

6 . 1 1

i u p p o r t I n t h e i orm o i i t u d y d a y i and

I n d i v i d u a l a d v i c e .

The R o y a l C o l l e g e o i N u n l n g l i a l i o t h e

pro i e n l o n a l o r g a n l i a t l o n i o r n u n e i and o U e n

e d u c a t i o n a l o p p o r t u n l t l e i i o r I t i m e m b e n .

Through t h e i o r e i l g h t and a c t i v i t y o i a number o i

p r a c t i c e n u n e i , t h e R o y a l C o l l e g e o i N u n l n g now

h a i I n p l a c e a P r a c t i c e N u n e Forum w h i c h o U e n

c o n t i n u i n g e d u c a t i o n p r o g r a m m a I n t h e i orm o i

i t u d y d a y i and newi l e t t e n i o r p r a c t i c e n u n e i .

The m a j o r i t y o i p a r t l c l p a n t i , 3 84 ( 82. 4%)

w e r e m e m b e n o i t h l i i o ru m and 43 (9. 2%) i t a t e d

t h e y wo u ld l i k e t o j o i n i u c h a g r ou p I n t h e i r

l o c a l i t y .

Academi c Q u a l l i l c a t l o m

The r e i p o n d e n t i h e l d a number o i a c a d e m i c

q u a l l i l c a t l o m and t h a e a r e d e t a i l e d I n T a b l e

6 . 1 2

T a b l e 6 . 4 : AeademJic q a a L L l L e a t l o n i

Q u a t l H c a t l o n T r e q a e n c y % C u m u l a t i v e

'O' L e v e l i 296 63 . 5 175. 1

' A' L e v e l i 385 4 2 .6 111. 6

T i n t De gr ee 114 24. 5 29 . 0

Hi gh er De gr ee 21 4 . 5 4 . 5

N: 466

More t h a n 100% b e c a u i e r e i p o n d e n t i may t h a n one a ca d em ic q u a l l i l c a t l o n .

h o l d more

I t wo u l d a p p e a r i rom t h e i e d a t a t h a t p r a c t i c e

n u n e i w i t h a w i d e r a n g e o i a c a d e m i c

q u a l l i l c a t l o m a r e more l i k e l y t o be w o r k i n g I n

p r a e t l e e i w i t h p a t i e n t H i t i l z e i r a n g i n g i rom,

5001 - 12500 w i t h t h e i e p r a e t l e e i h a v i n g e i t h e r

two or t h r e e p r a c t i c e n u n e i I n p o i t .

bJORKING ENVIRONMENT

T h l i i e c t l o n d e i c r l b e i t h e c h a r a c t e r l i t l c i o i t h e

w o r k i n g e n v i r o n m e n t I n w h i c h t h e p r a c t i c e n u n e i

6 . 1 3

were employed and d l i e u a e i i a e k d e t a l l i a i t h e

t y p e o i b u i l d i n g I n w h i c h t h e r e i p o n d e n t i work;

w h e t h e r t h e i u r g e r y l i p u r p o i e b u i l t or a d a p t e d

p r e m l i e i ; d e t a l l i a b o u t t h e p a t i e n t r e g l i t e r e d

H i t i l z e , and w h e t h e r t h e p r a c t i c e l i a p p r o v e d a i

a t r a i n i n g p r a c t i c e i o r t r a i n e e g e n e r a l

p r a c t l t l o n e n . I n i o r m a t l o n r e l a t i n g t o t h e

t h e i u p p o r t i t a H b o t h e mp loy ed and a t t a c h e d and

p r a c t i c e t eam m e e t l n g i a r e a l i o p r e i e n t e d and

d l i c u i i e d .

Type oi P r a c t i c e p r e m l i e i

The t y p e o i p r e m l i e i I n w h i c h t h e p r a c t i c e n u n e

w or ked wai e i t h e r a p u r p o i e b u i l t i u r g e r y , h e a l t h

c e n t r e or a d a p t e d p r e m l i e i . The g r e a t e r number

o i i u r g e r l e i I n t h e i t u d y we r e p u r p o i e b u i l t , 283

(60. 7%) and 161 (34. 5%) we r e a d a p t e d p r e m l i e i t h e

r e m a i n i n g , 22 (4. 9%) w e r e p u r p o i e b u i l t h e a l t h

c e n t r e i .

P r a c t i c e S i z e

The m a j o r i t y o{, p r a c t i c e s w i t h i n t h e i t u d y had a

r e g l i t e r e d p a t i e n t H i t i l z e o i 7501 - 10000 and

t h l i r e p r e i e n t e d 91 ( 19. 5%) o i t h e t o t a l number

o i p r a e t l e e i I n w h i c h t h e r e i p o n d e n t i I n t h e i t u d y

w o r ke d . The i m a l l e i t i l z e d p r a e t l e e i w e r e un de r

2500 o i w h i c h t h e r e w e r e 27 (5. 8%) and t h e l a r g e i t

we r e o v e r 20000 o i w h i c h t h e r e w e r e 19 ( 4 . 1%) .

T a b l e 6 . 5 g l v e i t h e d e t a i l o i t h e p r a c t i c e H i t

i l z e .

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a T-— t— 1—. CM zz

VA.ac.t^c.2.6MBM MM BMW MM hfca «MM as

M o ^ e t h a n k a t ^ o^ tho, p^actJ ic . 2.6 jin t h d 6tu.dy voq kq,

a p p ^ o v t d a.6 tKaJinX^ng p ^ a c t Z c e , ^ , 23S ( 51 , 5%) ,

VfLQ^domLnaYLtty, tke . t^aX,nJiyLg pKac.tJic.2.6 w e - t e tko^o ,

w/ iXc / i had a. tafig^n. Ke.gji6te.^e.d p a t j i z n t t Z 6 t 4 X z e 0 ^

7501 and above.. The, t ^ a J in tn g pfiac.tLc.2,6 a t6 o had

c.ompKe.ke.n6JLv e. 6 a p p o ^ t te,ami Jin p ta ce . . Mo6t

pn.aQ.tX,c.zi i^kLak WCAC tn.aX.nLng pn.ac.tX.c.0.^ had one.

ge.nzn.at p n a z t t t t o n z n . , 139 ( 29. 8%) n . z c o g n t6 z d a6 a

t n a tn z n . and n z ^ p o n ^ t b t z , tkzn.z{,on.z , Ion. t k z

t n a t n t n g o l t k z t n . a t n z z g zn zn .a t p n . a z t t t t o n z n . .

Tkz numbzn. 0 t n a t n z z g zn zn .a t pn.aztX. ttonzn.1

a t t a z k z d t o a pn.aztX.zz Ma6 d z p z n d z n t upon

numbzn. 0 tn.atnzn.^ vuX.tktn any o n z p n . a z t t z z .

Gznzn.at p n a z t t z z 6t aXX•BMMM «M» MM MM MM MMMM MM MM MM MM MMMM

G z n z n a t P n a z t t t t o n z n . 6

Tkz numbzn 0 ^ g z n z n a t p n a z t t t t o n z n ^ u ) t t k t n any

p n a z t t z z n z t a t z d t o t k z t t 6 t 6 t z z and t k z a v z n a g z

6 . 1 7

6 t z z ^on any o nz g z n z n a t p n a z t t t t o n z n wa-6

2500. Mo^t p n a z t t z z ^ had b o t h ^ z m a t z and m a t z

d o z t o n i . Ho p n a z t t z z ovz n t k z t t 6 t 6 t z z o l 5000

had z t t k z n o n t y m a t z d o z t o n i on ^ z m a t z d o z t o n é and

no p n a z t t z z u j t t k a t t 6 t 6 t z z o^ 5000 on t z 6 6 had

o n t y {jZmatz d o z t o n ^ . T h z n z wa6 no i t g n t ^ t z a n z z

t n t k z z o n n z t a t t o n bztvuzzn ^ z m a t z g z n z n a t

p n a z t t t t o n z n ^ and t k z numbzn o^ p n a z t t z z nun^z6

z m p t o y z d t n any on z p n a z t t z z . T a b t z 6 . 6 d z t a t t ^

t k z numbzn o l ^ z m a t z and m a t z g z n z n a t

p n a z t t t t o n z n ^ and p n a z t t z z nun^z6 n z t a t z d t o

p n a z t t z z n z g t ^ t z n z d p a t t z n t t t 6 t ^ t z z .

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mzmbzn a t t a z k z d , Tnatntng p n a z t t z Z ‘à wznz monz

t t k z t y to kavz a zompnzkzn^tvz pntmany k z a t t k zanz

tzam tkan non- tnatntng p n a z t t z z ^ . A l a t t tzam

Moatd zon6 t6 t o^ k z a t t k v t ^ t t o n ^ , d t 6 t n t z t nan6z^,

zommantty mtdMtvz6 and zommuntty p ^ y z k t a t n t z

n u n ^ z ^ ,

Otkzn pno^z^!>6tonat ‘Sta^^ t d z n t t ^ t z d tn t k z 6tudy

voko v t 6 t t z d pn a z t t z z ^ and p a n t t z t p a t z d t n p a t t z n t

zanz ujznz:

* Cktnopodt6t6

* V t z t t t t a n ^

* Spzzzk Tkznapt6t6

* V t a b z t t z Hzat tk \ / t6tton6

* Pky^ to tkznap t^ t ^

* MzMtttan Hun6Z6

6 . 2 0

* s to m a Nun6Z6

* O z c u p a t t o n a t ThznapJi6t6

* C o u n 4 z t t o n 6

* S o z t a t Wonkzn^

* O p t o m z t n t ^ t ' i

EmpZouzd P n a z t t z z St aXX«BBMM Ism MM MM Abs MM BM MM MM MM MM MM MM MM BM a&M .U a

Tkz ^o t touot ng ^ t a H voznz z m p t o y z d by p n a z t t z z ^ t o

6 u p p o n t g z n z n a t p n a z t t z z a z t t v t t y :

* P n a z t t z z Managzn^

* P n a z t t z z Admtnt - i i tnaton^

* S z n t o n P z z z p t t o n t 6 t 6

* P z z z p t t on t4 >t 6

* P t t t n g Ct znk6

* Data I n p u t C t znk4

* Rz zond C t z n k ^

* T z t z p k o n t 6 t 6

* S z z n z t a n t z ^

* T y p t 6 t 6

* Pk an ma z t 6 t6

6 . 2 1

* V t 6 p z n 6 t n g A 6 6 t 6 t a n t 6

* A c c o u n t a n t s

* Book - Kc cpc ns

T kz n u n s z s t d z n t J i l t z d a numbzn o^ t k z a b o v z d u t t z s

w k t c k t k z y u n d z n t o o k . T k z s z a c t t v t t t z s t n c l u d z d ,

p n a z t t z z n u n s z / p n a z t t z z managzn , p n a z t t z z n u n s z l

n z z z p t t o n t s t , and p n a z t t z z nuns z / k z a Z t k v t s t t o n .

O t k z n n z s p o n s t b t t t t t z s uuznz a t s o t d z n t t ^ t z d and

t k z d z t a t t t s t t z m t s z d t n T a b t z 6 . 7 .

6 . Z Z

T a b t z 6 . 7 : O tkzn a s p z z t s o£ t k z P n a z t t z z Nansz*s

R o t z

R o t z Numbzn o l % C a m u ta t t v z _______________________________ R z s p o n d z n t s ______________ %_______

P n a z t t z z Huns z l Na nagz n 51 10, 9 10, 9

P n a z t t z z H u n s z / R z z z p , 27 5 , 8 16, 7

P n a z t t z z H u n s z ! H z a t t k V t s t t o n 2 ,4 17,1

O t h z n s : 6 1 ,3 18, 4

P n a z t t z z H u n s z l V t s p z n s z n 2 ,4

P n a z t t z z H u n s z l C o u n s z t t o n 1 ,2

P n a z t t z z H u n s z l P t t t n g C t z n k 1 ,2

P n a z t t z z Hu ns z /A d m t n t s t n a t o n 1 ,2

P n a z t t z z Hu ns z /T z t z p h o n t s t 1 ,2

I t t s s t g n t l t z a n t t o n o t z t h a t n u n s z s z m p t o y z d t n

t n a t n t n g p n a z t t z z s ujznz u n t t k z t y t o bz u n d z n t a k t n g

z t t k z n a d m t n t s t n a t t v z d u t t z s on n z z z p t t o n wonk,

Somz n u n s z s voznz z m p t o y z d t n a d u a t n o t z z a p a z t t y ,

t k z m a j o n t t y , kov j zvzn , w z n z n o t and vohz tkzn t k z

6 , 2 3

n u ^ s z u n d z n t o o k n z z z p t t o n voonk as p a n t o i a

z o n t n a z t i i a t annang z m z n t on b z z a a s z n u n s z s kad

s p a n z z a p a z t t y t o k z t p t n t k t s a n z a o^ t k z

p n a z t t z z t s t m p o s s t b l z t o d z t z n m t n z .

EHPLOVMEHT ARRANGEMENTS

T k t s s z z t t o n o l t k z z k a p t z n t d z n t t ^ t z s and

d t s z u s s z s t k z n z s p o n d z n t s ^ z o n d t t t o n s o^

z m p t o y m z n t t n z t u d t n g z o n t n a z t s o^ z m p t o y m z n t , j o b

d z s z n t p t t o n s f kouns o l voonk s t u d y t z a v z and

p z n l o n m a n z z nzv t zvo .

C o n d t t t o n s oX Emptoymznt

Employzn

Tkz m a j o n t t y o l p n a z t t z z n u n s z s p a n t t z t p a t t n g t n

t k z s t u d y w z n z z m p t o y z d by t k z p a n t n z n s o^ t k z

p n a z t t z z , 433 ( 92 . 9%) , 4 [0,9%] s p z z t ^ t z a t t y

t d z n t t ^ t z d t k z s z n t o n p a n t n z n as t k z t n z m p t o y z n

and 5 (1, 1%) w z n z wo nk tn g t n H z a t t k C z n t n z s and

6 , 2 4

w z nz , t k z n z l o n z , z m p t o y z d by t h z H z a t t k A i i t k o n t t y ,

Otkz n n z s p o n d z n t s t d z n t t ^ t z d v a n t o a s p z n s o n s wkom

t k z y a n d z n s t o o d t o b z t k z t n z m p t o y z n , Ea mt t y

H z a t t k S z n v t z z A a t k o n t t y , P n a z t t z z Managzn, S z n t o n

R z z z p t t o n t s t , P n a z t t z z A d m t n t s t n a t o n , S z n t o n Nunsz

and t k z P n a z t t z z ,

Con tn a z t s 0 / Emptoymzn t and Job V z s z n t p t t o n s

Uzan ty t k n z z q u a n t z n s o l t k z p a n t t z t p a n t s kad

z o n t n a z t s 0 ^ z m p t o y m z n t b a t n o t a t t o^ t k z s z

n u n s z s a t s o kad j o b d z s z n t p t t o n s , 01 t k z t o t a t

n z s p o n d z n t s , 166 ( 35, 6%) d t d n o t k a v z j o b

d z s z n t p t t o n s and 1 28 ( 27, 5%) d t d n o t k a v z

z o n t n a z t s oj, z m p t o y m z n t , T a b t z 6 , 8 t d z n t t { , t z s

t k z d z t a t t .

6 , 2 5

Tabte. 6 . 8 : C o n tn a z t s o£ Emptoymznt and Job

D z s z n t p t t o n s h z t d by R z s p o n d z n t s

ï d z n t t £ t z a t t o n Numbzn o£ % C u m u t a t t v z___________________________Rzs p o n d z n t s ______________ %_______

C o n t n a z t s o i Emptoymzn t 338 72 , 5 72 , 5

Job V z s z n t p t t o n s 300 64 , 4 136 , 9

C u m u t a t t v z % monz t k a n 100% b z z a u s z o^ m u t t t p t z z o d t n g ,

Xt t s o i s t g n t ^ t z a n z z t o n o t z t k a t n u n s z s won k t ng

t n t n a t n t n g p n a z t t z z s w z n z monz t t k z t y t o k a v z

z o n t n a z t s o^ z m p t o y m z n t and j o b d z s z n t p t t o n s t k a n

t k o s z wo nk tn g t n n o n - t n a t n t n g p n a z t t z z s and t k z n z

w z n z n o t a b t z d t ^ z n z n z z s t n t k z n z g t s t z n z d p a t t z n t

t t s t s t z z and w k z t k z n t k z p n a z t t z z n u n s z s kad

z o n t n a z t s o^ z m p t o y m z n t and j o b d z s z n t p t t o n s , and

T a b t z 6 , 9 k t g k t t g k t s t k z d z t a t t .

6 . 26

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dCJ'ddd

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0\G Lf>

Go . Cm f M «— CM

co co Co co co co co o dCO co co co co co co co •wCo co If* co If* co If* co *d oIf* If* fM Co CM If* fM co dCm t— fM 1— f — CM d1 II 1 1 1 1 1 d

5d co co co co co co co co d'd Lf* o If* co If* If* If* co Nd CM «f* hM co CM « f* fM co o: 3 »— fM f-> fM CM C_)

Hoans wonkzd

Thz houns wonkzd by p n a z t t z z n u n s z s t n t k t s s t u d y

v a n t z d ^nom onz koun - t h z n u n s z u n d z n t o o k

z o m b t n z d d u t t z s - t o s z v z n t y kouns w t t k t k z

a v z n a g z b z t n g 23 kouns p zn wz z k . Most n u n s z s ,

t k z n z ^ o n z , wonk p a n t - t t m z , P n a z t t z z n u n s t n g ,

k o w z v z n , z a n n o t bz z o n s t d z n z d t o t a t t y p a n t - t t m z

b z z a u s z a s m a t t numbzn, 68 (14, 5%) wonkzd

l u t t - t t m z k o u n s , T a b t z 6 , 1 0 d z t a t t s t k z numbzn

o l n u n s z s wonk t ng ^ u t t - t t m z and p a n t - t t m z

z o n n z t a t z d a g a t n s t n z g t s t z n z d p a t t z n t p n a z t t z z

t t s t s t z z .

6 . Z &

T a b t z 6 . 1 0 : N a m b z n o £ V n a z t t z z N u n s z s w o n k t n g

i u t t - t t m z a n d p a n t - t t m z z o n n z t a t z d

a g a t n s t n z g t s t z n z d p n a z t t z z p a t t z n t

t t s t s t z z

P n a z t t z z L t s t

Undzn 2500

2501- 5000

5001- 7500

7501- 10000

10001- 12500

12501- 15000

15501- 17500

17501- 20000

200 01 and ov z n

Cotumn t o t a t

T u t t - T t m z

68 (14, 5%)

P a n t - T t m z

383 (82. 1%)

V z n l o n m a n z z R z v t z w

R z s p o n d z n t s w z n z a s k z d t ^ , as p a n t ojJ s t a / , ^

6 . 2 9

pznionmcLYLZz and dz v z l o p m z n t , t k z y kad s t a ^ ^

a p p n a t s a t . S t g n t ^ t z a n t t y , 368 [79%] kad n o t kad

a n z v t z w 0 / t k z t n p z n / o n m a n z z and 96 ( 20. 6%) kad

b z z n a p p n a t s z d . T k z n z wz nz two n o n - n z s p o n d z n s .

Tkz n z v t z w was u n d z n t a k z n by a v a n t z t y 0

p z n s o n n z t w t t k t k z s z n t o n p a n t n z n b z t n g t k z m os t

t t k z t y p z n s o n t o u n d z n t a k z t k z s t a ^ l a p p n a t s a t , 61

(13. 0%) and t k z p n a z t t z z managzn z t t k z n a t o n z on

t n z o n j a n z t t o n w t t k t k z s z n t o n p a n t n z n n z x t m os t

t t k z t y t o u n d z n t a k z t k z n z v t z w , 15 ( 3 . 2%) .

Nunszs wonk t ng t n t n a t n t n g p n a z t t z z s , 75 (78. 1%)

ol t k z t o t a t 96 n u n s z s wko kad b z z n a p p n a t s z d

wz nz monz t t k z t y t o k a v z an a n n u a t pzn/^onmanzz

n z v t z w t k a n n u n s z s wonk tng t n n o n - t n a t n t n g

p n a z t t z z s . S t a ^ ^ a p p n a t s a t was n o t n z t a t z d t o

g n a d t n g on pay n z v t z w b u t was a m a n a g z n t a t t o o t

t o z n a b t z d t s z u s s t o n t o t a k z p t a z z b z t w z z n s t a ^ ^

manag z m z n t and p z n s o n n z t and p n a z t t z z

d z v z t o p m z n t s .

6 . 3 0

P n a z t t z z M z z t t n g sMSB MM MM M.B MIM MM MM

P n a z t t z z m z z t t n g s w z n z h z t d tn. a t t t k z p n a z t t z z s

and t h z m a j o n t t y , 264 (56.7%) wz nz z o n v z n z d d a t t y .

01 t k z p n a z t t z z s h o t d t n g m z z t t n g s , t k z p n a z t t z z

s t a l l w t t k t n t n a t n t n g p n a z t t z z s wz nz monz t t k z t y

t o m z z t z v z n y day , 152 (32 . 6%) t k a n n o n - t n a t n t n g

p n a z t t z z s . P n a z t t z z n u n s z s a t s o t n d t z a t z d t h a t

t k z y m z t s z p a n a t z t y as a t z am u s u a t t y z a z k

q u a n t z n .

C o n z t u s t o n

T k t s z k a p t z n has p n z s z n t z d t k z d z t a t t as t t

n z t a t z s t o t k z n z s p o n d z n t s p z n s o n a t and

p n o l z s s t o n a t z k d n a z t z n t s t t z s and t k z n u n s z s

wonk tng z n v t n o n m z n t . T k t s t n l o n m a t t o n p n o v t d z s

z o m p n z k z n s t v z t n l o n m a t t o n a b o u t t k z n z s p o n d z n t s

and z o n l t n m s n o t o n t y t k z v a n t z d b a z k gn o un d s Inom

w k t z k p n a z t t z z n u n s z s zomz b u t a t s o t k z d t l I z n z n t

z n v t n o n m z n t s w t t k t n w k t z k t k z n u n s z s wonk. Tkz

z k a p t z n w k t z k l o t t o w s w t t t p n z s z n t t k z d a t a as t t

6 . 3 1

n z t a t z s t o t h z n z s p o n d z n t s ' t z a n n t n g n z z d s and

t z a n n t n g o p p o n t u n t t t z s .

6 . 3 2

C H A P T E R S E V E N

LEARNING OPPORTUNITIES ANV LEARNING NEEDS

T k t s z k a p t z n p n z s z n t s t k z d z t a t t as t t n z t a t z s t o

t z a n n t n g o p p o n t u n t t t z s and t z a n n t n g n z z d s and

t n z t u d z s t n l o n m a t t o n a b o u t s t u d y t z a v z , t n - s z n v t c z

and t n - k o u s z t n a t n t n g and z d u z a t t o n o p p o n t u n t t t z s ,

t k z a l l z z t on p n a z t t z z o l a t t z n d t n g an a p p n o v z d

E n g t t s k N a t t o n a t Boand p n a z t t z z n u n s z z o u n s z ,

o v z n a t t o p p o n t u n t t t z s t o a t t z n d z o u n s z s ,

z o n l z n z n z z s and t k z p n o l z s s t o n a t j o u n n a t s n z a d by

t k z n z s p o n d z n t s .

T k z n z s p o n d z n t s t d z n t t l y t k z z d u z a t t o n and

t n a t n t n g n z z d s t k z y p z n z z t v z t k z y n z q u t n z t n

ondzn t o u n d z n t a k z t k z t n o z z u p a t t o n a t n o t z

z o m p z t z n t t y . T k t s s z z t t o n o l t k z q u z s t t o n n a t n z

a b o u t t z a n n t n g n z z d s was d z t t b z n a t z t y t z l t opzn

z n d z d n o t o n t y t o a t t o w t k z n u n s z s t o monz I n z z t y

z x p n z s s t k z t n z d u z a t t o n and t n a t n t n g n z z d s b u t

a t s o t o k z t p t k z n u n s z s I z z t t k a t t k z n z w z n z no

fLZStntzt toYLS wkzYL t d z n t t l y t n g t k z t n n z z d s . T kz

n z s p o n d z n t s w z n z z n zo un a g zd t o a s z t k z k z a d t n g

w t t k w k t z k t k z y w z n z l a m t t t a n and w k t z k t k z y kad

i i szd wkzn g t v t n g d z t a t t s t n an z a n t t z n p a n t o l t k z

q u z s t t o n n a t n z a b o u t o z z u p a t t o n a t n o t z .

T kz z k a p t z n t s d t v t d z d t n t o two s z z t t o n s . T k z

I t n s t p a n t p n z s z n t s t k z d z t a t t as t t n z t a t z s t o

t k z n z s p o n d z n t s ’ t z a n n t n g o p p o n t u n t t t z s and

t n z t u d z s t n l o n m a t t o n a b o u t s t u d y t z a v z , t n - s z n v t z z

and t n - k o u s z t n a t n t n g , p o s t b a s t z z d u z a t t o n

o p p o n t u n t t t z s and t k z n a n g z o l p n o l z s s t o n a t

j o u n n a t s t h z n z s p o n d z n t s n z a d . Tkz t a t t z n p a n t

o l t k z z k a p t z n t s d z v o t z d t o t k z p a n t t z t p a n t s *

p z n z z t v zd t z a n n t n g n z z d s as t k z y p z n t a t n t o

o z z u p a t t o n a t n o t z a z t t v t t t z s and t n z t u d z z t t n t z a t

t a s k s and n u n s t n g p n o z z d u n z s , k z a t t k s u n v z t t t a n z z ,

z t t n t z a t z x a m t n a t t o n s , t n v z s t t g a t t o n s , z t t n t z s ,

z k t t d n z n , p n o I z s s t o n a t u p d a t t n g , manag z m z n t ,

t z a z k t n g and o t k z n t z a n n t n g n z z d s w k t z k t k z

n z s p o n d z n t s d t d n o t t n z t u d z t n t k z o t k z n

s z z t t o n s .

s tu dy L zclvz:

S p z z L l t z ZzoLvz I on s t u d y t s n o t an a u t o m a t t c

z n t t t t z m z n t . In t k t s s u n v z y monz t k a n t k n z z

q u a n t z n s o l t k z n z s p o n d z n t s w z n z a l Z o w z d t o a t t z n d

s t u d y d a y s , 378 ( 8 1 . 1 %) , Howzvzn, p n a z t t z z

n u n s z s wonk t ng t n g z n z n a t p n a z t t t t o n z n t n a t n t n g

p n a z t t z z s w z n z s t g n t l t z a n t t y a t t o z a t z d monz s t u d y

t z a v z t k a n p n a z t t z z n u n s z s wonk t ng t n n o n - t n a t n t n g

p n a z t t z z s . 01 t k z 466 n z s p o n d z n t s , 246 (52. 8%)

wonkzd t n g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s

and t k z n z m a t n t n g 220 ( 47. 2%) w z n z z m p t o y z d t n

n o n - t n a t n t n g p n a z t t z z s .

01 t k z 378 p a n t t z t p a n t s a t t o z a t z d s t u d y t z a v z , 193

s u b j z z t s (51. 0%) wonkz d t n g z n z n a t p n a z t t t t o n z n

t n a t n t n g p n a z t t z z s and 185 ( 49. 0%) w z n z z m p t o y z d

t n n o n - t n a t n t n g p n a z t t z z s . Tkz mzan numbzn o l

t n a t n t n g p n a z t t z z s was 552 w t t k a s t a n d a n d

d z v t a t t o n o l 543 and t k z mzan numbzn o l p n a z t t z z

n u n s z s wonk tng t n t n a t n t n g p n a z t t z z s I on wkom

s t u d y t z a v z was a t t o z a t z d was 985 w t t k a

s t a n d a n d d z v t a t t o n o l 9 7 7.

T kz d t l l z n z n c z b z t w z z n g z n z n a t p n a z t t t t o n z n

t n a t n t n g p n a z t t z z s and n o n - t n a t n t n g p n a z t t z z s

a t t o z a t t n g s t u d y t z a v z t o p n a z t t z z n u n s z

z m pt o y z z * s was k t g k t y s t g n t l t z a n t u s t n g z k t -

s q u a n z d (X^= 5 2 9 . S, d l 2, p - <0 . 0 1 ) . T k z n z was

a t s o a k t g k t y s t g n t l t z a n t p o s t t t v z z o n n z t a t t o n

b z t w z z n t n a t n t n g p n a z t t z z s and s t u d y t z a v z

a t t o z a t t o n , [n- 0 . 2 1 1 0 , p - <0 . 0 1 ) .

01 t k z 378 n z s p o n d z n t s a t t o z a t z d s t u d y t z a v z , o n t y

155 ( 33. 2%) a t t z n d z d a s t n g t z s t u d y d a y .

Howzvzn, t k z numbzn o l s t u d y days o U z n z d t o

p n a z t t z z n u n s z s wonk t ng t n g z n z n a t p n a z t t t t o n z n

t n a t n t n g p n a z t t z z s was k t g k z n ( 31. 0%) t k a n s t u d y

day a t t o z a t t o n t o p n a z t t z z n u n s z s z m p t o y z d t n n on-

t n a t n t n g p n a z t t z z s , ( 29 . 0%) . P n a z t t z z n u n s z s

wonktng t n g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s

wz nz a t s o a t t o z a t z d on a v z n a g z 4 s t u d y da ys pzn

y z a n , w k z n z a s p n a z t t z z n u n s z s z m p t o y z d t n non-

t n a t n t n g p n a z t t z z s w z n z o U z n z d an a v z n a g z o l

2 Study days pzn yzan.

T k z n z t s n z g t o n a t v a n t a t t o n t n t k z numbzn o l p a t d

s t u d y days p z n y z a n a t t o z a t z d t o p n a z t t z z n u n s z s .

