Work Of Health Visitors Research Articles

Cooperation between the health visitor and the physician as one of the pillars of the 108-year-old Hungarian Health Visitor Service

Despite the more than 100-year history of the Hungarian Health Visitor Service, no study has yet been carried out that looked back at the cooperation between health visitors and physicians. Our aim was 1) to explore the professional advances of the health visitor service and the cooperation between health visitor and physician by examining historical documents, legal and professional regulations governing the work of health visitor, furthermore, 2) to investigate whether there are compulsory training elements in today's training for health visitors that prepare students for health visitor and physician collaboration, moreover, 3) to search for old tools and documents used by health visitors and doctors in the North-West of Transdanubia. A literature search was carried out to identify documents relating to the development of the work of health visitors, the cooperation between health visitors and physicians, past and current legal and professional regulations, the current regulation on training of health visitors. Through field research, we tracked down old tools and documents of health visitors and physicians. The establishment of the Hungarian Health Visitor Service is associated with the names of professors of medicine. The historical documents and regulations testify the development of the work of the health visitor, the expansion of her competences and the importance of the health visitor and physician cooperation. The training competences required for the cooperation between health visitors and physicians, health visitors and specialists are regulated by the regulation on training of health visitors. We have found many old objects and documents used in the work of the health visitor and doctor. The documents that have preserved almost invariably describe the health visitor as a person working alongside the physician, in cooperation with the physician. Nowadays, the regulation of cooperation covers for all specialties in the field of health visitor. Based on our research, it is fair to say that the health visitor-physician cooperation is an important pillar of the 108-year-old Hungarian Health Visitor Service. Orv Hetil. 2023; 164(33): 1311-1318.

Organising health visiting services in the UK: Frontline perspectives

The organisation of health visitor work is an important part of service design, which can have an impact on when and where services are provided and who gains access. This article reports a 2018 survey of UK health visitors conducted to provide an overview of the range of ways in which health visitor cases and workloads are organised. The 584 respondents confirmed the operation of three broad types of health visitor service delivery models; namely, the individual case, the corporate case and the combination model. Themes that emerged from practitioners' experiences of working with the different models reflected concerns about continuity and staffing, accommodating different needs and different services in different places. Overall, the data indicated a lack of consistency in health visitor service across the UK. The advantages and disadvantages of each workload model are detailed and considered with respect to markers of a quality service, including achieving relationships with clients and sufficient communication within and across teams.

Preventive care and public health

The Long Term Plan for the NHS in England provides a clear focus on the importance of prevention and work that can be undertaken to address inequalities in health, and therefore the work of health visitors, says Crystal Oldman

Symbolic capital of the work of the female health visitors of the Public Health Service Foundation in the State of Alagoas, Brazil

This study of a historical nature analyzes the work of health visitors of the Public Health Service Foundation in Alagoas between 1960 and 1990 and the symbolic capital attributed to them. Documental and oral sources were used, the latter produced in interviews conducted using thematic oral history, given by the visitors, the physician and nurse. The information was analyzed based on the concepts of habitus, field, symbolic capital and distinction of Pierre Bourdieu, and revealed that health visitors were relevant in the healthcare of the communities where they worked with distinctive approaches to inculcate health practices through home visits and authority to reconfigure the hygienic habitus of families. This activity gave them symbolic power and capital legitimized by the community.

