Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharpe r focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspe ctives of service users; identifies areas of change; clarifies core and spe cialist skills; defines new roles among the primary health care nursing tea m; proposes a new model of working; and identifies appropriate education. T he project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in prac tice and to develop and refine existing theory to underpin nursing roles. T hroughout the research regular team meetings allowed reflection and discuss ion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and ind ividual interviews with GPs, practice managers and area managers. Reflectiv e diaries and a patient survey were also used. The analysis of the quantita tive and qualitative data collected from patients formed a basis for practi ce development and facilitated the team's reflection on the areas of change . Overall high satisfaction with services and care was expressed in the pat ient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and respo nsibilities for team members. Regarding the team perspective, the data indi cated many areas that could be considered for development. The community nu rsing team decided to concentrate on three key areas: child health, leg ulc er management, and cardiovascular health. The research concludes that actio n research presents some problems and challenges but is a useful approach t o developing team-working in primary health care.