title: Community psychiatric nurses and the care co-ordinator role: squeezed to provide 'limited nursing'.
abstract: OBJECTIVE
  This paper reports a study illuminating the factors that either facilitate or constrain the ability of community psychiatric nurses, in their role as care co-ordinators, to meet service users' and carers' needs.
  
  
  BACKGROUND
  The Care Programme Approach is the key policy underpinning community-focused mental health services in England, but has been unevenly implemented and is associated with increased inpatient bed use. The care co-ordinator role is central to the Care Programme Approach and is most often held by community psychiatric nurses, but there has been little research into how this role is performed or how it affects the work of community psychiatric nurses and their ability to meet the needs of service users.
  
  
  METHODS
  A multiple case study of seven sectorised community mental health teams was employed over 2 years using predominantly qualitative methods including participant observation, semi-structured interviews and document review. The data were collected in one National Health Service trust in south England between 1999 and 2001.
  
  
  RESULTS
  Additional duties and responsibilities specifically associated with the care co-ordinator role and multidisciplinary working, combined with heavy workloads, produced 'limited nursing', whereby community psychiatric nurses were unable to provide evidence-based psychosocial interventions that are recognized to reduce relapse amongst people with severe mental illness.
  
  
  CONCLUSIONS
  The role of the Care Programme Approach care co-ordinator was not designed to support the provision of psychosocial interventions. Consequently, community psychiatric nurses in the co-ordinator role are faced with competing demands and are unable to provide the range of structured, evidence-based interventions required. This may partially account for the increased inpatient bed use associated with the Care Programme Approach.
authors.affiliation: Mental Health and Learning Disability, St Bartholomew School of Nursing and Midwifery, City University, London, UK. a.simpson@city.ac.uk
authors.forename: Alan
authors.initials: A
authors.lastname: Simpson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019090:Case Management; D003152:Community Health Nursing / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D024802:Nurse's Role; D011568:Psychiatric Nursing / Q000458:organization & administration*; D016526:Workload