Ton z x a m p t z , 21.0% o l n u n s z s wo nk tn g t n t k z s o u t k

ol Engt and and wo nk t ng t n g z n z n a t p n a z t t t t o n z n

t n a t n t n g p n a z t t z z s k a v z a s p z z t l t z numbzn o l s t u d y

days a t t o z a t z d t o t k z m w t t k t n t k z t n z o n t n a z t s o l

z m p t o y m z n t , w k z n z a s t n t k z n o n t k o l Eng t and o n t y

16.2% o l t k z n z s p o n d z n t s * wonk t ng t n g z n z n a t

p n z t t t t o n z n t n a t n t n g p n a z t t z z s kad a s p z z t l t z

numbzn o l s t u d y da ys a t t o z a t z d t o t k z m w t t k t n

z o n t n a z t s on z m p t o y m z n t . T k z n z t s a t s o n z g t o n a t

v a n t a t t o n t n t k z numbzn o l s t u d y days t a k z n by

p n a z t t z z n u n s z s , w t t k n u n s z s * t n t k z Mz ns z y n z g t o n

t a k t n g t k z m o s t s t u d y days ( s z v z n ) and E a s t k n g t t a

t k z I z w z s t (2) d a y s . A g n z a t z n numbzn o l n u n s z s

a t t z n d z d I o n s t u d y days t n t k z Non tk E a s t R z g t o n ,

18 (5.0%) z ompanzd w t t k 8 (2. 2%) t n Oxlond R z g t o n .

T k z s t u d y d a y s u b j z z t s t n z t u d z d :

* CkJitdnzn* s t m m u n t s a t t o n s

* T n a v z t k z a t t k

* CJomzn’s k z a t t k

* M z n s ' k z a t t k

* As t kma and n z t a t z d n z s p t n a t o n y p n o b t z m s

* V t a b z t z s

A t t t k z n u n s z s wko a t t z n d z d t k z s t u d y days w z n z

a t n z a d y u n d z n t a k t n g t k z a z t t v t t t z s t n t k z t n

p n a z t t z z . Nuns zs wko a t t z n d z d t k z a s t k m a and

n z t a t z d n z s p t n a t o n y p n o b t z m s s t u d y d a ys d t d n o t

k o t d t k z A s t kma d t p t o m a , n z t t k z n kad t k z n u n s z s

wko a t t z n d z d t k z V t a b z t z s s t u d y d ay s s t u d t z d t k z

n z z o g n t s zd ENB V t a b z t z s z o u n s z . F a z t o n s

a l l z z t t n g s t u d y t z a v z a t t o z a t t o n a n z p n z s z n t z d t n

T a b t z A ( A p p z n d t x t x ) .

J n - S z n v t c z T n a t n t n g :

Thz n z s p o n d z n t s w z n z a s k z d t o t d z n t t l y t k z t n t n -

s z n v t z z t n a t n t n g o p p o n t u n t t t z s , 01 t k z 466

p a n t t z t p a n t s , 69 (14, 8%) kad b z z n o U z n z d t n -

s z n u t z z t n a t n t n g . T kz d t H z n z n z z t n p n o v t s t o n

b z t w z z n n z s p o n d z n t s won k t n g t n g z n z n a t

p n a z t t t t o n z n t n a t n t n g p n a z t t z z s and p n a z t t z z

n u n s z s z m p t o y z d t n n o n - t n a t n t n g p n a z t t z z s was

l o u n d t o b z k t g k t y s t g n t l t z a n t u s t n g z k t - s q u a n z d

and t k z n z t a t t o n s k t p b z t w z z n t n a t n t n g p n a z t t z z s

t n - s z n v t z z t n a t n t n g p n o v t s t o n I on p n a z t t z z n u n s z s

s ko wz d a k t g k t y s t g n t l t z a n t p o s t t t v z z o n n z t a t t o n ,

01 t k z 193 s u b j z z t s a t t o z a t z d s t u d y t z a v z and

won ktn g t n g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s

111 (57. 5%) wz nz a t s o o U z n z d t n - s z n v t z z t n a t n t n g .

T kz mzan numbzn o l p n a z t t z z n u n s z s a t t o z a t z d t n -

s z n v t z z t n a t n t n g was 23 8 w t t k a s t a n d a n d

d z v t a t t o n o l 426 . T k z d t H z n z n z z b z t w z z n

g z n z n a t p n a z t t t t o n z n t n a t n t n g p n a z t t z z s and non-

t n a t n t n g p n a z t t z z s a t t o z a t t n g t n - s z n v t z z t n a t n t n g

t o p n a z t t z z n u n s z s was l o u n d t o bz k t g k t y

s t g n t l t z a n t , fX*= 2 2 1 9 . 9 9 8 8 , d l 20, p= <0 . 0 1 ) .

T k z n z was a t s o a k t g k t y s t g n t l t z a n t p o s t t t v z

z o n n z t a t t o n b z t w z z n t n a t n t n g p n a z t t z z s and t n -

s z n v t z z t n a t n t n g p n o v t s t o n , (n= 0 . 1 2 0 1 , p= <0 . 0 1 ) .

D z t a t t s n z t a t t n g t o t n - s z n v t z z t n a t n t n g

o p p o n t u n t z s a n z p n z s z n t z d t n T a b t z B [ k p p z n d t x

t x ) .

T k z n z was a s t g n t l t z a n t d t l I z n z n z z & p o s t t t v z

n z t a t t o n s k t p b z t w z z n t k z z o n t n a z t z d kouns t k z

n z s p o n d z n t s wonkzd and t k z a t t o z a t t o n o l s t u d y

t z a v z and t n - s z n v t z z t n a t n t n g . P n a z t t z z n u n s z s

wonk t ng a mzan o l 22 . 5 26 kouns p z n w z z k w t t k a

s t a n d a n d d z v t a t t o n o l 10 . 08 wz nz s t g n t l t z a n t t y

a t t o z a t z d monz s t u d y t z a v z , 5 1 9 . 8 8 0 3 , d l 2 p=

<0. 01) and t n - s z n v t z z t n a t n t n g , (X^= 4 3 1 . 2 7 7 0 , d l

2, p= <0 . 0 1 ) . Tkz n z t a t t o n s k t p b z t w z z n s t u d y

t z a v z a t t o z a t t o n and t k z z o n t n a z t z d kouns wonkz d

by t k z n z s p o n d z n t s wz nz z o n n z t a t z d and l o u n d t o bz

k t g k t y s t g n t l t z a n t (n= 0 . 1 3 1 6 , p- <0 . 0 1 ) . T k z n z

was a t s o a k t g k t y s t g n t l t z a n t z o n n z t a t t o n b z t w z z n

Jin-6 Q,fLvJic.2, t^a.LnX,ng and t k z . n.Q,6pondQ,nt6 <iontn.ac.tiid

houn.6 0 ^ ivonk, (n.= 0 , 1 1 1 8 , p= <0 , 0 1 ) , A l t h o u g h

t h t n . 0. u)a6 a ^ I g n l ^ l a a n t dl^^e.n.e.nc.e. bztMC.e.n

c .on tn . ac t td houn.6 vJon.kzd by pn.ac.tlc.2. nun.60.6 and

le.an.nlng op pon . tun l t l e . 4 the.n.z uja6 no 6 l g n l i l c . a n t

con.n.e. lat lon be.tuue.zn ln-6e.n. \/ lae. t r a i n i n g a l l o c a t i o n

and ye.an.6 o i p n . a c t l c c a6 a p r a c t i c e . nun.6c,

{n.= - 0 . 0 3 3 1 , p - 0. 4 7 6 ) , The. d e . t a l l r e l a t i n g t o

c o n t n . a c t c d houn.6 and le.an.nlng opp on . tu n l t l e . 6 an.c

pn.c6cnte.d I n T a b i c C (Appendix. I x ) .

0^ t h e 466 n . e6 p o n d e n t 6 , 69 (14. 8%) had a t t e n d e d

coun.6e6 a6 pan.t o^ l n - 6 e n v l c e t n . a l n l n g and t h e

d e t a i l o l t h e coun.6e6 a t t e n d e d an.e pn.c6 e n t e d I n

T a b l e 7.1

Table, 7 .7 C o u ta & a a t t e n d e d by p n a e t l c e nun.6e6 a-6

ln -6 eK vJ iee tn.alnJing

C 0U A4&4 A t t e n d e d Numbea o i 1le6pondent6

% o i T o t a l

C o l p o s c o p y

EWB f a m i l y P l a n n i n g

Asthma Diploma

Bl ood Pn.essun.e

Manic Can l e Canccn S c n c c n l n g

Diploma I n Nuns lng

Dip loma I n H e a l t h E d u c a t i o n

Diploma I n P n a c t l c e Management

D i a b e t e s EWB

W r 4 6 6

18 . 8

D e t a i l uohlch n e l a t e d t o c o u n s e a s s e s s m e n t , c n e d l t

a c c u m u l a t i o n and c o u n s e r é c o g n i t i o n ^on r e c o r d a b l e

q u a l l l l c a t l o n we r e n o t a s k e d i o r . The main

p u r p o s e o i t h e q u e s t i o n was t o d e t e r m i n e t h e r a n g e

OjJ e d u c a t i o n and t r a i n i n g s u p p o r t p r a c t i c e n u r s e s

7 . 1 0

had r e c e i v e d w h i l s t I n p o s t . The n u r s e s who had

a t t e n d e d i o r t h e a b o v e c o u r s e w e r e a l r e a d y

u n d e r t a k i n g t h e r e l a t e d a c t i v i t i e s .

I n - H o u s e T r a i n i n g

The r e s p o n d e n t s wer e a s k e d t o g i v e d e t a i l s , a b o u t

t h e I n - h o u s e t r a i n i n g t h e y had r e c e i v e d . The

I n f o r m a t i o n r e q u e s t e d I n c l u d e d t h e s u b j e c t t a u g h t

and by whom and w h e t h e r t h e s u b j e c t t a u g h t was

a l s o a s s e s s e d and who u n d e r t o o k t h a t a s s e s s m e n t .

The S u b j e c t s w h ic h w e r e t a u g h t w e r e a l l c l i n i c a l

a c t i v i t i e s and we r e I d e n t i f i e d as r o l e e x t e n s i o n .

The t e a c h e r s o f t h e s u b j e c t s r a n g e d f r om t h e

g e n e r a l p r a c t i t i o n e r on t h e one hand t o t h e

l a b o r a t o r y t e c h n i c i a n on t h e o t h e r . The m a j o r i t y

u n d e r t a k i n g t h e t e a c h i n g and t r a i n i n g o f t h e

v a r i o u s s k i l l s a l s o u n d e r t o o k t h e a s s e s s m e n t .

A l l t h e s u b j e c t s t a u g h t by t h e n u r s e s w e r e a l s o

a s s e s s e d by t h e n u r s e s . S k i l l s t a u g h t by a

g e n e r a l p r a c t i t i o n e r we r e n o t a l wa ys a s s e s s e d .

T e c h n i c i a n s t e a c h i n g e l e c t r o c a r d i o g r a p h y or

7 .7 7

v e n e p u n c t u r e t e c h n i q u e a l t a s s e s s e d t h e i r

s u b j e c t s . The d e t a i l o f t h e s u b j e c t s t a u g h t , by

whom and d e t a i l a b o u t a s s e s s m e n t a r e

I d e n t i f i e d I n T a b l e 7 . 2

T a b l e 7 . 2 D e t a i l s o f Jn-Hoase T r a i n i n g u n d e r t a k e n

by t h e R e s p o n d e n t s

S u b j e c t Number Numberand % A s s e s s e d

C h i l d r e n * s Im m u n isa t io n sT e a c h e r : G e n e r a l Vr ac . 50 21A s s e s s o r ‘. G e n e r a l Vrac . 4 2 . 0

C e r v i c a l SmearsT e a c h e r : G e n e r a l Vr ac . 41 28A s s e s s o r ' . G e n e r a l Vr ac . 6 8 . 2

T e a c h e r : P r a c t i c e N u r s e 20 20A s s e s s o r ' . P r a c t i c e N u r s e 100 . 0

D i s t a n c e L e a r n i n g 10

Ear S y r i n g i n gT e a c h e r : G e n e r a l Vrac . 11 5A s s e s s o r ' . G e n e r a l Vr ac . 4 5 . 5

M enepunctureT e a c h e r : L a b o r a t o r y T ec h . 8 8A s s e s s o r : L a b o r a t o r y T ec h . 100 . 0

E l e c t r o c a r d i o g r a p h yT e a c h e r : T e c h n i c i a n 7 7A s s e s s o r ' . T e c h n i c i a n 100 . 0

Vost -BasLc . E d u c a t i o n and t h e E n g l i s h N a t i o n a l

Board P r a c t i c e N u r se Co ur se

The p r e v i o u s c h a p t e r I d e n t i f i e d t h a t more t h a n

h a l f - 244 152. 4%) o f t h e r e s p o n d e n t s had a t t e n d e d

an a p p r o v e d p r a c t i c e n u r s e c o u r s e o f w h i c h 219

( 44. 1%) had c o m p l e t e d t h e c o u r s e s i n c e becoming a

p r a c t i c e n u r s e and 152 (32. 6%) had a t t e n d e d a

c o u r s e p r i o r t o p r a c t i c e . Nur s es w e r e a s k e d t o

I d e n t i f y t h e s p e c i f i c t o p i c s or a r e a s o f s t u d y I n

t h e ENB p r a c t i c e n u r s e c o u r s e w h i c h t h e y

c o n s i d e r e d had s u b s e q u e n t l y a f f e c t e d t h e i r

p r a c t i c e . The t o p i c s I d e n t i f i e d by t h e

r e s p o n d e n t s r a n g e d f rom a c c o u n t a b i l i t y as b e i n g o f

h i g h p r i o r i t y t o s e l f - a p p r a i s a l as l ow I n

I m p o r t a n c e . The c o n t e n t I d e n t i f i e d by t h e

r e s p o n d e n t s as a f f e c t i n g p r a c t i c e a r e d e t a i l e d I n

T a b l e 7 . 3 .

T a b l e 7 - 3 T o p i c s I n c l u d e d I n t h e ENB P r a c t i c e

Nurse c o u r s e which r e s p o n d e n t s

c o n s i d e r e d had s u b s e q u e n t l y a

p r a c t i c e .

f f e c t e d

T o p ic s Number o f R esp o n d e n ts

i o f T o t a l

k cc o u n t a b l i l t y 12 2 . 5

P r a c t i c e N u r s e ' s r o l e 11 2 . 3

I n f o r me d P a t i e n t c o n s e n t 8 1 . 7

M e d i c o - l e g a l a s p e c t s 6 1. 2

Co mmu n ic a t io n s k i l l s 1 0 . 2

S e l f - a p p r a i s a l 1 0 . 2

The n u r s e s who had a t t e n d e d t h e ENB p r a c t i c e n u r s e

c o u r s e we r e a l s o a s k e d t o I d e n t i f y t h o s e t o p i c s

w h i c h t h e y wou l d l i k e t o ha ve had I n c l u d e d I n

t h e c o u r s e and t h e t o p i c s I d e n t i f i e d c o v e r a w i d e

r a n g e o f s u b j e c t a r e a s , I n c l u d i n g c l i n i c a l and

management s k i l l s . The t o p i c s w h i c h t h e p r a c t i c e

n u r s e s who had a t t e n d e d t h e ENB p r a c t i c e n u r s e

c o u r s e w o u l d l i k e t o h a v e had I n c l u d e d I n

7 . 14

subs e q u e n t p r a c t L c e n u r s e c o u r s e s a r e l i s t e d I n

T a b l e 7 .4

T a b le 7 . 4 : L i s t e d t o p i c s w h ich s h o u l d b e I n c l u d e d

I n s u b s e q u e n t ENB P r a c t i c e N urses

c o u r s e s .

* C h i l d r e n ' s h e a l t h

* ((/omen's h e a l t h

* Men' s h e a l t h

* D i s e a s e manag ement

* E m er g e n c i e s

* T r e a t m e n t room manag emen t

The r e s p o n d e n t s w e r e a l s o a s k e d t o I d e n t i f y t h o s e

t o p i c s w h i c h t h e y c o n s i d e r e d c o u l d be e x c l u d e d

f rom s u b s e q u e n t ENB p r a c t i c e n u r s e c o u r s e s . The

t o p i c s w h i c h we r e I d e n t i f i e d w e r e :

* t h e r o l e o f t h e p r i m a r y h e a l t h c a r e

t ea m

* n u r s i n g mode l s

* v i s i t o r s f r om pro f e s s l o n a l o r g a n i s a t i o n s

and S t a t u t o r y B od i es

* v i s i t s t o r e s o u r c e c e n t r e s - L i b r a r y

P r o f e s s i o n a l J o u r n a l s

The m a j o r i t y o f t h e r e s p o n d e n t s I n t h i s s u r v e y

r e a d p r o f e s s l o n a l j o u r n a l s t o ke ep p r o f e s s i o n a l l y

u p d a t e d , 449 ( 9 6 . 4 %) , T a b l e 7 . 5 d e t a i l s t h e

j o u r n a l s r e a d by t h e r e s p o n d e n t s .

7 . 16

Table, 7 . 5 : PeXaJils o f t h e j o u r n a l s r e a d by I k e

r e s p o n d e n t s t o h e l p k eep

p r o f e s s i o n a l l y u p d a t e d

J o u r n a l P r a c t i c e T r e e I n d i v i d u a l__________________________S u b s c r i p t i o n __________S u b s c r i p t i o n

P r a c t i c e N u r s e 104 - 345

P u l s e - GP J o u r n a l 96

GP J o u r n a l 68

Updat e D o c t o r s J o u r n a l 50

N u r s i n g Times 14

N u r s i n g S t a n d a r d 10 34

Pro f e s s l o n a l N u r se 12 4

D i s t r i c t N u r s e 4

H e a l t h v i s i t o r 2

7 . 1 7

L e a r n i n g N e e d s

The r e s p o n d e n t s I d e n t i f i e d a d i v e r s i t y o f

e d u c a t i o n and t r a i n i n g n e e d s I n a l l a s p e c t s o f

t k e l r o c c u p a t i o n a l r o l e . The n e e d f o r t r a i n i n g

I s n o t t h e same f o r a l l a c t i v i t i e s . The d a t a do

show, h o w e v e r , v e r y h i g h p r o p o r t i o n s I n some

a r e a s , s u c h as h e a l t h s u r v e i l l a n c e and w e l l woman

s c r e e n i n g w h e r e some 376 180. 6%) o f t h e

r e s p o n d e n t s I d e n t i f i e d a l e a r n i n g n e e d . A l l 466

s u b j e c t s e x p r e s s ed a n eed f o r t r a i n i n g I n r u n n i n g

D i a b e t i c c l i n i c s and 402 [86. 2%) I n t h e o p e r a t i o n

of As thma c l i n i c s .

S p e c i f i c c l i n i c a l t a s k s and n u r s i n g p r o c e d u r e s

The n u r s e s I d e n t i f i e d t h e f o l l o w i n g t a s k s and

n u r s i n g p r o c e d u r e s f o r w h i c h t h e y c o n s i d e r e d t h e y

had a t r a i n i n g n e e d . The g r e a t e s t r e q u e s t was

f o r wound management - some 85 ( 18. 2%)

r e s p o n d e n t s .

The o t h e r s u b j e c t s I d e n t l f l e d f i r s t a i d ,

emerg e n c l e s w i t h i n t h e p r a c t i c e and I n f e c t i o n

c o n t r o l and T a b l e 1 , 6 g i v e s t h e d e t a i l e d br eakdown

o f t h e s p e c i f i c c l i n i c a l t a s k s and n u r s i n g

p r o c e d u r e s I n w h i c h t h e r e s p o n d e n t s s a i d t h e y

woul d l i k e a d d i t i o n a l t r a i n i n g .

7 . 19

e•9 od "4"Wd d•d dd dd "do djien. *dd05e so

s*9 "W

ed de •d•de 9d ■w

e*9 d#d *d*9 ed o•w a. «9

*9 •dd dd *5> dd ede .e 05•w e«V '4d .e ed '4d d

.eV« 3 "W"fd *e *dd o ea. dCO

•Q2VOVO

•W O)^ a ee O)*a -W c

* eo d e Q. d •0 o* d d d K*d *?• -W

d•oBd

*C 05V d ^ e

o d #d di

o d o & d '^ -CO "W d e o d d d

s•oEd%

s :■s«Çd"Wdd

d0 d D.

1*Q§e

t:»dJO5d

JÇ?dJO

Cvl c n cr> VO

Oo CO CO VO

t o ÛO CoOo V» vq- f n

i n O ' i n CO

CO 'y - VO COO ' CO Co CO

Csj VO VOCvj O ' CO VO

c n vq-

-w oe *ed •wS sed oO ) «<3 od de ' d •*'? s fd d o5 • < e

d •K»* d •w o j de *9 d dd JC* d ■VO<0 Q S e

u . U J

H e a l t h S u r v e l l l a y i e e

The n u r s e s I d e n t i f i e d h i g h l e v e l s o f c o n c e r n I n

t h i s a s p e c t o f t h e i r r o l e . Not o n l y w e r e t h e y

w a n t i n g f u r t h e r e d u c a t i o n and t r a i n i n g I n w e l l

woman s c r e e n i n g b u t 310 (66. 5%} I d e n t i f i e d t h e

s c r e e n i n g o f a l l ' a t r i s k ' g r o u p s o f p a t i e n t s a l s o

as a r e a s o f c o n c e r n . The s c r e e n i n g o f w e l l men

291 ( 62. 4%) was s i g n i f i c a n t l y h i g h I n t h i s s e c t i o n

t o o . T a b l e 7 . 7 g i v e s t h e d e t a i l e d b r e a k down of

t h e r e s p o n d e n t s ' p e r e e l v e d e d u c a t i o n and t r a i n i n g

needs I n h e a l t h S u r v e i l l a n c e .

■s•H3

*dyddded

d*deoa.d

d>e■w

■gde

«9 d)"W e O:

a d « d '^ •d d -w *e d v *9

d a d *a a. d d

I S ' g S '% <» d

*9 dî•m d

^ d a d %d

•d d *e d V d a .a a. d E S) *d d d e % (d d

r — r-M C >

«N» VO r —m O ' e n CM

dd c o c q CQ•a r—- O ' c o O '

B C sj Cm * —

in V » o

«N» O VO CMC o v o VO Cm

dd VO < o o o

. a f — O v O vB e n e n CMd

d d I.d "W ü 1•w d"d d ! K>d d s 1 SXd d s 1 dd:1 i

oiC*d j

•• d I dd 1 d —• co 1 S - d d

fs . 1 a «<3 O-d 1 S *-? sd VO •W 1 OdN VO N 1 «N?•o d 1 «V? "W ‘dd • • d 1 o •< cJK- : z % 1 S - S UJ

C l i n i c a l E x a m i n a t i o n s

The n u r s e s I d e n t i f i e d t h e f o l l o w i n g s p e c i f i c a r e a s

I n t h e i r r o l e o f u n d e r t a k i n g c l i n i c a l

e x a m i n a t i o n s . The a r e a s o f c o n c e r n we r e

e x a m i n a t i o n o f t h e e ar s 304 (65. 8%) e x a m i n a t i o n o f

t h e b r e a s t s 212 (45. 4%) and p e l v i c e x a m i n a t i o n 208

( 44 . 6%) . The o v e r a l l numbers and p e r c e n t a g e s

m i g h t be h i g h e r when t a k i n g I n t o a c c o u n t w e l l

woman s c r e e n i n g . T a b l e 7 .8 g i v e s t h e d e t a i l e d

breakdown o f t h e r e s p o n s e s w i t h r e g a r d t o c l i n i c a l

e x a m i n a t i o n s .

7 . 23

Wd-d•W•ddd•9dc

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g•g•g•5'dddda

< 2 3 %S3 "Y d a .d

d dS % .3• o d d

a**«g %

OE 'd W 'd da d N d *d

% a d d d

iS3 da d .a ^ 4Y

*d d d d*e d -w o d d a a W •o a. d d E E *9 <d w d a d d X % M a d d

CM O ' co e n if>

S - Cm co Cm O 'e n O ' co

*eCk)•aEa

s - f 'v c o IM. CMc o O ' o O '

CM s - VO i n

i n m S - CO s -VO s - S - CM

*edJOSa

S - Cm CO S -co CO en Cm

en CM CM

N d 1d ■m a 1d d '4 1 d o d d

d V 1 *a wd o •dd a d I S» '4 V"4 'd d -K? s»

d "f 1 VO a a VOo E 1 a <o d a O

d 1 •-'> Ck)H 1 d d s s d

UJ 1 o a a "9 oCo I •-? X• N -m +V S) o V

d 1 a a -w a ad 1 d d «9 o o d

d VO 1 <3 a •>? -wVO d 1 S iC* E d o o s d

•O S- 1 a a a *e «V *e a dd • • 1 X UJ X CQ cJ d X 'MO

H S: Ü 1 UJ U j PU O UJ

I n v e s t l a a l l o n sMW WM MM IlMS MM Ma* MM

N u r s e s ' u n d e r t a k e a w i d e v a r i e t y o f I n v e s t i g a t i v e

p r o c e d u r e s and a number o f r e s p o n d e n t s I d e n t i f i e d

t h e c o n c e r n t h e y had f o r f u r t h e r e d u c a t i o n and

t r a i n i n g . The m a j o r i t y o f n u r s e s 211 ( 45. 2%) and

110 ( 23 . 6%) , n e a r l y a q u a r t e r r e c o g n i s e d t h e i r

n e ed f o r a u d l o l o g y t r a i n i n g . The d e t a i l o f t h e

r e s p o n d e n t s ’ r e q u e s t s w i t h r e g a r d t o t h e i r

p e r c e i v e d n eed f o r f u r t h e r t r a i n i n g I n

I n v e s t i g a t i v e p r o c e d u r e s a r e I d e n t i f i e d I n T a b l e

7 . 9 .

7 . 25

*9dd•aa aa da •d•9 "Wd *ea a

S3d•d d"W a

S3ai•a *ad•a dd d"fS3 a-W dd ad S•a d

*9 dd aa

ai■m da •daj •W'4S? •d«9 d O)d '4 da •dd 3 d

'4d ad a d

-d S3 "WK

d.d*a' "S

*9 Qî ■W Ç *9 S3 d do d .a

"d a a d d ■w'd d o à d •o n. d d E »9 *a a a d d a% cd a

I3a o* d

d -aa "W

VOVOS-

■3 g -aS3 d da d .a d

~a a a a d -w a d a a a,•a a d E '9 ‘aa d :z a(

d*ea*adda

Iîdadw

S•aE

co co O v *— CO

< o co O v Ov coco co VO o o co

co CM CMr ~ S - r —CM

CM VO ^ __ O o m

m en CM O v CMs CM CM

o en VO CMf — r— co S - t—CM *—

X?do-waco a» '9

>— <'— 1 '— 1 ---- 1 -d -wV oV a '9S) «nj a a dd a o d ■wo d < ^ '^ C35 *9d '-j a c% o d C35hM a C35 d o "4 a d

cJ 'aa» 0 5 a d •K> a.d E a a ai a O ao d -W ^ CJ5 o d dV •d a o o o a a da cJ S "W d d S 3 *9d a d «9 d o •wo "f a '4 ** cJ CJ5 d

JO CQ 5: 3= :s “a d da a N a

-4 1 I 1 1 ■< Uj - j co

CULnlcs

T h e r e we r e c e r t a i n c l i n i c s w h e r e t h e e x p r e s s e d

n ee d f o r t r a i n i n g was g r e a t e r t h a n o t h e r s . A l l

t h e r e s p o n d e n t s e x p r e s s e d t h e i r n eed f o r f a r t h e r

t r a i n i n g I n r u n n i n g D i a b e t i c and As thma c l i n i c s .

Ot h er c o n c e r n s I n c l u d e d s t o p s m o k i n g , t r a v e l l e r s

h e a l t h and d i e t and e x e r c i s e . T a b l e 7 . 1 0 d e t a i l s

t h o s e c l i n i c s I n w h i c h n u r s e s h a v e I d e n t i f i e d

a p e r c e l v e d n e e d f o r f u r t h e r t r a i n i n g .

7 . 27

d•d•WS3O

O) d « »9

d•y V d d d d d «9 9) "W

9) o 9) 9) o <4i à«O n. 9) d +v oB *9 d V o* d ad 9) o a 9) d *dz « *9 o. d S3 9>

I «w»

s•oBI

CO Cm im in CM e n VO

co v£> in oo s - e n VOco O o O v O v VO in VO

VO CM CM VO CM oo s-VO co O v en r v . S- CMs- s - «—■ f—

«9■g9)d

C3Î co CM VO co en fv- O v Cm

d ■y • » • • • • • . •a co VO en O v s- O v

d '9 o . «N» co oo s - CM CMd -w f —a S3 d O )9) o 9 ) d 1

9 ^d d d 1 d

9) 9 ) a 9 ) 1 9)•d j a B . 9 ) 1 *Q VO CM Oo Cm co VO O v *—■m E *9 d 1 E VO CO co en r-~ O v en

«9 d 9 ) o 1 d S - s - CM< a 2 ( d 1 %d d 1a 9)

* a i*9 d 1 •wd o 1 a'•i Q . I od '9 1 -d 9) dd I •W *9

d S ' e nO

a9 )-d

d'4d ■ad• • 1 d X d a

c o s? 9 ) a e n-o> d s 9 ) o 9>« o 9) 'a SX '9 • 9

r v . *9 cJ s S ? d d o Od 1 a • 9 S a ai a d d9) VO '•i 9) s 9) s > SX 9)

VO d • O - d C L a ■m ' 4 o a •v•o s - a •W O a 9 ) s d d da •S V d a 9 ) di aK" % o i •< CO K CO u . :5 o lu

C h i l d r e n

D i f f e r e n t a s p e c t s o f c h i l d c a r e w e r e h i g h l i g h t e d

b y t h e r e s p o n d e n t s , s u c h a s c h i l d r e n ’ s

I m m u n i s a t i o n s a n d v a c c i n a t i o n s , t h e I d e n t i f i c a t i o n

a n d ma n a g e m e n t o f r a s h e s , c h i l d h o o d I l l n e s s e s ,

a b u s e d c h i l d r e n a n d c h i l d d e v e l o p m e n t a n d

S u r v e i l l a n c e . By f a r t h e g r e a t e r m a j o r i t y

I d e n t i f i e d t h e i r n e e d f o r t r a i n i n g I n t h e

I m m u n i s a t i o n v a c c i n a t i o n p r o g r a m m e s f o r c h i l d r e n ,

4 0 3 ( 8 6 . 4 % ) a n d n e a r l y h a l f , 2 1 0 { 4 5 . 0 % )

r e c o g n i s e d t h e i r n e e d f o r e d u c a t i o n a l s u p p o r t w i t h

c h i l d r e n ’ s r a s h e s . T a b l e 7 . 1 1 d e t a i l s t h e

r e s p o n d e n t s ’ p e r c e i v e d e d u c a t i o n a n d t r a i n i n g

n e e d s f o r t h i s a s p e c t o f t h e i r r o l e .

