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Buller and Butterworth: Skilled nursing practice - four domains?

Posted Nov 28 2010 8:45am
The health care domains model identifies four domains within health and social care and medicine. What evidence is there to support the model's inclusion of
INTERPERSONAL : SCIENCES
SOCIOLOGY : POLITICAL

- plus the spiritual within and without? Steve Buller and Tony Butterworth undertook a ethnographic study in 2001 ' Skilled nursing practice - a qualitative study of the elements of nursing'. With skilled nursing practice at the center (Fig. 5.) they identified
relating and communicatingdoing the job
being professionalmanaging and facilitating

There is some overlap, reflection arises in relating and communicating and doing the job. Overall however there is a definite correspondence between these domains and those within h2cm - the health care domains conceptual framework. I have equated being professional with the SOCIOLOGY domain as for the authors this includes being with patients, conveying confidence, handling situations, being informed. Managing and facilitating is undoubtedly POLITICAL with supervising, auditing, making sure things get done. Doing the job - is based upon planning, informing, assessing, intervening, and being confident (with equipment, procedures, manual dexterity..).

Having been thinking and writing about h2cm for many years it is a shame that other models have benefitted from funding and gain "ward and community (research) cred" while here evidence is retrofitted. Looking at the paper just in the decade since submission and publication I wonder which elements remain local, and where other elements of the skills base (care concepts) have migrated to ethnographically?

Steve Buller, Tony Butterworth (2001) Skilled nursing practice — a qualitative study of the elements of nursing. Int. J. of Nursing Studies. 38, 4, 405-417.
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