With the year 2009 came a major landmark in community nursing - district nursing celebrated 150 years as a recognised specialist area of nursing practice. As such, 2010 brings not only a new decade but also the ideal opportunity to reflect on and celebrate past achievements in community care while preparing for the challenges of the future.
In the past 150 years, community nurses and nursing work have evolved to support a very different area of practice. In the early years, female superintendents and sanitary inspectors focused on communities, health chances and optimising health in often terrible environmental conditions worsened by a lack of political, personal or social concern for the welfare of others. Thankfully, through the entrepreneurial work of community nursing’s pioneers, this main area of health was nurtured and sustained and has flourished, moving on from the terrible human contexts in which early nursing care was delivered.
‘One thing is clear about the future of community nursing: it needs to evolve and drive the provision of care from being community based to being community focused’
In this millennium, community nursing challenges us - as it did the early pioneers - but this time to establish a direction for care closer to home. This is driven by challenges from within the profession as well as the social contexts of healthcare practice that affect the health and life chances of the population.
Society in the 21st century is one of changing demographics, with an ageing population within nursing and among the individuals for whom we care. This is as much a result of the success of the NHS as of improvements in access to clean water, better diets and appropriate housing.
The demographic change includes a broader and more ethnically diverse population than ever. The lowering of borders across Europe and the need for a worldwide perspective on many aspects of health and wellbeing directly affect demands for healthcare. More than ever, nurses need to provide and communicate an understanding of health and care across a kaleidoscope of cultures. The diversity of our own professional groups helps support and sustain the development required to provide for the needs of a multiethnic, multicultural Britain. The call is definitely a case of sustaining a diverse workforce to provide for a diverse population.
By far the greatest change that will shape the development of community nursing will be the sustained move to community care and care closer to home. With improvements in technology, greater knowledge and application of research evidence indicating the physical, emotional and social benefits of shorter hospital stays, this “quiet revolution” has been going on for the last few decades.
Front Line Care, the report published recently by the Prime Minister’s Commission on the Future of Nursing and Midwifery, sets out the “new business case/context” for nursing care. As a member of the commission, I was privileged to play a part in steering nursing and midwifery towards a vision that would enable us to close the gap between hospital and community care. From the public consultation, we learnt the importance of understanding the reality of how nursing care is experienced and understood by patients.
Community nursing featured high in the stories of those who shared their hopes, thanks and worst fears about caring for themselves, or being cared for in their community. One thing became clear about the future of community nursing: it needs to evolve and drive the provision of care from being community based to being closer to home and community focused.
In this technological age, community nursing must shed its image of being less critical and less skilled than the higher technical areas of intensive inpatient care. Community nursing is equal to hospital based care - it just has a different focus. Whether this focus requires, or will ultimately result in, community nursing being offered as a separate degree from general nursing to ensure specialist practitioner training remains to be seen.
Our patients are informed, active negotiators of their care pathways. In living with illness and caring for their loved ones, they are experts in their care and its impact on their lives. Advances in technology and access to IT in the home have revolutionised the way in which people experience and make sense of their health.
The indications are that nursing care will no longer simply be “based” in the community but will be “focused” there. Community nurses are ideally placed not only to support the care of patients but also to lead the development of community focused care, research and education.
The emphasis of community focused care generates a vision of a sustained, energised and systematic purpose to providing care in the homes and communities where people spend the majority of their lives.
The life and health experiences of these people who continue to manage and live with illness epitomises community nursing’s starting point more than 150 years ago. How we learn from, experience and respond to the increasing focus of nursing in communities will reflect on the nursing workforce we produce for the future and, ultimately, the communities in which we live.
LAURA SERRANT-GREEN is professor of community and public health nursing at the University of Lincoln