7 . 2 9

•a9)

<adad9)

9)9^•O.2

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gSdda9)N•ada

VOVOS -

II“ %

o y oî-w D.*d d a *9 o o9) -w d d d «9 *a

a a 9)S3 S3 da o* dai a 9)

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a SB-w

!i3 ' ^d d

aS3 S3ad ga•o di S

S•oi

S•aEda:

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■Vi co O v VO O o

vo in O v o oo o ■VI- r — «—■

da-99) 9)

-9 O*a -9 dd 9) d aa d 9) sS d sd d S 'a -wo o s 9) d

Q o 9)•H» -w *a -d d Sa a o O a SX•9 d o *9 o•-e *9 'a Nd o O *a 9) *a àd o -d s *9 s? aS a «9 Q a "f as o a vd vQ -d "a

C J • < C J

Pro f e s s l o n a t Up da t i ng

T h i s was n o t a h i g h p r i o r i t y a r e a f o r t h e

n u r s e s I n t h e s t u d y w i t h 2 2 [4.7%) I d e n t i f y i n g

a c c o u n t a b i l i t y and r e s p o n s i b i l i t y as t h e m o s t

I m p o r t a n t a s p e c t o f p r o f e s s i o n a l u p d a t i n g and

c ha n g e s I n h e a l t h c a r e p r o v i s i o n 10 [ 0 . 2 % ) .

Management

The n u r s e s w e r e aware o f t h e i r r e s p o n s i b i l i t i e s

so f a r as t h e i r r o l e I n s t o c k c o n t r o l manag emen t

was c o n c e r n e d and 389 [83.7%) I d e n t i f i e d t h i s

p a r t i c u l a r a s p e c t as an a r e a I n w h i c h t h e y

c o n s i d e r e d t h e y n e e d e d f u r t h e r e d u c a t i o n and

t r a i n i n g . Ot h er h i g h p r i o r i t i e s w e r e t i m e

management , a d m i n i s t r a t i o n o f t h e t r e a t m e n t room,

s e l f and p e r s o n n e l management . The d e t a i l s a r e

I d e n t i f i e d I n T a b l e 7 . 1 2 .

*9"Wd da a

O) *a *9 «d VO ov co s- ov end d s a M d • . • • • >a a *d d 94 «-» S- co m S- rv.

d B.'4 y a *a m m o r- Vi*9 d y S3 d

a a a y ad « a* y aj■w a o

S3 d y yda a:

•a a a *9 y y dd 6 d *9 y y da d a a a d a

a .d B. a o y •ovo y «9 a* a a E *— VO »—• CM co vo

a B y a a* a d a co VO co ÇJv S" end a 3 d d a y a: CM CMa %

aoa *9

•a ya da•a *a *9a d y a S- OO T— en en"f a a y • • . . • •S3 a. y y en ■Vi en VO T- VO'•i '9 <9 d y 94 Oo vo S- CM

"W ■w a a yd d « a^ya a a «o•a •a S3 d y

da a a *9 G d da B. d a a o CM CM VO

-d *9 a vd B. •a Oo CO co CM O o+V a

d•a y *9E y a Ea

en en Cm

*a a 3 d %d a %a •d

"W■wd S3a a yB da •9 Ck) adî •a S 9) S ya a a y -d a dd a y y y s y en aa d 0. o d a Sac a y so S 3 O a d a

o o o d s a CJ)« d a E aCm y y y y y CJ) dd d d d d a y a• a o 9) 9) 9) d a sIsg o S9) S s9) y a

sdd - 9a VO aj -o» CJ) O) a o * 9

N VO a o a a a S 3 - 9 a•o S- d a d d d y d da a y a a K— a a yH» s ac co s Co PU co

T h i s was n o t a h i g h p r i o r i t y f o r t h e p r a c t i c e

n u r s e s , a l t h o u g h p e r h a p s s i g n i f i c a n t l y 10 (2,1%)

a s k e d f o r f u r t h e r e d u c a t i o n and t r a i n i n g I n t h e

t e a c h i n g o f a l l ag e g r o u p s , and a l l t y p e s o f

t e a c h i n g s i t u a t i o n s w h e t h e r t h e y be o n e - t o - o n e or

g r o u p t e a c h i n g and 7 (1.5%) I d e n t i f i e d t e a c h i n g

s m a l l g r o u p s as an a r e a f o r w h i c h t h e y w o u l d l i k e

f u r t h e r t r a i n i n g . T h i s f i n d i n g was v e r y

s u r p r i s i n g b e c a u s e p r a c t i c e n u r s e s a r e

t e a c h i n g p a t i e n t s ' a t a l m o s t e v e r y c o n s u l t a t i o n .

Ot her

A t o t a l o f n i n e t e e n d i f f e r e n t c o n c e r n s we r e

h i g h l i g h t e d I n t h i s s e c t i o n , many o f w h i c h had

s i g n i f i c a n t l y h i g h p r i o r i t y . T h o s e w i t h a h i g h

p r o f i l e w e r e p h a r m a c o l o g y 217 ( 4 6 .5 % ) , AIDS and

HIM p o s l t l v e ‘r e l a t e d I l l n e s s 1 97 (42 . 7%) and a l l

f orms o f c o u n s e l l i n g 137 ( 2 9 . 3 % ) . T a b l e 7 . 1 3

g i v e s t h e d e t a i l e d br eakdown o f t h e ' o t h e r '

7 . 33

6u.bjQ,ct ^ 0 ^ vokJidh tho, 6ub jzc i t6 c o w a ld c A

t k t y ne,e,d ^ im t kd K ^ducoitJion and tfiaLnJinQ *

«4?t!Oa .

soeoÜ

• * «o

td%)*ed

s•wo

"S* eoN5

■S%)y

' do§a .

VOV3^5-

g 'g %) ^'y Q)y ya

C g '3a a .

Hj O 9)y »y *o*y -w§ 3 5% S N3

o O v o O n O < 5 NO

o \Q CM ©O o \Q O n

o Cm t — o T— NO N »o \o t — »—

• oEy

CS4« ntr>

Cm O Orr> ,—

* 9 y■w Sy - W9) O Cm O o © o < a Cm CM ir »

" y y • • . • • • • .

y . m Cm O n CO * — t f> O n T b i oa 9 ) OV» N5- CM Cm 9>l CO

a . - y •

«9 "W9 )y a )

a - yy

y • w y9 ) y y

« a y > oS ' y E r> * hM O n t — ©O ►— CO r —

y y y T—. O n CO O n tN . ■©J- Cm

% y S : Cm

y 9 ) 9 )

y ■y * 9 O9 ) y y yy y 9 ) 9 ) ay * 9 • 9 ■w ya o o ' 4 N O 9 )

o s» *9 ÇX y CO«9

N O CJ s ? ya S i y a N? y N?

• 9 y •N? 4Y - w«9 e n O e n 9 ) •W y o N Oy o a . * * ^ y 5 = y 9 ) a y 9 ) y9 ) N • w > CO a •N? * yy o z> 'G yi 9 ) y

< O w %) y «=S> e n ' 9 9 )y 5 : 4 Y 9 ) y •N? y © "4 y ~ y

y E y • 9 y « o o y a 9 )9 ) y CO y a y *>-> 9 ) a y • 9

> y y A 9 ) y y - y y * y y •N? y"W • y bM i J o a 9 ) s © ^ P L y - ao fX . ■ < o o U J p L ■ <

C O T— C O * - n & 0 o o

CM f— M-

C O C O c o C O C O C O CM o C O C O

• 9O

s 'y K>‘ a ■H» 9 ) S9) ' 9 a . * y 9 )

a ‘ 4 a . 9 )

g •s? y a . MO

y o a . O

-w S ' S ? •N? y yy *9 c j *y o a .a o n N O yCJ e n y y y 'y ©N?

y 'N? CO -y y y» . S a . y y

CO *y y 9) ~y e n yi -y Xy «9 o 9 ) y o ©s> 9 )

• *y y y y ©V ©N> COb s o S 9 ) S ? o y © ^ 1

y *9 S o 'y -y s o a9) y y y 9) y s > y y -y

N 9) 9) a . y -w o E •9 • w o> a S? •y E s > o o y y y . y y,a 9) y o y y 9) 9> o -y 9) *9

K ç y y j o ç y a . ç y 5 : ç y PL a .

I t JL6 o l 6Â,gnÂ,^Â,c.a.nce, t o note, t h a t o^ the, 466

^e,4,ponde.nt6, 206 (44 , 2%) o^ the, o p t n t o n t h a t

t h z y we.Kt u n d e . ^ t a k t n g e,x.te,ndzd aote. a a t t o t t J i e , 6 .

The, e,on,n,e.tatJion be,tuje,e,n e,x.te,nde,d Kole, and j o b

de,^Q.KtptLon wa4 ^ ou n d t o be, 6jLgnt^j ic.ant wLth

nuK6e,6' a n de , ^ t a k t n g e,xte,ndzd Kote, ac,tX,vLtJie,6 { on,

wht ah the,y d t d n o t hoZd j o b de,6c,Ki,ptJion6.

P^ a c t t ae , p f i o t o a o t ^ l o ^ a t t e,xte,nde,d fiote,

aatJioJitJie,^ ^ofi a t t pfiaatJice,^ iva6 44 (9.4%) and

loK t a a t n t n g pA.ac.tjic.e,6 16 ( 3 .4 % ) . V Ko t o a o t ^ u6e,d

Ion. 6ome, a a t t v t t t e . ^ , Ion. a l t pn.ac.ttc.e.6 voa6 140

(30.0%) and ion, tn,atnJing pn.ac.tJie.e.6, 95 ( 20 , 3%).

The, io tZoM tng tabZe, Lde,ntJLiJie,i the, aange. o i

pn,otoaot6 ujhJLah pn.ac.ttce,4> have, Jin ptaae, vuhJiah an.e,

6 p e .c t iJ ic a l ly ion. pn.ac,ttc.e. nunse, a c - t t v t t y .

7 . 37

TabZe, 7 . 1 4 : TKactZce. pK o to c .o t6 ion. pKac.tJic.e. niinée.

e.xte.nde.d note: actJLvlXy

P n o to c o t Numbcn o i Pnac.tJic.e.6

C k t t d n t n ’ 6 tmmaYitioLtJioYi^ 193

Btood pn.e.66ane. 190

VtoLbntJic. t t tY i tc . 172

CtnvtdCLt 6me,an.4 171

H o t t d a y vac . c . tna t ton6 170

Ean ^ynJingtng 105

(i}e.tt man 90

bJ t t t Moman 89

A6tkma 73

Vn z 6 6 t n g ^ and wound cane. 49

Eme.nge.ncy t n c a t m c n t 30

L t p t d ^ c n e c n t n g 27

S t e . n t t J i 6 a t t o n o i e .qatpmcnt 9

New p a t t c n t 6cne . cntng 9

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7 . 38

Vtany necondi

I t L6 ^ t g n t i t c a n t t o n o t e t h a t t h e a n a Z y ^ t ^ inom

t h e d t a n y n e e o n d t n g 6 w h t c h t h e p n a e t t e e nun^e^

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mont hs i o Z t o w t n g ZmpZ emen ta tZ on o i t h e New GenenaZ

V n a c t Z t Z o n e n C o n t n a e t [1990) h Z gh Z Zg h t ed t h e need

i o n ed i iea t Zon and t n a Z n Z ng p a n t Z e u Z a n Z y Zn t h e

anea6 o i k e a Z t h ^ e n e e n Z n g , d Z6 ea 6 e management ,

e h Z Z d n e n ' 6 ZmmanZ^atZon^ and t n a v e Z Z e n ^ ’ h e a Z t h ,

whene t h e p n a e t Z e e nan6 e^ 6 noZe had p a n t Z e a Z a n Z y

e x t e n d e d . The n e 6 p o n d e n t ^ a n d e n t a k Z n g t h e

a e t Z v Z t Z e ^ b o t h b e i o n e and p o 4 t ZmpZ emen ta tZ on o i

t h e New GP C o n t n a e t , ( 1990) ane d e t a Z Z e d Zn TabZe

7. 15.

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need6 wZth t h e Z n p n o i e 6 6 Z o n a Z baekgnoand6 and

knowZedge 6 a4 & 4 .

7 .4 7

CHAPTER EIGHT

LEARNING NEEVS ANV THE RESPOHVENTS^ PROFESSI ONAL

BACKGROUNVS

ThZ6 ehapten. vaZZZ p n e ^ e n t and dZ6eu66 t h e d a t a

a6 Z t n.eZate6 t o t h e r e s p o n d e n t s ’ p e n e e Z v e d

e d a e a t Z o n and t n aZ nZ ng n e e d s and t h e p n o ^ e s s Z o n a Z

baekgnoand q a a Z Z ^Z ea t Z on s and e d a e a t Z o n a Z

o p p o n t a n t Z e s inom uohZeh t h e p n a e t Z e e n a n s e s eome.

I t Zs n o t Z n t e n d e d t o eompane ZeannZng n e e d s wZth

t h e Z e n g t h o i t Zme t h e r e s p o n d e n t s h a v e been

penionmZng t h e a e t Z v Z t y , t h e q a e s t Z o n n a Z n e dZd n o t

t a k e Z n t o a e e o a n t t h Z s a s p e e t o i t h e r e s p o n d e n t s ’

p e n e e Z v e d ZeannZng n e e d s . hleZthen dZd t h e

q a e s t Z o n n a Z n e e o Z Z e e t Z n io n m a t Z o n a b o a t t h e

r e s p o n d e n t s ’ p o s t n e g Z s t n a t Z o n e x p e n Z e n e e . I t Zs

a p p n e e Z a t e d t h a t some r e s p o n d e n t s may Z d e n t Z i y

e da e a t Z o n and tn aZn Zn g n e e d s ev en t h o a g h t h e y may

have s p e e Z i Z e baekg noan d knovoZedg e and skZZZs

n e Z a t e d t o t h e s a b j e e t a r e a i o n whZeh t h e y ane

Z d e n t Z i y Z n g e d a e a t Z o n a Z n e e d . Saeh n e q a e s t s may

be r e l a t e d t o t h e t i m e I n t e r v a l b e t w e e n s t a d y l n g

t h e s u b j e c t a r e a Zn q a e s t Z o n and a c t u a l l y

p er i o r m Z n g t h e a c t Z v Z t y or Z t may be

d e t e r m Z n e d by t h e n u r s e s needZng t h e

r e a s s u r a n c e t h a t w ha t t h e y a r e doZng Zs wZthZn t h e

b ou nda rZe s o i c u r r e n t p r a c t Z c e , For o t h e r s ,

ho we v e r , workZng p r e v Z o u s l y Zn an e a r , n o s e and

t h r o a t ward or d e p a r t m e n t mZght mean t h e y a r e l e s s

I Z k e l y t o Z d e n t Z i y a l e a r n Z n g need Zn examZnatZon

o i t h e e a r , i o r e x a m p l e .

I t Zs r e c o g n Z s e d t h a t t h e n e ed i o r t r a Z n Z n g ,

Z r r e s p e c t Z v e o i p r o i e s s Z o n a l b a c k g r o u n d , w Z l l n o t

be t h e same i o r a l l t a s k s or nursZng a c t Z v Z t Z e s ,

For e x a m p l e a l l t h e r e s p o n d e n t s Z d e n t Z i Z e d t h e Z r

n e ed i o r i u r t h e r e d u c a t i o n and t r a i n i n g Zn c a r i n g

i o r p a t i e n t s w i t h V Z a b e t e s even t h o u g h 2

r e s p o n d e n t s had c o m p l e t e d t h e E n g l i s h N a t i o n a l

Board Co ur se on V Z a b e t e s , some 155 had a t t e n d e d

s t u d y days on t h e s u b j e c t and 244 had c o m p l e t e d an

a p p r o v e d p r a c t Z c e n u r s e c o u r s e o i w h i c h V Z a b e t e s

wou ld iorm p a r t o i t h e c u r r i c u l u m .

P r a c t Z c e n u r s e s wZ tkZ n t h e s t u d y h o l d i n g t h e

pro i e s s l o n a . 1 q u a l l i l e a t l o n o i d i s t r i c t n u r s e or

h e a l t h v i s i t o r w e r e s l g n l i l c a n t l y u n d e r t a k i n g more

e x t e n d e d r o l e a c t i v i t i e s and t h i s was r e i l e c t e d

b o t h I n t h e d l v e r s l t y o i t h e o c c u p a t i o n a l r o l e

t h e y we r e p e r i o r m l n g and t h e i r p e r c e l v e d l e a r n i n g

n e e d s r e l a t e d t o p r a c t i c e .

S p e c l j l c c l i n i c a l t a s k s and n u r s i n g p r o c e d u r e s

The n u r s e s I d e n t l i l e d t h e i o l l o w l n g t a s k s and

n u r s i n g p r o c e d u r e s i o r w h i c h t h e y c o n s i d e r e d t h e y

had a t r a i n i n g n e e d t h e s e d a t a a r e c o r r e l a t e d w i t h

p r o i e s s l o n a l b a c k g r o u n d k n o w l e d g e w h e r e t h e

I d e n t l i l e d c l i n i c a l t a s k s a r e known t o i orm p a r t

o i t h e c u r r i c u l u m , T a b l e 8 .1 d e t a i l s t h i s

I n i o r m a t l o n .

aa aa •4•4 44 •44 a "aa a aa y a

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nj «a UJ aa 44a •4 a a3 a a•9 «9 *a a>*9 44 a NOa a *a •444 a a 44'a a a•4 a 44 aa a 44 •aa CL a •4•4 *9a a a a*4 y > «9•4 a ya a >a a«a aa 44 a a*4 -aN O >a 2 a•4 a •9a •4 *a ya «a a aCL 2 a %

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I t I s s l g n l i L c a n t t o n o t e t h a t o v e r h a l i o i t h e

d i s t r i c t n u r s e s I d e n t l i l e d a n eed i o r

e d u c a t i o n a l s u p p o r t I n wound management and n e a r l y

one t h i r d o i t h e r e s p o n d e n t s who had a t t e n d e d an

a p p r o v e d p r a c t i c e n u r s e c o u r s e p e r c e l v ed s u c h a

t r a i n i n g n e e d . Only a r e l a t i v e l y s m a l l number

o i n u r s e s who had a t t e n d e d an a p p r o v e d c o u r s e ,

n i n e t e e n [1.1%] c o n s i d e r e d t h e y n e e d e d i u r t h e r

e d u c a t i o n and t r a i n i n g I n I n i e c t l o n c o n t r o l and

e i g h t e e n [1.3%) I n t h e manag emen t o i e m e r g e n c i e s .

H e a l t h S u r v e l l l a n c e

T h e r e a r e c e r t a i n c l i n i c s w h e r e t h e n e ed i o r

t r a i n i n g I s g r e a t e r t h a n o t h e r s . The h i g h e s t

p r o p o r t i o n o i n u r s e s who c o n s i d e r e d t h e y had a

t r a i n i n g need r e l a t e d t o t h e h e a l t h p r o m o t i o n

s c r e e n i n g o i a l l ' a t r i s k ’ g r o u p s and some 96.1%

o i t h o s e n u r s e s u n d e r t a k i n g t h i s a s p e c t o i

p r a c t i c e n u r s i n g e x p r e s s e d t h e i r n e e d . P r a c t i c e

n u r s e s w i t h a h e a l t h v i s i t o r q u a l l i l c a t l o n we r e

l e s s l i k e l y t o I d e n t l i y a n e e d i o r t r a i n i n g and

n u r s e s who had c o m p l e t e d a N a r l e C u r i e Women’s

S c r e e n i n g c o u r s e or a Blood P r e s s u r e c o u r s e ,

s t u d y days on women’s and m e n ’s h e a l t h or I n - h o u s e

t r a i n i n g we r e a l s o l e s s l i k e l y t o I d e n t i f y

i u r t h e r t r a i n i n g n e e d s . T a b l e 8 . 2 I d e n t l i l e s

t r a i n i n g needs by q u a l l i l c a t l o n and

p o s t - b a s i c p r o i e s s l o n a l e d u c a t i o n .

ptS £

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aa •9o a y•4 •4 A. a■w N»s aa a M ua •oa 1*a 44a *9 a

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aa a y•a •4 -a a+4 NO 44 44

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a* 44a aa ai aa •a a 44a •a a

*4 *9 a *4•4 •a y a•4 a ©4 44a a a *9 ya a a *4 ay a A %a aj *4CO a «9

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Where p a t i e n t s a r e v i s i t e d a t home i o r t h e i r

a s s e s s m e n t , I n t h e e a s e o i p a t i e n t s ag ed 75 y e a r s

and o v e r , t h e m a j o r i t y o i n u r s e s u n d e r t a k i n g t h e s e

a s s e s s m e n t s w i t h o u t e i t h e r a d i s t r i c t n u r s e or

h e a l t h v i s i t o r q u a l l i l c a t l o n d i d n o t p a r t i c u l a r l y

e x p r e s s a n ee d i o r t r a i n i n g I n t h i s a s p e c t o i

t h e i r r o l e , t h e i r c o n c e r n s w e r e r e l a t e d t o t h e

a c t u a l a s s e s s m e n t r a t h e r t h a n t h e e n v i r o n m e n t o i

t h e a s s e s s m e n t a l t h o u g h I t I s a p p r e c i a t e d t h e

e n v i r o n m e n t o i t h e p a t i e n t I s an I n t e g r a l p a r t o i

t h e t o t a l a s s e s s m e n t .

C l i n i c a l E x a m i n a t i o n

The n u r s e s u n d e r t o o k a number o i c l i n i c a l

e x a m i n a t i o n s and I d e n t l i l e d s p e c l i l c a r e a s o i

c o n c e r n i o r w h i c h t h e y p e r c e l v ed an e d u c a t i o n and

t r a i n i n g n e e d . The e x p r e s s e d n e e d s we r e

s l g n l i l c a n t when compared w i t h p r o i e s s l o n a l

b a c k g r o u n d , and T a b l e 8 . 3 p r o v i d e s t h e d e t a i l .

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I -4 •4 X •4©4 1 +4 44 N? UJ ©4 44a I a a 44 a aa 1 a a *9 CJ o a‘4 1 *4 N? •4 a •4 •4 •4 s?a 1 s y s o o o E ©)•4 1 a a a y ©4 y a 9)©4 >i UJ >i uo cJ 9) X NOCJ 1 UJ UJ A. CJ UJ

I n v e s t l q a t l o n s

The n u r s e s I n t h e s t u d y who we r e u n d e r t a k i n g

I n v e s t i g a t i v e p r o c e d u r e s r e c o g n l s ed t h e i r n e e d i o r

t r a i n i n g , P r o i e s s l o n a l b a c k g r o u n d k n o w l e d g e was

s l g n l i l c a n t I n t h i s a s p e c t o i t h e i r r o l e . For

e x a m p l e , n u r s e s w i t h a d i s t r i c t n u r s e

q u a l l i l c a t l o n d i d n o t I d e n t l i y u n d e r t a k i n g

l a b o r a t o r y I n v e s t i g a t i o n s as an a r e a i o r t r a i n i n g .

S i m i l a r l y , t h o s e n u r s e s who had s u c c e s s i u l l y

c o m p l e t e d t h e As thma d i p l o m a c o u r s e , 12 (17.3%)

d i d n o t I d e n t l i y l u n g i u n c t l o n s c r e e n i n g t e s t s as

a p e r c e i v e d l e a r n i n g n e e d . Whereas s k i n

s c r a p i n g , a v e r y s p e c i a l i s e d a s p e c t o i n u r s i n g

p r a c t i c e , was I d e n t l i l e d by a l l t h e n u r s e s

I r r e s p e c t i v e o i q u a l l i l c a t l o n and b a c k g r o u n d

k n o w l e d g e as an a r e a i o r t r a i n i n g .

C l i n i c s

C h r o n i c d i s e a s e management c l i n i c s , I n c l u d i n g

V l a b e t e s , As thma and H y p e r t e n s i o n , p r a c t i c e n u r s e s

8 . 1 0

with. a h e a l t k v i s i t o r q a a Z l i l c a t l o n we r e

s l g n l i l c a n t l y l e s s l i k e l y t o I d e n t l i y an e d u c a t i o n

and t r a i n i n g n ee d e s p e c i a l l y I n As thma and

H y p e r t e n s i o n d i s e a s e management c l i n i c s . Whereas

p r a c t i c e n u r s e s w i t h a d i s t r i c t n u r s e

q u a l l i l c a t l o n w e r e l e s s l i k e l y t o I d e n t l i y an

e d u c a t i o n and t r a i n i n g n e e d I n As thma d i s e a s e

manag ement c l i n i c . V l a b e t e s was I d e n t l i l e d by

a l l t h e r e s p o n d e n t s as a s e l i p e r c e l v ed a r e a i o r

i u r t h e r l e a r n i n g ,

Ot he r c l i n i c s , s u c h as s t o p s m o k i n g , t r a v e l l e r s ’

h e a l t h , d i e t and e x e r c i s e w e r e a l l s p e c i a l i s e d

a r e a s o i p r a c t i c e i o r w h i c h t h e q u a l l i l c a t l o n s ,

h e a l t h v i s i t o r or d i s t r i c t n u r s e had no

s l g n l i l c a n c e so i a r as p e r c e l v ed e d u c a t i o n and

t r a i n i n g n e e d s o i t h e r e s p o n d e n t s . Where n u r s e s

had u n d e r t a k e n s p e c l i l c t r a i n i n g I n p a r t i c u l a r

sub i e c t s , Su ch as h y p e r t e n s i o n , t h e n t h o s e n u r s e s

wer e u n l i k e l y t o I d e n t l i y i u r t h e r e d u c a t i o n and

t r a i n i n g n e e d s .

8 , 1 1

C k l l d r e n

V l i i e r e n t a s p e c t s o i c k l t d c a r e we r e I d e n t l i l e d by

t h e r e s p o n d e n t s . The e x p r e s s e d n eed i o r t r a i n i n g

v a r i e d with, pro i e s s l o n a t b a ck g r o u n d k n o w l e d g e .

R e s p o n d e n t s h o l d i n g h e a l t h v i s i t o r , or m l d w l i e r y

q u a l l i l c a t l o n b e i n g l e s s l i k e l y I n m o s t a s p e c t s o i

c h i l d c a r e t o I d e n t l i y e d u c a t i o n and t r a i n i n g

n e e d s . T a b l e 8 . 4 d e t a i l s t h e p r a c t i c e n u r s e s ’

s e l i - p e r c e l v ed t r a i n i n g n e e d s by q u a l l i l c a t l o n .

8 . 12

*9»9 44*a O9) a9) A.a «9

aa)a a *9

•4 o aa •4 o

•4 44 •4a a yy o a44 •4 a

Ad a9) »9 •a

a aAd NO aa O•4 y *9NO A. a•4 *944 Al ya •O aa a

Ad 9*4 44 ©4

a ©49) a a

-a Ad (44 a «a 9)

o 44 yAd A. •4 aa *9 3 aa 9)

o•4•OK

944aa OV>AdaoA.•9a vQ y(a vo a

Ad b\oaya a44 NO vn y*9 *4 eo a•4 3 " - «QOîAd Ea *4 •• a«a ac A: :z

•a3a9)A:

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Nb O O n ©O vo

b n e n b ne n T— ON^ b CM

N b ©O NO

44 O n

bN© o

•9 aa•9 a

Ad «9 aSi a aa a a a

©4 ©4 a*9 >9 ©4 ©4 ya a •4 •4 +4 Ado o a s; ©4*4 *4 s» n a •4S S — y s -aa a a a sn. a•9 a a CO o*4 *4 «9 y ©4 Ada o à Ad Ad a aa cj -a ©4 ©4 a *9E a •9 *4 *4 9) aE A> a -a -a Ad unbM «a CJ CJ •<

P r o i e s s l o n a t u p d a t i n g

T h i s was n o t a h i g h p r i o r i t y i o r t h e n u r s e s

p a r t i c i p a t i n g I n t h e s t u d y and o i t h e 22 (4.7%)

who I d e n t l i l e d a c c o u n t a b i l i t y and r e s p o n s i b i l i t y

and c han ge s I n h e a l t h c a r e p r o v i s i o n , 10 (0.2%)

as a s p e c t s i o r w h i c h t h e y , t h e sub J e c t s ,

r e c o g n l s ed t h e i r n e ed i o r i u r t h e r e d u c a t i o n a l

s u p p o r t , t h e s e r e s p o n d e n t s d i d n o t r e c o r d any

b a c k g r ou n d k n o w l e d g e or I d e n t l i y any p r o i e s s l o n a l

q u a l l i l c a t l o n t h e y m i g h t h a v e p o s s e s s ed and w h i c h

m i g h t h ave I n i l u e n c e d t h e i r r e s p o n s e .

