Standards for education and training for interagency working in child protection in the UK: implications for nurses, midwives and health visitors

This article presents a discussion of key issues for the education of nurses, midwives and health visitors following the completion of a Department of Health funded project, managed by the General Social Care Council and conducted jointly by two research centres; Salford Centre for Social Work Research and Salford Centre for Nursing, Midwifery and Collaborative Research. The work was initiated in response to Lord Laming's report on the circumstances leading to the death of Victoria Climbié. The project was conducted in relation to specified professions and occupational groups: doctors; health visitors; midwives; nurses; police; teachers, and social workers. It was undertaken in two stages. The first stage mapped existing material about standards in relation to education and training for interagency working. The second stage engaged in an extensive consultation exercise through which a model and a set of proposed standards for interagency education and training for interagency work were developed. The former is detailed fully in this report, while nine examples of standards are presented. The project final report was presented seven months after commencement.     

Postregistration genetics education provision for nurses, midwives and health visitors in the UK

BACKGROUND: Rapid advances in genetics following the sequencing of the human genome will progressively reach all aspects of health care. Developments in genetics will increasingly having a significant influence on the work of nurses, midwives and health visitors. Therefore, these practitioners need to understand the impact that genetics will have for their patients and should be able to incorporate this new knowledge into their clinical practice to ensure that they continue to offer holistic care and influence the strategic development of health care. An earlier survey of higher education institutions in the United Kingdom (UK) offering preregistration courses for nurses, midwives and health visitors showed that the teaching of genetics was very limited in most curricula. AIM: To assess the provision of education on genetics for postregistration and postgraduate nurses, midwives and health visitors in the UK, as these practitioners are mostly likely to influence current health care provision and initiate changes in clinical practice. METHOD: A total of 38 higher education institutions from 11 regions were surveyed via telephone or e-mail, using a semi-structured interview schedule. RESULTS: The findings showed that the inclusion of genetics in the curriculum was highly variable. A small number of institutions (n = 3) offered courses with whole modules on genetics, whereas 19 of the 38 responding did not include any genetics in their curriculum at a postregistration level. CONCLUSION: The findings suggest that there is lack of recognition of the impact genetics is likely to have on health care. It is, therefore, recommended that the profile and relevance of genetics to nurses, midwives and health visitors should be promoted by the major organizations responsible for developing, commissioning and providing health care education.     

Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses

Scand J Caring Sci; 2011; 25; 542–548
Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses Background: While there exists an extensive amount of research regarding the medical aspects of abortion, there is a great lack of studies investigating staff’s views and experiences of working in abortion services. Aims: To elucidate gynaecologists’ and midwives’/nurses’ experiences, perceptions and interactions working in abortion services, their experiences of medical abortions and abortions performed at the woman’s home. An additional aim was to illustrate gynaecologists’, midwives’ and nurses’ visions of their future professional roles within the abortion services. Method: Three focus group discussions within each profession were carried out in 1‐hour sessions with a total of 25 gynaecologists and 15 midwives/nurses from three different hospitals. Results: The content analysis reflected that gynaecologists and midwives/nurses had no doubts about participating in abortions despite the fact that they had experienced complex and difficult situations, such as repeat and late‐term abortions. They experienced their work as paradoxical and frustrating but also as challenging and rewarding. However, they were rarely offered ongoing guidance and continuously professional development education. For gynaecologists, as well as midwives/nurses, their experiences and perceptions were strongly linked to the concurrent development of abortion methods. The interaction between the professions was found to be based on great trust in each other’s skills. Conclusions: In order to promote women’s health, gynaecologists’ and midwives’/nurses’ need for a forum for reflection and ongoing guidance should be acted on. With a higher number of abortions done medically and a higher proportion of home abortions, midwives/nurses will get increased, responsibilities in the abortion services in the future.     

