Features

The right move?

08 February 2019

Dawn Loman, senior lecturer in SCPHN, asks what influences nurses to hang up their uniforms and become health visitors.

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The quality of nursing practice is constantly being challenged by changing goals in practice and education (Department of Health (DH), 2011a). This is a particularly interesting era of change due to health-visiting recruitment’s high position on the last government’s agenda (DH, 2011b).

In order for a nurse/midwife to transition into the specialist community public health nurse (SCPHN) role, they must have, or obtain, professional values in order to facilitate work with individuals, families, groups and communities to provide a positive influence on the prevention of disease and the promotion of health. Health visitors lead and deliver the Healthy Child Programme, the evidence-based public health programme for children and young people, which provides a range of health interventions and support, beginning in pregnancy and continuing through early childhood.

A health visitor works daily in the lives of young clients who struggle with poverty, drug use, family violence and the stigma of being teenage parents – all of which affect health and often lead to illness.  

Research evidence from the fields of neuroscience and social science confirms the importance of early intervention to support a child’s future development (Allen, 2011; Munro, 2011; Tickell, 2011; Field, 2010; Marmot, 2010).

The Francis report (2013), the Keogh report (2013), the Cavendish (2013) and Berwick reviews (2013) all highlight the need to improve our professional values. To deliver the health-visiting service required, nurses/midwives applying for the SCPHN programme must have the professional values to work alone and cope with the challenges of a non-differentiated caseload. The importance of the health-visiting role can therefore not be undermined by negating the significance of professional values.

This article is a synopsis of a grounded theory (GT) research study of student health visitors’ professional values. Using a small-scale qualitative study and the principles of the GT methodology, the research explored whether professional values develop through the duration of a year-long SCPHN programme.

 

A historical perspective

To understand why qualified nurses choose to become health visitors, it is important to gain an understanding of the role of the health visitor. Over the past century, the requirements of the health-visiting role have changed. This is in response to the changes in communities and priorities in public health. A century and half ago, improving sanitation and reducing infectious disease was the priority (Dingwall, 1977); today, it is addressing the antecedents of chronic disease and ensuring every child has the best start in life (DH, 2015; Allen, 2011; Munro, 2011; Tickell, 2011; Field, 2010; Marmot, 2010).

Much has been written about the changing requirements of the health visitor’s role. Billingham et al (1996) and Baldwin (2012) have both written about the changing professional identity of the health visitor. More recently, the coalition government of 2010-15 recognised the importance of the diversity of the role within the public health arena (DH, 2013; 2011). Currently, the move of the health-visiting service to providers outside the NHS has now focused the role requirements on key performance indicators in delivering a 0 to 19 service (Public Health England, 2016; 2015).

While it can be argued that historically health visiting has not been seen as an attractive career choice (Whittaker et al, 2013; Chalmers et al, 2011; Stinson et al, 2004), it is becoming more appealing to nurses wishing to undertake an autonomous job role that challenges them both professionally and personally (Herd, 2018).

 

Changes of lifestyle

So what makes a qualified nurse choose to undertake the SCPHN programme to become a qualified health visitor? Is it their skills and knowledge which lend themselves to this career pathway? Or is it a change in family and life priorities?

Students were attracted to the holistic approach to health on the scphn programme

Poulton (2009) explored a cohort of health visitors undertaking a SCPHN programme, and found that the key priorities for a student choosing a career pathway changed as the individual’s work/life priorities changed. Whittaker et al (2013) found that students undertaking a SCPHN programme did so because they were attracted by the holistic approach to health.

However, transferrable skills and professional values are required to support the role of the health visitor. Professional values structure the essence of the character of a health visitor and intercede with ethical decision-making in the practice of health visiting (Bidmead, 2013).

Problem-solving, critical thinking, prioritising care needs and attention to the client and family concerns are core professional values integral to health visiting, and influence the quality of care (Cowley, 2008). Professional values are also about personal beliefs of the quality, concepts and behaviours within a discipline.

These beliefs, concept and behaviour lead to the development of standards from which a health visitor evaluates care and decides an action. Therefore, qualities and characteristics determine whether a student has the appropriate nature to be a health visitor. However, Cowley and Bidmead (2009) and Schank et al (1996) advise that a student health visitor can build on their skills to acquire these qualities and characteristics.

 

Conclusion

Whatever the reasons an individual chooses to become a health visitor, whether professional or personal, if they are committed to undertake the SCPHN programme then they can develop the skills and aptitude required to fulfil the role. According to Whitehead et al (1998: 159), ‘individuals take risks, overcome barriers, relinquish their own comfort and security and generate extraordinary effort because of their values’. In summary, changes of family dynamics may influence a qualified nurse’s decision to change their care pathway – but the diversity of the role and the development of self-awareness make the change the right move.  

Dawn Loman is senior lecturer in SCPHN and specialist community public health programme lead at the Leicester School of Nursing and Midwifery, De Montfort University. 


From nurse to HV: transferrable professional skills

  • Working alone and coping with the challenges of a non-differentiated caseload
  • Confidence in clinical judgement and autonomy
  • Proactively interested in providing a positive influence on the prevention of disease and the promotion of health
  • Effective communication
  • Empathy and attention to the client and family concerns
  • Problem-solving
  • Critical thinking
  • Prioritising care needs
  • Directly influencing quality of care.