Nanagement

The n u r s e s I d e n t l i l e d t h e i r c o n c e r n a b o u t t h e

v a r i o u s a s p e c t s o i management as I t a H e c t e d t h e i r

p r a c t i c e s . T ho se n u r s e s who we r e more r e c e n t l y

q u a l l i l e d , i rom 19 84 and h e l d a d d i t i o n a l

q u a l l i l c a t l o n s we r e l e s s l i k e l y t o e x p r e s s a n e e d

i o r management t r a i n i n g t h a n t h o s e n u r s e s who had

c o m p l e t e d t h e i r r e g i s t e r e d g e n e r a l n u r s e t r a i n i n g

8 . 14

b e f o r e t h a t t i m e .

T e a e k l n q

T e a c h i n g was n o t a p r i o r i t y a r e a o i p r a c t i c e or

p e r c e l v ed l e a r n i n g n eed s i o r t h e r e s p o n d e n t s

I n t h i s s t u d y . The d a t a , w e r e c r o s s

r e i e r e n c e d a g a i n s t t h e r e s p o n d e n t s ’ p r o i e s s l o n a l

q u a l l i l c a t l o n s , d i d show t h a t t h o s e p r a c t i c e

n u r s e s who h e l d t h e a d d i t i o n a l q u a l l i l c a t l o n s o i

R e g i s t e r e d H e a l t h V i s i t o r or R e g i s t e r e d N l d w l i e

we r e l e s s l i k e l y t o I d e n t l i y an e d u c a t i o n and

t r a i n i n g n e e d . Both o i t h e s e p r o i e s s l o n a l

g r o u p s h a ve t e a c h i n g me t hod s ' I n c o r p o r a t e d w i t h i n

t h e i r c u r r i c u l u m and p a r t i c i p a t e , as p a r t o i t h e i r

r o l e , I n t e a c h i n g v a r i o u s c l i e n t g r o u p s .

Ot her s

From t h e number o i ’ o t h e r ’ t o p i c s i o r w h i c h t h e

r e s p o n d e n t s I d e n t l i l e d a s e l i - p e r c e l v e d e d u c a t i o n

and t r a i n i n g n e e d , r e g i s t e r e d g e n e r a l n u r s e s ,

q u a t l i l e d a l t e r 1 9 84 w e r e s Jig n i l l e a n t Jiy l e s s

l i k e l y t o e x p r e s s a n eed l o r i u r t h e r e d u c a t i o n and

t r a i n i n g I n s u c h t o p i c s as c o u n s e l l i n g , c o r o n a r y

h e a r t d i s e a s e , p a i n r e l l e i and r e s e a r c h .

P r a c t i c e n u r s e s w i t h a d d i t i o n a l c ommuni ty

q u a l l i l c a t l o n s wer e a l s o l e s s l i k e l y t o e x p r e s s

t r a i n i n g n eeds I n c o u n s e l l i n g , e l d e r l y s o c i a l

s e r v i c e p r o v i s i o n and a b u s e d a d u l t s .

C o n c l u s i o n

T h i s c h a p t e r has s p e c l i l c a l l y p r e s e n t e d and

d i s c u s s ed t h e s e l i - p e r c e i v e d I t a r n l n g n e e d s o i t h e

r e s p o n d e n t s w i t h t h e i r known p r o i e s s l o n a l

b a c k g r o u n d s . T h e s e d a t a h a ve I d e n t l i l e d v a r i o u s

a s p e c t s o i p r a c t i c e n u r s i n g wh er e pro i e s s l o n a l

q u a l l i l c a t l o n s h av e s l g n l i l c a n t l y I n i l u e n c e d

l e a r n i n g n e e d s . The c h a p t e r w h i c h i o l l o w s

c o n s i d e r s t h e r e s p o n d e n t s ’ s e l i - p e r c e l v e d

l e a r n i n g n eed s as t h e y r e l a t e t o t h e i r

o c c u p a t i o n a l b a c k g r o u n d s .

8 . 1 6

C H A P T E R N I N E

LEARNING NEEVS ANV THE R E S P O N V E N T S ’ OCCUPATIONAL

BACKGROUNVS

The p r e v i o u s two c h a p t e r s h a v e p r e s e n t e d and

d i s c u s s ed l e a r n i n g n e e d s as t h e y r e l a t e f i r s t l y t o

t h e a c t i v i t i e s t h e n u r s e s w e r e u n d e r t a k i n g and

s e c o n d l y t h e e d u c a t i o n and t r a i n i n g n e e d s as t h e y

p e r t a i n t o t h e r e s p o n d e n t s ' p r o f e s s i o n a l

b a c k g r o u n d k n o w l e d g e and s k i l l s . T h i s c h a p t e r

w i l l p r e s e n t and d i s c u s s e d u c a t i o n and t r a i n i n g

needs I n t h e c o n t e x t o f t h e r e s p o n d e n t s '

o c c u p a t i o n a l b a c k g r o u n d s . The d a t a w i l l be

p r e s e n t e d u s i n g t h e h e a d i n g s u n d er w h i c h t h e

p r a c t i c e n u r s e s I d e n t i f i e d t h e a c t i v i t y . T h e r e

I s e v i d e n c e o f some o v e r l a p I n how t h e n u r s e s '

p e r c e i v e t h e s e a c t i v i t y . For e x am p l e , some

n u r s e s ' h a v e I d e n t i f i e d c e r v i c a l c y t o l o g y as a

n u r s i n g pro c e d u r e , o t h e r s h a ve c o n s i d e r e d t h e

the, p^oc.e.du^z a-5 a. c.lJLnJic.al e,KamjinatJion and 4ome

have, viewed ee^ v le & l 6me,aa aeteewlwg a4 p a t l

k z a Z t k 4%%velll&%ee. Tkd da ta w i l l 6e p t e a e w le d

wll /i lAe d e ^ e t l p l l o M o^ 1/te naa^e, paoczdaae, , the,

nambzK ol n.Z6pondtnt6 ptn.ion.mLng t k t a c t L v L t y and

t k t numbtn. o i 6 a b j t c t 4 cvko h a v t p t a c t L v t d an

t da ca tL on and tnaLnLng weed. dJhtnt appn.opn.Latt

t k t t i i t c . t 6 o i t k t t n vLnonmtn t o i p n a t t L t t ,

t o ntn.ac.taaL tmpLoymtnt an.n.ang tm tn t6 on

pn. 0 i t66LonaL p n a t t L t t and LtaanLng n t t d 6 w i l l 6 e

p n . t 6 t n t t d and d L 6 t u6 6 t d ,

HtanLy kaLi oi t k t pan . tL tLpan t6 , 210 (45,0%) oi

t k t 466 6 a b j t t t 6 t o n ^ L d t n t d t k t y v j tn t ptn.ion.mLng

an t n k a n t t d noL t , Tk t mtan nambtn. o i p n a t t L t t

nan^ t ^ ptnionmLng exlewded noL t a t t L v L t L t ^ uja6

479 vüLtk a 6 tandand d t v L a tL o n oi 553 and

p n a t t L t t nan6t6 ujonkLng Ln g t n t n a L p n a t t L t L o n t n

tnaLnLng p n a t t L t t ^ uj tnt ^L gn L i L t a n t L y mont LLktLy

t o b t and tn takLng exlewded noL t a t t L v L t L t ^ t k a n

p n a t t L t t nan^ t6 wonkLng Ln non- tnaLnLng p n a t t L t t ^ ,

(X^ = 226 , 8 1 2 1 , d i 2, p= <0,01) and t k t n t voa6 a

kJigkty ^LgriLiLcant p o s i t i v e t o n n tZ a t L o n b t t u j t t n

g t n t n a L p n a t t L t L o n t n tnaLnLng p n a t t L t t ^ and

n t 6 p o n d t n t 6 and tn takLng t x . t t n d t d no L t a t t L v L t L t é ,

(n = , 1218 , p= <0,01) ,

Hovotvtn, w h t n t tvoo on mont i t m a L t g t n t n a L

p n a t t L t L o n t n ^ ’ ionmtd t k t t o t a L on p a n t o i a

p n a t t L t t mtdLtaL t t a m , L n n t é p t t t L v t o i t k t t y p t on

n t g L 6 t t n t d p a t L t n t LL6t 6 L z t oi t k t p n a t t L t t ,

p n a t t L t t nan^ t6 w t n t 6LgnL iL tan tLy 1&44 LLktLy

t o a n d t n t a k t t x t t n d t d noL t a t t L v L t L t é ,

(X^ = 82, 6552, d i 2, p= <0 ,01) , TabLt V

(ApptndLx Lx) gLvt6 t k t d t t a L L ah L t n t L a t t h t o

t k t h L g n L i L t a n t t oi t k t t nvLnonmtn t o i p n a t t L t t

and t k t n t h p o n d t n t h ptnionmLng t x t t n d t d

n oL t a t t L v L t L t h ,

P n a t t L t t nanhth voLtkLn t k t h tady koLdLng t k t

pnoi thhLonaL qaaLL iL ta tLon oi d L h t n L t t nanh t on

k t a L t k vLhLton, hLgnL iL tan tLy votnt and tn takLng

mont t x t t n d t d noLt a t t L v L t L t h t k a n t k o h t

n t h p o n d t n t h ujLtkoat t k o h t n t t o n d a b L t pno i thhLonaL

qnaLLlLtatLonh , T k t mtan numbtn oi pan tL tL pa n th

voJith d L h t n L t t nunht qua lL iL ta t J ion and tn takLng

t x t t n d t d n oL t a c t L v L t L t h utah 12 wLth a

h tandand d t vL a tL on o i 5. Tkoh t p n a t t L t t

nanhth voLtk a d L h t n L t t nan h t qaaLL iL ta tLon v j t n t

hLg nL iL tan tLy ptnionmLng an t n h a n t t d no L t ,

(X^ = 58 .000 , d i 2. p= <0.01) .

Th t mtan nambtn oi n t h p o n d t n t h ’ qaaLL iL td ah

h ta L t h v L h L t o n h ' and tn takLng t x t t n d t d noL t

a t t L v L t L t h wah 12 vjLth a h tandand d t v L a tL on oi

8, Tkoh t p n a t t L t t nanhth ptnionmLng an

t n k a n t t d n oL t , hLgnL iL tan tLy k tLd a k t a L t k vLhLton

qaaLL iL ta tLon , (X^ - 48 . 000 , d i 2, p= <0 .0 1 ) .

TabLt E (ApptndLx Lx) d t taLLh t k t h L g n L i L t a n t t

b t t vo t t n t k t n t h p o n d t n t h o t t a p a t L o n a L batkgnoandh

and pno i thhLonaL p n a t t L t t .

P n a t t L t t nanhth ptnionmLng t x t t n d t d no L t

a t t L v L t L t h votnt hLgnL iL tan tLy and tn takLng t n k a n t t d

noLt Li t k t y uj tnt t o n t n a t t t d t o vjonk b t t u j t t n 22

and 23 koanh p t n i v t t k . T k t mtan nambtn oi koanh

vjonktd by p n a t t L t t vmnhth ptnionmLng t x t t n d t d no L t

voah 22. 526 voLtk a h tandand d t vL a tL on o i 10 .08 ,

(X^- 7 . 7143 , d i 2, p= <0 .02) . T k t n tZa tLonhkLp

b t t w t t n t x t t n d t d n o t t and t o n t n a t t t d koanh Monktd

by p n a t t L t t nanhth L d t n t L i L t d a kLgkZy h L g n L i L t a n t

p o h L t L v t t o n n tZ a t L o n , In = 0 .1316 , p- <0 .01 ) .

TabLt F (ApptndLx Lx) hkoujh t k t h L g n L i L t a n t t oi

n t h p o n d t n t h t o n t n a t t t d koanh o i p n a t t L t t .

P n a t t L t t nanhth ptnionmLng an t n k a n t t d n oL t

Mtnt hLg nL iL tan tLy mont LLktLy t o k a v t Job

d t h t n L p t L o n h . Oi t k t t o t a L nambtn o i n t h p o n d t n t h

an d t n takLng t x t t n d t d no L t a t t L v L t L t h , 134 (63.8%)

h a b j t t t h kad Job d t h tn L p t L o n h , (X^- 290.7985 , d i

2, p= <0 .01 ) . T k t n t loah a kLgkLy h L g n L i L t a n t

p o h L t L v t t o n n tL a t L o n b t t w t t n t k o h t p n a t t L t t nanhth

wko k tL d Job d th tnLp tLonh and w t n t p tninomLng

t x t t n d t d noL t a t t L v L t L t h , (n = 0 .2306 , p- <0.01)

di 2, p- <0.01) and t k t n t wah a kLgkLy h L g n L i L t a n t

p o h L t L v t t on n tL a t L o n b t t w t t n n t h p o n d t n t h

an d tn takLng t x t t n d t d no L t a t t L v L t L t h and h tady

L t a v t (n = 0 .1176 , p- <0 .01) , and p a n tL tL p an th

ptnionmLng t n k a n t t d n o t t and L n - h t n v L t t t naLnLng ,

[n - .1142, p= <0.01 ) .

Oi t k t 134 p n a t t L t t nanhth wko w t n t p tn ionmLng

t x t t n d t d n o t t a t t L v L t L t h , 6 3.8% h Lg nL iL t an tLy kad

nanh t pnoto toLh t o wkLtk t k t y wonk td ,

(X^= 183.3677, d i 2, p- <0 . 01) . TabLt G (ApptndLx

Lx) d t taLLh t k t h L g n L i L t a n t t oi tmpLoymtnt

annangtmtn th on pnoi thhLonaL p n a t t L t t .

Tk t nanhth w t n t and tn takLng a wLdt and vanLtd n o L t

wLtk t k t majonLty oi t k t n t h p o n d t n t h n t hp on hLb L t

i on t k t ioLLowLng a t t L v L t L t h ; L n i t t t L o n t o n t n o L ,

466 ( 100. 0%) , 422 (90.5%) woand manag tmtn t and

woand dnthhLng and 401 (86.5%) n t hponhLbL t i on

kandLLng tmtng t n t L t h wLtkLn t k t p n a t t L t t and 396

(84.9%) ptnionmLng i L n h t aLd t a n t . S p t t L a L L h t d

a t t L v L t L t h ha t k ah h ynLngLng t t a n d a t t h and naLL

t n tpkLnLng w t n t a n d t n t a k t n by onLy 4 o i t k t

n th p o n d tn t h (0. 8%) . TabLt 9.1 d t taLLh t k t

tLLnLtaL t ahkh and nanhLng p n o t t d a n t h and t k t

n t h p o n d t n t h h t L i ~ p t n t t L v t d LtannLng n t t d h .

*aft) y

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ole y-w d '<? •9y S CD a] yo d s! y acJ o:'4 o •V? •V?

a «9 d C5) •9 +Vy y s> •V? "a y — ao a d O y *9

s *e y a *e d •v>•w 'a d ai yo ~a a) •w "9 *a ad y "a *9 sVO a y d *e "4 sy a a S a -y '-f*-4 s UJ U. UJ C_)

oo C si C O t v . *— C O O o m V - r v «—

O ' CM V— V O V O CM O Q V - O ' t v m

V O V O V - CM CM T— * — Ooo»

ft)ay•wyod

CM o VO oo CM vj- Oo oo vO va-tv O' Oo r— CM O Oo VO V» co CMCO CM Cm CM

Iada vca•9 JM S'"9 *9 s s CL *e y

y d y y d y d aa CO d h~» d a S •v?

cn -4 a a a •9 S 'y ■w -y ai d S ' -y s? a a

a a a S' a S ' s? «N* dy d •9 -w ‘v> d a CL •V? y d Pu

*c* 2 Co •9 2 a "9cJ o a v<3 *0 o *e *9 ai a] d y 1 CLa o •m a CL COa d y y CO d CLa a o y «9 a) *e•v? y an a

a y a •v> y CL'a N y d s»)— a a d Cj *e •V? S? '4 •9 «d «9+v CL a »9 a *e 'a a *9 ad d a *a a *4 y a a d a •4 d a a le*v<3 a y s y *e 'O '4 s a d -9 S» d s? a

a *a d d a d *9 s a iC* d •9 5 *a a PuCO ■< a. ad CJ •< CO CQ 2: C o

V- IV IV Oo oo

CT) T— ,— O O

VO oo oo "O' V-

■9'd S»ft) y dy a ay Co ‘V? *ay d S a>V '4 Co y yy *e y a d aa a 'P d yÜ a>«y S y S?a> o a ‘V? -y

a ai aj CL• <S ai "V? CL y dO' a L:» *e a '4 *ed a *e Is» a) ■sft) d *9 •V? 'a y

a '9«Q y d d d *ed ai CL a> aW- CD UJ UJ CO 2

Tht da ta hhow t h a t w k t n t nanhth a n t wonkLng

wLthLn pn a t t J i t t h Ln a nana l Lo t a t L o n t h t y

woatd b t mont LLktLy t o b t and tn takLng t m t n g t n t y

and t a h a a L t y wank. Whtntah nanhth wonkLng wLthLn

Lnntn t L t y p n a t t L t t h on p n a c t L t t h wLtkLn d t p n L v t d

antah w t n t Lthh LLktLy t o b t and tn takLng

t n a v t L L t n ' h h ta L t h p n o t t d a n t h . I t Lh oi

h L g n L i L t a n t t t o n o t t t h a t t h t da ta aLho hkow t h a t

w h t n t p n a t t L t t nanhth a n t wonkLng wLthLn

tnaLnLng p n a t t L t t h , t k o h t nanhth w t n t Lthh LLktLy

t o b t andtn takLng t t n v L t a L hmtanh and b n t a h t

t xamLna tLon . SLmLLanLy, w k t n t p n a t t L t t h kad

mont t k a n o n t i tm a L t g t n t n a L p n a t t L t L o n t n t k t

nanhth wouLd b t Lthh LLktLy t o k a v t

nthponhLbLLLty i on and tn takLng wtLL woman

h t n t t n L n g and iamLLy pLannLng, t v t n L i t k t nanht

wah iamLLy pLannLng t n a L n t d .

CLLnLtaL ExamLnatLonh

Tk t nanhth L d t n t L i L t d a wLdt n an g t o i a t t L v L t L t h

wkLtk t k t y a n d t n to o k ah t kLh a h p t t t o i t k t L n noLt .

T k t n t h p o n d t n t h n t t ognLh t d h p t t L l L t antah oi

t o n t t n n i on wkLtk t k t y p t n t t L v t d an t d u t a t L o n and

tnaLnLng n t t d and t k t h t L n t l a d t d , t xamLnatLon oi

t k t t a n h , bn tah th and p e l v i c t xamLnatLon. I t

w i l l b t n o t t d t k a t t k t n t Lh o v t n l a p o i nanhLng

a t t L v L t y Ln tkLh t a t t g o n y wLtk tLLnLtaL t a h kh and

nanhLng p n o t t d a n t h d t t a L L t d Ln TabLt 9 . 1 . Ton

example bLood p n t h h a n t n t t o n d L n g , an d t n takLng

t t n v L t a L hmtanh, and t k t txamLnatLon oi t k t t y t h

and t an h . TabLt 9 .2 d t taLLh t k t tLLnLtaL

txamLnatLonh a n d t n t a k t n by a l l t k t n t h p o n d t n t h

wLtkLn t k t h tady and h p t t L i L t t d a t a t L o n and

tnaLnLng n t t d h .

yd•c

5'dyoQ.

3dft)•W•o

*dyd«9yo

•1dft)s>dCJ'4y

Ovf t)S•O

*9■Sft)y

I“dydyo

■3a .

•303B.1Vs"3*9

*dft)'4V3

VOVOV)-

a * d *9 i CM O ' 0 e n i r jf t ) * d ' d • . . •a y ft) oVa S t- Cm 0 CM O '

*9 *4 d ft) e n O ' 0 I V* d +Y w y !y y Od ft) *e *d ft)3>0

y B.-Wa I d B.VS O

1 3 ^ - 1 I•e2 *9 ft) -w

1 1+v y a

«9ya■w y O V5 y "j '"4 a ft) -d y -W

~d d '^ d *e yft) a ft)

o B. ft)E «9 "d ft)d ft) y >y% d d "W

■1dHUJ

•s'do•30

S)-o tv 00 rvO v C j O '

V3 a. i CM VO tv irj IVa •9 1 • • • • • •ft) I «n IfJ V- Co V- »—«N» o\o VO Sh CM m CM

S h Cm C o s i f - t—c , 0 e n CM S)-en CM Cm CM

c J d y d-y -y 0 -ys s? SS 9V<3 v< 3 d V o d0 0 y d 0 ie

' 4 d dy y s s y 90 a d CO 0 9

" 4 X ' 4 dS' S' 9 d s s iï*d d S? d d puy y 9 ft) eJ y

9 d *1? •s> '4 S? 'ds *e s d > a s 0 ) ad d d S ' d d a

tu X CQ d d VO s>lu lu pu 0 lu PQ

m tv VO Oo IV «n o oo

VQ tn *— Ln «n *— IV cosa- SI- SJ- »— *— *— en

IV SI- S ^ S)- SJ- e n e n S hc o O ' IV v o m e n

Cvi CM

'Oft)d 9 d dy 9 - d -y -y

' 4 • • - d d S SV CD O dy y d - y 9 v<3 V<3o d ) ' - f >y d CD ‘4 O <0o y y d S 9

S y ç:a S O y y# f s» d B . C J d y o <0

CM 9 s ' d 2 d CD S d id PU C_) b-* d d s s y

O ' h - d d s Sd ) 1 1 S 'd y y d d

ft) d S d 9 o SS y d - y S S S y <0< o 5 9 9 d CD d *y yd d •4 d U J h- o

K - 2 U - (y UJ UJ 1—

HtaLth Sunv tLLZanc t

Tht pa n tL t L p a n t h a n d t n t a k t h t a L t h h a n v t L L L a n t t

and i o t a h upon aLL a g t gnoaph. Th t t o p L t h a n t

wLdt nangLng and L n t L a d t , hmokLng, RubtLLa and

aLtohoL t onhamptLon , HtaLth h a n v t L L L a n t t wah an

Lmpontant a h p t t t L n t n o d a t t d Ln t h t Htw GtntnaL

P n a t t L t L o n tn C o n t n a t t o i 1990, and Lh n t t o g n L h t d

ah an Ln t t g n a L p a n t o i p n a t t L t t nanhLng and t h t

noLt o i t k t p n a t t L t t n a n h t . TabLt 9 . 3 d t taLLh

t k t t o t a L k t a L t k h a n v t L L L a n t t pnovLhLon and

t k t p t n t t L v t d t d a t a t L o n and tnaLnLng n t t d h o i t k t

n t h p o n d t n t h :

S•üyoB.3«eft)«y"W

s•ayyft)oyy

3a§«9

•y•w

■Sft)y

Iyy■w•yyyyo

oy*yft)

SB.1va

■3•9

*yft)•V?v a

yft)•yS

■’ •3

'y *9 ft) ‘y *y y y ft) y

•y *wy y y y y y y a

*y ft) y y Q.-W ft) a i y

«o Q .v a ft) B 9 ^ y y y y "y % y 9 y S!

II•w Sf

av a D.

*9 O)•W y

v a y a y -y

'y y y y Sf

D. y3 -gy y

y«aBy

Iyyyyft)*9

SJ- tv O|o\o rv VO Sb

Ln O' tn Cm

|yI yjuo15 O Oo r— oo1 y O' O O'12 CM Cm *—

VO m S3- S b I V Cm coco VO CM LO Cm O ' O 'OO VO VO S b O ' O o oo LT»

| y 1 yjuo 1 5 V O co C M C M V O m1 d I v f — O ' f — en f -

12 en en C M Cm Sb Sb sb

•V y y 9y y s 1 B.y N 1 d d% '4 1 a y 9

y 1 y d da 1 CD 9 S a S

•» y 1 y 9 d s a C3)en y 1 y — cJ d S y d

• co 1 5 ■oi y y •V? d dOv 1 a 9 eJ d) B. s d S' d

.y 1 2 •4 2 s d 9 dy VO •w 1 Od y 'd eu s d ds) VO s 1 s ' S d a d S y•a Sb y 1 S S? S 'y a 2 a oy y 1 y < y s S d lui -d 9K 2 % 1 s - s Ü J CQ 2 CD

O ' CM VO CO o o O o I V LT> «nVO f — I V L n L n S b S b CO oo CMS b CM 1— *— 1— »—

O ' O ' CM en co O ' O ' co co CMT— O ' Oo r v I V VO VO Ln Sb »—CM

'CJf t ) 9 9y d Sy 5 d s 95 d d S-w d S d d " V .

y s y S S d N ya y d) d CL d S a do d o eu a d S y d CD

d y S d d s> E dtt 2 B. S d cj B. d 9 •V>«n d a S a y -d dj• d> d S d eJ o 9 S a MO

O ' y 9 d ‘d *v> • 4 d S N d dd d d d S s? o d 9 a S MO

f t ) d y 1 "d a d -d y •V? .d SS a 9 d S y * Q c i î y a B . a d S ?* o y - v î S y d y a C j u o sy a Çd d *d 9 S d u j d S ? S y c J

C J • < C J ( d 5 C J c o ■ < e u s

ïnv t h tLqatLonh

Uunhth a n d t n t a k t a d L v t n h t n a n g t oi L n v t h t L g a t L v t

p n o t t d a n t h and a nambtn oi p an tL tL p a n t h

L d t n t L i L t d t h t L n n t t d i on i a n t k t n t d a t a t L o n and

tnaLnLng. Many o i t k t p n o t t d a n t h t an b t n t Z a t t d

t o t k t L o t a t Lo n o i p n a t t L t t h . Tk oh t p n a t t L t t h

wkLtk a n t Ln a nanaL h t t t L n g a n d t n t o o k mont

Lnv t h tL g a t L v t p n o t t d a n t h wLtkLn t k t p n a t t L t t

h t t t L n g . TnaLnLng p n a t t L t t h w t n t aLho mont LLk tLy

t o a n d t n t a k t a iaLL n an g t o i L n v t h t L g a t L v t

p n o t t d a n t h . T k t d t t a L L ah L t n t L a t t h t o t k t

iaLL na ng t o i L n v t h t L g a t L v t p n o t t d a n t h a n d t n t a k t n

by p n a t t L t t nanhth and t k t L n h t L i - p t n t t L v t d

LtannLng n t t d h a n t L d t n t L i L t d Ln TabLt 9 . 4 .

y *y•y y•w yd) y

•a ay +Vy y•y yy yHV *yy yy

•y *yy yy

*59 3y yy yy y

*y a.y 1y vaa •yy ya . 9y *ya y

"f•w vay "f% "W

*4 y■w y9 *yyay y

-yvaa *y •

. y 9y y 'yOî yy 9 yy "W yy y

y Ojs 'y ys yy a yva a.

9 yy y y

>y y •wH-

VOVOSb

va o co oa *y 9 . • . ,y'y *y o co O ' O '<N» a y y

9 o y ft)*y -W y y y y o y

co co VO O o

y y y a •y y y y a.-y y a I y «Q a. va y B 9 *y y y y y'y Iy

2 y 9 y "W

II■w yava SX 1 CM VO ooa 9 . « • ■y 1 LT» « n CM O 'y 1 o \o S b CM CM

y9 yj**"W e y 9 va y y y a y «y y) y •y y y y -wv *y a y 9 y a. y y y 9 *y a a y y y y y y M o.

yyMOSy

o CMr— tv

yft)MO5y2

*— c o e n VO*— f — c o S bCM

SS >dCD 2 9

r —1 f—1 r— 1 r —, 2 S?S> S B . 99 s d d ft)f t ) d çj y Sa t) s *4 2d S ' - f d CD a d

bM d C3î d a ad a S ' d ' 4

d j '4 N d) a y Sy 5 a a ' ^ 2 d da f t ) S ? S 'Q CD d d

S ? «d d a a a a dd d B S» y S y V<3y a ft) 9 d a S»a d *4 '4 d 2

MO CQ 2 2 2 ft) dd d S d

— ) 1 1 1 1 •< U J — j

m en t v Oo en VO NO O v o o OQ

CM Cm L n S b CM o o VO Cm NOL n CM CM CM CM CM

SbSbCm

NO sb V. o

VOOvOvr v

oNO CMen

ydy'4 S 2SI d dy d sa 9 S sy 2 2 9 2

d d ft) S2 S S>SX 9 d 2 d

S b d *4 . d o d ft) 2 Oy 9 2 y d 9 y ft) O ■<

Ov eJ 2 - d o a d 2 d9 S • • 2 v~ S 2 lu lu d sy d 9 d d

N d d CD d•Q d ft) 9y y 2 y •4

2 2 2 e u 2

CLLviLth

Tk t da ta hkow an Lncntah t Ln p n a t t L t t na nh t

p a n t L tL pa tLo n Ln and n thponhLbLLLty i on tLLnLth

i on hp t tLaL p n o t t d a n t h , pnobLtnth, Lnv t h tL g a t Lo n h

and d L h t a h t manag tmtn t . I t vooaLd app tan t k a t

wLtk h a t k a kLgk pnopontLon o i nanhth nannLng

tLLnLth t k a t t kLh kah b t t o m t an Ln t t g n a L p a n t o i

p n a t t L t t nanhLng and kah b t t o m t i andamtn taL t o t k t

n oL t o i t k t p n a t t L t t n a n h t . T k t n t Lh Ln t v L t a bL y

homt noL t outnLap wLtk o t k t n t o L L t a g a t h , h a t k ah

k t a L t k vLhLtonh ’ wko aLho wonk Ln baby tLLnLth and

a n t t - n a t a L t LL nL t h . FLtxLbLt p a t t t n n h o i

wonkLng, k o w t v t n , h t tm t o b t a k t y Lhha t wLtk

tLLnL t pnovLhLon. TabLt 9 .5 d t t aLLh t k t

tLLnLth nan by p n a t t L t t nanhth i on h p t tL a L

p n o t t d a n t h , pnobLtmh, Ln v th tLg a t Lon h and d L h t a h t

managtmtnt and t k t n t h p o n d t n t h ’ p t n t t L v t d

t d a t a t L o n and tnaLnLng n t t d h .

