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ABSTRACT

This paper reports some findings from a study which aimed to explore community nurses� understandings of discrimination and equalities issues. It focuses specifically upon their accounts of working with culturally diverse clients, highlighting some (un)-certainties of everyday community practice.
The study took place during 2003 in an English city with a large and culturally diverse population. Semi-structured interviews were undertaken with 18 �District Nurses�; these are qualified and experienced community nurses who provide care to a range of clients in community and primary care settings, and also manage the community nursing team and resources. A qualitative methodological approach was used underpinned by an interest in discourse analysis.
District nurses� accounts were marked by uncertainty suggesting many lacked confidence discussing issues of ethnicity and cultural difference. There were differences in the extent they recognized or engaged with client�s experiences of discrimination or inequalities, or recognized inequitable service provision to clients from minority ethnic groups. Key issues were a lack of provision of district nursing services to some older clients, and failures to meet language and communication needs, and although reflecting organizational constraints, such continuing inequities were largely unquestioned.
The findings suggest that despite a professional emphasis upon individualised care, district nurses faced difficulties in making inter-connections between an individual�s identity and circumstances, and how this intersected with wider societal, organisational and structural contexts and issues. This often constrained both their ability to offer equitable and appropriate care to culturally diverse clients or to consider the complexities of accomplishing this in the busy everyday world of district nursing practice. The paper concludes there is a need for further policy, practice and educational engagement with these issues to support community nurses to meet the challenges of providing care to an increasingly diverse population in the 21^st century.

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