Image credit | iStock

References

Allen G. (2011) Early intervention; smart investment and massive savings. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/61012/earlyintervention-smartinvestment.pdf (accessed 10 January 2019).

Baldwin S. (2012) Exploring the professional identity of health visitors. Nursing Times 108(25): 12-5.

Bidmead C. (2013) Health visitor/parent relationships: a qualitative analysis. In: Cowley S, Whittaker K, Grigulis A, Malone M, Donetto S, Wood H, Morrow E, Maben J (eds) Why health visiting? A review of the literature about key health visitor interventions, processes and outcomes for children and families. See: https://www.kcl.ac.uk/nursing/research/nnru/publications/Reports/Appendices-12-02-13.pdf (accessed 10 January 2019).

Billingham K, Morrell J, Billingham C. (1996) Reflections on the history of health visiting. British Journal of Community Health Nursing 1(7): 386-92.

Chalmers L, Hamer S, Holt J, Ramsbottom R, Trickett R. (2011) Training and retaining. Community Practitioner 84(4): 18-20.

Cowley S (ed). (2008) Community public health in policy and practice: a sourcebook (2nd edition). Baillière Tindall Elsevier: London.

Cowley S, Bidmead C. (2009) Controversial questions (part two): should there be a direct-entry route to health visitor education? Community Practitioner 82(7): 24-8.

Department of Health. (2015) Getting it right for young people, children and families. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216464/dh_133352.pdf (accessed 10 January 2019).

Department of Health. (2015) NHS constitution for England. https://www.gov.uk/government/publications/the-nhs-constitution-for-england (accessed 22 January 2019). 

Department of Health. (2013) Delivering high quality, effective, compassionate care: developing the right people with the right skills and the right values. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/310170/DH_HEE_Mandate.pdf (accessed 10 January 2019).

Department of Health. (2011a) Educating health visitors for a transformed service. See: http://www.gov.uk/government/publications/educating-health-visitors-for-a-transformed-service (accessed 22 January 2019).

Department of Health (2011b) Health visitor implementation plan 2011-15: a call to action. 
See: https://www.gov.uk/government/publications/health-visitor-implementation-plan-2011-to-2015 (accessed 22 January 2019).

Dingwall RWJ. (1977) Collectivism, regionalism and feminism:health visiting and British social policy 1850-1975. Journal of Social Policy 6(3): 291-315.

Field F. (2010) The foundation years: preventing poor children becoming poor adults. See: https://webarchive.nationalarchives.gov.uk/20110120090141/http://povertyreview.independent.gov.uk/media/20254/poverty-report.pdf (accessed 10 January 2019).

Francis R. (2013) Report of the Mid Staffordshire NHS Foundation Trust public inquiry. See: https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry (accessed 22 January 2019).

Herd L. (2018) Navigating a change of nursing career. Community Practitioner 91(2): 19.

Keogh B. (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. See: https://www.nhs.uk/nhsengland/bruce-keogh-review/documents/outcomes/keogh-review-final-report.pdf (accessed 22 January 2019).

Marmot M. (2010) The Marmot review: Fair society, healthy lives. See: https://www.parliament.uk/documents/fair-society-healthy-lives-full-report.pdf (accessed 10 January 2019).

Munro E. (2011) The Munro review of child protection: final report. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/175391/Munro-Review.pdf (accessed 10 January 2019).

Poulton B, Bataille A, Lyons A, Graham S. (2009) Motivations for training as an SCPHN in Northern Ireland. Community Practitioner 82(11): 28-32.

Public Health England. (2016) Best start in life and beyond: Improving public health outcomes for children, young people and families. See: https://www.gov.uk/government/publications/healthy-child-programme-0-to-19-health-visitor-and-school-nurse-commissioning (accessed 10 January 2019).

Public Health England. (2015) Rapid review to update evidence for the Healthy Child Programme 0-5. See: https://www.gov.uk/government/publications/healthy-child-programme-rapid-review-to-updateevidence (accessed 18 January 2019).

Schank M, Weis D, Ancona J. (1996) Reflecting professional values in the philosophy of nursing. Journal of Nursing Administration 26(7-8): 55-60.

Stinson L, Dickson P, Pearson D (2004) Support, security, stimulation: the secret of recruitment and retention in primary care trusts. Education for Primary Care 15(3): 291-7.

Whitehead DK, Tappen R, Weiss S. (1998) Essentials of nursing leadership and management. Davis Publishers. Philadelphia. Pennsylvania, USA

Tickell C. (2011) The early years: foundations for life, health and learning. See: http://www.educationengland.org.uk/documents/pdfs/2011-tickell-report-eyfs.pdf (accessed 10 January 2019).

Whittaker K, Grigulis A, Hughes J, Cowley S, Morrow E, Nicholson C, Malone M, Maben J. (2013) Start and stay: the recruitment and retention of health visitors. See: https://www.kcl.ac.uk/nursing/research/nnru/publications/Reports/Start-and-Stay-report-FINAL.pdf (accessed 10 January 2019).

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