9 . 20

9 yy ‘yo y

oS a.y 92 yH ySI9 yya •sy

#» y9E y 9y y "y

•y yvO 9 yy •y yy aa. y Ç3î

y y•v a. •y

9 yy •y •yy y yy s y

*y y sy •Sy •yy S yy y ya. yE y

•y y yy 2 •y•y y Sfy y yy y ya. E d9 *y

y yy 9y yva y y

9 a9 •y •yy *y y•y oy 'y y•y y ys y a.ÇJ

VOVOSb

Fs•y

y y ft) o

"y 9y *y a y y •y y y y y o ys . 5 ?

I- y y 9 y s•o a. va y1 3 ^ - 1

II•S y yva Q. y 9y

«#A y

9^ g y y*yy y 2 9y yy y *y *yvO a. y yB 9 y *yd y d s2 y y CJ

9y'4yo

o o LT» L n CM e n

o o L n Oo S b e no o O v O v VO L n

yft)M3Sd

VO CM CM VO CM OOVO O O v e n I V s bS b S b r - T---

< a Cm «— VO «a en O v

o VO en O v S b O v r —ca OO S b CM CM Ln

yft)•osd

VO CmVO oS b S b

r— OoO enCm f-

CMS bCm

vdS ft)S 9d •y 2ft) y d

-d y •y2 ft) dd 9 X d•y — lu d d

y *y dy O cJ "d a. B•y B «y d os d 9 «y d 2 5e j) B ft) S

M 3 a . a S •y «yd S o d ft) B «y•y 9 S y •y d cJÇd •< 2 K Çd l u 3

S b S b t v t n e n O O CM O o S b t v Ov CM• •

t v t v VO VO X 3 e n f — o o o o t v r — COs b S b S b S b S b CM Cm »— t—

t— oo VO VO »—• CJv oo VO VO Ov t—CM CM *— r — *— r — O v oo Oo enCM Cm CM CM CM t—-

•noft)•y*QK

9do•ysd9•yddSsb-*

dft)y*y•y>do

9 -d9 d K

ft) y yy d •y 2d ft) 2 s d9 o 5 y d 2 d9 •y 2 oy cJ y 2O d d y •y ft) ft) y eJ

d y •y *y s? ft) d PL 9 S 9d Pu s d d o d CO d y y2 CJ eJ d «y CJ d o 2

*d •y 1ft)

d 1 y PL ft)s y 2 a y y y d «ss y M3 y S 2 2 d d d yft) S d ft) d ft) y •y ft) 2 d3 CQ CQ CJ ■< CJ 2 2 O lu

CkLZdntYL

V L i i t n t n t a h p t t t h o i c kL td t a n t w t n t L d t n t L i L t d by

t k t n t h p o n d t n t h . Wktn t t k t n t w t n t t o m p n t k t n h L v t

pnLmany k t a l t k t a n t t tamh Ln p L a t t wLtkLn

p n a t t L t t h L t wah t v L d t n t t k a t p n a t t L t t nanhth w t n t

no t and tn takLng ah wLdt a n o t t . P n a t t L t t nanhth

wonkLng wLtkLn hma t t p n a t t L t t h , wLtk a LLmLttd

t t a m w t n t mont LLktLy t o b t and tn takLng t k t h t

a t t L v L t L t h . TabLt 9 .6 p n t h t n t h t k t n a n g t oi

tkLLd t a n t a t t L v L t L t h a n d t n t a k t n by p n a t t L t t

nanhth and t k t nanhth^ p t n t t L v t d t d a t a t L o n and

tnaLnLng n t t d h n t L a t t d t o t k t h t a t t L v L t L t h .

2Jft)"W

2f ddd

y9ft) 99 2*y ft)d ft)d dft) d)o d•y •yV do •yd dy ya. s2 2*•o d

ddft) d•d ad •yS sy dft) o•d dd 2)d ft)9 2*ft) ft) 94 a ft)4 *3 Sa o•y y as ft) •yü a. sd o

9 dft) ft)y 9 ft)d y 9ü d ft)

d -d2 S•y ft)*y vS* o

S SÇJ

ft)•y*o

VOVOSb

vaO "X* 9f t ) \ j \ j a SÎ ft)9 >U cj ft)'Q W ^ *i« S! O Bf Xj ft) y o 21 ft) *y

G-yft) o I d •Q a. sa o B 9«y d d ft) ft)*d

y 9 ft) s

“ S«Na y

H? d sa Si *y d ft) .d

tJ d d d ft) o d*d ao o. ft) o *yB 9 2 * 4 S d ft) d vd O % y d u d

dft)•§

yM3Sd2

«ncosb

S b CO O v VO e%)

V O Lr> Q v Oo COOO S b «— t—

9 deJ d9 «y9 cy HV

d e J d •y dd d o ft) ft)

S y a Bd d «y 2f y a.y o 4 S d o•y •y 4 9 sS ' S ' 2f Mi e J

e d d O o d a9 d O ft) ft)•y •y 9 >d 2} y 25d o cJ 2* ft) 2*d e J .d «y 9 «y 2 fB d 9 •y d •y dS a d -d M 3 .d db-4 yd o ■ < o

HtaLth VnomotLon and HtaLth EdutatLon

P n a t t L t t nanhth apptan t o pLay a t o m p n t k t n h L v t

no L t Ln t k t pnovLhLon oi k t a L t k t d a t a t L o n and

k t a L t k pnomotLon , T k t n t Lh, k o w t v t n , an

a p p a n t n t hk on t i a LL Ln tnaLnLng i on t kLh a h p t t t oi

t k t p n a t t L t t n a n h t h ' n oL t . HtaLtk vLhLtLng

pn t pana tLon Lh t k t onLy t o a n h t wkLtk Lh t o mm L t t t d

t o k t a L t k pnomotLon, ba t t k t n t a n t ho i t w p n a t t L t t

nanhth wko a n t aLho n t g L h t t n t d k t a L t k vLhLtonh -

14 (3.0%) Ln tkLh h a n v t y and t kLh kLgkLLgkth no t

onLy pohhLbLt gaph Ln pnovLhLon ba t aLho t k t

pohhLbLLLty o i homt d t g n t t o i ov tnLap b t t w t t n t k t

k t a L t h vLhL ton 'h n o L t and t k t p n a t t L t t n a n h t ’h

noL t . Th t da ta inom t kLh h tady kLgkLLgk t t k t wLdt

na ng t o i k t a L t h pnomotLon and k t a L t h t d a t a t L o n

pnognammth t o wkLth p n a t t L t t nanhth a n t

t o m m L t t t t d , and aL t koagk homt antah k a v t b t t n

L d t n t L i L t d by t h t p n a t t L t t nanhth ion i a n t h t n

t d a t a t L o n and tnaLnLng Ln o t h t n a h p t t t h o i t k t L n

noLt a p t n t t L v td LtannLng n t t d kah n o t b t t n

n t L a t t d h p t t L i L t a L L y t o t h t h a b j t t t h o i k t a L t h

9 . 2 5

tdiLtatLoYi and h t a L t h pnomotLon v L t w p o L n t .

TabLt 9 .7 d t taLLh t h t h t o p t o i h t a L t h pnomotLon

and h t a L t h t d a t a t L o n i on whLtk p n a t t L t t nanhth

a n t n thponhLbL t . Th t n t h p o n d t n t h dLd n o t

L d t n t L i y h p t t L i L t t d a t a t L o n and tnaLnLng n t t d h i on

t kLh a h p t t t o i t k t L n n o L t .

T a b l t 9 . 7 H taLth VnomotLon and H taL th E du ta tL on

pnognammth io n uhLth p n a t t L t t nunhth

a n t n th p o n h L b L t hhouLng t h t numbtn

and p t n t t n t a g t o i pnouLhLon a g aL n h t

t o t a L numbtn o i n t h p o n d t n t h .N:466

H taLth PnomotLon Numbtn o i n th p o n d tn th n th p o n h L b L t io n h ta L th pnomotLon

% o i t o t a L n th p o n d tn th

V L t t 280 60. 0

S top hmokLng 232 49. 7

(fJtLL Woman 203 44. 6

ALaohoL 207 44. 4

WtLght aontnoL 205 43. 9

Pnognammt dLhpLayh Ln hangtny 205 43 . 8

9 . 2 6

T a b t e . 9 . 7 : c o n t j i n i i c d

Ex.Q,n.c.Ji6Q, 2 0 2 4 3 , 3

W2.ll ?2.n.^0YL 1 93 41 ,4

B^2.CL6t ExamLnatJion 191 40 , 9

C.on.OYLCLKy c.a.n.2. 86 18, 4

Chot2,^t2.KoJi l2,V2.l6 84 18, 0

Asthma 78 16, 7

E l d 2. f i ly 7 2 15, 4

T2,6tJLc.alaLfi6 2.1^- 2.x am Jin a t Lon 61 13 ,0

'F t u p n z v 2.n tL on SO 10 ,7

? ^ 2.-c.onc.2. p t a a t 42 9 ,0

H e .a t th E d a c a tL o n

VL2.L 232 49 ,7

AntL-6mokLng 231 49, 5

E^2.a6t 2.xamLnatLon 224 48 ,0

AtaokoL c.on6u.mptLon 223 47 .8

W2.Lgkt K2.dac.tLon 2 1 6 46 .3

EamLty pLannLng 215 46.1

T a b t e . 9 . 7 : c . o n t t n a e . d

HotLday^ abKoad 215 46,1

214 45, 9

Hea t t k and t J i ^ e 6 t y t e 1 06 22 ,7

StKe.6 6 96 20 ,6

knt (L -na ta t c.aK.2. 76 16,3

UenopaiL^e 75 16, 0

VetoJit I toon. e.xe.Kc.Ji^e-6 44 9 ,4

VKug aba4) e 24 5,1

CkKonlc J i t tne66 advLae 24 5,1

S e x u a l t y t n a n à m L t t e d dt^za^e. ' i 13 2 ,7

EpX.te.p6y 2 0 ,4

CeKvtcat 6me.an.6 1 0 ,2

A n t i 'FZ% 7 0 ,2

PKe.-conc.e.ptuat c.aKt 1 0 , 2

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a g a i n s t a c t i v i t y h i g h l i g h t t h e d l v e a s l t y o i

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The r e s p o n d e n t s wer e u n d e r t a k i n g a w i d e r a n g e o l

m a n a g e r i a l a c t i v i t i e s some o l w hi ch w e r e d i r e c t l y

r e l a t e d t o n u r s i n g a c t i v i t i e s s u c h as managment

o l t h e t r e a t m e n t room and s t o c k c o n t r o l . Ot her

a s p e c t s Such as p a y r o l l , p r e s c r i p t i o n s b e i n g s e n t

t o t h e T r i c i n g A u t h o r i t y , summar i es o l P a t i e n t ' s

M e d i c a l Re cord s wer e q u e s t l o n n a b l e as t o w h e t h e r

t h e y c o u l d be c o n s i d e r e d as p a r t o l t h e n u r s e ' s

r o l e . T hos e p r a c t i c e s w h e r e a manager was I n

p o s t I t was l e s s l i k e l y t h a t a p r a c t i c e n u r s e

woul d be u n d e r t a k i n g o t h e r m a n a g e r i a l d u t i e s o t h e r

t h a n t h o s e a s s o c i a t e d w i t h p r a c t i c e n u r s i n g .

However , t h e d a t a show t h a t p r a c t i c e n u r s e s

w o r k i n g I n s m a l l e r p r a c t i c e s wer e s l g n l l l c a n t l y

more l i k e l y t o be u n d e r t a k i n g a d m i n i s t r a t i v e

d u t i e s . T a b l e 9 , 1 0 d e t a i l t h e r a n g e o{,

m a n a g e r i a l r e s p o n s i b i l i t i e s and t h e a s s o c i a t e d

l e v e l o l s e l l ~ p e r c e l v ed e d u c a t i o n and t r a i n i n g

n e e d s .

9 , 3 7

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S 4 9) 9) 9) SX CD 9) 4o s; 4 Xi Çj -d 9 4 4 d 4 d# • 4 9) y 4 y 4 y 4 jM 9)o 9 4 Xs 9) 4 V<3 y y cJ o y 4*v Xs4 'y CD O NO 4 y 9 4 s 4

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T h e s e d a t a h ave shown t h a t t h e o e e a p a t l o n a t r o l e

o l p r a c t i c e n u r s e s , and s e l l - p e r c e i v e d e d u c a t i o n

and t r a i n i n g n e e d s a r e a l l e c t e d by t h e e n v i r o n m e n t

o l p r a c t i c e . U n d o u b t e d l y s m a l l e r p r a c t i c e s , w i t h

s i n g l e handed p r a c t i t i o n e r s and a s m a l l t e a m o l

s u p p o r t s t a l l r e s u l t s I n p r a c t i c e n u r s e s

u n d e r t a k i n g a w i d e r and more d i v e r s e r o l e w i t h

more a p p a r e n t au t onomy and r e s p o n s i b i l i t y l o r

a c t i v i t i e s d e l e g a t e d t o t h e m . Nu rs es w o r k i n g I n

Such e n v i r o n m e n t s a r e a l s o more l i k e l y t o be

u n d e r t a k i n g a s p e c t s o l manag emen t w h i c h w o u l d

n o r m a l l y be c o n s i d e r e d o u t s i d e t h e r o l e o l t h e

n u r s e .

P r a c t i c e s n u r s e s h a ve a p p a r e n t l y many more

o p p o r t u n i t i e s t o d e v e l o p s p e c i a l i s t a c t i v i t i e s I n

l a r g e r and t r a i n i n g p r a c t i c e s , b o t h o l w h i c h a r e

more l i k e l y t o h a v e c o m p r e h e n s l v e p r i m a r y h e a l t h

c a r e t e a ms I n p l a c e and more p r a c t i c e n u r s e s ’ I n

p o s t . Nur se s who work I n t r a i n i n g p r a c t i c e s h ave

more o p p o r t u n i t y t o a t t e n d s t u d y days and

c o u r s e s and more o l t h e s e n u r s e s a l s o r e c e i v e d I n -

9 , 40

h o u s e t r c L l n l n g t h a n n u r s e s w o r k i n g I n n o n - t r a l n l n g

p r a c t i c e s . T r a i n i n g p r a c t i c e s w e r e more l i k e l y

t o h a v e c o m p r e h e n s l v e p r i m a r y h e a l t h c a r e t e a m s I n

p l a c e and t h i s had a d e f i n i t e e H e c t on p r a c t i c e

n u r s i n g a c t i v i t i e s e s p e c i a l l y I n c h i l d c a r e .

The l o c a t i o n o l p r a c t i c e s a l s o had a b e a r i n g on

p r a c t i c e n u r s e s a c t i v i t y and t h e r e l o r e on

l e a r n i n g n e e d s . S u r g e r i e s l o c a t e d I n d e p r i v e d

a r e a s we r e more l i k e l y t o o U e r a l u l l r a n g e o l

p r a c t i c e n u r s i n g a c t i v i t i e s and I n v e s t i g a t i v e

p r o c e d u r e s on an o p p o r t u n i s t i c b a s i s b e c a u s e

p a t i e n t s r a r e l y r e - a t t e n d , [ Try , 19 8 8 ) , Whereas

p r a c t i c e s I n r u r a l s e t t i n g s o U e r e d a w i d e r a n g e

o l p r a c t i c e n u r s i n g a c t i v i t i e s and I n v e s t i g a t i v e

p r o c e d u r e s b e c a u s e o t h e r l a c l l l t l e s s u c h as

h o s p i t a l d e p a r t m e n t s m i g h t be many m i l e s away Irom

t h e p r a c t i c e s i t e , some o l t h e s e l a c l l l t l e s m i g h t

be o l l e r e d t h r o u g h m o b i l e u n i t s , ( Tr y , 1 9 88) ,

I t was a l s o a p p a r e n t I rom t h e s e d a t a t h a t w h e r e

p r a c t i c e n u r s e s w e r e w o r k i n g I n a p r a c t i c e

wh er e t h e r e w e r e two or more f e m a l e g e n e r a l

p r a c t i t i o n e r s , t h e y w e r e l e s s l i k e l y t o u n d e r t a k e

w e l l woman s c r e e n i n g , b r e a s t e x a m i n a t i o n and

t e a c h i n g s e l l - e x a m i n a t i o n o l t h e b r e a s t s and

l a m l l y p l a n n i n g n u r s i n g even I I t h e n u r s e was

q u a l l l l e d I n l a m l l y p l a n n i n g n u r s i n g and w e l l -

woman s c r e e n i n g ,

The r e s p o n d e n t s a l s o I d e n t l l l e d a v e r y w i d e r a n g e

o l ’ o t h e r ’ a c t i v i t i e s w h i c h t h e y p e r l o r m w i t h i n

t h e r o l e o l p r a c t i c e n u r s i n g . T h e r e I s no c l e a r

p a t t e r n w h i c h can be t r a c e d w h i c h I d e n t l l l e s some

a c t i v i t i e s I n t r a i n i n g p r a c t i c e s , o t h e r s I n r u r a l

p r a c t i c e s b u t t h e r a n g e and d l v e r s l t y o l t h e

t o p i c s m i g h t r e l l e c t dev e l o p m e n t s I n p r a c t i c e

n u r s i n g and c ha n ge s I n l o c u s o l h e a l t h c a r e

p r o v i s i o n , u n d o u b t e d l y t h e y h a v e I m p l i c a t i o n s l o r

t h e p r o v i s i o n o l e d u c a t i o n and t r a i n i n g l o r

p r a c t i c e n u r s e s .

The c h a p t e r w h i c h l o l l o w s w i l l d i s c u s s l e a r n i n g

n ee ds as t h e y r e l a t e t o b o t h p r o l e s s l o n a l and

9 . 42

o c c a p a t l o n a Z backg r o u n d s o l t h e r e s p o n d e n t s Jin

t h i s S u r v e y .

9 . 4 3

CHAPTER TEN

VÏSCUSSÏON

ï n t r o d u c t I o n

I t was a r g u e d t h a t p r a c t i c e n u r s i n g I s an

a m a l g a m a t i o n o l d l H e r e n t s e g m e n t s o l n u r s i n g .

T hi s has been s e e n t o be t h e c a s e . Each

s e g m e n t , has I t s own s p e c l l l c body o l k n o w l e d g e

and t h e p o t e n t i a l t o undergo l u r t h e r

s p e c i a l i s a t i o n . P r a c t i c e n u r s e s h av e u t i l i s e d

t h e p r o l e s s l o n a l b a c k g r o u n d k n o w l e d g e and s k i l l s

t h e y p o s s e s s and h a v e dev e l o p e d I n d i v i d u a l and

S p e c l l l c b o d i e s o l knowl edg e and l l e l d s o l

p r a c t i c e t o m e e t t h e v a r i e d demands o l p r a c t i c e .

The e d u c a t i o n and t r a i n i n g need s o l p r a c t i c e

n u r s e s a r e I n l l u e n c e d by n o t o n l y t h e s e l l -

p e r c e i v e d n e e d s l o r t r a i n i n g b u t a l s o by t h e i r

p r o l e s s l o n a l b a c k g r o u n d knowledg e and s k i l l s and

t h e e n v i r o n m e n t w i t h i n w h i c h t h e y wo r k . T h i s

1 0 . 1

c h a p t e r w i l l d i s c u s s t h e s e f e a t u r e s .

The c h a p t e r I s d i v i d e d I n t o t h r e e s e c t i o n s w i t h

each p a r t h a v i n g a number o l s u b - d l v l s l o n s . Each

s e c t i o n w i l l r a i s e and d i s c u s s t h o s e a s p e c t s

Irom t h e d a t a w h i c h h a v e been shown t o r e l a t e t o

t h e e d u c a t i o n and t r a i n i n g n ee ds o l t h e

r e s p o n d e n t s . P a r t one d i s c u s s e s t h e I n l o r m a t l o n

Irom t h e s t u d y as I t r e l a t e s t o t h e r e s p o n d e n t s ’

work s i t u a t i o n , p a r t two l o c u s e s upon t h e

r e s p o n d e n t s ’ p r o l e s s l o n a l b a c k g r o u n d s and t h e

l l n a l s e c t i o n a d d r e s s e s t h e e d u c a t i o n a l

o p p o r t u n i t i e s o l t h e r e s p o n d e n t s ’ .

PART ONE

Re spond e n t s and t h e i r work s i t u a t i o n

T hi s l l r s t s e c t i o n w i l l be d i v i d e d I n t o t h r e e

s u b - s e c t i o n s and w i l l d i s c u s s t h e p e r s o n a l d e t a i l s

ol t h e r e s p o n d e n t s ’ , t h e i r w o r k i n g e n v i r o n m e n t

and e mp lo yme n t a r r a n g e m e n t s .

1 0 . 2

V e r s o n a t d e t a i l s

The age p r o f i l e o l p r a c t i c e n u r s e s I n t h i s

s t u d y showed t h a t , I n s p l t e o l t h e c o n s i d e r a b l e

I n c r e a s e I n t h e number o l n u r s e s becoming

p r a c t i c e n u r s e s , t h e age p r o l l l e r e m a i n s

uncha nged I rom G r e e n l l e l d e t a l ( 1 987) and Reedy

e t a l ( 1976) s t u d i e s , and t h e e x p l a n a t i o n l o r t h e

m a j o r i t y o l p r a c t i c e n u r s e s b e i n g I n t h e l o r t y

y e a r age g r o u p s t i l l a p p l i e s . Nu rse s who a r e

r e t u r n i n g t o n u r s i n g p r a c t i c e a l t e r a p e r i o d o l

t i m e a t home c a r i n g l o r t h e i r l a m l l y a r e more

l i k e l y t o s e e k e mp l oymen t w h ic h o U e r s l l e x l b l e

p a r t - t i m e hours and g e n e r a l p r a c t i t i o n e r s ’

c o n t i n u e t o employ n u r s e s who a r e o l d e r and

e x p e r i e n c e d I n l a m l l y l l l e . T h e s e d a t a do n o t

s u p p o r t t h e t h e o r y d i s c u s s e d by M a r t i n ( 1987) t h a t

p r a c t i c e n u r s i n g I s moving t o w a r d s a y o u n g e r

w o r k l o r c e . N o n e t h e l e s s , t h i s s t u d y d i d I d e n t l l y

r e g i o n a l v a r i a t i o n s I n t h e age o l e mp loy ed

p r a c t i c e n u r s e s . P r a c t i c e n u r s e s e mp l oy ed I n

t h e No r th o l England we r e on' a v e r a g e y o u n g e r t h a n

p r a c t i c e n u r s e s e mp l oyed I n t h e S o u t h o l Eng land .

T h i s l l n d l n g m i g h t be r e l a t e d t o t h e e l i g i b l e

p o p u l a t i o n w o r k l o r c e , b u t t h e I n l o r m a t l o n was n o t

compared w i t h p o p u l a t i o n c e n s u s d e t a i l s .

U n d o u b t e d l y t h e l e n g t h o l t i m e away Irom p r a c t i c e

w i l l h a ve a b e a r i n g on t h e l e v e l o l c o m p e t e n c e t o

p r a c t i c e and l e a r n i n g n eed s o l t h e r e s p o n d e n t s .

The I n t r o d u c t i o n o l s t a t u t o r y ’ Back t o

N u r s i n g C o u r s e s ’ I n 199 0 l o r p r a c t i t i o n e r s ’

who h ave been away Irom n u r s i n g p r a c t i c e l o r l i v e

y e a r s or more. I n t r o d u c e d by t h e n u r s i n g S t a t u t o r y

B o d i e s , does a d d r e s s t h i s I s s u e b u t was n o t

a v a i l a b l e when c o n s i d e r a b l e numbers o l n u r s e s we r e

becoming p r a c t i c e n u r s e s . T h i s s t u d y I d e n t l l l e s

t h e d i l emma some o l t h e s e n u r s e s m i g h t h ave

e n c o u n t e r e d b e c a u s e none o l t h e r e s p o n d e n t s had

a t t e n d e d an I n d u c t i o n programme, v e r y l ew

r e s p o n d e n t s ’ had a t t e n d e d c o u r s e s as p a r t o l I n -

s e r v i c e t r a i n i n g - 69 ( 14 . 8%) , 244 ( 52. 4%) had

c o m p l e t e d an a p p r o v e d p r a c t i c e n u r s e c o u r s e ,

t h e c o n t e n t o l s u c h c o u r s e s d i d n o t I n c l u d e

cllYLlcaZ. s k i l l s t e a c h i n g and a s s e s s m e n t and t h e

t o p i c s w h i c h t h e r e s p o n d e n t s c o n s i d e r e d s h o u l d be

I n c l u d e d I n s u b s e q u e n t c o u r s e s and l i s t e d I n T a b l e

7.4 h i g h l i g h t t h i s , o n l y 155 S u b j e c t s ( 33. 2%) had

a t t e n d e d s t u d y days and 148 p a r t i c i p a n t s (31. 7%)

had r e c e i v e d any lorm o l I n - h o u s e t r a i n i n g . The

l u l l r a n g e o l t h e r e s p o n d e n t s ^ p r e v i o u s y e a r ’s

l e a r n i n g o p p o r t u n i t i e s I d e n t l l l e d I n T a b l e 7.6

l u r t h e r I d e n t l l l e s t h e d i l emma I n w h i c h some

n u r s e s m i g h t h ave been p l a c e d and r a i s e s I s s u e s

a b o u t p e r c e i v e d e d u c a t i o n and t r a i n i n g needs

b e c a u s e n u r s e s ’ may be p r a c t i s i n g a t d l H e r e n t

l e v e l s o l c o m p e t e n c e . In a d d i t i o n t h e d a t a show

t h a t o n l y 96 (20. 6%) o l t h e r e s p o n d e n t s had

r e c e i v e d a p e r l o r m a n c e r e v i e w .

The l e n g t h o l t i m e r e s p o n d e n t s had w o r k ed as

p r a c t i c e n u r s e s had c h a n g e d s i n c e t h e s t u d y by

G r e e n l l e l d e t a l I n 1987. I n t h i s s t u d y , 50%

ol t h e r e s p o n d e n t s r e p o r t e d t h e y had w o r k e d l e s s

t h a n l i v e y e a r s as a p r a c t i c e n u r s e , w h e r ea s I n

t h i s S u r v e y 67% o l t h e n u r s e s had w o r k e d l e w e r

t h a n l i v e y e a r s . T h i s n o t o n l y I d e n t l l l e s t h e

g r o w t h I n t h e numbers o l p r a c t i c e n u r s e s , b u t a l s o

h i g h l i g h t s t h e l a c t t h a t a h i g h p r o p o r t i o n o l

n u r s e s we r e n o t o n l y new t o p r a c t i c e n u r s i n g b u t

may a l s o be o u t o l t o u c h w i t h c u r r e n t knowledg e

and dev e l o p m e n t s I n p r a c t i c e .

I t was s l g n l l l c a n t t o d l s c o v e r Irom t h i s s u r v e y

t h a t s i x o l t h e r e s p o n d e n t s we r e d i r e c t e n t r a n t

m l d w l v e s . T h e s e q u a l l l l e d m l d w l v e s , wer e

employ ed as p r a c t i c e n u r s e s and u n d e r t a k i n g

a c t i v i t i e s I n a c c o r d a n c e w i t h t h e knowl edg e and

s k i l l s s t u d i e d as a d i r e c t e n t r a n t m l d w l l e . Two

o l t h e s i x r e s p o n d e n t s w e r e a l s o u n d e r t a k i n g

t h e r o l e o l t h e m l d w l l e by u n d e r t a k i n g a n t e - n a t a l

c a r e o l p a t i e n t s w i t h i n t h e p r a c t i c e . Tour o l

t h e m l d w l v es w or ked w i t h o t h e r p r a c t i c e n u r s e s ,

and two wo r ke d on t h e i r own, as t h e o n l y p r a c t i c e

n u r s e I n t h e s u r g e r i e s I n w h i c h t h e y we r e

employ e d . A l l n u r s e s a r e r e s p o n s i b i l i t y l o r

u n d e r t a k i n g o n l y t h o s e n u r s i n g a c t i v i t i e s l o r

w h i c h t h e y h a v e u n d e r t a k e n t h e n e c e s s a r y t r a i n i n g

1 0 . 6

and e d u c a t i o n and l o r w h ic h t h e y h a v e t h e

n e c e s s a r y c o m p e t e n c e s t o p e r l o r m and I I d i r e c t

e n t r y m l d w l v e s a r e e m p l oy ed as p r a c t i c e n u r s e s I t

I s d l l l l c u l t t o c ompr ehend how a m l d w l l e can be

l u l l l l l l n g t h e r o l e o l t h e n u r s e . The U n i t e d

Kingdom C e n t r a l C o u n c i l keep on r e g i s t e r t h e

d e t a i l o l n u r s e s , m l d w l v e s and h e a l t h v i s i t o r s

p l a c e o l emp l oy me n t and r e c o r d a b l e q u a l l l l c a t l o n s ,

b u t b e c a u s e p r a c t i c e n u r s i n g , a t t h e p r e s e n t t i m e ,

does n o t a t t r a c t a r e c o r d a b l e q u a l l l l c a t l o n t h i s

I n l o r m a t l o n wo ul d n o t be e n t e r e d on t h e r e g i s t e r .

T h i s s t u d y has h i g h l i g h t e d a p o t e n t i a l p r o b l e m

I n r e c o r d i n g p r a c t i t i o n e r ' s q u a l l l l c a t l o n s and

p r a c t i c e s t a t u s .

The m a j o r i t y o l r e s p o n d e n t s were members o l t h e

Roya l C o l l e g e o l N u r s i n g , and some a l s o s u b s c r i b e d

t o t h e M e d i c a l V e l e n c e Uni on . A m a jo r p r o p o r t i o n

o l t h e s u b j e c t s we r e members o l t h e R o y a l C o l l e g e

o l N u r s i n g P r a c t i c e Nu rse s Forum and ev en more

a t t e n d e d t h e i r own l o c a l p r a c t i c e n u r s e I n t e r e s t

g r o u p . The l orum. M e d i c a l V e l e n c e Union and

l o c a l g r o u p s h ave been t h e ma j or s o u r c e s o l

e d u c a t i o n a l s u p p o r t l o r p r a c t i c e n u r s e s k e e p i n g

t hem u p d a t e d w i t h dev e l o p m e n t s I n a l l a s p e c t s

w h ic h m i g h t a l l e c t t h e i r p r a c t i c e . I t wou ld

a ppear t h a t l o r many o l t h e r e s p o n d e n t s t h e s e

h ave been t h e o n l y means o l e d u c a t i o n a l s u p p o r t .

