The development of a theory based nursing assessment format for generalist community health nurses working within the Illawarra Area Health Service

Generalist community health nurses work according to the primary health care model with an emphasis on needs based care, self-determination and health promotion. Despite this, the nursing assessment form used by generalist community health nurses employed by the Illawarra Area Health Service, has been developed according to the reactive Problem Oriented Medical Records Policy. This policy identifies problems after they occur and limits the nursing process. In contrast the Modeling and Role-Modeling Theory developed by Erickson, Tomlin and Swain(1983) focuses on a client centred approach, is closely aligned to the primary health care model and enhances the nursing process. The following literature review outlines the definition, philosophy and importance of primary health care to community health nurses. Also identified are the benefits of combining the nursing process with nursing theory and more specifically, the Modeling and Role-Modeling Theory, in the implementation of the primary health care model. This quantitative research project evaluates a nursing assessment format developed for generalist community health nurses, based on the Modeling and Role-Modeling Theory. The methodology involves postal questionnaires and incorporates the use of the delphi technique and a panel of experts. A comparison is made with the non-theory based nursing assessment form currently used, in terms of ability to encourage the provision of primary health care, personalised holistic care, development of nursing care plans and nursing judgements. Unlike the currently used non-theory based nursing assessment format, a significant number of respondents perceived the theory based nursing assessment as encouraging primary health care and personalised holistic care. Views from nurse managers, resource personnel and the client population, were also obtained. The experts were found to support the use of theory based clinical practice. This research therefore identifies important issues for nurses working within the primary health care model to consider, particularly in order to maintain credibility and ensure best practice principles of care.