Policy: Reconnecting health visiting and public health

Prevention and public health are the basis of the work of health visitors. How can the wider public health community work with health visitors to make best use of this valuable front line public health resource?In 2012, in addition to all the other celebrations, the first 150 years of health visiting was celebrated and the new Institute of Health Visiting (www.ihv.org.uk) was launched. The history of health visiting roots the profession in the work of home visitors, employed by the Ladies Branch of the Manchester and Salford Sanitary Association to visit women and children in slum areas of Manchester and Salford to promote hygiene and health in the home.1 The existence of this and many other associations was in itself a reflection of the growing concern with public health during the early and mid 19th century, which focused on issues around industrialization and infectious diseases, epitomized by the work of John Snow whose bicentenary is celebrated this year.While the practice of health visiting may go back to 1862, it was not until 19772 that the underpinning philosophy of health visiting practice was fully articulated in the four principles of health visiting:* The search for health needs* The stimulation of an awareness of health needs* The influence on policies affecting health* The facilitation of health enhancing activities3These principles identify the health visitor as a preventive, public health worker working both with individuals, families and communities and acting to influence the wider public health context. The principles form the basis for the Nursing and Midwifery Council (NMC) approved health visiting programmes, which led to registration of health visitors as Specialist Community Public Health Nurses (Health Visitor) on the third part of the NMC register. Health visiting programmes also make use of the Public Health Skills and Competencies4 but the time is probably long overdue for the competencies for health visitor education to be based more clearly on these generic public health skills and competencies. If this was the case then the critical role of the health visitor as a Band 6 or 7 practitioner in public health might be more clearly seen by the wider family of public health practitioners.The launch and subsequent implementation of the Health Visitor Implementation Plan 2011-15 A Call to Action5 in England has led to a re-energizing of health visiting and health visitors in England and throughout the UK.6 The plan initiated the new four-level health visiting service for families: community; universal; universal plus and universal partnership plus, all informed by attention to safeguarding and child protection concerns. The reality of implementation, within the context of an ongoing programme to raise the numbers of health visitors from a historically low base, has been a focus, by commissioners, on commissioning and monitoring achievement of the activity in the three service areas (universal, universal plus and universal partnership plus). Reporting has focused on achievement of activities, for example the new birth visit at 10 to 14 days, monitoring of breast feeding at initiation and continuation, and management of vulnerable families and children at risk.A task-focused counting of contacts and activities does not, however, sit well with the 'opportunity' identified in the Call to Action for health visitors to: 'promote community capacity building to enable families and communities to build on their strengths to develop new ways for providing services as part of the Big Society'.This type of statement acknowledges that the health of the community is dependent on multiple factors which may be impacted by interdisciplinary and community collaboration. …

GPs' and health visitors' views on the diagnosis and management of postnatal depression: a qualitative study

In the UK, 8-15% of women suffer from postnatal depression, with long-term consequences for maternal mood and child development. Previous literature suggests that health visitors struggle with their conflicting roles with respect to mother and infant. Current policy is redirecting the emphasis and organisation of health visitor work, but guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression. To explore the views of GPs and health visitors on the diagnosis and management of postnatal depression. A qualitative study nested within a multicentre randomised controlled trial. Nine primary care trusts in Bristol, Manchester, and London. In-depth interviews with GPs and health visitors from primary care trusts participating in a randomised controlled trial of antidepressants versus health visitor-delivered non-directive counselling. Interviews were audiotaped and fully transcribed. Thematic analysis with an iterative approach was used to develop conceptual categories from the transcripts. Nineteen GPs and 14 health visitors were interviewed. GPs and health visitors described their work in making and negotiating the diagnosis of postnatal depression, the value of a long-term relationship with the woman, and how labelling affects management of women with postnatal depression. Responders described how they viewed others' roles in the management of postnatal depression, and how national policy and local organisational changes had an impact on patient care, so that no one health professional was assuming overall responsibility for the care of women with postnatal depression. Ongoing organisational changes within primary care, such as the implementation of corporate working by health visitors, affect care provided to women after birth, which in turn has an impact on the diagnosis and management of postnatal depression.

The work of health visitors and school nurses with children with psychological and behavioural problems

This paper is a report of a study to describe the workload of health visitors and school nurses in relation to children and young people with psychological, emotional or behavioural problems, and to identify perceived challenges, obstacles and sources of satisfaction associated with this aspect of their work. There is little published information on the work performed by non-specialist community nurses with children and young people who have psychological, emotional and behavioural problems. We analysed data from a survey conducted in 2002 - 2003 of 1049 Scottish professionals working with children and young people. Data included quantitative responses and free-text describing the cases seen by respondents. Responses from a sub-sample of 71 health visitors and 100 school nurses were analysed using a combination of descriptive statistics and analysis of themes emerging from the text. Although community-based nurses saw a relatively small number of children with psychological, emotional or behavioural problems each week, dealing with these problems took up a disproportionate amount of time. The commonest types of problem were self-harm, externalizing behaviours and family difficulties. Few respondents had received specific training in child and adolescent mental health but most expressed a wish to receive such training. The work of health visitors and school nurses in caring for children with mental health problems is substantial and important. Development of their public health role should not be at the expense of this important contribution. There is a need for rigorous evaluation of nursing mental health interventions among children and young people.

