Changes in patterns of knowing the patient: the case of British district nurses.
British district or home nurses, have until recent years been hidden from the wider context of the British National Health Service. Policy changes in UK over the last two decades of the 20th century have increasingly focussed on Primary Care Services and district nurses (DNs) have seen substantial changes to their workload. This paper addresses the question of how the changes in the organisation of Primary Care Services affected some aspects of DNs' work. Thus, the focus of this paper is an examination of the relationship DNs had with patients through a period of turbulent change. Knowing the patient is a central element of nursing practice. Data are presented here form a multi-site ethnographic study of DNs' work undertaken in four purposively sampled study sites. Applying Carper's (1978) framework, the data presented here show that there has been a shifting emphasis in knowing the patient from aesthetic and personal knowing to knowing about and empirical knowing.
Speed
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School of Nursing, Midwifery and Social Work, University of Manchester, Coupland III, Oxford Road, Manchester M13 9PL, UK. sspeed@man.ac.uk
Luker
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KA
D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003152:Community Health Nursing / Q000193:education / Q000458:organization & administration*; D018166:Health Care Reform / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019359:Knowledge; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology; D015279:Organizational Culture; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration; D011637:Public Health Nursing / Q000193:education / Q000458:organization & administration*; D036301:Qualitative Research; D012649:Self Concept; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D006113:United Kingdom