Teamwork in primary care: an evaluation of the contribution of integrated nursing teams
This paper examines the community nursing contribution to primary care by reporting on a qualitative evaluation study of the introduction of integrated nursing teams by an NHS community trust in one location in the United Kingdom. A pluralistic evaluation approach ( Smith & Cantley 1985) was used to identify the various criteria by which the different stakeholders involved in the initiative judged the integrated nursing teams to be successful. Six teams at various stages of development were included in the study, together with other groups who had a vested interest in the performance of the teams. Data were collected by means of in-depth individual interviews with team coordinators, team facilitators, senior trust managers, GPs and practice managers; and focus group interviews with team members. The criteria for success identified by the various stakeholders provided a framework through which the overall success of the initiative was judged. Five meanings of success were identified, namely: team working; effective communication; an orientation towards the general practice; changes in working practices; and responsiveness to change. Key findings relating to each of the criteria are presented and consideration given to the implications arising for the development of Primary Care Groups (PCGs). The paper concludes that, paradoxically, by stepping aside from the traditional hierarchy inherent in the primary health care team (PHCT), integrated nursing teams may provide community nurses with the opportunity to make a more active contribution to the future development of primary care.