The p r i n c i p l e e m p l o y e r o l t h e p r a c t i c e n u r s e I n

t h i s s t u d y was t h e g e n e r a l p r a c t i t i o n e r . T h e r e

has been some c o n s i d e r a b l e d i s c u s s i o n a b o u t t h i s

d u r i n g more r e c e n t y e a r s , b e c a u s e o l t h e c o n c e r n

e x p r e s s ed by some t h a t p r a c t i c e n u r s e s b e c a u s e

t h e y a r e emp lo yed by g e n e r a l p r a c t i t i o n e r s and

have work d e l e g a t e d t o them by t h e i r d o c t o r

c o l l e a g u e s t h a t t h e y m i g h t be l o l l o w l n g a m e d i c a l

mo de l , ( Hockey , 1984) r a t h e r t h a n a n u r s i n g

I ramework . Pe ac he y , ( 1987) has a r g u e d t h a t

empl oyment o l p r a c t i c e n u r s e s by g e n e r a l

p r a c t i t i o n e r s o U e r s l l e x l b l l l t y and au tonomy

e n a b l i n g t h e n u r s e s t o n e g o t i a t e t h e i r r o l e

a c c o r d i n g t o t h e n e e d s o l t h e p a t i e n t s o l t h e

p r a c t i c e and n o t by a r o l e mode l p r e - d e t e r m i n e d by

1 0 . 8

e.duc.atÀ,onaZl6t6 and manago,K6, C l a ^ k [1 989] , on

the, ûtkQ,fL hand a^gue.^ , t h a t g t n t ^ a Z p ^ a c . t t t t o n e . ^ 6

have, no tde,a a b o u t wh a t p ^ a c t t c e , nu^6e.6 do and may

t n a d v e,Kte,ntZy, the.n.e,io^e,, p lace . p ^ c ^ ^ u ^ c on

p r a c t i c e . nuK6C6 t o u n d e r t a k e a c t X , v t t t c 6 c t t h c K

l o ^ Mhtch the .y an.e, n o t t r a i n e d , on. e x p e c t nun^eé

t o t a k e n e ^ p o n ^ t b t i t t y ^on. pn.ocedun.e6 vohtch ane

beyond t h e n.ole o^ t h e nun.6e. The H a t t o n a l

H e a l t h Sen . v t ce Management E x e c u t i v e , ( 1 993 ) ,

hoioeven., n. ecognt6 e t h e p a n t t h a t t h e g e n e n a l

p n a c t t t t o n e n p l a y 6 t n t h e d t n e c t emplo y m en t o l

p n a c t t c e nun6e6 and doe6 n o t l o n e ^ e e any c h a n g e t n

t h t 6 annang e m e n t ,

Wonktng e n v t n o n m e n t

The numben o i p n a c t t c e nun6e6 (\}onktng I on 6 t n g l e

handed p n a c t t t t o n e n ^ haé n t 6 e n 6 l t g h t l y ^nom t h a t

n e p o n t e d by Reedy e t a l ( 1 976 ) and Gneen{^ te ld

e t a l ( 1 989 ) , f o u n o u t o(, ^ t v e p n a c t t c e n un^ eé

nou) vionk u j t th o t h e n p n a c t t c e n u n i e 6 , T h t 6 ,

companed u i t th t h e d a t a o^ Reedy e t a l ( 1976) ujho

6houjed t h a t t w o - t h t n d 6 pnac t J i ce nun6e6 voonked

on t h e t n own. In g e n e n a l t h e namben o^ p n a e t l e e

nun6e6 emp loyed a t a p n a e t l e e I n e n e a 6 e 6 w i t h t h e

numben o^ g e n e n a l p n a e t l t l o n e n 6 won k l n g t h e n e .

The numben o^ houn6 wonked I n a week by a p n a e t l e e

nun6e a l 6 o I n e n e a ^ e w i t h t h e numben o^ g e n e n a l

p n a e t l t l o n e n 6 wonk l ng I n t h e p n a e t l e e , Thene l 6

l e 6 6 0 ^ a n e l a t l o n é h l p b e t we e n t h e numben o^

p n a e t l e e nun6e6 wonk ln g ^nom a p n a e t l e e and t h e

a v e n a g e won kl ng wee k . The d a t a 6how t h a t nun6e6

wonk l ng on t h e l n own I n 6 m a l l p n a e t l e e ^ w i t h

6 l n g l e handed p n a e t l t l o n e n 6 and l i m i t e d t eam

6 u p p o n t ane mone l i k e l y t o be u n d e n t a k l n g a w iden

n ang e o^ p n a e t l e e n u n ^ l n g a c t i v i t i e s , and o t h e n

n o n - n u n s l n g d u t i e s , b u t ane l e s s l i k e l y t o h ave

t i m e away ^nom t h e p n a e t l e e {^on s t u d y .

One I n t h n e e p n a e t l e e nuns es wonk I n g e n e n a l

p n a e t l t l o n e n t n a l n l n g p n a e t l e e s and t h e n e ane

d l ^ l e n e n e e s Ion t h e s e nuns es b o t h I n t h e l n

o c c u p a t i o n a l n o l e and I n t h e c o n d i t i o n s o^ t h e l n

e mpl oy me nt , V n a e t l e e nuns es won k l ng I n t n a l n l n g

1 0 , 1 0

p n a e t l e e an e l e s s l i k e l y t o e xa mi n e b n e a s t s , t a k e

e e n v l e a l smeans and u n d e n t a k e s t e t k o s e o p l e

e x a m i n a t i o n o^ t h e h e a n t and e h e s t , Howeven,

p n a e t l e e nans es wonk l ng I n t n a l n l n g p n a e t l e e s have

g n e a t e n I n v o l v e m e n t I n h a v i n g n es pons l b l i l t y ^on

h e a l t h p n o m o t l o n e l l n l e s ^on a l l gnoaps o^

p a t i e n t s t h a n nuns es won k l ng I n n o n - t n a l n l n g

p n a e t l e e s . The d a t a a l s o show t h a t n u n s es

wonk lng I n t n a l n l n g p n a e t l e e s ane l e s s l i k e l y t o

be u n d e n t a k l n g n o n - n u n s l n g m a n a g e n l a l t a s k s .

They a ne a l s o l e s s l i k e l y t o be u n d e n t a k l n g t h e

mone g e n e n a l a s p e c t s o^ p n a e t l e e n u n s l n g s u c h as

a d v i c e on common I l l n e s s e s , I d e n t i f y i n g d e p n e s s l o n

and p n o v l d l n g I n f o n m a t l o n on w e l f a n e b e n e f i t s ,

V n a e t l e e n u n s e s wonklng I n t n a l n l n g p n a e t l e e s ane

a l s o l e s s l i k e l y t o u n d e n t a k e home v i s i t s . The

n u n s e s e mp l oy ed I n t n a l n l n g p n a e t l e e s a ne mone

l i k e l y t o u s e s p e c i a l i s e d s k i l l s and d e v e l o p

s p e c i f i c a s p e c t s o f h e a l t h c a n e p n o v l s l o n , s u c h as

o p t h a l m o l o g y and d e n m a t o l o g y , -

Thene ane I m p l i c a t i o n s f o n e d u c a t i o n and t n a l n l n g

1 0 , 1 1

f o n n u n s e s who ane won kl ng I n I n n e n e l t y p n a e t l e e s

and d e p n l v e d aneas as w e l t as f o n n u n s e s wonk l ng

I n s u n g e n l e s l o c a t e d I n n u n a l s e t t i n g s , T h e s e

n u n s e s ane mone l i k e l y t o u n d e n t a k e a w i d e and

d l v e n s e na ng e o f n u n s l n g and n o n - n u n s l n g

a c t i v i t i e s and e x e n e l s e a g n e a t e n d e g n e e o f

f l e x i b i l i t y and au tonomy I n p n a e t l e e , Th en e I s

e v i d e n c e a l s o t o s u g g e s t t h a t t h e s e n u n s e s ane

l e s s l i k e l y t o h ave t i m e f n e e f o n s t u d y .

Employment annang ement s

Most p n a e t l e e n u n s es now ane l i k e l y t o be s a f e l y

e mpl oy ed w i t h e l t h e n on b o t h e o n t n a e t s o f

e mpl oymen t and j o b d e s e n l p t l o n s , I t was

I n t e n e s t l n g t o d l s e o v e n t h a t a l t h o u g h s t u d y l e a v e

was p a n t o f t h e e o n t n a e t o f e mp l o y m e n t d e t a i l ,

veny f ew n u n s e s had been a b l e t o t a k e t h e l n

a l l o c a t e d numben o f s t u d y d a y s . The m a j o n l t y

had o n l y had one s t u d y day f o n t h e p n e v l o u s y e a n ,

Evans (1992) s u g g e s t s t h a t m o s t p n a e t l e e n u n s e s

a t t e n d s t u d y days I n t h e l n own t i m e and S l a u g h t e n

1 0 , 1 2

(1991) I d e n t i f i e s how a namben o f p n a e t l e e n u n s e s

f i n d I t d i f f i c u l t n o t o n l y t o h a ve t i m e f nom

p n a e t l e e f o n s t u d y p u n p o s e s b u t a l s o f u n d i n g f o n

s t u d y , Ross and Bowen ( 1992) n e p o n t e d t h a t

u s u a l l y g e n e n a l p n a e t l t l o n e n s s u p p o n t e d t h e l n

p n a e t l e e n u n s e s by g i v i n g t i m e o f f t o a t t e n d s t u d y

days and a l s o s u p p o n t e d t h e l n c o l l e a g u e s by

f u n d i n g t n a l n l n g , e ve n s o , Ross and Bowen f o u n d

t h a t one I n t w e n t y n u n s e s p a i d f o n t h e l n own

t n a l n l n g and a t t e n d e d s t u d y days on e o u n s e s I n

t h e l n own t i m e . V o l l e y d o c um en t s h ave

s t n e s s e d t h e I m p o n t a n e e o f c o n t i n u i n g e d u c a t i o n

f o n p n a e t l e e n u n s e s , (VHSS, 1986 and 1987; VH,

1990; UKCC, 1990 and 1993, MHS Management

E x e e u t l v e, 1 993 ) ,

VART TWO

R e s p o n d e n t s and t h e l n p n o f e s s l o n a l b a ek gno und s

T h i s a s p e c t o f t h e s t u d y has h i g h l i g h t e d t h e

v a n l e t y and n a n g e o f t h e wonk o f p n a e t l e e n u n s e s ,

10 , 13

Some n u n s e s a ne e Z e a n t y u s i n g t h e l n s p e c i a l i s e d

s k i l l s t o d e v e l o p s e n v l c e s f o n e x a m p l e , p n a e t l e e

n u n s e s w i t h a h e a l t h v l s l t o n q u a l i f i c a t i o n wene

dev e l o p i n g c h i l d dev e l o p m e n t and c a n e s e n v l c e s and

s u p p o n t l n g f a m i l i e s whene c h i l d a b u s e had

o e e u n n e d . The n a n ge o f a c t i v i t i e s does vany

w i t h p n a e t l e e s i z e , l o c a t i o n , numben o f g e n e n a l

p n a e t l t l o n e n s , and w h e t h e n t h e p n a e t l e e I s a

t n a l n l n g p n a e t l e e on n o t . C l e a n l y some o f t h e

t a s k s t h e n u n s e s wene u n d e n t a k l n g wene s u p p o n t

a c t i v i t i e s f o n t h e g e n e n a l p n a e t l t l o n e n , s u c h as

s e e i n g p a t i e n t s w i t h n a s h e s and o t h e n p o t e n t i a l

mlnon a i l m e n t s .

The s e l f - p e n e e l v e d n e e d f o n t n a l n l n g v a n l e d

a e e o n d l n g t o t h e t a s k b e i n g u n d e n t a k e n , What I s

d i f f i c u l t t o a s e e n t a l n I s w ha t t h e p n a e t l e e n u n s e s

a c t u a l l y do w i t h i n each a c t i v i t y and a t w ha t l e v e l

t h e y e o n s l d e n t h e y n e e d f u n t h e n e d u c a t i o n and

t n a l n l n g . The s u b j e c t ' s p e n e e l v e d n e e d w i l l

depend upon p n e v l o u s e x p e n l e n e e , k n o w l e d g e bas e

and c l i n i c a l s k i l l s and when t h e p a n t l e l p a n t l a s t

1 0 , 1 4

p n a e t l e e d . Eon e xa mp l e a l l t h e n e s p o n d e n t s

I d e n t i f i e d a need f o n t n a l n l n g f o n n u n n l n g

d i a b e t i c c l i n i c s , wheneas o n l y some I d e n t i f i e d a

n eed f o n n u n n l n g g e n e n a l h e a l t h p n o m o t l o n c l i n i c s ,

The p n a e t l e e n u n s e s I n v o l v e m e n t I n a l l t h e t a s k s

and a c t i v i t i e s l i s t e d I n t h i s s t u d y show t h a t

t h e n e I s an I n e n e a s e I n t h e nange o f t a s k s b o t h

n u n s l n g and n o n - n u n s l n g f nom t h e f i n d i n g s o f t h e

s t u d y o f G n e e n f l e l d e t a l [1 987] , I t ' wo ul d

appean fnom t h e d a t a t h a t a l t h o u g h t h e d l v e n s l t y

o f p n a e t l e e n u n s l n g n e m a l n s , t h e n e ane a l s o aneas

o f s p e c i a l i s t p n a e t l e e and a g n e a t e n I n v o l v ement

I n e e n t a l n a c t i v i t i e s , s u c h as c h i l d and

as thma c a n e . I t m i g h t be as sumed t h a t some

o f t h i s wonk, p n e v l o u s l y u n d e n t a k e n by g e n e n a l

p n a e t l t l o n e n s , has now been d e l e g a t e d t o p n a e t l e e

n u n s e s . I t was a l s o n o t i c e a b l e t h a t mone

p n a e t l e e n u n s e s wene u n d e n t a k l n g a w i d e n n a n ge o f

I n v e s t i g a t i v e p n o e e d u n e s . The, n ang e and t y p e of

I n v e s t i g a t i v e p n o e e d u n e was a f f e c t e d by t h e

l o c a t i o n o f t h e p n a e t l e e s , and n u n s e s won kl ng I n

10, 15

n u n a t s e t t i n g s and t n a l n l n g p n a e t l e e s wene mone

l i k e l y t o be I n v o l v ed I n t h i s a s p e c t o f p n a e t l e e

n u n s l n g . The d a t a I n d i c a t e s t h a t t h e n e I s

dev e l o p i n g a c l e a n d e m a n k a t l o n b e t w e e n some n u n s e s

who ane e mp lo ye d s p e c i f i c a l l y t o u n d e n t a k e

d e l e g a t e d t a s k s and o t h e n n u n s e s d e s i g n a t e d f o n

t h e p u n p o s e o f u n d e n t a k l n g h e a l t h p n o m o t l o n ,

s e n e e n l n g o f p a t i e n t s and d i s e a s e manag e m e n t ,

The d a t a do n o t p a n t l e u l a n l y h i g h l i g h t

S p e c i f i c e h a n a e t e n l s t l e s wh i ch s i n g l e o u t

p n a e t l e e s f nom o t h e n s who a ne f o l l o w i n g t h i s n o u t e

o f wonk s h a n l n g .

I t has been angued t h a t some o f t h e wonk p n a e t l e e

n u n s e s ane u n d e n t a k l n g , e s p e c i a l l y I f t h e y ane

wonk l ng on t h e l n own w i t h i n s m a l l p n a e t l e e s and

w i t h i n a l i m i t e d t ea m s t n u e t u n e , on w i t h i n

p n a e t l e e s l o c a t e d I n d e p n l v e d a n e a s , t h a t t h e

p n a e t l e e n u n s e ' s n o l e o v e n l a p s w i t h o t h e n pn l many

h e a l t h c a ne t eam c o l l e a g u e s , Ton e x a mp l e I n some

a s p e c t s o f c h i l d c a n e J e f f n e e ( 1992) angued t h a t

t h e p n a e t l e e n u n s e ’s n o l e o v e n l a p s w i t h t h a t

1 0 , 1 6

o f h e a l t h v i s i t o n s . Howeven, p n a e t l e e n u n se s

wonk l ng I n p n a e t l e e s l o c a t e d I n d e p n l v e d aneas

aim t o p n o v l d e h e a l t h c a ne on an o p p o n t u n l s t l e

b a s i s , b e c a u s e p a t i e n t s n a n e l y n e t u n n f o n f o l l o w -

up a p p o i n t m e n t s . T h e s e d a t a have a l s o shown t h a t

mone n u n s e s wonk lng I n p n a e t l e e s s i t u a t e d I n

d e p n l v e d aneas u n d e n t a k e a mone d l v e n s e and

e o m p n e h e n s l v e n o l e .

The Mew Genen al P n a e t l t l o n e n C o n t n a e t , ( 1990)

I n e n e a s e s t h e n e s p o n s l b l l l t y o f g e n e n a l

p n a e t l t l o n e n s f o n h e a l t h p n o m o t l o n , s e n e e n l n g and

a n t l e l p a t o n y c a n e . The g e n e n a l p n a e t l t l o n e n s

w i l l be e x p e c t e d t o d e v e l o p h e a l t h p n o m o t l o n

pnognammes t o m e e t t h e n eeds o f t h e p n a e t l e e

p o p u l a t i o n . T h e s e pnognammes w i l l I n c l u d e ,

s t o p s mok i ng pnognammes t o n e d u e e t h e n l s k o f

m o n t a l l t y and m o n b l d l t y f nom h y p e n t e n s l o n , h e a n t

d i s e a s e and s t n o k e . T h e s e a c t i v i t i e s w i l l be

d e l e g a t e d t o t h e p n a e t l e e n u n s e , ( Ha s l e n , 1992}

and a l n e a d y ane c a u s i n g e d u c a t i o n and t n a l n l n g

n e p e n e u s s l o n s f o n t h e p n a e t l e e n u n s e s u n d e n t a k l n g

10, 17

Suck activities.

The n u n s e s I n t h i s s t u d y h e l d a w i d e nange

o f p n o f e s s l o n a l and a ca d em ic q u a l i f i c a t i o n s , The

m a j o n l t y o f n u n s e s a c h i e v e d t h e l n p n o f e s s l o n a l

q u a l i f i c a t i o n s some t e n t o t h l n t y y e a n s ago.

T h i s I n f o n m a t l o n I m m e d i a t e l y h i g h l i g h t s t h e

d l v e n s l t y o f l e a n n l n g n e ed fnom n o t o n l y t h e nange

o f q u a l i f i c a t i o n s a c h i e v e d b u t a l s o t h e t i m e when

t h e y wene o b t a i n e d , V n a e t l e e n u n s e s have

u t i l i s e d t h e l n backgn oun d k no wl e d g e and s k i l l s I n

p n a e t l e e and dev e l o p e d t h e l n own u n i q u e body of

k n o w l e d g e f o n p n a e t l e e , Nunses may, be

n e t u n n l n g t o n u n s l n g p n a e t l e e a f t e n s e v e n a l yeans

bneak fnom n u n s l n g s e n v l c e . The e d u c a t i o n and

t n a l n l n g n ee ds o f a n u n s e e n t e n l n g p n a e t l e e

n u n s l n g a f t e n a numben o f yeans bneak I n n u n s l n g

p n a e t l e e w i l l h ave d l f f e n e n t l e a n n l n g n e e d s f nom a

n u n s e n e l a t l v e l y n e wl y q u a l i f i e d who has c h o s e n

p n a e t l e e n u n s l n g as t h e s p e c i a l i s t anea o f

p n a e t l e e , a l t h o u g h t h e n e I s no d a t a t o

s u b s t a n t i a t e t h i s a s s u m p t i o n . T h i s s t u d y d i d

1 0 , 1 8

n o t I d e n t i f y t h e s p e c i a l i s t anea I n w h ic h t h e

n u n s e was w onk lng p n l o n t o becom ing a p n a e t l e e

n u n s e . The p n e v l o u s c h a p t e n s , how even , d i d

I d e n t i f y t h a t a numben o f n u n s e s w o n k ln g I n

I n t e n s i v e c a n e u n i t s had c h o s e n p n a e t l e e n u n s ln g

I n onden t o e n t e n a d l f f e n e n t end p o i n t o f p a t i e n t

c a n e and become I n v o l v e d I n pnev e n t l v e n u n s ln g

p n a e t l e e . T h e s e d a t a f u n t h e n h i g h l i g h t t h e

d i lemma o f m e e t i n g t h e d l v e n s e l e a n n l n g n e e d s o f

p n a e t l e e n u n s e s . On t h e one hand t h e n e I s t h e

n u n s e who may h a ve been o u t o f p n a e t l e e f o n some

l e n g t h o f t i m e and n e e d s t h e o n e t l c a l as w e l l as

c l i n i c a l s k i l l s u p d a t i n g and on t h e o t h e n t h e n e I s

t h e n u n s e , n e l a t l v e l y n e w ly q u a l i f i e d h a v in g

wonked I n a h ig h t e c h n o l o g y I n t e n s l v e c a n e u n i t

and I s c o m p e t e n t I n t h e f i e l d o f t h i s

s p e c i a l i s t f i e l d o f n u n s l n g , who c h a n g e s d l n e c t l o n

and c h o o s e s t o become p a n t o f pn lm any c a n e n u n s ln g

and has e d u c a t i o n and l e a n n l n g n e e d s a s s o c i a t e d

w i t h pn lmany ca n e n u n s l n g .

I t I s I n t e n e s t l n g t o n o t e t h a t a numben o f n u n s e s

1 0 ,1 9

wene u n d e n t a k l n g a d d i t i o n a l n o l e s oven and a bove

t h o s e o f p n a e t l e e n u n s l n g . T h e s e a d d i t i o n a l

d u t i e s I n c l u d e d t h e d u a l n o l e o f p n a e t l e e managen

and p n a e t l e e n u n s e , p n a e t l e e n u n s e and

n e c e p t l o n l s t , p n a e t l e e n u n s e and d l s p e n s e n and

p n a e t l e e n u n s e and h e a l t h v l s l t o n , A numben o f

p n a e t l e e n u n s e s wene u n d e n t a k l n g t h e a c t i v i t i e s

b e c a u s e t h e y had been d e l e g a t e d t o them on t h e

n u n s e s wene u n d e n t a k l n g t h e t a s k s as p a n t o f t h e

p e n e e l v e d p n a e t l e e n u n s e s n o l e , on b e c a u s e t h e

p n a e t l e e was busy and t h e n u n s e was g i v i n g e x t n a

s u p p o n t t o c o l l e a g u e s ,

PART THREE

E d u c a t i o n and t n a l n l n g o p p o n t u n l t l e s and l e a n n l n g

n eed s

D i s c u s s i o n w i l l c e n t n e anound t h e e d u c a t i o n and

t n a l n l n g o p p o n t u n l t l e s I d e n t i f i e d by t h e

n e s p o n d e n t s * and t h e l n l e a n n l n g n e e d s . The d e t a i l

a b o u t s t u d y l e a v e , I n - s e n v l c e and I n - h o u s e

1 0 , 2 0

t n a l n l n g , p o s t - b a s i c e d u c a t i o n o p p o n t u n l t l e s and

t h e n ange o f pno f e s s l o n a l j o u n n a l s t h e n e s p o n d e n t s

nead w i l l be f o c u s e d upon I n t h e f l n s t I n s t a n c e

and l e a n n l n g n eed s n e l a t e d t o o c c u p a t i o n a l n o l e

s u b s e q u e n t l y .

S t u d y l e a v e

T h i s s u n v e y has shown t h a t s t u d y l e a v e I s n o t an

a u t o m a t i c e n t i t l e m e n t , The d a t a I d e n t i f i e d

t h a t mone t h a n t h n e e q u a n te n s o f t h e n e s p o n d e n t s

wene a l l o w e d t o a t t e n d s t u d y d a y s , b u t t h e a c t u a l

u p t a k e o f s t u d y l e a v e I n a yean was n e l a t l v e l y

S m a l l , 755 ( 33. 2%) o f t h e t o t a l n e s p o n d e n t s . The

numben o f s t u d y days o f f e n e d t o p n a e t l e e n u n s e s

wonklng I n t n a l n l n g p n a e t l e e s was h l g h e n (31%)

t h a n t h e s t u d y day a l l o c a t i o n I n n o n - t n a l n l n g

p n a e t l e e s (29%) and t h e n e s p o n d e n t s wene mone

l i k e l y t o be o f f e n e d mone s t u d y days w i t h an

a v e n a g e o f 4 days pen y e a n . T h i s I n f o n m a t l o n

c l a n l f l e s t h e c u n n e n e t s i t u a t i o n as I t n e l a t e s t o

s t u d y l e a v e a l l o c a t i o n . I t I s c l e a n , t h a t even

1 0 . 2 1

I f s t u d y days ane t n e o n p o n a t e d w i t h i n e o n t n a e t s o f

e m p lo y m e n t , I t I s no g u a n a n t e e t h a t t h e n u n se s

w i l l t a k e them and 3.2% of t h e t o t a l n e s p o n d e n t s

had n o t t a k e n a s t u d y day d u n ln g t h e p a s t y e a n .

T h e s e d a t a show t h a t t h e n e ane n e g l o n a l v a n l a t l o n s

I n t h e numben o f p a i d s t u d y days pen yean

a l l o c a t e d t o p n a e t l e e n u n s e s . In t h e s o u t h o f

England 21% o f t h e n u n s e s w onk lng I n t n a l n l n g

p n a e t l e e s had s p e c i f i c s t u d y days a l l o c a t e d them

w i t h i n c o n t n a c t u a l em p loym en t annang e m e n t s ,

wheneas I n t h e n o n th o f England I t was o n l y 16. 2%.

Thene I s a l s o n e g l o n a l v a n l a t l o n so f a n as t h e

numben o f s t u d y days t a k e n by p n a e t l e e n u n s e s w i t h

n u n s e s ’ I n t h e Mensey R e g io n t a k i n g t h e m o s t and

E a s t A n g l i a t h e f e w e s t . The g n e a t e n numben o f

n u n s e s a t t e n d e d fo n s t u d y days I n t h e Nonth E a s t

R e g io n .

The d a t a showed t h a t a l l t h e n u n s e s who a t t e n d e d

s p e c i f i c s t u d y days wene a l n e a d y u n d e n t a k l n g t h e

a c t i v i t i e s I n t h e l n p n a e t l e e , a l t h o u g h I t was n o t

1 0 . 2 2

c l e a n fnom t h e d a t a w h e th e n t h e n u n s e s wene

a t t e n d i n g t h e s t u d y days as an I n t n o d u c t l o n t o t h e

s u b j e c t on as an u p d a t e .

J n - S e n v l c e t n a l n l n g

The n e s p o n d e n t s I d e n t i f i e d t h e e o u n s e s w h ic h t h e y

had a t t e n d e d s i n c e b e i n g I n p o s t as a p n a e t l e e

n u n s e , 69 (14. 8%) o f t h e n e s p o n d e n t s had a t t e n d e d

e o u n s e s . The n u n s e s who had a t t e n d e d f o n t h e

e o u n s e s wene a l n e a d y u n d e n t a k l n g t h e n e l a t e d

a c t i v i t i e s .

I n - h o u s e t n a l n l n g

The p a n t l c l p a n t s d e t a i l e d t h e I n - h o u s e t n a l n l n g

t h e y had n e c e l v e d . The I n f o n m a t l o n I n c l u d e d t h e

S u b j e c t a n ea , by whom t h e t o p i c was t a u g h t and

w h e th en t h e s u b j e c t t a u g h t was a l s o a s s e s s e d , and

who u n d e n to o k t h a t a s s e s s m e n t . A l l t h e s u b j e c t s

I d e n t i f i e d by t h e n e s p o n d e n t s wene c l i n i c a l

a c t i v i t i e s and fonmed p a n t o f n o l e e x t e n t l o n . The

1 0 . 2 3

S u b j e c t s t a u g h t by t h e n u n s e s and t e c h n i c i a n s wene

a l s o a s s e s s e d wheneas t h e s k i l l s t a u g h t by a

g e n e n a l p n a e t l t l o n e n wene n o t a lw a ys a s s e s s e d .

Po s t - b a s i c e d u c a t i o n and t h e E n g l i s h N a t i o n a l

Boand P n a e t l e e Nuns e Co u n s e

Mone t h a n h a l f o f t h e s u b j e c t s had a t t e n d e d an

ap p n o v e d p n a e t l e e n u n s e c o u n s e , some 152 (32. 6%)

had c o m p l e t e d t h e c o u n s e p n l o n t o becom ing a

p n a e t l e e n u n s e and 219 (44. 1%) had u n d e n t a k e n t h e

c o u n s e s i n c e becoming a p n a e t l e e n u n s e . The

p a n t l c l p a n t s I d e n t i f i e d s u b j e c t a n ea s w i t h i n t h e

c o u n s e t h a t t h e y c o n s l d e n e d had a f f e c t e d p n a c t l s e

and a l s o s h o n t f a l l s I n t h e c o u n s e c o n t e n t . The

m a j o n l t y o f t o p i c s w h ic h t h e n e s p o n d e n t s ’

c o n s l d e n e d s h o u l d be I n c l u d e d I n s u b s e q u e n t

p n a e t l e e n u n s e e o u n s e s p n l n c l p a l l y n e l a t e d t o t h e

s u b j e c t s w h ic h wene b e in g I n t n o d u c e d as p a n t o f

t h e n e q u l n e m e n t s o f t h e New G en en a l P n a e t l t l o n e n

C o n t n a e t ( 1990) and I n c l u d e d h e a l t h s e n e e n l n g ,

and c h n o n l c d i s e a s e m anagem ent .