The midwife's role in providing smoking cessation interventions for pregnant women: The views of midwives working with high risk,disadvantaged women in public sector antenatal services in South Africa

ObjectiveThe purpose of this study was to assess the knowledge, attitudes, beliefs and current practices of South Africa midwives in relation to providing smoking cessation education or counselling to pregnant women. This was with a view to involving them in a potential smoking cessation intervention, targeting a sub-group of South African women who are at particularly high risk of the adverse pregnancy outcomes associated with smoking.DesignA cross-sectional survey of midwives, supplemented by individual, in depth, qualitative interviews.SettingPublic sector antenatal clinics serving this particular community of women in five of the major urban centres of South Africa.ParticipantsA total of 102 midwives were surveyed across 29 antenatal clinics and 24 were interviewed.MeasurementsSelf-administered survey and semi-structured, individual interviews describing constructs from the Theory of Planned Behaviour with respect to the provision of smoking cessation education/counselling, including: knowledge, attitudes, subjective norms and perceived behavioural control.FindingsThe majority of midwives accepted that providing smoking cessation advice was a part of their remit, perceived prevailing social norms to be supportive and were, overall, positively predisposed to participating in a smoking cessation intervention in antenatal clinics. However, the study identified a number of constraints to midwives fulfilling this role, which affected their perceived behavioural control. These included stressful working conditions, too little time, a dearth of educational resources and a lack of knowledge of best practice intervention methods and counselling skills. Perceived patient resistance to quitting was a further obstacle.Key conclusions and implications for practiceFor the intervention to be accepted and adopted by midwives, it would need to offer them an opportunity to enhance their professional knowledge and expertise, provide them with attractive educational aids and take into account the very limited time they have for smoking education. Patient-centred, best practice methods for cessation counselling may help midwives overcome the problem of patient resistance and to engage smokers in constructive discussions about smoking with a greater prospect of success.     

Teamwork in primary care: the views and experiences of nurses, midwives and health visitors

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork team identity, leadership, access to general practitioners, philosophies of care, understanding of team members' roles and responsibilities, and, disagreement regarding roles and responsibilities Differences in the various views and experiences of teamwork were identified Midwives and health visitors emerged as the least integrated members of the primary health care team Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups The potential for teamwork in the future is discussed     

Relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women: A prospective study

AimTo determine the relationship of health practices with depression and maternal-fetal attachment in adolescent pregnant women.MethodsThis prospective study was conducted on 316 adolescent pregnant women with medical records at the health centers in Tehran, Iran. The participants were selected through the complete enumeration. Data were collected using the socio-demographic and obstetrics questionnaire, the Health Practices Questionnaire-II (HPQ-II), the Edinburgh Postnatal Depression Scale (EPDS), and the Cranley's Maternal-Fetal Attachment Scale (MFAS). The data were analyzed with the Pearson correlation test, the independent t-test, one-way ANOVA, and the general linear model.ResultsThe mean scores of health practices, depression, and maternal-fetal attachment were 135.3 (SD 9.1, range 34–170), 10.1 (SD 5.4, range 0–30), and 91.6 (SD 8.6, range 24–120), respectively. The results of Pearson correlation test showed that health practices had a significant relationship with depression (r = −0.29) and maternal-fetal attachment (r = 0.37). Results of general linear model showed that an increase in the health practices score led to a significant decrease in depression score during pregnancy [β = −0.10; 95% CI: −0.17 to −0.04] and a significant increase in maternal-fetal attachment score [β = 0.30; 95% CI: 0.19 to 0.40].ConclusionThere is significant relationship between health practices and depression, as well as maternal-fetal attachment in adolescent pregnant women. Therefore, intervention to improve one of them may improve the other one(s).     

Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children

Aims and objectives

To critically examine surveillance practices of health visitors (HV) in the UK and public health nurses (PHNs) in Canada.

Background

The practice and meaning of surveillance shifts and changes depending on the context and intent of relationships between mothers and HVs or PHNs.

Design

We present the context and practice of HVs in the UK and PHNs in Canada and provide a comprehensive literature review regarding surveillance of mothers within public health systems. We then present our critique of the meaning and practice of surveillance across different settings.

Methods

Concepts from Foucault and discourse analysis are used to critically examine and discuss the meaning of surveillance.

Results

Surveillance is a complex concept that shifts meaning and is socially and institutionally constructed through relations of power.

Conclusions

Healthcare providers need to understand the different meanings and practices associated with surveillance to effectively inform practice.

Relevance to clinical practice

Healthcare providers should be aware of how their positions of expert and privilege within healthcare systems affect relationships with mothers. A more comprehensive understanding of personal, social and institutional aspects of surveillance will provide opportunities to reflect upon and change practices that are supportive of mothers and their families.     

Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1)

Background

This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe.

Methods

The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe.

Results

Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392.200 asylum applications.The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental healthDue to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care.