Information management in health visitors’ public health and community development activities

This qualitative study aimed to identify UK health visitors’ management of information, with particular reference to their public health and community development activities. Widely recognized concepts, such as information audit to assess information need and process models of information management, were applied at operational level to represent health visitors’ information environment. The naturalistic methodology included interviews and observation, the use of NUD.IST to aid qualitative data analysis, and the code and retrieve method to develop theory. The results highlight information flows, categories of information need, and key issues relating to health visitors’ information management practice. It is concluded that the community development work of health visitors can be seen as information work, and that health visitors can be viewed as ‘information processors’ and ‘information facilitators’. It is suggested that health visiting requires an information policy that will inform the development of local information strategies and effective information management practices.

Protecting children: intuition and awareness in the work of health visitors.

Protecting children: intuition and awareness in the work of health visitors This paper is based upon an ethnographic study of a group of health visitors engaged in child protection work. The purpose of this paper is to explore the meanings individual health visitors attach to events concerned with identifying children who may be at risk of harm from child abuse, and also the idiosyncratic nature of health visiting in this complex but everyday social situation. The paper focuses on understanding the importance of a particular form of knowledge which the health visitors referred to as 'intuitive awareness'.

The impact of social inequalities in child health on health visitors' work.

Preventive and health promotion work by health visitors ought to reduce social inequalities in child health. However, the increased health and developmental problems among disadvantaged children may constrain health visitors' ability to carry out effective preventive work. This paper measures the impact of socioeconomic inequalities in children's health on the work of health visitors and the amount of preventive work they can provide, with emphasis on 'parenting' programmes. Data collected for health visitors' profiles were analysed in an ecological cross-sectional study. Individual caseloads were classified according to the proportions of families in social class IV or V and families headed by an unemployed person. A range of measures of young children's health and development indicated the demands on health visitors' time. Preventive work was divided into post-natal support, parenting programmes, special clinics and other preventive work. All the outcome measures were poorer in the most disadvantaged caseloads. Odds ratios between the most and least disadvantaged 20 per cent of caseloads were 0.6 for breast feeding at birth, and at seven months, 1.9 for post-natal depression, 3.2 for mothers under 18, 10 for lone parent families, 2.6 for families needing high intervention, 4.5 for families with a smoker, 11 for domestic violence, 4.4 for parents with a chronic health problem, 2.7 for children on the child protection register and 2.8 for children with developmental problems. There was 30 per cent greater health visitor time provided in the most disadvantaged caseloads than in the most advantaged. There was no consistent difference in the amount of preventive work carried out; in particular, parenting programmes were delivered at a similar rate in all caseloads. Large differences in demands on health visitors' time exist between affluent and disadvantaged caseloads which are barely reflected in the provision of extra time to poorer caseloads. There is no consistent pattern to the delivery of preventive programmes designed to ameliorate the effects of disadvantage on children's health and development.

Depression in female health visitor consulters: social and demographic facets.

The primary health care setting has been established as a key venue for identifying and working with depression. Despite this, and the high risk of depression experienced by women in the postnatal period, maternal depression has been little examined in the work of health visitors. Furthermore, although research has been undertaken on social factors related to depression in the general population, there is nothing specifically on the population of health visitor clients. This study focuses on social and demographic factors related to maternal depression amongst users of health visitor services. In a study of 701 women in rural and urban areas, maternal depression was found to be significantly associated with the absence of receipt of further or higher education, housing status, employment status, reliance on state benefit, family size, family breakdown (reconstituted families and single divorced or separated women), perceptions of support and difficulty in getting children off to sleep, particularly after the first year of the child's life. Loglinear analysis was used to identify the most parsimonious model of these relationships, and three key areas emerged: social and economic disadvantage, family size and history of family disruption. The model suggested that 'behind' these data may have been poor life chances, as evidenced by data on further and higher education. These data identify elements of objective life circumstances important for depression in this group. They have considerable significance for the organization of health service resources and these are discussed.

