District nursing: Its focus through a comparative analysis of nursing problems.

The thesis explores the focus of district nursing practice in order to identify areas of study for inclusion in the district nurse curriculum. The "focus" is defined as the point of greatest activity (Chambers, 1991) and so evolves from nursing actions. It is assumed that some nursing actions are dependent upon the patients'needs/problems identified in the assessment process. As all district nurse students are Registered General Nurses they are familiar with nursing needs in hospital and the knowledge that underpins them. The problems experienced frequently by patients at home were explored and compared with those that occur frequently in hospital. The differences in the problems between the two settings enabled knowledge specific to district nursing to be identified. Data was collected from hospitals and the community in one outer London Health Authority. The research was structured through Facet theory which allowed the focus and parameters of the study to be made explicit. The data was analysed using a multiple sorting task, multidimensional scaling procedures and statistical tests. The results demonstrated that a relationship exists between some problems and illustrated those that are likely to occur together. A difference was found between some common problems experienced by patients at home from those experienced in hospital. However, other problems occur with equal frequency and severity in both settings. This suggests that the focus of care is different at home from hospital but that a family resemblance exists. It was argued that the focus of district nursing is on health teaching, which is facilitated by the giving of physical care. Concepts fundamental to district nursing, which underpin the focus of care at home, were identified. Areas of study for inclusion in the district nurse curriculum were suggested and questions for further research raised