Comments and Remarks

Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

     

A qualitative study of health service reform on nurses’ working lives: Learning from the UK National Health Service (NHS)

Background and objectives

The need for efficiency and cost effectiveness in healthcare is of international concern and has been an important influence to changes in nursing skill mix in Organisation for Economic Cooperation and Development countries. This article investigates the impact that the British Government's strategy designed to reform the NHS has had on nurses’ day-to-day working lives. Nurses have been presented as key players in changing the culture of the NHS and the government has sought to provide them with greater empowerment primarily through skill mix changes. However, government policy may have resulted in greater productivity not greater empowerment for nurses who have often been required to compensate for loss of medical capacity as a consequence of the reductions in junior doctors’ hours in line with the European Working Time Directive. Furthermore, what constitutes ‘genuine’ nursing has been difficult to define and ‘caring’ difficult to measure. Thus even without work intensification nurses may believe that health service reform has been disempowering by its focus on quantitative targets.

Methods

This article is based on data from interviews with nurses in three English hospitals providing acute care. It compares and contrasts the perceptions of ward sisters, specialist nurses and staff nurses.

Results

Uncertainty concerning what is the proper task of a nurse has been reinforced by skill mix changes which have resulted in staff nurses and ward sisters perceiving that they are ‘losing nursing’. However, the article shows distinct intra-occupational outcomes. In particular specialist nurses believe that NHS reform has provided greater empowerment by increasing their authority in clinical decision-making.

Conclusion

The findings suggest that the consequences of government strategy have been inconsistent for front-line staff often combining empowerment, disempowerment and work intensification. This article provides empirical evidence which contributes to a debate about whether and why ‘caring’ may have become a lost art in nursing. It also demonstrates the possible effects on nursing of using skill mix change as a method for gaining greater workforce efficiency and as a response to medical staff shortages.     

Smoking cessation for patients with head and neck cancer: a qualitative study of patients' and nurses' experiences in a nurse-led intervention

Smoking is a major risk factor for head and neck cancer. Smoking during diagnosis and treatment increases risks for disease recurrence, treatment failure, and increased side effects. Despite recommendations, many patients fail to stop smoking. A theory-based nurse-led intervention program was developed to support smoking cessation. This article describes the program itself and presents a framework approach for analysis of unstructured diary notes to understand the experiences of 13 patients and 2 nurses in regard to the program. The results are presented in 3 major categories: the patient-nurse relationship, factors facilitating or hindering behavioral change, and drug (ab)use. The most salient new finding of the study is the importance of a therapeutic patient-nurse relationship on the smoking cessation process, which was recognized in both patient and nurse diaries. These findings lend further support to known benefits of nurse-led interventions. The situation in Sweden, with radiation therapy given by specialist nurses, allows a unique possibility to integrate smoking cessation programs with existing cancer care. This has made it possible to determine when the patient is well-motivated for change, to balance the smoking cessation process with other care needs, and to view smoking cessation as an intrinsic part of the patient's anticancer treatment.     

The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women

OBJECTIVE

To study the effects of lifestyle intervention on gestational weight gain (GWG) and obstetric outcomes.

RESEARCH DESIGN AND METHODS

The LiP (Lifestyle in Pregnancy) study was a randomized controlled trial in 360 obese women allocated in early pregnancy to lifestyle intervention or control. The intervention program included dietary guidance, free membership in fitness centers, physical training, and personal coaching.

RESULTS

A total of 360 obese pregnant women were included, and 304 (84%) were followed up until delivery. The intervention group had a significantly lower median (range) GWG compared with the control group of 7.0 (4.7–10.6) vs. 8.6 kg (5.7–11.5; P = 0.01). The Institute of Medicine (IOM) recommendations on GWG were exceeded in 35.4% of women in the intervention group compared with 46.6% in the control group (P = 0.058). Overall, the obstetric outcomes between the two groups were not significantly different.

