Clinical Effectiveness: The Challenge for Community Nursing

Abstract

If this chapter were solely to report, concisely but fairly, the available evidence for the clinical effectiveness of community nursing services, it might be very short indeed. It is often said that there is little or no scientific evidence to support many health care interventions, but this evidentiary vacuum is more marked in some professions and care settings than in others. It seems to an outside observer that those working in community nursing services, such as district nursing, health visiting, practice nursing and school nursing, have remarkably little formal evidence with which to justify their patterns of clinical practice, or even in some cases their continued employment. There is a growing pressure on health care professionals in all disciplines and specialties, not just in the UK but internationally, to demonstrate the value of the services they provide. For community nurses in the NHS this challenge is particularly serious, because many of the services they deliver are already threatened by continuing changes resulting from the NHS reforms of 1989. In the 1990s, health care professions and organisations will increasingly have to demonstrate not only that they provide good quality care, at a low cost, but that their care is clinically and cost effective. Those who cannot or do not prove the effectiveness of what they do may not be doing it for much longer.