A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice

The role and expectations of community nurses in carrying out needs assessm ents changed when an internal quasi-market was introduced to the British he alth service under the National Health Service (NHS) & Community Care Act 1 990. This paper reports on a study commissioned by the English National Boa rd for Nursing, Midwifery and Health Visiting (ENB) to investigate the chan ging educational needs of community nurses with regard to needs assessment in the context of this legislation. A multiple case study design was utiliz ed and four cases identified, incorporating the geographical variation in E ngland. Recently qualified practitioners (health visitors and district nurs es) were observed during a regular shift (n=134 visits), concentrating on t heir practice of assessing needs, and on liaison and collaboration within t eams and across sectors. Participants were interviewed after the observatio n period (n=33 practitioners), to determine the extent of formality they at tached to each assessment, and to elicit information about aspects which ma y be embedded in everyday practice. Single and multiple case analyses acros s the four cases used an iterative process of pattern-matching, replication logic and explanation building. The preliminary analysis yielded a descrip tive 'taxonomy' which could serve as a basis for classifying the variants o f needs assessment and help to clarify the whole phenomenon. When applied f urther to the data, this revealed the complex interactions between the diff erent ideals (relating to policy, nursing and ascribed worth), the various types (purpose, formality/specificity and complexity) and timing (in relati on to client, service and practice issues) within needs assessment.