Abstract
The purpose of this research was to ascertain how primary nursing care is perceived by both the elderly infirm living in the community and their district nurses. How the perceptions of needs for care were translated into action and the sort of expectations they had and results they achieved. The research also examined whether or not differences in nursing care patterns occurred between those nurses working within a primary health care team and those aligned to a number of single-handed general practices. The main research instrument was in the form of interview schedules. These contained structured and open ended questions as well as Likert assessment scales, and were administered by the researcher to patients, nurses and general practitioners at various stages of care. Over a period of 18 months a total of two-hundred patients and their district nurses and general practitioners from one health district participated. The results were analysed with the help of a computerised statistical package for social science. The findings indicate that district nurses' perception of patient needs is illness focused and, as such, prescribe and give nursing care on the basis of the medical model. The patients' perceive their state of health mainly in terms of discomfort and disability and their effects. As their problems manifest themselves to a great extent in multiple health as well as social issues as a legacy of past life events, a shift from the medical towards the social model of care seems, therefore, of prime importance. There is little doubt that where district nurses become involved with the elderly infirm person she becomes the focal health care professional support. It seems that this emphasis on the district nurse becoming the key member of the primary health care team produces a whole new set of values. This approach has implications not only for post basic nurse training but also demands a change of attitude towards organisational support. As the role of the district nurses as a fully participant health care team member in Attachment schemes has not been established conclusively in this research it is important to consider professional support by strengthening the peer reference group. These findings and their limitations are discussed and areas of further research identified.