10 . 24

P n o f e s s l o n a l j o a n n a t s

The I m p o n t a n e e o f t h e pno f e s s l o n a l j o a n n a l as a

v e h i c l e f o n c o n t i n u i n g e d u c a t i o n was h i g h l i g h t e d ,

w i t h 449 [96, 4%) n e s p o n d e n t s n e a d ln g p n o f e s s l o n a l

j o u n n a l s t o keep p n o f e s s l o n a l l y u p d a t e d .

The n e s p o n d e n t s I d e n t i f i e d a w id e n a n g e o f

e d u c a t i o n and t n a l n l n g n eed s I n a l l a s p e c t s o f

t h e l n o c c u p a t i o n a l n o l e . The need f o n t n a l n l n g

was n o t t h e same fo n a l l a c t i v i t i e s . The

d i s c u s s i o n w i l l be s p e c i f i c t o t h e p e n c e l v e d n e ed s

o f t h o s e n e s p o n d e n t s ’ who ane u n d e n t a k l n g t h e

a c t i v i t i e s .

S p e c i f i c c l i n i c a l t a s k s and n u n s ln g p n oe e d u n e s

The g n e a t e s t n e q u e s t f o n w h ich t h e s u b j e c t s

I d e n t i f i e d a t n a l n l n g need was I n wound

m anagement , w i t h 85 ( 19. 2%) n e s p o n d e n t s ’ . T h i s

f i n d i n g was n o t s u n p n l s l n g b e c a u s e o f t h e

v a n l e d co m p le x s t n a t e g l e s o f wound manag e m e n t .

. 1 0 . 2 5

H e a l t h S u n v e l l l a n e e

H e a l t h s e n e e n l n g I s a new a s p e c t o f ' n u n s ln g

I n t e n v e n t l o n w h ich u n t i l n e c e n t l y has n o t been

I n c l u d e d I n g e n e n a l n u n s e t n a l n l n g . H e a l th

s u n v e l l l a n c e , howeven, was an I n t e g n a l p a n t o f t h e

New G enena l P n a e t l t l o n e n C o n t n a e t o f 1990 and

s e n e e n l n g became a majon a s p e c t o f p n a e t l e e

n u n s l n g . I t was n o t s u n p n l s l n g , t h e n e f o n e , t h a t

t h e n e s p o n d e n t s ’ I d e n t i f i e d h ig h l e v e l s co n cen n

I n t h i s a s p e c t o f t h e l n n o l e .

C l i n i c a l e x a m i n a t i o n s

The l e a n n l n g needs o f t h e n e s p o n d e n t s ’ w i t h i n t h i s

a s p e c t o f t h e l n n o l e a l s o h i g h l i g h t e d t h e d i lemma

I n w h ic h some n u n s e s ’ fo u n d t h e m s e l v e s . Many o f

t h e c l i n i c a l e x a m i n a t i o n s n e l a t e t o n o l e e x t e n t l o n

and o c c u n n e d as a n e s u l t o f t h e New G enena l

P n a e t l t l o n e n C o n t n a e t ( 1990) and t h e s t a t u t o n y

n e q u l n e m e n t s I d e n t i f i e d w i t h i n t h e G enena l

P n a e t l t l o n e n ’s Tenms and C o n d i t i o n s o f S e n v l c e

1 0 . 2 6

( 1 9 9 0 ) .

Tnve.itJiQatX.oni

\Jeny many mone I n v e s t i g a t i o n s wene b e in g

u n d e n t a k e n w i t h i n p n a e t l e e , e l t h e n b e c a u s e

h o s p i t a l f a c i l i t i e s wene some d i s t a n c e fnom t h e

p n a e t l e e s i t e and p a t i e n t ’s w o u ld h a v e lo n g

d i s t a n c e s t o t n a v e l , on b e c a u s e p n a e t l e e s wen.e

p l a c e d w i t h i n d e p n l v e d a n e a s , and t h e p a t i e n t ’s

a t t e n d i n g fo n c o n s u l t a t i o n wene a l s o I n v e s t l g a t e d

o p p o n t u n l s t l c a l l y b e c a u s e o f t h e p n o b lem o f poon

p a t i e n t f o l l o w - u p a t t e n d a n c e . F u n th en n e a s o n s may

h a ve been due t o t h e o v e n a l l c h a n g e I n e m p h a s i s

and t h e n o t i o n o f p n o v l d l n g a e o m p n e h e n s l v e

s e n v l c e f o n p a t i e n t ’s , and a d d n e s s l n g t h e

c o n s t n a l n t s o f u n e m p lo ym e n t w h ic h wene b e in g

e n c o u n t e n e d a t t h e t i m e o f t h i s s t u d y . The

s u b j e c t s wene ven y I n v o l v ed I n u n d e n t a k l n g

I n v e s t i g a t i v e p n o e e d u n e s and t h i s was an anea o f

c o n cen n and need fo n c o n t i n u i n g t n a l n l n g .

1 0 . 2 7

C l i n i c s

Thcnc w e n t c c n t a l n c l i n i c s w h ich t h e n e s p o n d e n t s '

e x p n e s s ed n ee d f o n t n a l n l n g was g n e a t e n t h a n

o t h e n s . A l l t h e p a n t l c l p a n t s wene c o n c e n e d a b o u t

n u n n ln g V lab e t l c and Asthma c l i n i c s and o t h e n s

wene c o n c e n n e d a b o u t t n a v e l l e n ’s h e a l t h c l i n i c s ,

s t o p sm o k in g and d i e t and e x e n c l s e . The d l n e c t

n e s p o n s l b l l l t y o f o p e n a t l n g a n u n s e nun c l i n i c

I s a n e l a t l v e l y new I n n o v a t i o n so I t was n o t

s u n p n l s l n g t o s e e s u c h a h i g h demand f o n f u n t h e n

e d u c a t i o n and t n a l n l n g I n t h i s a s p e c t o f t h e

p n a e t l e e n u n s e ’s n o l e .

C h l l d n e n

Vanlous a s p e c t s o f c h i l d ca n e wene h i g h l i g h t e d by

t h e n e s p o n d e n t s . By f a n t h e g n e a t e n m a j o n l t y

I d e n t i f i e d t h e l n n e e d f o n t n a l n l n g I n t h e

I m m u n i s a t i o n and v a c c i n a t i o n pnognammes f o n

c h l l d n e n 403 186.4%) n e s p o n d e n t s . Othen aneas

o f c o n c e n n I n c l u d e d c h i l d h o o d I l l n e s s e s , a b u s e d

1 0 . 2 8

c h l t d n e n , and c h i l d dev e l o p m e n t and s u n v e l l l a n c e .

I t was n o t p o s s i b l e t o d e t e n m l n e t h e d e g n e e o f

I n v o l v e m e n t I n t h e s e a neas o f s p e c i a l i s t c h i l d

ca n e b u t t h e c n o s s t a b u l a t i o n d i d show t h a t whene

s u c h a c t i v i t i e s wene b e in g u n d e n t a k e n by t h e

p n a e t l e e n u n s e p n l n c l p a l l y t h e y wene I n p n a e t l e e s

s i t e d I n d e p n l v e d a neas and I n p n a e t l e e s whene

t h e n e wene l i m i t e d p n lm any h e a l t h ca n e t e a m s .

T h e s e d a t a have h i g h l i g h t e d t h e p nob lem s

a s s o c i a t e d w i t h d e v e l o p i n g a c e n t n a l c u n n lc u lu m

fo n p n a e t l e e n u n s e s n o t o n l y b e c a u s e o f t h e

d l v e n s l t y o f t h e l n n o l e b u t a l s o b e c a u s e o f t h e

v a n l e d p n o f e s s l o n a l k n o w le d g e b a ses and s k i l l s

fnom w h ic h t h e y come. The d a t a h a ve a l s o

h i g h l i g h t e d c o n c en n s a b o u t pno f e s s l o n a l c o l l e a g u e s

becoming p n a e t l e e n u n s e w i t h o t h e n t h a n a n u n s ln g

q u a l i f i c a t i o n . I f p n a e t l e e n u n s ln g does become

d l n e c t e n t n y t h e n t h e t y p e s o f t n a l n l n g w i l l

n e q u l n e d l f f e n e n t b o d i e s o f k n o w le d g e and t h e

s t n u e t u n e w i l l a l s o n e e d t o be d l f f e n e n t . The

I n f o n m a t l o n I n t h i s s t u d y n e l a t e s t o t h e s t a g e o f

1 0 . 2 9

dev e l o p m e n t o f p n a e t l e e n u n s ln g as I t I s now, when

I t I s dnawlng p e o p l e f nom t h e d l f f e n e n t bna n eh es

o f n u n s l n g . B e ca u se n u n s e s e n t e n p n , a c t l c e

n u n s ln g w i t h a w id e v a n l e t y o f k n o w l e d g e b a s e s ,

e x p e n l e n e e and s k i l l s t h e d a t a f nom t h i s s t u d y

have h i g h l i g h t e d I n t e n e s t l n g p o i n t s a b o u t

s p e c i a l i s m w i t h i n t h e w o n ld o f n u n s l n g . I f an

I n i t i a l t n a l n l n g c o u n s e wene t o be d e v e l o p e d I t

would n o t I n c l u d e t h e w h o le b n e a d th o f m o d u le s

w h ich an e I n c l u d e d I n t h i s nes eanch b u t m i g h t mone

a p p n o p n l a t e l y be u n d e n t a k e n I n g e n e n a l p n a e t l e e

w i t h g n e a t e n em phas is p l a c e d on p n a e t l e e I t s e l f .

The c h a p t e n w h ic h f o l l o w s dnaws c o n c l u s i o n s f nom

t h e S u n v e y , I d e n t i f i e s s t n e n g t h s and w e a k n e s s es o f

t h e s t u d y and makes n e co m m e n d a t lo n s f o n b o t h

p o l i c y and f u n t h e n n e s e n a c h .

1 0 . 3 0

C H A P T E R E L E V E N

CONCLUSIONS ANV RECOMHENVATIOHS

I n t n o d u c t l o n

T h i s has been an e x t e n s i v e s t u d y w h ic h has

c o l l e c t e d a c o n s l d e n a b l e amount o f d a t a a b o u t

p n a e t l e e n u n s e s and p n a e t l e e n u n s l n g . The d a t a

c o n f ln m t h e d l s p a n a t e n a t u n e o f t h e p n a e t l e e n u n s e

and h i g h l i g h t s t h e w i d e and v a n l e d o c c u p a t i o n a l

n o l e f o n w h ich t h e n e I s a t p n e s e n t no c l e a n

b o u n d a n y . The d a t a a l s o c o n f l n m t h e d l v e n s l t y o f

t h e p n a e t l e e n u n s e ’s s e l f - p e n e e l v e d e d u c a t i o n and

t n a l n l n g n e e d s .

The f i n d i n g s f nom t h i s n e s e a n c h I d e n t i f i e d a l a n g e

and gnowlng wo n k f o n c e , t h e m a j o n l t y o f w h ic h wonk

p a n t - t l m e . The p n a e t l e e n u n s e s e n t e n e d p n a e t l e e

n u n s ln g w i t h a w i d e n a n g e o f pno f e s s l o n a l

q u a l i f i c a t i o n s and u t i l i s e d t h e l n ba ckg n o u n d

k n o w led g e and s k i l l s t o d e v e l o p t h e l n own p e n s o n a l

1 1 . 1

body o f kn o w le d g e fo n p n a e t l e e .

P n a e t l e e n u n s ln g I s p n e d o m l n a n t l y a f e m a l e

o c c u p a t i o n and t h e n e s p o n d e n t s I n t h i s s u n v e y wene

a l l f e m a l e . The age n a n g e o f t h e p a n t l c l p a n t s

was f nom 22 yeans - 62 y e a n s w i t h t h e m a j o n l t y o f

p n a e t l e e n u n se s I n t h e s t u d y aged 30 - 49 y e a n s .

The S u n v e y d i d show n e g l o n a l v a n l a t l o n I n age

d l f f e n e n e e w i t h p n a e t l e e n u n s e s I n t h e s o u t h o f

E ngland b e in g o ld e n t h a n t h o s e I n t h e n o n t h o f

E n g la n d . Most n e s p o n d e n t s wene m ann led w i t h o n l y

a s m a l l m l n o n l t y b e in g s i n g l e .

The m a j o n l t y o f n u n s e s wene n e g l s t e n e d g e n e n a l

n u n s e s , and mone t h a n h a l f o f t h e n e s p o n d e n t s h e l d

mone t h a n one q u a l i f i c a t i o n w i t h t h e m o s t common

c o m b i n a t i o n b e ing n e g l s t e n e d g e n e n a l n u n s e and

n e g l s t e n e d m i d w i f e . J t was s u n p n l s l n g t o f i n d

t h a t six. n e s p o n d e n t s wene d l n e c t e n t n y m ld w lv e s

em ployed as p n a e t l e e n u n s e s . The g n e a t e n

numben o f s u b j e c t s wene e n t e n e d on t h e

p n a c t l s l n g n e g l s t e n o f t h e U n i t e d Kingdom C e n t n a l

CouYicll f o n N u n s e s , M ldwlves and Health. V i s i t o n s

and a l l n e s p o n d e n t s had I n d e m n i t y I n s u n a n c e c o v e n .

The g n e a t e n numben o f p a n t l c l p a n t s wene n o t o n l y

c o v e n e d f o n I n s u n a n c e by t h e R oya l C o l l e g e o f

n u n s ln g b u t a l s o wene membens o f t h e p n a e t l e e

n u n s e fonum o f t h e c o l l e g e .

Many o f t h e n u n s e s I n t h e s t u d y had a gap I n

n u n s ln g p n a e t l e e I n onden t o u n d e n t a k e f a m i l y

c o m m i tm e n t s . G e n en a l p n a e t l t l o n e n s c o n t i n u e t o

employ p n a e t l e e n u n s e s I n t h e o l d e n age gnoup w i t h

f a m i l y l i f e e x p e n l e n e e and n o t n e c e s s a n l l y fo n

t h e l n pno f e s s l o n a l q u a l i f i c a t i o n . The n u n s e s I n

t h e S u n v e y I d e n t i f i e d a numben o f a c a d e m ic

q u a l i f i c a t i o n s w h ic h t h e y h e l d , a l t h o u g h t h e s e

d i d n o t appean t o be s i g n i f i c a n t e l t h e n fo n

emplo y m e n t s e l e c t i o n on p n a e t l e e .

The n u n s e s I n t h e s t u d y wonked I n a w id e n a n g e o f

e n v l n o n m e n t s , some o f w h ich wene p u n p o s e b u i l t

s u n g e n l e s on h e a l t h c e n t n e s and t h e n em a ln d en wene

a d a p t e d p n e m l s e s . The a c t u a l f a c i l i t i e s w i t h

7 7 . 3

(jüktck the, YLVLfi e, u}OKke,d 6ac.h a6 the, nu.n.6e, h a v tn g

he,fi own t^e .a tm e,n t %oom c .on6u.t t tng fioom Ifiom

whJLch t a p ^ a c t t c e , and compute,^ and te,te,phone,

6y6te,m6 we,ae, n e t le,atan,e,6 whJich we,n.e, ae,c.oade,d t n

thJi6 6 t a d y ,

Wot e t h a n h a t ^ p^ac.tjic.e,6 t n the, 6aave,y

we,n.e, appfLOve,d ge,ne,Kat p ^ a c t t t t o n e . ^ t ^ a t n t n g

paacttcie .6 and the,n.e, we,fit c te ,aa a d v a n ta g e,6 ion.

tho6e. who we,ne, e,mpZoye,d t n t n a t n t n g

pfiac.tJic.e.6. The, nan.6e,6 had the. advantage , o i

w onk tng w t t h a i u t t 6 u p p o n t te.am and a nange. o i

pn. 0 i e .^4 i tona t ^ t a ü who we.ne. a t t a c h e d t o the.

p a a c t t a e , . The. nan.^e.6 a ^ u a t t y wonke.d w t t h

othe.n nan.6e, c.oZte.ague.6 and c.te.an.ty had mone,

o ppon . tan t tJ iz6 t o a t te .n d pn.ac.tJic.e. pn tm any

h e ,a t th cane, te,am me.e.tJing^ on a ne.gatan ba6À.6

t h o a g h o a t the. ye.an. Jn a d d t t t o n nanie.6

wonktng t n ge.ne.naZ pna c tZ tZ o n e ,n tnaZ nZ ng

p n a c tZ c c 6 we.ne. anZtke.Zy t o be. ande.ntakZng othe.n

t h a n nan^Zng datJie.6, b a t Z i two on mone.

ie.maZe. ge.ne.naZ pnac tZ tZone .n6 ionme.d p a n t on the.

7 7 . 4

t o t a l m tdJical t e a m , pnac tZce , nan6Z6 wonkZng t n

6ac.h. a tea m w o u ld n o t be u n d e n t a k l n g 6 u e k an

e x t e n s i v e enhanced n o i e .

The d a t a h i g h l i g h t e d t h e v a n l a t l o n I n em p lo ym en t

a n n a n g e m e n té . The m a j o n l t y o i p n a c t l c e n u n ^eé

p a n t l c l p a t l n g I n t h e 6 t u d y wene em p lo y e d by t h e

p a n t n e n i o i t h e p n a c t l c e , U eanly t h n e e q u a n te n 6

o i t h e n e ^ p o n d e n t6 had c o n t n a c t 6 o i em p lo ym en t

b u t n o t a l l o i t h o 6 e nun^e6 a l6 o had j o b

d e ^ c n l p t l o n ^ , Nun^e-i em p lo yed I n g e n e n a l

p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ wene c l e a n l y a t an

a d v a n t a g e and wene mone l i k e l y t o h o l d j o b

d e 6 c n l p t l o n 6 and c o n t n a c t i o i e m p lo y m e n t .

The m a j o n l t y o i n e ^ p o n d e n t ^ wene c o n t n a c t e d t o

wonk p a n t - t l m e , w i t h t h e a v e n a g e houn6 wonked

b e in g b e tw e e n 22 and 23 houn6 and t h e n e wene a

6 m a l l numben who wene c o n t n a c t e d a6 i u l l - t l m e

membené o i 6 t a i i . The nun^e6 I n t h e ^ t u d y had

n o t had a p e n io n m a n c e n e v l e w n e l t h e n had any o i

t h e nun6e6 c o m p l e t e d an I n d u c t i o n pnognamme p n l o n

t o becoming a p n a c t l c e n u n ^ e .

7 7 . 5

A l t t h e d a t a h i g h l i g h t e d t h e d l H l e a l t y t h e nan6e6

e n e o a n t e n e d I n b e in g ne lea-éed inom p n a e t l e e t o

pan6ue i u n t h e n p n o i e 6 6 l o n a l 4 t u d l e 6 . Some nun4»e6

had n e e e l v e d ln~hou4>e t n a l n l n g and o th e n 6 had been

a b l e t o a n d e n t a k e 6 t u d l e 6 a6 p a n t o i l n ^ 6 e n v l e e

t n a l n l n g . Howeven, n o t a l l t h e c l i n i c a l ta6k4>

w h ich wene t a u g h t wene a l6 o a66e66ed 6o t h e l4>6ue

o i c o m p e t e n t p n a c t l t l o n e n io n e n h a n c e d n o t e

a c t i v i t y wa6 a p nob lem io n 6ome n e ^ p o n d e n t 6 .

S p e c l i l c l e a v e i o n 4>tudy wa6 n o t an a u t o m a t i c

e n t i t l e m e n t . I n t h e 6 u n vey mone t h a n t h n e e

q u a n te n ^ o i t h e n e 6 p o n d e n t6 wene a l l o c a t e d 6 t u d y

l e a v e b u t t h e a c t u a l u p t a k e o i 6 t u d y l e a v e wa6

6 m a l l . I t l 6 a p p a n e n t inom t h l 6 l u n v e y t h a t l i

6 t u d y day^ an e a l l o c a t e d t o nun4>e6 w i t h i n

c o n t n a c t ^ o i em p lo ym en t t h l 6 l 6 no g u a n a n t e e t h a t

t h e nun^e6 w i l l t a k e th e m . The numben o i 6 t u d y

day6 o i i e n e d t o nun6e6 wonk lng I n g e n e n a l

p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ wa-5 i l g n l i l c a n t l y

h lg h e n t h a n t h e 6 t u d y day a l l o c a t i o n I n non-

t n a l n l n g p n a c t l c e ^ . Thene can be a numben o i

1 1 . 6

necL^on6 i o n t ( i l 6 . I t m i g h t be a66VLmed t h a t

g e n e n a l p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ ane mone

awane and a t a n e d t o t h e n e e d i o n c o n t i n u i n g

e d u c a t i o n and pno i e ^ ^ l o n a l u p d a t i n g . k n o t h e n

nea6on m i g h t be n e l a t e d t o t h e i a c t t h a t g e n e n a l

p n a c t l t l o n e n t n a l n l n g p n a c t l c e ^ employ mone

n un6e6 , t h e n e i o n e , I t m i g h t be e a ^ l e n i o n a n u n ^ e

w i t h i n a n u n 6 ln g te a m t o be n e l e a ^ e d io n à t u d y

l e a v e . But t h a t angum en t can be d i s c o u n t e d

b e c a u s e p n a c t l c e n u n s e s I n g e n e n a l p n a c t l t l o n e n

t n a l n l n g p n a c t l c e s an e u n d e n t a k l n g mone e x t e n d e d

n o l e a c t i v i t i e s and a n u n s e away i o n s t u d y l e a v e

w ould l e a v e a gap I n s e n v l c e p n o v l s l o n .

The d a t a d e t a i l e d I n T a b l e A ( A p p e n d ix Ix) showed a

s l g n l i l c a n t d l H e n e n c e and a p o s i t i v e n e l a t l o n s h l p

b e tw e e n t h e c o n t n a c t e d houns t h e n e s p o n d e n t s

wonked and t h e a l l o c a t i o n o i s t u d y l e a v e and I n -

s e n v l c e t n a l n l n g . P n a c t l c e n u n s e s c o n t n a c t e d t o

wonk b e tw e e n 22 and 23 houns wene s l g n l i l c a n t l y

a l l o c a t e d mone s t u d y l e a v e and I n - s e n v l c e

t n a l n l n g .

7 7 . 7

T n a ln ln g and E d u c a t i o n

T h i s s t u d y has shown t h e w i d e v a n l a t l o n

I n a c t i v i t i e s t h e n u n s e s u n d e n t a k e ,

t h e d l v e n s l t y o i t h e p n a c t l c e n u n s e ' s n o t e

and t h e v a n l e d n a t u n e o i p n a c t l c e n u n s l n g .

The n e e d io n t n a l n l n g and e d u c a t i o n

I d e n t l i l e d by t h e n e s p o n d e n t s I s e q u a l l y

d l v e n s e and w i d e n a n g ln g b u t any p n o v l s l o n

n eed s t o be c o n s l d e n e d w i t h i n t h e w id en

c o n t e x t o i pn lm any ca n e n u n s l n g , i u t u n e

p o l i c y i o n h e a l t h c a n e p n o v l s l o n w i t h i n t h e

pn lm any ca n e s e t t i n g and a g a i n s t t h e

knowledg e b a s e t h e n u n s e s p o s s e s s .

The m a j o n l t y o i p n a c t l c e n u n s e s h a ve

a c h i e v e d R e g l s t e n e d G enena l Nunse and

t h e i a c t t h a t s i x n e s p o n d e n t s I n t h i s

s t u d y wene d l n e c t e n t n y m ld w lv e s was an

u n u s u a l and u n e x p e c t e d i l n d l n g . P n a c t l c e

n u n s ln g I s c l e a n l y made up inom t h e

a m a lg a m a t io n o i s e g m e n t s o i p n o i e s s l o n a l

k n o w l e d g e a n d s k i l l s w h i c h t h e p n a c t l c e

n u n s e s u t i l i s e I n p n a c t l c e . P n a c t l c e

n u n se s h a v e d e v e l o p e d t h e l n own p e n s o n a l

body o i knowledg e t o m e e t t h e demands o i

p n a c t l c e w i t h i n t h e e n v l n o n m e n t w i t h i n w h ich

t h e y wonk and t h e n e can be l i t t l e d o u b t t h a t

p n a c t l c e n u n s ln g has d e v e l o p e d b e c a u s e

n u n s e s h a v e been a b l e t o d e v e l o p s e n v l c e s

inom t h e s k i l l s t h a t t h e y a l n e a d y p o s s e s s .

P o s t - b a s i c pno i e s s l o n a l e d u c a t i o n has been t o d a t e

veny p a t c h y and u n c o - o n d l n a t e d . I t was

some o i t h e g e n e n a l p n a c t l t l o nens ba ck I n t h e

1 9 7 0 ^s who i l n s t n e c o g n l s e d t h e l n c o l l e a g u e s need

io n e d u c a t i o n a l s u p p o n t t o e n a b l e th e m t o

u n d e n t a k e some o i t h e p n o c e d u n e s and t a s k s w h ich

t h e d o c t o n s wene d e l e g a t i n g t o th e m , (N o u n ln ,

1980) . T h e s e c o u n s e s and s t u d y days wene o n l y

a d d n e s s l n g , howeven, n e c o g n l s e d s k i l l s t n a l n l n g

s h o n t c o m l n g s , ( Reedy , 1 9 8 0 ) . The R o y a l C o l l e g e

o i N u n s ln g , a i t e n l o n g d e l l b e n a t l o n s ,

necommended t h a t t h e i o u n n a t i o n a l boands

1 1 . 9

i o n n u n s ln g e s t a b l i s h a t e n day e o a n s e io n

p n a c t l c e n u n s e s , inom an I d e n t l i l e d , p la n n e d

c e n t n a l c u n n l c u l u m , t h e c o n t e n t o i w h ic h w ou ld

I n c l u d e pno i e s s l o n a l n o l e d e v e l o p m e n t , t n e a t m e n t

noom p n o c e d u n e s and t e c h n i q u e s and management o i

t h e t n e a t m e n t noom. T h i s c o u n s e has now become

e s t a b l i s h e d t n a l n l n g i o n p n a c t l c e n u n s e s and t h e n e

ane ap p n o ved c o u n s e s e s t a b l i s h e d t h n o u g h o u t t h e

U n i t e d Kingdom. The d i s c u s s i o n e a n l l e n I n t h i s

t h e s i s I d e n t l i l e d t h e d l H l c u l t y n u n s e s ha ve

e x p e n l e n c e d I n b e in g n e l e a s e d inom p n a c t l c e

b e c a u s e o i t h e l n p a n t - t l m e w onk lng houns and a l s o

b e c a u s e o i t h e s m a l l management s t n u c t u n e w i t h i n

w h ich t h e n u n s e s wonk. G en en a l p n a c t l t l o n e n s ane

n e l u c t a n t t o n e l e a s e t h e l n n u n s e c o l l e a g u e s t o

a t t e n d io n s t u d y l e a v e b e c a u s e t h e n e I s no one t o

do t h e l n wonk when t h e y an e away inom t h e

p n a c t l c e . The E n g l i s h N a t i o n a l Boand n e v l e w o i

t h e p n a c t l c e n u n s e c o u n s e s ( 1990) io u n d t h a t t h e

n u n se s wene i l n d l n g I t d l H l c u l t t o a t t e n d b e c a u s e

o i t h e c o s t , b e in g n e l e a s e d inom p n a c t l c e and t h e

d l i i l c u l t y o i t n a v e l l l n g l o n g d i s t a n c e s t o

1 1 . 1 0

I n s t i t u t e s o i h lg h e n e d u c a t i o n , Hodes ( 1990) came

t o s l m l t a n c o n c l u s i o n s and t h i s s t u d y has i u n t h e n

s u b s t a n t i a t e d t h i s p n o b lem . I t has shown t h a t

d e s p i t e s t u d y l e a v e b e in g p a n t o i e m p lo y m e n t

a n n a n g e m e n t s , veny iew o i t h e p n a c t l c e n u n s e s t o o k

mone t h a n one s t u d y day I n t h e p n e v l o u s y e a n .

T h e s e d a t a a l s o I d e n t l i l e d t h e s h o n t i a l l I n t h e

c u n n l c u l u m c o n t e n t o i p n a c t l c e n u n s e c o u n s e s , and

t h e n e s p o n d e n t s ’ s p e c l i l e d t h o s e t o p i c s w h i c h t h e y

c o n s l d e n e d s h o u l d be I n c l u d e d I n s u b s e q u e n t

c o u n s e s .

Othen e d u c a t i o n a l I n i t i a t i v e s h a ve I n c l u d e d

I n d u c t i o n pnognammes c o n v e n e d by F a m i ly H e a l t h

S e n v l c e A u t h o n l t l e s , V l s t n l c t H e a l t h A u t h o n l t l e s

and R e g i o n a l H e a l th A u t h o n l t l e s , b u t n o t on e o i

t h e n e s p o n d e n t s I n t h i s s t u d y had a t t e n d e d s u c h an

I n d u c t i o n pnognamme. The m a j o n l t y o i p n a c t l c e

n u n s e s h a v e s u p p l e m e n t e d t h e l n own s h o n t i a l l s I n

s k i l l s and e d u c a t i o n io n p n a c t l c e as t h e y

n e c o g n l s e d a need and h a v e e l t h e n a t t e n d e d

h o s p i t a l o u t - p a t i e n t s , nead j o u n n a l s on a t t e n d e d

7 7 . 77

s t u d y d a y s . I n a d d i t i o n t o m e e t in g t h e l n own

e d u c a t i o n and t n a l n l n g n e e d s , mone e x p e n l e n c e d

p n a c t l c e n u n s e s h a v e become ’n u n se m e n t o n s ’ t o

s u p p o n t ’new' p n a c t l c e n u n s e s . T h is s u p p o n t has

o i i e n e d p n o i e s s l o n a l a d v i c e and some h a v e become

I n v o l v e d I n t h e t e a c h i n g o i s k i l l s and o t h e n s

o i i e n m onal and c a n i n g s u p p o n t .

