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Aims and objectives. 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. Design. 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. Relevance to clinical practice. 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 ofCCNservices 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. [ABSTRACT FROM AUTHOR]

AIM: Little is known about the working practices of community children's nurses and how they manage the complexities of working with children and young people with life-limiting, life-threatening and chronic ill-health conditions and their families. This action research project aimed to find ways of managing community children's nursing caseloads that would improve the efficiency, effectiveness and equity of services and inform negotiations with service commissioners. METHODS: A data collection template comprising six input categories was adapted from the Cornwall Community Trust's health visitor weighting framework to reflect the complexity of need and the family focus of the service provided. Data were collected for one year by nurses in one integrated community children's nursing and clinical psychology service in the Southwest of England. Qualitative interviews were held with the nurses to further explore patterns identified in the input data. RESULTS: From the documentary analysis and the interviews it was possible to identify a typical ratio of client numbers in each category which allowed the nurses to be proactive in meeting children's and families' assessed needs. The numbers of clients on caseloads fluctuated over time and varied between geographical caseload areas. The type of work carried out by individual nurses varied depending on the type of contract for their locale. However, by weighting the clients in each category it was possible to arrive at a means of meaningful comparison in terms of family centred nursing. CONCLUSION: The nursing input framework supports monthly caseload monitoring by community children's nurses and informs reports to the service commissioners as part of activity monitoring data. The mechanism will be tested in comparable services in the UK to gauge its transferability. [ABSTRACT FROM AUTHOR]

UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours.