Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Negotiating: Experiences of Community Nurses When Contracting with Clients

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Negotiating: Experiences of Community Nurses When Contracting with Clients

Article excerpt

Chronic diseases and long term health conditions are a major challenge for the Australian community and health system. In New South Wales nearly three quarters of the population are diagnosed with a chronic disease (Garling, 2009). The present aim of the health system is to reduce the reliance on tertiary health care, reduce the number of presentations to emergency departments and readmission rates of clients by improving primary health care in the community and to facilitate the integration of community- based services to support people living in the community with chronic diseases (Davidson et al., 2001; Department of Health and Ageing [DoHA], 2009; Harrison et al., 2002; Leung et al., 2004).

As one of the major providers of primary health care community nurses require a considerable depth of knowledge and a range of nursing skills. These skills include comprehensive assessment, communication, negotiation, supporting people with chronic diseases, and providing quality nursing care (Hallett, Austin, Caress, & Luker, 2000; Houston & Cowley 2002; St John & Keleher, 2007). Community nurses focus on the promotion of health, primary health care and establishing a productive partnership with the client in health care decision making, rather than just the treatment of disease (Bauman, Fardy, & Harris, 2003; Brookes, Davidson, Daly, & Hancock, 2004; St John & Keleher, 2007).

The importance of 'getting to know the client' is not a new observation in itself. This emotional labour (Hochschild, 1983) is essentially invisible work, which is meaningful to community nurses. In a UK based study Luker, Austin, Caress, and Hallett (2000), found that spending time in the home, and ensuring continuity of care were prerequisite to knowing the client, and furthermore, having time to provide more than the physical aspects of care was an essential component of high quality care. McGarry (2003) found that the centrality of the home was pervasive when defining the role of community nurses because the home environment as a location of care provision is largely beyond the public and professional gaze, and remains potentially hidden from scrutiny. McGarry argues that healthcare continues to be increasingly located outside the hospital setting, and a number of key issues identified within her study have received little research attention. These include the relationship between district nurses and their clients, the longevity of care provided and the balances that nurses have to strike between clients' wishes and professional practice (Goodman, 2001). McGarry suggests that many notions of nursing within the community and the taken for granted assumptions raise tensions for nurses trying to balance notions of community and community based care within the parameters of organisational and professional boundaries.

Community nursing is more than merely practising nursing in a community setting, and a nurse with excellent interpersonal, teaching, collaborative and clinical skills would not be able to function effectively in the community without the added knowledge and skills to analyse and understand the people who make up the community (Allender & Spradley, 2005; Edgecombe, 2001; Houston & Cowley, 2002; Jayasekara, 2001). Community nurses are expected to provide care that is equitable, accessible, culturally sensitive, affordable, and assist the client towards self-reliance and self- determination (Hunt, 2005; Jayasekara, 2001; Keleher, 2007).

A care contract is a means through which clients are assisted by community nurses to develop selfdetermination and are a means of bring about active client involvement. A care contract can take many forms and is essentially any working agreement that is continuously negotiated between a nurse and a client (Saucier Lundy, & Janes, 2001; St John & Keleher, 2007). By having active client involvement in developing an individual care contract there is evidence to suggest that there is increased client satisfaction and engagement with their health care, improved quality of life and reduced client anxiety (Hunt, 2005; Stewart, 2001). …

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