The guideline contradiction: health visitors’ use of formal guidelines for identifying and assessing families in need
Introduction
The potential for health visitors to accurately identify children and families in need, to promote family health and well being and to protect vulnerable children is acknowledged in current health and social policy (Home Office, 1998; Department of Health, 2000). Health visitors are in a unique position to identify parents and children experiencing stress and to undertake short-term preventative work with families because of their current, albeit often limited, universal access to families (The National Society for the Prevention of Cruelty to Children, 1996; Department of Health, 1999). As such, assessment of family health and social need is a central feature of the health visitor's role in which a range of skills and knowledge are used. These assessments are crucial in identifying children and families in need and in determining levels of health intervention to be offered. Drawing on recent empirical research, this paper examines health visitors’ use of formal guidelines in identifying health needs and prioritising families requiring extra health visiting support.
Section snippets
Universal vs. targeted service
Health visiting is a health-promoting service offered to all families with pre-school children. Health visitors are registered nurses who have undergone post-registration specialist training which focuses specifically on health promotion and disease prevention amongst all population groups. Most health visitors work in the community and through a combination of home visiting, clinic work and community-based activities are well placed to identify and work with vulnerable groups.
Despite the
Identifying children and families in need
Child health promotion work forms the basis for assessment and targeted work with children and families in need. Health visitors have traditionally adopted a number of approaches to identify children and families requiring extra health visiting. These include risk assessment screening, the use of guidelines and a reliance on health visitor professional judgement. These approaches are reported in more detail elsewhere (Appleton, 2002a). However, there is a dearth of research evidence exploring
Study design
A case study strategy (Stake (1994), Stake (1995); Appleton (2002a), Appleton (2002b)) guided by a constructivist methodology (Guba and Lincoln, 1989) was used to undertake an in-depth examination of how health visitors identify families deemed to require additional support. Insights from the preliminary survey work influenced the purposive sampling strategy to select three main study Trusts and one pilot site where contrasting guidelines were issued to health visitors to assist in the
Findings and discussion
A feature of the analysis was the variety and range of criteria available for the identification of families needing increased support. Table 2 illustrates the formal guidelines existing in the case sites. The following sections will describe in more detail the characteristics of the guidelines existing in each site.
Conclusion
The requirement to target health visiting interventions to those families with increased health needs has led to a rapid growth in the development of formal guidelines to assess families in need (Appleton, 1997). While it is acknowledged that extra health visiting support should go to those children and families with most demonstrable need, there seems to be a view that equity in access to scarce health-care resources can be addressed by the development of such guidelines. This paper has
Acknowledgements
We would like to express our sincere appreciation to the research funders and to all the participants who gave up their time so willingly to take part in this research and made the study possible. Smith and Nephew Foundation Nursing Research Fellowship and Department Health/CPHVA Centenary Scholarships funded this research.
References (60)
Establishing the validity and reliability of clinical practice guidelines used to identify families requiring increased health visiting support
Public Health
(1997)- et al.
Health needs assessment in the health visiting service and the impact on the ethnic community
International Journal of Nursing Studies
(2003) - et al.
Empowerment or control? An analysis of the extent to which client participation is enabled during health visitor/client interactions using a structured health needs assessment tool
International Journal of Nursing Studies
(2003) Health visitor assessment of vulnerability
Health Visitor
(1995)Assessing vulnerability in families
Using guidelines to prioritise families who need additional health visiting support
- Appleton, J.V., 2002a. An examination of health visitors’ professional judgements and use of formal guidelines to...
Critiquing approaches to case study design for a constructivist inquiry
Qualitative Research Journal
(2002)- et al.
Family based interventions with children in need
Community Practitioner
(1999) - et al.
Analysing clinical practice guidelines. A method of documentary analysis
Journal of Advanced Nursing
(1997)
Valuing professional judgement in health visiting practice
Community Practitioner
The Child Development ProgrammeA Collaborative Programme Linking Parents, Community and Health Visitors
A demotion of professional skills
Health Visitor
Health Trends Over Time and Major Outcomes of the Child Development Programme. Evaluation Document 15. Early Child Development Unit
Assessment of Need for Health Visiting Research Monograph No. 2. Department of Nursing and Community Health
Giving and receivingan empirically derived theory on health visiting practice
Journal of Advanced Nursing
Searching for health needsthe work of health visiting
Journal of Advanced Nursing
What are clinical judgements?
Development and application of a generic methodology to assess the quality of clinical guidelines
International Journal of Qualitative Health Care
Making Sense of Qualitative Data. Complementary Research Strategies
HVs rebel over drug questionnaire
Nursing Times
What's in a name? Health visiting is health visiting
Community Practitioner
The search for health needs
A structured health needs assessment toolacceptability and effectiveness for health visiting
Journal of Advanced Nursing
Exploring needs assessment in community nursing
Health Visitor
A taxonomy of needs assessment, elicited from a Multiple Case study of Community Nursing Education and Practice
Journal of Advanced Nursing
Mothers’ views on the First Parent Health Visitor Scheme
Community Practitioner
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