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Family Health - Nursing in Scotland: A report on the WHO Europe pilot
Introduction
The Family Health Nurse project has placed Scotland firmly on the International health care map. A core strategy of the WHO Europe's health policy document (HEALTH21) is to strengthen primary health care by developing family and community-oriented health services. Although differences exist across Europe in the delivery of primary care, there is universal agreement that primary care must be the core of service provision and that provision of medical and nursing services based on specialism is unsustainable in the long term.
Community nursing in the UK has grown and developed, directed by health policy and in response to changing health care needs. The current system comprises eight different specialist nursing pathways within the national regulatory framework of the Nursing and Midwifery Council (NMC). Whilst education programmes have for many years been moving towards a more integrated approach, combining core with specific modules across the eight pathways, practice has, in general, continued with a very specialist approach. In this sense although educationally community nurses are seen to have areas of shared knowledge and skills, once in practice the different community nursing specialisms work within quite clearly defined professional boundaries.
The Family Health Nurse project has challenged this approach by exploring the feasibility of preparing a generalist community nurse who can work across these professional boundaries. Scotland's reputation of well established community nurse education and practice systems, provided a solid foundation on which to test this different approach to service delivery.
WHO Europe described the role of the Family Health Nurse as one which
contains elements which are already part of the role of several different types of nurses working in primary care across the European region. What is new is the particular combination of the various elements, the focus on families and on the home as the setting where family members should jointly take up their own health problems and create a 'health family' concept. (WHO Europe 2000:2).
In this sense the focus is very much on the practice approach of working with families in a different way and at a different level from existing models. In line with WHO Europe thinking the use of the term family is operationally defined in its broadest sense to encompass the notion of a unit which may include:
individuals with geographically distant relatives
friends who provide a supportive role in a similar way to a family member
traditional nuclear family with different generations being geographically close.
The Scottish Family Health Nurse project was established initially as a two-year pilot in line with WHO guidance. This report summarises the processes, experiences and learning gained from the two-year Scottish pilot (2001-2003), sharing the journey travelled by those involved in the project to explain Scotland's involvement in the WHO Europe multi-national study. Exemplars and anecdotal accounts are given where possible to reflect the personal experiences of those involved in the pilot.
Two years is a very short period of time to undertake a very complex development involving the simultaneous education of nurses and development of a new model of practice. However, the pilot nature of the project has meant that learning would be formally evaluated and that if unsuccessful, the development could be halted. A clear conclusion from the deliberations of the project steering group is that while some questions remain unanswerable from the project to date, there is sufficient value in this new approach to practice to continue to develop and explore its potential. The report therefore concludes by setting out the next steps in the development of Family Health Nursing in Scotland.
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