At home with clients: health visiting know how in action

Dr. Alison Bryans

Glasgow Caledonian University

Funding Body - QNIS

Study background

• Research approach builds on earlier published research into district nursing assessment practice during home visits

• Sample of health visitors recruited from Greater Glasgow Primary Care NHS Trust

• Data-gathering from September 2000 - January 2002

Practice context

• Health visiting in UK broad in scope

• Core service is to families with children under 5 years

• Dominant focus is prevention

• Home visits vary considerably in duration and content

• Potential to address ‘felt needs’ of clients

Study aims

• to explore the knowledge and skills which underlie health visiting practice during home visits

• to reveal previously tacit or hidden elements of health visiting expertise

• to relate processes to client issues and needs addressed during visits

Study methods

• 20 minute simulated home visit

• interview immediately afterwards which focuses on the simulated visit

• subsequent observation of actual home visits with all participants (after preliminary data analysis)

Simulated client profiles

• Biographical information

• Reason for visit

• Family situation and lifestyle

• General health & medical background

• Home setting

• Personal appearance/presentation

• Speech mannerisms and phrases

Study findings

• content analysis - identified issues and needs discussed during the simulated visits and the main focus of visits

• process-orientated analysis - examined micro-processes and health visitors’ approaches during the simulated visits

Content findings

• most HVs covered a wide range of the built-in client issues and needs

• reasonable degree of consistency within cases but also interesting variation in terms of overall focus and balance of visits

Examples of content codes

• Infant feeding issues• grandmother’s advice• weaning to solids• breastfeeding• expressing milk• mother’s feelings

about feeding

• Psycho- social issues• maternal mental health• maternal social

support• mother-father

relationship

Process findings

• include characteristics of health visitor activity and client response / activity

• reflexive-interactive HV approach

• less reflexive HV approach

Reflexive-interactive HV

• immediately pursues issue raised by client

• explicitly acknowledges client feelings

• gives ‘tailored’ context-specific advice

• explicitly seeks client perspective

Client responses to RI approach

• Client raises issues, asks questions and freely volunteers new information

• Responds actively and positively to HV suggestions and advice

Relating content and process

• in ‘balanced’ (M&I issues) and more maternally-focused visits ‘felt’ needs and psycho-social issues were more prominent

• these visits were reflexive-interactive in nature

• positive client responses were more common in these visits

Simulation findings

HV approaches

Reflexive-interactive

Less reflexive

Needs & issues

Main HV focus M & I or M issues

Main HV focus Infant

Observational data

• a health visitor’s approach to actual home visits generally matched her approach to the simulated visit

• content of observed visits was too varied and diverse to allow comparison with content-focused simulation findings although therapeutic activity and psycho-social focus did ‘match’

Case studies

• These and other aspects of study findings are synthesised and presented in case study form in the report of this study

• These provide a more holistic and accessible view of the overall findings for educators and practitioners

• They are selected to be representative of findings

Report

• Bryans A. (2003) At home with clients: a study of health visiting expertise during home visits Queen’s Nursing Institute Scotland / Glasgow Caledonian University