CONCLUSIONS

Lifestyle intervention in pregnancy resulted in limited GWG in obese pregnant women. Overall obstetric outcomes were similar in the two groups. Lifestyle intervention resulted in a higher adherence to the IOM weight gain recommendations; however, a significant number of women still exceeded the upper threshold.Maternal obesity has become highly prevalent worldwide and is associated with adverse outcomes for mothers and infants (1). As one of the most common risk factors, maternal obesity remains a significant obstetric challenge, and 12.2% of Danish pregnant women are obese, with a BMI of ≥30 kg/m² (2). Several studies have shown that maternal obesity is related to a number of adverse outcomes, including miscarriage, gestational diabetes mellitus (GDM), preeclampsia, stillbirth, macrosomia, and cesarean section (3–5). Maternal obesity leads to obesity in infancy and among young adults, and the long-term consequences can be seen in observational studies.Prepregnancy BMI and gestational weight gain (GWG) are strong predictors for high birth weight and obesity in infancy and adulthood (6,7). High GWG in the first part of pregnancy is especially associated with obesity in later life (8). In addition, interpregnancy weight gain increases the risk of GDM in future pregnancies (9). The increased risk of GDM has short- and long-term consequences for the mother and her offspring and increases the development of diabetes in future generations (10,11). The management of obesity in pregnancy includes the recommendation of appropriate GWG. In 2009, the U.S. Institute of Medicine (IOM) recommended a GWG of 5–9 kg in obese women (BMI ≥30 kg/m²) (12). Some observational studies have suggested that a GWG of <5 kg may reduce the number of complications (13,14) without increasing the risk of adverse outcomes.The evidence for clinical effects of lifestyle intervention in pregnancy is conflicting. Only a small number of studies have addressed the issues of limiting GWG exclusively in obese women (15–17). Other interventional studies included normal weight and overweight/obese women, without success in limiting GWG among the obese (18–20). None of these interventions significantly improved obstetric outcomes, but the studies were not powered to address these. The exception was the Australian study by Quinlivan et al. (20), who succeeded in limiting GWG and found a lower incidence of GDM in a randomized trial of overweight/obese women.Accordingly, our aim with this randomized trial was to study the effects of lifestyle intervention on GWG and obstetric and neonatal outcomes in a large group of obese pregnant women.     

Smoking cessation in patients with diabetes mellitus: results from a controlled study of an intervention programme in primary healthcare in Sweden

OBJECTIVE: To evaluate an intervention programme on smoking cessation in patients with diabetes mellitus in primary healthcare. DESIGN: Regional controlled intervention study. SETTING: Seventeen primary healthcare centres in Sweden. INTERVENTION: In the intervention centres, nurses with education in diabetes were given one half-day of training in motivational interviewing and smoking cessation. An invitation to participate in a smoking cessation group was mailed to patients from the intervention centres followed by a telephone call from the patient's diabetes nurse. The nurses who intervened were specially educated in smoking cessation. The control group received a letter containing advice to stop smoking and information about a one-year follow-up. PATIENTS: Daily smokers with diabetes mellitus, 30-75 years of age. In the intervention centres 241 patients fulfilled the criteria and in the control centres 171 patients. MAIN OUTCOME MEASURES: Self-reported smoking habits after one year. RESULTS: In total, 21% of the smokers accepted group treatment. After 12 months, 20% (42/211) in the intervention centres reported that they had stopped smoking and 7% (10/140) in the control centres; 40% (19/47) of the smokers who had participated in group treatment reported that they had stopped smoking. CONCLUSION: A computerized record system for patients in primary healthcare was used to identify diabetic patients who were smokers. The selected group was invited to a stop smoking programme. At a one-year follow-up significantly more patients in the intervention centres had stopped smoking compared with patients in the control centres.     

Experiences of using the ISBAR tool after an intervention: A focus group study among critical care nurses and anaesthesiologists

ObjectiveThe ISBAR tool is a structured approach to communication between healthcare professionals and refers to Identity, Situation, Background, Assessment, and Recommendation. The objective of this study was to explore how critical care nurses and anaesthesiologists experience using the ISBAR tool in clinical practice.DesignThree focus groups were conducted with a total of three anaesthesiologists and 14 critical care nurses from two hospitals in Norway after they had attended an intervention.SettingThe intervention consisted of two days at a university, with a four-month interval between, attending resource lectures and simulation exercises focusing on the ISBAR tool. The focus groups were audio-recorded, transcribed and analysed thematically to understand the participants' experiences.FindingsThree major themes emerged from the data: (1) predictability and security, (2) usability and (3) recommendations for further use. A feeling of predictability and security was identified through increased awareness of communication and professional roles. Usability included identifying appropriate situations to use the ISBAR tool in clinical practice, the importance of tailoring the use to each situation and some physicians were not interested in using it. Finally, recommendations for further use of the ISBAR tool were identified.ConclusionThe findings highlight the importance and need to improve the use of the ISBAR tool to increase patient safety. It is essential that healthcare professionals work together to ensure that everybody has the same situational awareness and that good clinical handover practices are developed and maintained.