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A distinction needs to be drawn between myth and reality if Florence Nightingale's contribution to nursing is to be understood. The reality of Nightingale's life is far from the image of the woman who glided through a hospital giving succour to dying soldiers. She was a radical who challenged the poor quality of women's lives as compared to those of male contemporaries. She stepped outside the boundaries of the accepted female gender role and the social expectations of her social class. She provides an example of someone who challenged the establishment pursuing a cause in which she fervently believed without seeking personal gain.

The NHS was established to meet the health needs of a fairly homogenous population but much has changed since the end of World War II. Britain is now a multicultural society with 6% (3.4 million) of the total household population in 1996/97 belonging to an ethnic minority group (Office for National Statistics, 1998). The NHS must change to reflect the reality of the society it serves. In this context, the death of Stephen Lawrence and the subsequent Inquiry (Home Office, 1999) has lessons for everyone. The great danger is that the Inquiry is seen as only reflecting issues of pertinence to the police rather than British society and its institutions as a whole.

The Audit Commission (1999) offers a timely review of district nursing as primary care redefines itself and primary care groups develop their capacities to reconfigure service provision to meet local health needs. The increasing demand for nursing in the home is clearly evident not only in terms of the patients cared for but also through the continuing high number of referrals. A noteworthy trend has been the increased district nurse workload in residential homes. The impact of demographic trends with a growing ageing population combined with the extending life span of the long-term disabled inevitability requires reconsideration of how these growing health needs may be met within primary health care — yesterday’s approach will not suffice especially as the number of qualified district nurses is on the decline.

The proposals put forward by JM Consulting Ltd (1999), following their independent year-long review of the Nurses Midwives and Health Visitors Act 1997, recommend that the UKCC and the four National Boards are replaced by a single, UK-wide regulatory body. The Government has accepted most of the proposals; however, the response (NHS Executive, 1999) has indicated that there is much competition for parliamentary time therefore changes in legislation governing the regulation of the profession will be enacted through an amendment to the current Health Bill.

Since the New Year there has been unending press comment on the shortage of nurses and critical reviews of current nurse education systems. Unfortunately, Frank Dobson, Secretary for Health, has decided to link these two issues. However, as Christine Hancock points out there is no evidence that nurse education is to blame for the current staff shortages.

The government claims that the introduction of primary care groups (PCGs) like previous NHS reforms will provide a more effective basis for organizing sound care delivery. A cynical view might perceive them as representing the roll-out of multi-funds nationwide, the only difference being that while previously general practices worked with their ‘friends’ they are now obliged to work with whoever serves the designated community, ‘friends’ and ‘enemies’ alike. Furthermore, although other stakeholders including community nurses are represented on PCGs, GPs continue to hold the power through majority representation and guaranteed chairmanship.

The staffing crisis facing the NHS is at last being recognized. However, the surprise announcement of a new breed of ‘super’ nurse, namely, the nurse consultant was as unexpected as it is unnecessary if reports are to be believed. More importantly, the current staffing crisis will require a sound strategy to bring about a resolution rather than rhetoric, however, well meaning.

Prescribing, purchasing and taking medication is a major component of healthcare provision in UK. The effectiveness of medication depends on both the appropriateness of the medication and the regimen used. Thus failure to take medication appropriately is likely to result in therapeutic failure such as a continued infective state and unrelieved symptoms. However, inappropriate use of medication also has major economic consequences at national and individual levels, e.g. misuse of expensive drugs, the social and economic costs of ill health and increased health needs which may result in the need for secondary care. Nonetheless, the evidence suggests that many clients do not follow the terms of their prescriptions and this is particularly true in chronic illness.

Current economic imperatives demand the development of alternative healthcare models both to complement and replace the more traditional type of health care provision, i.e. inpatient hospital stays. Consequently, a variety of ‘hospital at home’ schemes have emerged in recent years. However, despite having similar labels, there are often important differences between the schemes which reflect their different ambitions and intentions. This poses a major challenge for those who seek to evaluate the effectiveness of such schemes since it is only meaningful to compare different models of care which attempt to achieve similar goals for a similar population.

Frank Dobson, Secretary of State for Health, at the annual congress of the Royal College of Nursing, combined kind words about the value of nurses to the provision of 24–hour care throughout the year with the announcement that £14 million of national funding is to be allocated to extending nurse prescribing to all areas of the community.