The experiences of mothers caring for a child with severe atopic eczema

Atopic eczema is a relatively common disease which frequently occurs during childhood. This paper reports the findings of a research study which explored the effects upon family life of caring for a child with severe atopic eczema. Seventy-seven accounts written by mothers of preschool children with this disease were analysed using qualitative latent content analysis. The focus of this paper is on the implications of the disease for the mothers' role and the additional work generated by the disease. The implications of these findings for nursing practice, in particular the work of health visitors and paediatric community nurses, is discussed. Throughout this paper the term 'nurse' is used to describe both nurses and health visitors.

Depression in the work of British health visitors: Clinical facets

The primary health care setting has been established as a key venue for identifying and working with depression. Despite this, and the high risk of depression experienced by women in the post-natal period, maternal depression has been little examined in the work of health visitors. This study focuses on clinical facets of this work, including the rate and content of depression amongst health visitor attenders, the capacity of health visitors to identify accurately the presence of depression, the relationship between depression and child abuse and child behavioural issues, variations in the practice of health visitors and work with other professionals. In a cohort of 701, 11% of women were depressed, with distinguishing symptoms including fatigability, disgust/hate of herself and a sense of failure. Health visitors were not generally accurate in their identification of depression, were significantly more likely to see depressed women at home (than at clinic), but there was little difference in mean frequency of consultations according to whether or not the women were depressed. Urban health visitors had a higher mean frequency of consultations, but rural health visitors showed a rather greater tendency to increase frequency of consultation with the presence of depression. Child abuse concerns and behavioural problems were significantly associated with depression and these were three times as frequent amongst depressed women with no children aged under one compared with women in their post-natal year. Depressed women were far more likely to be involved with other agencies, but the GP was by far the most likely other professional to be involved. Health visitors are in a strategic position to help women with depression, and it is important that they are able to identify its presence. The association with child abuse is very important and indicates the need for multi-professional involvement, particularly with social workers, to a greater degree than was evident. The higher rate of depression in women beyond the post-natal year, was a surprising finding, and particularly in view of its relationship with child abuse concerns, suggests that this is a group of attenders who should be carefully monitored.

Public perceptions of a health visitor

This paper outlines the views of a random sample of 175 members of the public on the role and function of the health visitor. Those who had previous contact with a health visitor were more likely to know † † In the absence of a generic term the health visitor is referred to in the female gender, although the author recognises that health visitors may be male or female. her employer but not necessarily her qualifications. They also had a greater knowledge of the type of clients a health visitor may see and the advice she is able to give. Although many people were aware of the health visitor's work in health promotion, very few would contact a health visitor for health advice, the vast majority choosing to see their GP. Health visitors should be aware of this and the way in which their profession is viewed by those whose health they aim to influence and may also consider a change of name and/or direction if the profession is to continue to develop and be more responsive to the needs of the 90s.

Survey of health visiting in antenatal care.

The range of the health visitor's work is expanding. To find out what antenatal work health visitors actually carry out and what their attitudes towards such work are we surveyed general practitioners, midwives, and health visitors in three district health authorities. The results indicate that health visitors are qualified and willing to work with women in the antenatal period.

The role of the health visitor: a study conducted in Berkshire, England

A study of 1057 home visits undertaken by health visitors in Berkshire shows that the range of the health visitor's work is much wider than the stereotype, which portrays health visiting as an activity limited to maternity and child welfare and concerned primarily with physical care. Seventy per cent of the visits were to households containing a young child, 18% were to the elderly, and 12% to other households. The content of the visits was recorded in terms of the topics discussed. Some topics were essentially medical and some were within the scope of the stereotype, but many were topics not traditionally associated with health visiting and there was a considerable psychosocial content. Differences were found between visits recorded by younger and recently qualified health visitors and visits recorded by other health visitors.

The work of health visitors in an urban and a county area

The work of health visitors in an urban and a county area

The health visitor's work under the National Health Service Act, 1946. (c) The value of the health visitor's work to the community.

The health visitor's work under the National Health Service Act, 1946. (c) The value of the health visitor's work to the community.

The health visitor's work under the National Health Service Act, 1946. (b) The past, present and future duties of health visitors.

The health visitor's work under the National Health Service Act, 1946. (b) The past, present and future duties of health visitors.

The health visitor's work under the National Health Service Act, 1946. (a) Administration of the health visiting service.

The health visitor's work under the National Health Service Act, 1946. (a) Administration of the health visiting service.