L ca n n in g Needs:

The n e s p o n d e n t s I d e n t l i l e d a w id e n a n g e o i

e d u c a t i o n and t n a l n l n g n eed s I n a l l a s p e c t s o i

t h e l n p n o i e s s l o n a l n o l e I n n e s p e c t l v e o i w h e th e n

t h e I n d i v i d u a l had s t u d i e d t h e s u b j e c t and

c o m p l e t e d s k i l l s t n a l n l n g . The s t u d y d i d n o t

compane l e a n n l n g n e e d s w i t h t h e l e n g t h o i t i m e t h e

n e s p o n d e n t s had been p e n io n m ln g t h e a c t i v i t y ,

n e l t h e n d i d t h e s u n v e y c o l l e c t I n i o n m a t l o n a b o u t

t h e n e s p o n d e n t s ’ p o s t - n e g l s t n a t l o n e x p e n l e n c e .

I t I s n e c o g n l s e d t h a t some p a n t l c l p a n t s m i g h t h a ve

I d e n t l i l e d e d u c a t i o n and t n a l n l n g n e e d s even

t h o u g h t h e y had s p e c l i l c backgnound know ledg e and

n . 1 2

s k i l l s n e l a t e d t o t h e s u b j e c t anea i o n w h ic h t h e y

had I d e n t l i l e d a l e a n n l n g n e e d . I t m i g h t be

c o n j e c t u n e d t h a t t h o s e who wene u n d e n t a k l n g t h e

a c t i v i t y wene w a n t in g c o n i l n m a t l o n t h a t w h a t t h e y

wene d o in g was w i t h i n t h e b o u n d a n le s o i c u n n e n t

pno i e s s l o n a l p n a c t l c e .

The s t u d y d i d show t h a t n e a n l y h a l i o i t h e

n e s p o n d e n t s c o n s l d e n e d t h e y wene u n d e n t a k l n g

e x t e n d e d n o l e a c t i v i t i e s and p n a c t l c e n u n s e s

wonk lng I n g e n e n a l p n a c t l t l o n e n t n a l n l n g p n a c t l c e s

wene s l g n l i l c a n t l y mone l i k e l y t o be p e n i o n m l n g

an e n h a n c e d n o l e t h a n p n a c t l c e n u n s e s w o n k ln g I n

n o n - t n a l n l n g p n a c t l c e s . Thene wene o t h e n

s l g n l i l c a n t d l H e n e n c e s I d e n t l i l e d I n t h e

s t u d y w h ic h d e t e n m l n e d w h e th e n t h e n u n s e

would u n d e n t a k e e x t e n d e d n o l e a c t i v i t i e s I n

p n a c t l c e . Ton e x a m p le , whene p n a c t l c e s

had a m e d i c a l team c o n s i s t i n g o i two on

mone i e m a l e g e n e n a l p n a c t l t l o n e n s , p n a c t l c e

n u n se s wonk lng I n s u c h a p n a c t l c e e n v l n o n m e n t

wou ld be l e s s l i k e l y t o be p e n io n m ln g an

n . 1 3

e n k a n c e d n o t e . P n a e t l e e n u n s e s h o l d i n g t h e

pno i e s s l o n a l q u a l l i l e a t l o n o i d l s t n l e t n u n s e

on h e a l t h v l s l t o n wene s l g n l i l c a n t l y

u n d e n t a k l n g a mone d l v e n s e en h a n ced n o l e t h a n

n u n s e s w i t h o u t s u c h q u a l l i l c a t l o n s . k n o t h e n

s l g n l i l c a n t i e a t u n e I n t h e s t u d y n e l a t e d t o

t h e c o n t n a c t e d houns wonked by t h e

n e s p o n d e n t s . P n a c t l c e n u n s e s c o n t n a c t e d t o

wonk b e tw e e n 22 and 23 houns pen week wene

p e n io n m ln g an e n h a n ced n o l e and p n a c t l c e

n u n s e s u n d e n t a k l n g e x t e n d e d n o l e a c t i v i t i e s wene

s l g n l i l c a n t l y mone l i k e l y t o h a v e j o b d e s c n l p t l o n s

and t h o s e n u n s e s u n d e n t a k l n g e x t e n d e d n o l e

a c t i v i t i e s s l g n l i l c a n t l y wene o U e n e d mone

l e a n n l n g opp o n t u n i t i e s . Nunses p e n i o n m l n g an

e n h a n c ed n o l e wene s l g n l i l c a n t l y w o n k ln g t o

p n o t o c o l s . T h i s means t h a t t h e m a j o n l t y o i

n e p o n d e n t s d i d n o t have p n o t o c o l s t o w h ic h t h e y

wonked and I t I s I m p o n t a n t t o u n d e n s t a n d why o t h e n

p n a c t l t l o n e n s d i d n o t h a ve s u c h p n o t o c o l s .

The p n a c t l c e n u n s e s ' s e l i - p e n c e l v e d e d u c a t i o n and

1 1 . 1 4

t n a l n l n g n e e d s I d e n t i f i e d I n t h i s s t u d y n e l a t e n o t

o n l y t o t h e I n d i v i d u a l ’s b a ckgnound k n o w le d g e and

s k i l l s b a s e b u t a l s o t o o t h e n s p e c i f i c f e a t u n e s

a s s o c i a t e d w i t h p n a c t l c e n u n s l n g . Such as t h e

p a n t - t l m e n a t u n e o f t h e o c c u p a t i o n , t h e v a n l a t l o n

I n t h e knowledg e and s k i l l s b a s e t h e n u n s e

a c t u a l l y u t i l i s e I n p n a c t l c e , and t h i s w i l l be

d l f f e n e n t f o n each p n a c t l c e n u n s e and t h e demands

o f p n a c t l c e .

Recom mendat ions

Any e d u c a t i o n a l p n o v l s l o n w i l l need t o t a k e I n t o

a c c o u n t t h e s p e c i f i c f e a t u n e s o f p n a c t l c e n u n s l n g .

I t w ou ld appean t h a t t h e p n a c t l c e n u n s e ’s em p lo yen

I s mone l i k e l y t o be s y m p a t h e t i c t o a modulan

e d u c a t i o n a l ap p n o a ch . Such an appnoach a l l o w s

fo n f l e x i b i l i t y and a c c e s s i b i l i t y I n d e s i g n and

o f f e n s t h e n u n se s t h e o p p o n t u n l t y t o b u i l d on t h e

k n o w le d g e and e x p e n t l s e t h e y a l n e a d y p o s s e s s . I f

t h e m o d u le s wene a l s o t n a n s p o s ed I n t o d i s t a n c e

l e a n n l n g t h e p n a c t l c e n u n s e ’s em p lo ye n m i g h t be

n . 1 5

mone s y m p a t h e t i c t o t h e n u n s e on t h e n u n s e s

w i t h i n t h e p n a c t l c e s t u d y i n g on t h e l n own on as a

g noup . The n u n s e s w o u ld n o t need n e c e s s a n l l y t o

be away f nom p n a c t l c e fo n l o n g p e n l o d s o f t i m e and

t h e s t u d y t o p i c c o u l d be mone n e l a t e d t o p n a c t l c e

nee d s and t h e n e e d s o f t h e p n a c t l t l o n e n s , I t

m i g h t be t h a t t h e o u t l i n e c u n n lc u lu m a l n e a d y

a p p n o ved by t h e E n g l i s h N a t i o n a l Boand n e e d s t o be

n e - w n l t t e n I n d i s t a n c e mode fo n a w id e menu n a n g e

o f pnognammes t o be n e a d l l y a v a i l a b l e f o n p n a c t l c e

n u n s e s t o s t u d y . I t w o u ld I m m e d i a t e l y a d d n e s s

t h e pnob lem w h ich c u n n e n t l y e x i s t s , f o n e x a m p le ,

t h a t whene p n a c t l c e n u n s e s ane w a n t i n g t o

u n d e n t a k e a f a m i l y p l a n n i n g c o u n s e t h e n e I s oven

ah e i g h t e e n month w a i t t o s t u d y t h i s s p e c i a l i s t

f i e l d . I t may be t h a t t h e n o l e s o f t h e s t a t u t o n y

e d u c a t i o n b o d i e s f o n n u n s ln g need a l s o t o

ch a n g e and come I n l i n e w i t h t h e Open

Unlv e n s l t y w h ic h o p e n a t e s and s u p p o n t s

s t u d e n t s I n a c o - o n d l n a t l n g and a d m l n l s t n a t l v e

n o l e .

1 1 . 1 6

A f u n t k e n necommeYidoLtloYi, wkLch c o u l d be

a d v a n ta g e o u s t o a l l t h e p n a c t l c e team membens. I s

t h e d e v e l o p m e n t o f p n a c t l c e b a sed e d u c a t i o n and

t n a l n l n g pnognammes. Such an I n n o v a t i o n would

p n o v l d e t h e o p p o n t u n l t y f o n t h e p n a c t l c e team n o t

o n l y t o s h a n e l e a n n l n g t o g e t h e n b u t a l s o would

p n o v l d e t h e team w i t h t h e o p p o n t u n l t y t o d e t e n m l n e

s t n e n g t h s and w e a k n e s s es and w o u ld be t h e means o f

penhaps mone a p p n o p n l a t e l y u t l t l l s l n g n e s o u n c e s .

Thene w o u ld appean t o be a need t o d e v e l o p

p n a c t l c e s as t n a l n l n g e n v l n o n m e n t s fo n

p n a c t l c e n u n s e s . The c n l t e n l o n f o n a p n a c t l c e

t o become a n e c o g n l s e d t n a l n l n g p n a c t l c e

m i g h t f o l l o w t h e s l m l l a n l i n e s as t h o s e

f o n t h e n e c o g n l t l o n o f t n a l n l n g p n a c t l c e s

f o n g e n e n a l p n a c t l t l o n e n t n a l n e e s .

S t n en g t h s and w e a k n e ss es o f t h i s s t u d y

A c o n s l d e n a b l e amount o f d a t a h a v e been

c o l l e c t e d I n t h i s s t u d y and one o f t h e

7 7 . 7 7

c o n s t n a l n t s o f t h e s t u d y n e l a t e s t o t h e

t l m l t e d amount o f t i m e a v a i l a b l e t o

t h e n e s e a n e h e n t o a n a l y s e a l l t h e d a t a .

The m e th o d o lo g y was a l s o l i m i t e d t o a

s e l f - a d m l n l s t e n e d q u e s t l o n n a l n e and t h e

c o l l e c t i o n o f su b s e q u e n t d a t a t h n o u g h d l a n y

e n t n l e s o f p n a c t l c e n u n s ln g a c t i v i t i e s

a f t e n t h e I m p l e m e n t a t i o n o f t h e New

G enena l P n a c t l t l o n e n Q o n tn a c t o f 1990.

Thene wene d e f i n i t e pnob lem s a s s o c i a t e d

w i t h s e l e c t i o n o f t h e n e s p o n d e n t s and I t was

hoped t h a t t h e p n a c t l c e n u n s e s u l t i m a t e l y

I n v o l v e d I n t h e s t u d y wene a n e p n e s e n t a t l v e

s a m p le o f p n a c t l c e n u n s e s as a w h o le .

Having u s e d t h e P n a c t l c e Nunse J o u n n a l

as t h e v e h i c l e fo n d l s t n l b u t l n g t h e

q u e s t l o n n a l n e t o t h e n e s p o n d e n t s I t was

neco g n l s e d by t h e n e s e a n c h e n t h a t a l n e a d y

t h e n e was b i a s e n t e n l n g t h e s t u d y . Jn t h e

f l n s t I n s t a n c e , t h e p n a c t l c e n u n s e s n e a d ln g

t h e j o u n n a l would be s e l f - m o t i v a t e d n ea d e n s o f

t h e j o u n n a l .

11 . 18

k n o t h e n I m p o n t a n t f a e t o n w h l e h m i g h t have

I n f t u e n e e d t h e p n a e t l e e n a n s e ’s p e n e e p t l o n

o f e d u c a t i o n and t n a l n l n g n e e d s n e l a t e s

t o t h e t i m e o f t h e d l s t n l b u t l o n o f

t h e q u e s t l o n n a l n e . The q u e s t l o n n a l n e was

d l s t n l b u t e d I n J u n e , 1 9 89 j u s t p n l o n

t o t h e I m p l e m e n t a t i o n o f t h e New G e ne na l

P n a c t l t l o n e n C o n t n a c t ( 1 9 9 0 ) . The New

C o n t n a c t wou ld I n t n o d u c e l e g i s l a t i o n w h i c h

woul d e f f e c t d e l l v e n y o f h e a l t h c an e

I n g e n e n a l p n a c t l c e and had c o n s l d e n a b l e

I m p l i c a t i o n s f o n p n a c t l c e n u n s l n g and

t h e e x t e n d e d n o l e o f t h e p n a c t l c e n u n s e .

Data c o l l e c t e d fnom d l a n y e n t n l e s a b o u t

p n a c t l c e n u n s e a c t i v i t y s i x mon ths a f t e n

t h e I m p l e m e n t a t i o n o f t h e New Gen en a l

P n a c t l t l o n e n C o n t n a c t ( 1990) show a g n e a t e n

awaneness o f h e a l t h p n o m o t l o n and

s c n e e n l n g o f p a t i e n t s , m o n l t o n l n g d i s e a s e

p n o c e s s e s and e n s u n l n g t a n g e t s I n c e n v l c a l

smeans and c h l l d n e n ' s I m m u n i s a t i o n s ane a c h i e v e d .

1 1 . 1 9

A f u n t k e n w e a k n e s s o f t h e s t u d y n e t a t e s

t o t h e f o n m a t o f t h e q u e s t l o n n a l n e whene

e l e m e n t s o f b i a s m i g h t h ave a f f e c t e d t h e

p n a c t l c e n u n s e ’s n e s p o n s e ,

Fon e xa m p l e , t h e p n a c t l c e n u n s e was a s k e d

t o I d e n t i f y t h e o c c u p a t i o n a l n o l e and

p e n c e l v e d e d u c a t i o n and t n a l n l n g n e e d s . T h i s

was an open ended q u e s t i o n b u t t o h e l p

t h e n e s p o n d e n t s c o m p l e t e t h i s s e c t i o n .

S u g g e s t e d h e a d i n g s w hi ch n e l a t e t o t h e n o l e

o f t h e p n a c t l c e n u n s e wene d e t a i l e d . Thene

I s no d o u b t t h a t t h e n e s e a n c h e n ’s p e n c e p t l o n

o f n o l e and t h e onden I n wh i ch t h e h e a d i n g s

wene n e p n e s e n t e d c o u l d h av e a f f e c t e d t h e

p n a c t l c e n u n s e ’s n e s p o n s e t o t h e q u e s t i o n .

The u s e o f op en- ended q u e s t i o n s I n t h i s

Sunvey d i d p n o v l d e a c o n s l d e n a b l e amount o f

I n f o n m a t l o n , b u t I t wou ld h ave been e a s l e n

t o h a ve had t h e d a t a n e l a t l n g t o o c c u p a t l o n a l

n o l e and l e a n n l n g n ee ds n e c o n d e d by pno f e s s l o n a l

n . 2 0

gn.ou.ps. The a n a t y s l s wou ld t h e n have

been mone p n e e l s e and s p e c i f i c and t h e

n e c o mm en da t l o ns mone c l e a n .

I t wo u l d h a ve been h e l p f u l I f t h e q u e s t l o n n a l n e

had c o l l e c t e d d a t a a b o u t t h e n e s p o n d e n t s '

m o s t n e c e n t n u n s l n g p o s t and p n e v l o u s

e x p e n l e n c e b e c a u s e t h i s wo ul d h a v e g i v e n

v a l u a b l e I n f o n m a t l o n n e l a t l n g t o b ackgno und

knowledg e, n u n s l n g e x p e n t l s e and I f t h e

s k i l l s wene b e i n g u t i l i s e d I n p n a c t l c e .

U n d o u b t e d l y mone d e t a i l was n e e d e d a b o u t

t h e e n v l n o n m e n t o f p n a c t l c e . P n a c t l c e

n u n s e s , by h e a n s a y e v i d e n c e , wonk I n

a v a n l e t y o f s i t u a t i o n s , many o f w h i c h wou ld

appean t o a f f e c t t h e n o l e t h e n u n s e I s a b l e

t o u n d e n t a k e .

The s t n e n g t h s o f t h e n e s e a n c h , howeven , l a y I n t h e

f a c t t h a t I t was a l a n g e s a m p l e and t h e n e was a

veny h i g h I m m e d i a t e n e s p o n s e n a t e . Wi th t h e

m a j o n l t y o f n e s p o n d e n t s h a v i n g n e t u n n e d t h e l n

n . 2 1

c o m p t e t e d qu.es t l o n n a l n e w i t h i n a week o f

d l s t n l b u t l o n . The n e s p o n s e n a t e was so h i g h t h a t

no f o l l o w - u p was n e c e s s a n y . A f u n t h e n s t n e n g t h

l a y I n t h e f a c t t h a t t h e n u n s e s knew t h e s t u d y was

g o i n g t o t a k e p l a c e b e c a u s e I t had b een

h i g h l i g h t e d I n t h e P n a c t l c e Nunse J o u n n a l and I n a

s m a l l way t h e n e s p o n d e n t s wene p nepan ed f o n t h e

s t u d y and t h e p o s s i b i l i t y o f c o m p l e t i n g a l a n g e

q u e s t l o n n a l n e . P n a c t l c e n u n s e s wene a l s o awane

t h a t t h e n e s e a n c h e n was a l s o a p n a c t l c e n u n s e and

e d l t o n o f t h e P n a c t l c e Nunse J o u n a l and t h e

n e s p o n d e n t s m i g h t h a ve f e l t l e s s t h n e a t e n e d w i t h

t h i s knowledg e and p o s s i b l y f e l t mone c o m f o n t a b l e

a t c o m p l e t i n g t h e q u e s t l o n n a l n e b e c a u s e t h e

n e s e a n c h e n was awane o f t h e d i f f i c u l t i e s some

p n a c t l c e n u n s e s wene f a c i n g w i t h n egand t o

t n a l n l n g , s a f e emp l oy me n t and u n d e n t a k l n g e x t e n d e d

n o l e a c t i v i t i e s .

P o l i c y :

Pnlmany c a ne s e n v l c e s h a v e d e v l o p e d n a p l d l y o ven

1 1 . 2 2

t h e l a s t d e c a d e as new I d e a s f o n t h e d e l l v e n y o f

h e a l t h c a n e h ave emenged. I n c n e a s l n g l y , pnlmany

cane p n o f e s s l o n a l s an e wonk l ng as membens o f

m a l t l - d l s c l p l l n a n y t e a m s w i t h a c o n e o f g e n e n a l

p n a c t l t l o n e n s , p n a c t l c e n u n s e s and a d m l n l s t n a t l v e

s u p p o n t .

O n g a n l s a t l o n a l a n n a n g e m e n t s h a ve a l s o c h an ge d t h e

way pn l many c a n e I s d e l l v e n e d . Gen en al

p n a c t l t l o n e n f u n d h o l d l n g has opened up new

p a n t n e n s h l p s b e t w e e n pn l many and s e c o n d a n y c a ne

and h e a l t h a u t h o n l t l e s and l o c a l a u t h o n l t l e s

c o n t i n u e t o l o o k a t ways o f j o i n t l y c o m m i s s i o n i n g

s e n v l c e s f o n t h e b e n e f i t o f t h o s e I n t h e

c o m m u n i t y . The a d d i t i o n a l e s t a b l i s h m e n t o f

u n i f i e d h e a l t h a u t h o n l t l e s n e s p o n s l b l e f o n l o c a l l y

ag need s t n a t e g l e s f o n I m p n o v l n g h e a l t h and

dev e l o p i n g s e n v l c e s has added t o t h e s e new

a n n a n g e m e n t s . Such d e v e l o p m e n t s have a l l been

p a n t o f t h e p n o c e s s o f s e e k i n g t o a c h i e v e a

pnlmany c a n e l e d N a t i o n a l H e a l t h S e n v l c e w i t h I t s

aim o f b n l n g l n g d e c i s i o n making and t h e d e l l v e n y

n . 2 3

of s e n v l c e s as c l o s e t o t h e p a t i e n t as p o s s i b l e .

Fon p a t i e n t s t o be c o n f i d e n t a b o u t t h e c a n e t h e y

n e c e l v e , a l l t h o s e wonk l ng I n pn l many c a n e n e e d t o

h a v e t h e n e q u l s l t e b n e a d t h and d e p t h o f k n o w l e d g e

and s k i l l s t o d e l l v e n t o p a t i e n t s .

P n a c t l c e n u n s e s a l n e a d y p n o v l d e a w i d e n a n ge o f

s e n v l c e s , e x e m p l i f i e d I n t h i s n e s e a n c h , b u t t h i s

n e s e a n c h has a l s o I d e n t i f i e d t h e s c o p e f on

p n a c t l c e n u n s e s t o w i d e n t h e l n n o l e . The

o p p o n t u n l t l e s f o n p n o f e s s l o n a l s t o m a x i m i s e t h e l n

s k i l l p o t e n t i a l and t a k e n es pons l b l i l t y f o n a

wi den n o l e I n d e c i s i o n m a k i n g , p l a n n i n g and t h e

d e l l v e n y o f h e a l t h c a n e w i l l n e e d t o be

u n d e n p l n n e d w i t h f u n t h e n dev e l o p m e n t s I n

e d u c a t i o n , t n a l n l n g and nes eanch .

In O c t ob en , 1995 t h e S e c n e t a n y o f S t a t e f o n H e a l t h

opened t h e d e b a t e on t h e f u t u n e o f pn l many h e a l t h

c ane and v i e ws d u n l n g t h e e n s u i n g mont hs wene

s o u g h t n a t i o n a l l y and l o c a l l y f nom I n t e n e s t e d

1 1 . 2 4

p a n t i e s . The N a t i o n a l H e a l t h S e n v l c e Manag ement

E x e c u t i v e ’s R e p o n t ’’Pnlmany Cane: The F u t u n e ”,

( 1 996 ) s e t s o u t t h e p n l n c l p l e s w h ic h n e e d t o

u n d e n p l n and g o v e n n pn lmany c a n e s e n v l c e p n o v l s l o n

and s e c o n d a n y c a n e a c c e s s .

Nunses ane t h e l a n g e s t c l i n i c a l p n o f e s s l o n engaged

I n t h e d e l l v e n y o f pn lmany c a ne w i t h t h e l a n g e s t

gnowt h I n p n a c t l c e n u n s l n g I n t h e p a s t d e c a d e

whene t h e numbens have I n c n e a s e d by 374%,

( V e p a n t m e n t o f H e a l t h , 1994) . The g n o w t h I n

numbens o f p n a c t l c e n u n s e s has e n a b l e d t h e nan ge

o f s e n v l c e p n o v l s l o n I n g e n e n a l p n a c t l c e t o be

d e v e l o p e d , w h i c h I s d e m o n s t n a t e d I n t h i s s t u d y

whene n e s p o n d e n t s h a v e I d e n t i f i e d t h e d l v e n s l t y o f

t h e l n n o l e .

The n e p o n t a p p n e c l a t e s t h a t n u n s e s a l n e a d y p o s s e s s

many s t n e n g t h s and t h e l n p n a c t l c e I n c l u d e s h e a l t h

n eed s as s e s s m e n t , h e a l t h p n o m o t l o n and I l l n e s s

p n e v e n t l o n as w e l l as m o n l t o n l n g and s u p p o n t l n g

p a t i e n t s and t h e l n c a ne ns w i t h a c u t e and l o n g t en m

1 1 . 2 5

I l l n e s s . Some p n a e t l e e n u n s e s h a v e a l s o

dev e l o p e d a v i t a l l e a d i n g n o l e I n t h e p n o v l s l o n o f

I m m u n i s a t i o n , e a n e e n c y t o l o g y , n u n s e nun mlnon

I n j u n y c l i n i c s , n u n s e l e d home c a n e and

c o l l a b o n a t l v e s chemes e n a b l i n g p e o p l e t o be caned

f o n I n t h e l n own homes and p a t i e n t s t o be

d l s c h a n g ed e a n l y f nom h o s p i t a l . Some p n a c t l c e

n u n s e s ane o f f e n l n g s p e c i a l i s t s e n v l c e s s u c h as

d e n m a t o l o g y , l e g u l c e n , p a l l a t l v e c a ne and c a ne t o

p e o p l e f o n whom t h e t n a d l t l o n a l pn l many c ane

s e n v l c e s ane l e s s a c c e s s i b l e and a v a i l a b l e .

Nunse R o l e D e v e l o p m e n t :

T h i s S un v e y has I d e n t i f i e d t h e s c o p e o f p n a c t l c e

n u n s l n g w i t h many p n a c t l c e n u n s e s h a v i n g d e v e l o p e d

t h e l n n o l e f nom t h e knowl edg e and s k i l l s t h e y

p o s s e s s . The p n o p o s e d d e v e l o p m e n t s o u t l i n e d I n

t h e pn lmany c ane doc ume n t I n c l u d e a l l t h e

a c t i v i t i e s wh ic h some n u n s e s a n e a l n e a d y

u n d e n t a k l n g b u t by d i v i d i n g n u n s e p n a c t l c e I n t h e

f u t u n e I n t o t h n e e bnoad aneas o f C l i n i c a l Cane

1 1 . 2 6

Nuns lng whene n u n s es w o u l d e n t e n I n t o a mone

n e s p o n s l b l e and e o m p n e h e n s l v e n o l e I n t h e s h a n e o f

c a ne f o n p a t i e n t s I n pn l many and communi t y c a n e

s e t t i n g s ; P u b l i c H e a l t h Nunses w o u l d p l a y a v i t a l

n o l e I n p n ev e n t l n g I l l n e s s and p n o m o t l n g t h e

h e a l t h o f I n d i v i d u a l s , f a m i l i e s and c o m m u n i t i e s ;

and S p e c i a l i s t Nunses w o u l d p n o v l d e a d v i c e ,

s u p p o n t and c o n t i n u i n g e d u c a t i o n and t n a l n l n g f o n

membens o f t h e pnlmany h e a l t h c a n e t e a m . The

s p e c i a l i s t n u n s e ’s e x p e n t l s e and s k i l l s wo u ld p l a y

a v i t a l n o l e I n n s e a n c h and e v i d e n c e b a s e d n u n s l n g

p n a c t l c e .

I f n u n s e s ane g o i n g t o p l a y a l e a d n o l e I n

d e c i s i o n ma k i ng , l e a d t e a m s o f h e a l t h c a n e

p n o v l s l o n and p nomo te h e a l t h w i t h i n t h e l o c a l

commun i t y t h e n e needs t o be c ha n g e s b o t h I n t h e

e d u c a t i o n p n o v l s l o n and t h e h l e n a n c h l c a l

s t n u c t u n a l s y s t e m s w h i c h c u n n e n t l y p e n v a d e t h e

o n g a n l s a t l o n s . The s h a n l n g o f e d u c a t i o n and

t n a l n l n g b e t w e e n a l l p n a c t l c e s t a f f , w h i c h I s

u n l v e n s l t y b a s e d , and t h e d e v e l o p m e n t o f m u l t i -

n . 2 7

dlsc.JipJiJiYLa.ny annang emevits vokJich aZlow fon fneedom

of movement of p n o f e s s l o n a l s t a f f be tween gene na l

p n a e t l e e and t n u s t s would be ways of nemovlng t h e

bannlens which cun n en t l y e x i s t .

Funt hen Res eanch:

T h i s n e s e a n c h has I d e n t i f i e d a numben o f f u n t h e n

n e s e a n c h t o p i c s . The f l n s t o f w h ic h n e l a t e s t o

s k i l l mi x and o v e n l a p . I t wou l d appean f nom t h i s

s t u d y , t h a t many p n a c t l c e n u n s e s ane u n d e n t a k l n g

a c t i v i t i e s w h i c h o t h e n communi ty c o l l e a g u e s ane

t n a l n e d and q u a l i f i e d t o u n d e n t a k e , s u c h as c h i l d

s u n v e l l l a n c e and a n t e - n a t a l cane o f p n e g n a n t

women. H e a l t h c a n e p n o v l s l o n n e e d s t o be

f l e x i b l e I n a v a i l a b i l i t y and t h e n e I s a n e e d t o

d e v e l o p p a n t n e n s h l p s I n c a ne I n onden t o b e s t

u t i l i s e s c a n c e n e s o u n c e by l o o k i n g a t s k i l l m i x .

A f u n t h e n t o p i c w h i c h m i g h t show how p n a c t l c e

n u n s l n g has cha ng ed and a f f e c t e d t h e e d u c a t i o n and

t n a l n l n g needs o f p n a c t l c e n un s es I s t h e

1 1 . 2 8

JintfLodvLdtJioyL ^ u n d ho td j i ng , Thdfid X,6 no d o u b t

t h a t a6 mofid aatJ io t t J id^ arid l o d u i d d a t g d n t ^ a l

pn.ao.tLdd I d v d l t h a t t h d a d t L v L t L d é p n a d t L d d n a n i d i

and a n d d n t ak L ng and dx t dn d Ln g and d ha n g L n g ,

Thd6d d a t a havd hLghL Lgh td d t h d wLdd and vanLdd

o d d u p a t L o n a t n o t d o l t h d p n a d t L d d nanâd , u h a t

d a n n o t bd addnd66dd L6 t h d a d t u a Z oatdomd6 o l

nan^d L n t d n v d n t L o n and dvLddndd ba-idd nan^Lng.

Thdnd ujoatd a t i o appdan t o bd a nddd t o a n d d n t a k d

nd6dandh uohLdh vuoatd L d d n t L ^ y g d n d n a t

p n a d t L t L o n d n ^ vLduJ6 a b o u t p n a d t L d d nun^d d du ca tL on

and t n a L n L n g .

Condtu^Lon

ThL6 L6 t h d I L n ^ t pLddd o{ majon n d^dan dh

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