title: Maintaining the continuity of care in community children's nursing caseloads in a service for children with life-limiting, life-threatening or chronic health conditions: a qualitative analysis.
abstract: OBJECTIVE
  To explore the factors that influence community children's nurses' (CCNs') perceptions of their workload. To identify ways that CCNs develop and maintain continuity of care and carer.
  
  
  BACKGROUND
  The notion of continuity of care/carer has been central to nursing development for the last 30 years. In the literature, community nursing is used to illustrate the concepts of responsibility relationships and continuity of care/carer. However, an assumption is made that the case allocation method is assumed to be the norm in community nursing. The recent UK literature indicates that the case allocation method is not necessarily working in community nursing. It suggests that there may be continuity of care via teams of community nurses and health care assistants, but not necessarily continuity of carer. This seems to reinforce the notion that ideas about the nature of nursing work, the relationship between nurse and client and the mode of care are constructed, contextual and not self-evident. Little has been written about this regarding CCN work.
  
  
  METHODS
  Collaborative action research design using qualitative methods.
  
  
  METHODS
  In depth interviews with six CCNs drawn from a NHS funded, PCT hosted CCN service in the West of England; documentary analysis of caseload data; thematic analysis of analytical memos and field-notes.
  
  
  RESULTS
  The analysis of the CCNs' interviews identified the mechanisms and strategies they used for managing their work, meeting clients' needs while ensuring that continuity of care and carer was maintained. From their responses to questions, the responsibility relationship and autonomy characteristics of their role were perceived to be a good thing. However, they acknowledged that working in such a way is stressful and provided examples from their everyday working lives. They emphasised the role of support from colleagues as an important way of maintaining and sustaining the responsibility relationships inherent in their work pattern.
  
  
  CONCLUSIONS
  The findings from this study seem to support the notions prevalent in the literature that ideas about the nature of nursing work, the relationship between nurse and client and the mode of care are socially constructed and automatically given. The group of CCNs in this project actively manage their caseloads to maintain the continuity of care and carer in a particular model of service delivery.
  
  
  CONCLUSIONS
  This project provides some illustrations of the way continuity of care may be achieved at the informational, management and relational levels of practice. The typology of continuity of care allows the discrete areas of CCN work to be highlighted and explored, providing insights on an area of practice that is under-reported. The study provides a basis for future research to examine the different configurations of CCN services for the same client group or services for different clients, e.g. diabetes care, so that service providers may configure provision to meet children's and their family's needs.
authors.affiliation: Children's Nursing, Faculty of Health & Social Care, UWE, Bristol, UK. David.Pontin@uwe.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Pontin
authors.forename: Mary
authors.initials: M
authors.lastname: Lewis