9.5.3 An exploration of aspects of territoriality in two groups of specialist nurses caring for patients in the community (271)

Lesley Whyte, Lecturer, School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Glasgow, United Kingdom l.whyte@gcal.ac.uk

Abstract:

This study was undertaken to explore the independent and combined contributions of district nurses (DNs) and clinical nurse specialists (CNSs) to patients living in the community. The concept of human territoriality (Taylor 1988) was used as a framework to understand the relationship between these groups. A review of literature confirmed the extent to which nursing and health care are in a state of constant change. The shift in balance of care from secondary to primary care settings has resulted in the development of different networks of care. Traditional professional boundaries are being challenged by health policy directed at role expansion and new role development. The study used a modified ethnographic approach. Information was elicited from DN and CNS key informants by documentary accounts of practice (n=10) and in-depth interviews (n=12). Interviews were conducted during 2003 and 2004. Thematic analysis of the data, using Roper and Shapira’s (2000) framework, illuminated that a range of external factors resulted in both expansion and contraction of the professional territories of these nurses. The DN was seen principally as a care-giver, whilst the CNS had a focus on promoting self-care with patients. In relation to these activities, the nurses used a combination of clinical and contextual (patient focused) knowledge. Both groups expressed a high level of emotional attachment to their patients. Tensions sometimes arose due to differing expectations about each other’s contribution to patient care. In some situations, professional self-interest resulted in protection of their territories in a way that could impact negatively on patient care. The negotiation of mutual boundaries of practice was a key strategy in reducing the potential for territorial behaviour. The findings from this study are relevant to health policy directed at the blurring of professional boundaries and the development of more integrated working practices.

Biography:

I have a professional background in district nursing, latterly working in a joint appointment post as a lecturer/practitioner. The interest in my doctoral work was initiated whilst working in this post alongside clinical nurse specialist colleagues. During this time I was seconded to the Scottish Executive Health Department to the post of project officer for the WHO Europe Family Health Nurse Project. This increased my awareness of health policy and its impact on shaping nursing roles. My present post is co-ordinator for research teaching within the School of Nursing, Midwifery and Community Health at Glasgow Caledonian University