The work of district nurses: first assessment visits

District nurses are the largest group of community nurses in the United Kingdom and overall responsibility for assessing and planning how patients' and families' needs are met remains an essential element of their role.

To explore the nature of the knowledge required by district nurses to carry out first assessment visits and the relationship of this to the decisions they make.

An ethnographic design was used. The sample was 11 district nurses and the principal data collection methods were participant observation and two semi-structured interviews. The first interview, which took place immediately after the visit, was designed to explore general areas in relation to assessment and particular issues from the visit (phase 1). Following analysis of the phase 1 interview and fieldnote data, questions for the second interview were generated to facilitate further exploration and clarification of important issues that had arisen (phase 2). The second interviews were conducted approximately 1 year later and data were collected during 1997 and 1998.

The findings revealed a breadth and depth of community nursing knowledge that seemed to incorporate an amalgam of theoretical (knowing that) with practice-based (knowing how) knowledge. The findings depict the range and scope of knowledge in use by district nurses and reflexive character of the assessment process, and challenge the use of theoretical models that remove knowledge from the context in which district nurse-patient interactions take place.

The information search in assessment was paced to cope with the uncertainty that existed in many of the complex multifaceted situations encountered by the district nurses. Understanding assessment as a paced process was linked to making the best judgement at the time of the visit.