Kings College London

1
Kings College London

• Introducing the Family Partnership Training into
  Health Visitor Education
• Mary Malone and Brenda Woolfenden

2
Reasons and motivations for change

• At Kings we have a well established philosophy
  of aiming to produce practitioners who are
• Fit for practice at the point of qualification
• Who have a sound theoretical and
  evidence-based knowledge of interventions to
  promote family centred public health
• Who have the skills and competencies to
  deliver on a family centred public
  health agenda
• Sensitivity to local health needs -
  esp. parenting, child and maternal mental health
  in South London

3
PAT offered opportunities to deliver on all
three points

• Fit for practice at the point of qualification -
  esp. in core areas of work
• sound theoretical and evidence-based
  Interventions to promote family centred public
  health
• skills and competencies to deliver on a family
  centred public health agenda

• Traditional focus on role of health visitor with
  skills of practice learnt / enhanced
  post-registration
• PAT has strong theoretical and evidence-based
  foundations
• Parenting a key component of public health work
  with families
• Helper skills, qualities and characteristics an
  essential requirement to delivering on this.

4
PAT challenged assumptions education and
preparation

• Communication skills are covered within
  pre-registration programmes
• All nurses are natural communicators
• If you can talk to patients on a ward you must be
  able to communicate with families in their own
  homes - the skills are the same

• Yes - they are covered within most curriculae
  but how much is actually learnt is debatable
• Coping strategies which may not facilitate good
  communication are also learnt
• Many nurses are good communicators but skills can
  always be enhanced and applied in different
  contexts
• Ward-based skills may not be automatically
  transferable to work within the less hierarchical
  environment of the home

5
PAT challenged assumptions clinical practice

• Communication skills are the stock in-trade of
  community nurses - its what were good at
• One participant reflected this in her written
  comments upon the course content
• my main criticism is it(course content) is
  aimed at people with very negligible social
  skills ! eg. P.77 para. 2 states that (when
  parent/helper meet) parents are acknowldeged in a
  traditional greeting such as Hello! Surely HV
  students, NNEBs, HVs etc. would have this skill /
  knowledge? If not,Im concerned!!(Participant
  2003 PAT)

6
PAT challenged assumptions clinical practice

• Evidence suggests that this is not always so
• Restrictive and prescribed patterns of family
  contact increase demands made on communication
  skills (Cowley and Huston 2003)
• Health visitors have been found wanting (Roche et
  al. 2005)
• Awaremess of this amongst students and their
  mentors in practice
• Delivery of Health for all Children (Hall 4) is
  predicated on parental initiative - the
  foundation for which must be trust in the health
  worker
• A trust which must be established quickly and in
  a brief space of time - all of which demands
  enhanced communication skills

7
Process of inclusion of PAT

• Request from partner Trust for provision of
  post-registration PAT module
• Meetings with the PAT team and discussion of PAT
  - essence, history and evidence base
• Engaging with the KCL machinery - protocols,
  CIFs and MIFs
• Costing of the provision
• Allocation of resources

8
Challenges

• Credibility of facilitators to deliver module
• -Containing powerful and unanticipated emotions
  within the group
• Preparation and training
• Use of Training Manual
• Co-facilitating with experienced team member - a
  means of quality assurance

• Assessment
• To assess or not to assess ?
• How to assess ?
• Who can assess ?
• Issues of role conflict and ambiguity for
  facilitator/ teachers
• Non-assessor as member of the facilitation team

9
What do participants think ?

• A change in attitude seems to take place
• At first students find it obvious and simple
  
• for someone who has children and has many years
  nursing experience it was a bit like sucking
  eggs.
• (2003)
• Students may initially focus on the nature of
  the problem used within the skills session -
  what sort of problem ? How serious ? How personal
  ?
• Asking us to bring our own problems was strange
  and difficult and then became very unreal later
  when we all started making up problems.(2003)

10

• Feeling undermined - critically appraised by
  peers with regard to skills they thought they had
  mastered long ago -
• Re-learning skills is a challenge
• Like observing facilitators in role - sharing
  learning and sharing vulnerability
• Value feedback on own skills and skill
  development (I.e. from peers and facilitators)
• When asked to indicate the best aspect of the
  course participants said skills practice,
  group discussion, learning how to improve
  communication skills and group work
• Also for one participant the party and the
  certificate

11
How do participants feel ?

• Stressed - usually this coincides with period of
  intense academic requirements - I.e.submission of
  assignments
• Surprised at flexibility and applicability of the
  model
• Seeing application in practice - usually at end
  of the period of consolidated practice which
  takes place at the end of the programme of study.
  
• Students are more likely to articulate benefits
  when their mentors have undergone the PAT
• The benefits of the models partnership
  approach are seen to overcome any potential
  drawbacks to it e.g. length of required for
  contacts, loss of control on the part of the
  worker

12
Unanticipated benefits

• Multi-disciplinary learning
• A real forum for articulation of issues from
  practice and for discussion of major themes
  within working with families identifying
  vulnerability, the role of judgements and values,
  societal expectations, sanctions and taboos
• Integrating the reality of theory and practice -
  with all the ill-ease and uncertainty this
  contains
• Paradox of learning to challenge (and thereby to
  motivate change) but also to accept that the lead
  in this must be taken by the parent or parents
• Promotes a realistic understanding of
  professional power and accountability in family
  based work

13
Benefits identified by students

• Approaches to challenging constructs
• To be calmer
• Helped to be honest
• The effective use of silence
• Validation of the concept of partnership
• Greater understanding of collaboration vs expert
  approach
• Respecting individuals
• Exploring problems with clients
• Not to be judgemental
• Changed over the process of the year - from
  scepticism to a greater sense of value

14
The future

• New Nursing and Midwifery Register
• Government agenda
• Emphasising public health - esp. inequalities
  agenda ( DoH 2005)
• Choosing Health ( DoH 2004)
• Change for Children Every Child Matters (DfES
  2004)
• Common core of skills and knowledge for the
  childrens workforce (DfES 2005)

• Part 3 Specialist Community Public Health
  Nursing
• KCL - validation of a programme of preparation
  for entry to Part 3 of the register
• Modular
• Family partnership model will be a contributing
  module
• Recommended for those undertaking the pathway
  annotated HV
• Increased emphasis on lifestyle modification -
  and professionals acquisition of skills to
  facilitate this - family partnership model
  provides a basis for this and related areas of
  work.

15
References

• Cowley S and Houston A (2003) A Structured Health
  Needs Assessment Tool acceptability and
  effectiveness for health visiting . Journal of
  Advanced Nursing , 43 ,82-92
• DfES ( 2004) Every Child Matters Change for
  Children . The Stationery Office London
• DfES ( 2005) Common Core of Skills and Knowledge
  for the Childrens Workforce. The Stationery
  Office London
• DoH (2004) Choosing Health . Department of Health
  London
• DoH (2005) Tackling Health Inequalities Status
  Report on the Programme for Action. Department of
  Health London
• Hall DMB and Elliman D (2003) Health for All
  Children (4th Ed.) Oxford Medical Publications
  Oxford
• Roche B , Cowley S, Salt N, Scammell A, Malone M
  , Savile P , Aikins D, Fitzpatrick S (2005)
  Reassurance or Judgement ? Parents views on the
  delivery of child health surveillance programmes
  .Family Practice 22 , 507-512