Community Care - Developing an International Degree

Programme for Nurse Education

Pilot project 1995-1999

European level co-operation

• begun 1995

• partly funded by European Union Commission

• done between social and health care, practice and education

• is connected to research

Background for the European level co-operation

• Shift towards non-institutional care• Aim to develop client-centred and integrated

social and health care services• The shared understanding of community care at

European level is missing • Community care has been adopted to nursing,

especially to nursing education without deep and wide analysis of the concept

Aims of Community Care pilot project were

• to develop a curriculum for a degree programme of Community Care for nurse education at bachelor level

• to develop a curriculum for a continuing education of Community Care in multiprofessional studies

Project partners

• Oulu Polytechnic, Oulainen School of Health Care (co-ordinator), FIN

• Oulu Polytechnic, School of Social Work, FIN

• University of Oulu, Department of Nursing and Health Administartion, FIN

• Haagland College, NL

• University of Central England in Birmingham, UK

Analysis of the material produced in the pilot project

Salla Seppänen, RN MNSc

The purpose of the study

• was to describe the content of concept community care in nursing defined in European level co-operation at three levels

1) Philosophy

2) Practice

3) Theory

The research questions

• What is the philosophy of community care in nursing like ? ( LEVEL I )

• How could community care be implemented in nursing practice ? ( LEVEL II )

• What is the theoretical base for community care in nursing ? ( LEVEL III )

DATA COLLECTION

THROUGH THE INTERNATIONAL

CURRICULUM CO-OPERATION

1995-1999

Data1. Project application

2. Community care visions written by partner institutions

3. Project minutes

4. Project reports

5. Project evaluation reports

6. Developed curricula

- pre-registered bachelor nurse education

- CVT education for multiprofessional student group

Data analysis

Qualitative content analysis:

• main categories according to research questions

• sub-categories inductively according to data

The results of the study

1. Philosophy of community care

2. Implementing community care philosophy in nursing practice

3. Defining theory base for community care in nursing

1. Philosophy of Community Care

Individual

Family

Community

Well-being

Health

Community Care

Community Care

Physical

Technical factors

Economical factors

Cultural

factors

Political Legal factors

Copyright Leonardo da Vinci Pilot Project No 33150, Community Care

Philosophy of community care defined in the project

Community care is about people and the kind of services they need to enable them to live as independent a life as possible in their own communities. Central to the philosophy is notion of a person in their communities. This includes their relationships with family, neighbours, volunteers and paid workers; it also includes any relation they may have with local resources such as places of worship and educational provision. The client is defined as an individual, a family, a group of people or a whole community. There may be many professionals involved in contributing to provide services in an integrated and constructive way, so that all are clear about how various contributions can work to the best advantage for a person using services. For each country this philosophy will be affected by physical, technical. cultural, political, legal and economical factors on which the society is built.

Client

• an individual

• a family

• a group of people

• a community

The aim of community care is to meet the needs of the people

living in communities

Changes in Societies• in demography

• in structure of social and health care

• in living habits

• in health status and morbidity

• in medicine and technology

• in family patterns

• in economy

• in people´s expectation of care and services

The objective of community care

- to maintain and strengthen the subjectivity, activity and power of

a client

The central values of community care

• autonomy

• justice

• equality

The principles of community care

• holistic and client-centred service provision

• continuing of care - seamless services

• independence of a client

Quote from the project report

” Community care in nursing is caring and supporting people in their communities and helping them to cope as independent as possible in their homes or in homely settings”

2. Implementing community care philosophy in nursing practice

• at international level

• at national level

• at local level

Qualification of community nurse

• the ability to work in multicultural societies and communities with people at different ages and in different life situations

Professional competence

• knowledge

• attitude

• skills

• awareness ”practical wisdom”

Professional Skills1. Metacognitive

2. Social

a) co-operation & b) communication

3. Developmental

a) personal & b) development of practice

4. Management

5. Assessing and evaluation

6. Practical

” She or he is a co-ordinator of official and voluntary services in

the community, provider of information, key worker in

family, supporter for a family in complex situations, like in the

process of dying.”

Role defining in relation to

1. the structure of social and health care services

2. other nursing professionals

3. other professionals in community care practice

Community care A battle field of professional power

• ” Is it Medical model or Nursing model or Social model of care ?”

Co-operation with

• client and carers• institutional and non-

institutional sector• health care and social

welfare• local authorities and

voluntary sector / third sector

ANA’s definition of Community Health Nursing

” Community Health Nursing is a synthesis of nursing and public health practice applied to promoting and preserving the health of the population. The practice is general and comprehensive. It is not limited to particular age group or diagnosis and it is continuing not episodic. The dominant responsibility is to individuals, families or groups contributes to health of the total population. The focus of Community Health Nursing is on the prevention of illness and the promotion and maintenance of health”

Community Care in Nursing

• preventive care

• acute care

• palliative care

• rehabilitative care

Key Tools• interactive model for working

• social maps

• community networking

• case management

• teamwork

Tasks for community nurse • influencing

• advocating

• empowering

• establishing partnership

3. Defining theory base for community care in nursing• multiscientific

• family theories

• theories of social structure in cities, villages and neighbourhoods

• modern information and technology

• the practice theory of community care is missing!!!!

Nursing profession

• needs to develop theory base for community care

• study contextual knowledge, skills, attitude and awareness of community nurse

• integrate research and education to develop evidence-based community nursing practice

Conclusions

• Philosophy of community care can and should be shared between European countries as well as between professions working in community care practice.

• The implementation of philosophy is interpreted by each country and each profession in its unique way.

International co-operation

”It broadens the national understanding and models of community care…international co-operation force you to see your own practices and functions critically and reflect it to other’s functions and activities.”

The new pilot project aims in European level (FIN, H,NL,P)

• to specify the competence of nurse working in community care

• to specify the role, tasks and working discipline of a nurse in community care

The further activites

Nationally implemented questionnaires

October 2000 (n = 800)

in Haag

in Helsinki

in Warsaw

in Budapest

National seminars to promote discussion of community care in nursing

• Finland 26.-27.4.2001, Helsinki

• Hungary, May 2001, Budapest

• The Netherlands, Spring 2001,Haag

• Poland 8.- 9.5.2000, Busko

The shared understanding of content of community care is

needed• Nationally-Internationally

• Inside professions and between professions

• Between education and practice