Government policy emphasizes the importance of public health and the contribution made by community nurses. In so doing, it provides community nursing with a powerful opportunity and also a great challenge. Importantly, community nursing must be seen as really contributing to the health of the population not only through rhetoric but also evidenced by published rigorous research.

The Government has now published the long-awaited Green Paper Our Healthier Nation - a contract for health (Department of Health, 1998) which sets out two ambitions, namely

The review of The Regulation of Nurses, Midwives and Health Visitors Act 1997 is well underway, but its not too late to participate in this debate regarding the future shape of professional regulation. The consultative process does not close until 27 February 1998.

While the majority of our clients may have looked forward to and enjoyed the Christmas and New Year Bank Holidays, it is worth reflecting the extent to which the period is one of joy and pleasure for all citizens. The Christian festival, which began centuries ago to replace a pagan one, is barely recognisable with its commercial sponsors transforming shops shortly after the commencement of the new school year. Indeed, the confusion between commercialism and an established religious tradition should cause all community nurses to ponder. Firstly, there are other religious traditions within a multiethnic society which deserve equal acknowledgement – what about these important festivals? Do we remember them in our daily work? Secondly, the enforced break from normal everyday life presents a variety of challenges to individuals. Families often feel obliged to get together, not because they want to share but because it is expected of them – perhaps exposing the reality of family discord and the wisdom of minimal contact at other times of the year. And for those who have no family, through family breakdown, geographical or biological determinants, it may be a period of loneliness emphasising their deprivation of close family ties – the elderly, the mentally ill and other vulnerable groups including the runaway young person.

The beginning of the school year has revealed yet again what some children eat for their breakfast as they travel to school on public transport. Amazing dexterity is displayed as they juggle their school bags with quantities of confectionery which would make all dentists despair of the quest for improvement in oral health. There is clearly no easy answer to inspiring young people to adopt healthy eating habits. As a health visitor, I am always struck how most, if not all, parents express a concern to provide the very best diet for the new family member. Yet somehow, a continuing interest in nutrition become diluted over time as other parenting challenges come to the fore.

The protection of the public must be a concern of all registered nurses. However, when one examines procedures designed to protect the vulnerable citizen, it seems that some members of the ‘public’ are more deserving than others.

There are an increasing number of adults, including elders, living with disabilities which profoundly affect their lives and those of their informal carers.

Health records as a source of research data are examined. A case study approach is adopted to evaluate the reliability of health visitor records as a data source. It is argued that such records may be a rich source of epidemiological data although their deficiencies should be acknowledged.

The emergence of health visiting is traced through available historical material. It is argued that the evidence supports the view that the role of central government was limited and that health visiting owes its emergence to the pioneer work of able medical officers of health.

12-year-old Sarah has spastic quadriplegia and has been admitted to hospital to improve her mobility skills. She is also handicapped mentally. Some of the problems associated with Sarah’s condition are outlined and the way in which the nursing team will intervene to ensure that Sarah will be able to fulfil her maximum potential is given. Further problems need to be identified, together with the interventions necessary; the answers are at the end of the chapter.

A survey of childhood morbidity during the first two years of life is described. The findings confirm the continued increased morbidity of children resident in an inner city area and the detrimental influence of poor social circumstances upon child health.

A study reviewing the uptake of prophylaxis among 756 inner-city infants during their first two years of life is described. The contribution of the health visitor to uptake of prophylaxis in infancy is demonstrated. It is argued that health visitors as members of primary health care teams can do much to promote health in the community.

In this article we present a critical evaluation of the development of a protocol to support district nurses in the domiciliary annual review of older people with diabetes. We discuss the protocol’s development, identifying its limitations and making recommendations for its use. We conclude that although the protocol is a useful starting point its validity is challenged by a lack of primary research regarding the care of older people with diabetes. More work is needed to identify appropriate remedial therapy following the annual review. The health education component also requires development to better reflect the different needs of older people.

The continued extension of prescribing rights among nurses may necessitate that effective pain management will require more involvement of nurses in the prescription of controlled drugs. The prescription of strong opioid analgesic drugs for chronic non-cancer pain (CNCP) is viewed as controversial. Misconceptions about opioid drugs fuel this controversy. This case study highlights the knowledge gap that exists between pain and addiction medicine and highlights the problems that CNCP patients treated in the community with opioid therapy may encounter. Community nurses are in an ideal position to be instrumental in identifying such vulnerable patients and ensuring that appropriate interventions are available.