Conceptualising a model to guide nursing and midwifery in the community guided by an evidence review

Abstract

BackgroundSuccessful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services. Primary and community health services are the typical points of access for most people and the location where most care is delivered. The scope of primary healthcare is complex and multifaceted and therefore requires a practice framework with sound conceptual and theoretical underpinnings.The aim of this paper is to present a conceptual model informed by a scoping evidence review of the literature.MethodsA scoping evidence review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases included CINAHL, MEDLINE, PsycINFO and SocINDEX using the EBSCO platform and the Cochrane Library using the keywords: model, nursing, midwifery, community, primary care. Grey literature for selected countries was searched using the Google ‘advanced’ search interface. Data extraction and quality appraisal for both empirical and grey literature were conducted independently by two reviewers. From 127 empirical and 24 non-empirical papers, data extraction parameters, in addition to the usual methodological features, included: the nature of nursing and midwifery; the population group; interventions and main outcomes; components of effective nursing and midwifery outcomes.ResultsThe evidence was categorised into six broad areas and subsequently synthesised into four themes. These were not mutually exclusive: (1) Integrated and Collaborative Care; (2) Organisation and Delivery of Nursing and Midwifery Care in the Community; (3) Adjuncts to Nursing Care and (4) Overarching Conceptual Model. It is the latter theme that is the focus of this paper. In essence, the model depicts a person/client on a lifespan and preventative-curative trajectory. The health related needs of the client, commensurate with their point position, relative to both trajectories, determines the nurse or midwife intervention. Consequently, it is this need, that determines the discipline or speciality of the nurse or midwife with the most appropriate competencies.ConclusionUse of a conceptual model of nursing and midwifery to inform decision-making in primary/community based care ensures clinical outcomes are meaningful and more sustainable. Operationalising this model for nursing and midwifery in the community demands strong leadership and effective clinical governance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-017-0225-3) contains supplementary material, which is available to authorized users.

State of the Art on Family and Community Health Nursing International Theories, Models and Frameworks: A Scoping Review

“…After duplicates removal, screening of titles and abstracts, 392 studies remained. After full-text assessment, only 23 papers were included in this review [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. The overall selection process is shown in the PRISMA flowchart ( Figure 1 ).…”

“…3; 13%) [ 31 , 36 , 47 ]. The other studies were performed in Italy [ 30 , 46 ], The Netherlands [ 48 , 49 ], Australia [ 38 ], Ireland [ 44 ], Portugal [ 32 ], Norway [ 45 ], Thailand [ 40 ] and Slovenia [ 41 ].…”

“…Within these articles, we identified twelve models (52%) [ 32 , 33 , 35 , 38 , 40 , 41 , 42 , 43 , 44 , 46 , 48 , 49 ], six institutional documents about services and programs (26%) [ 30 , 31 , 34 , 37 , 45 , 51 ], four statements and frameworks of competences (17%) [ 29 , 39 , 47 , 50 ] and one theoretical model (5%) of FCHN [ 36 ].…”

“…Care receivers included individuals, families and community members ( n . 19; 83%) [ 30 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. The main elements of all models were summarized in Table 2 .…”

“…Examples of primary prevention interventions include the provision of educational sessions to improve parent–child relationship or vaccination activities [ 29 , 32 , 33 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 47 , 48 , 49 ]. Secondary prevention is mainly represented by screening activities, such as cancer and osteoporosis screening [ 38 , 39 , 40 , 41 , 44 , 47 , 50 ].…”