Background
to the
Research
- Community nursing services
for people with learning disabilities in NI developed slowly beginning
in the 1970s. In the early 1990s, with
the general move from hospital provision to community nursing in the
UK, the growth of these services accelerated. At this time the nature
of the service changed to a more specialist service based on individual
needs. These rapid developments altered the structure and organisation
of service and changed the role of the professionals involved. This
in turn had implications for service providers and users.
- This research examined the
structure and process of the CNMH service in NI. The aim of the research
was to provide a profile of the nurses within the service and a description
of their practices. This data generated an overview of the direction
in which the service was moving and contributed to the debate on the
role of the CNMH staff.
- This paper reports only
the data on the profiles of CNMHs and the similarities and differences
between the four health and social services boards.
Research
Approach
- Data were collected through a postal questionnaire
distributed to all 50 CNMH staff in NI in 1992. A total of 36 questionnaires
were returned (response rate 70%).
Main
Findings
- Almost 95% of the respondents were under
the age of 50 years.
- Almost two thirds of CNMHs had less then
five years experience as a CNMH and 36% had less than three years.
- 80% or respondents had grade G posts and
this varied from 43% in Board A to 100% in Board C.
- There were no CNMH staff at grades D or
F. Grade H posts were noted in Boards A and B - these nurses worked
as team leaders of community nursing teams. Grade E posts were noted
in Boards A and D.
- All respondents possessed the RNMH qualification
and two thirds had a post-basic qualification in relation to community
nursing.
- Almost a quarter were Registered General
Nurses and 11% held a teacher practitioner certificate.
- Few had a specialist qualification. One
CNMH had a certificate in health education, two had completed further
study in family therapy and one in the care of the violent and potentially
violent, and one held a qualification in behaviour therapy.
- There was no significant variation in
qualifications across Boards or according to gender.
- The average size of their caseload was
43 with marked variations between Boards.
- Frequency of visits needs to be taken
into account in an analysis of caseload. Monthly visits were the most
common in all four Boards. 90% of clients in Board B and 85% of clients
in Board C were visited at least once every three months, while the
figures for Boards A and D were 52% and 51% respectively.
- Authors commented that as services continue
to develop the body of experience and knowledge will be further enhanced.
They anticipated that it would be worth monitoring whether the changing
grade mix of CNMH services has any impact on the recruitment and retention
of younger staff.
- This study reported a male to female ratio
of almost 1:3 in CNMH services. This indicated an increase in the
number of male CNMH staff in NI since the DHSS Study in 1986 which
showed that all CNMH staff were female.
- The data on caseloads suggested that staff
in NI had considerably higher caseloads than their colleagues in the
rest of the UK (average caseload of 42.7 people in NI compared to
24.1 in the rest of UK). The recommended figure for a manageable caseload
was 30 in 1985.
- The authors pointed out the need for specialisation
in the role of the RNMH and the importance of clinical specialisation.
Although more than half the respondents had multiple qualifications
there was a near absence of clinical specialist training.
- They suggest that the lack of specialist
courses, limited funding, and poor career advice may explain why well-qualified
CNMH staff had little specialist training.
- The authors recommend that a structure
be put in place which would provide a range of educational opportunities
to maintain and improve specialist knowledge and competencies.
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