Early support needs of Finnish families with small children

AIMS: This study describes the early needs for support that families with small children have in the context of their own life situations. The study population consisted of Finnish families (n = 551) who participated in a project titled 'Families with Children' (1996-2001). The project supplemented the existing public services. The information provided by the study was utilized in supporting families and developing family work in seven experimental areas. METHODS: The data were collected between 1997 and 2000 using family service plans and client reports. The data were analysed with inductive content analysis and using the SPSS software (version 7.5). FINDINGS: The families needed support in the areas of parenthood, upbringing and child care, marital problems and social support networks. The need for early support was also connected to health problems of the children or the parents, problems with work or studies, unemployment, problems in economic or living conditions, or family crises. In addition to support, the families searched for help from family workers in disputes over child custody and visitation rights, intoxicant abuse and violence, and problems in adjusting to society. Each family had 4-5 needs for early support. CONCLUSIONS: The results demonstrate that families with small children have many needs for which they seek help when there are available services supplementing the existing public services. The information provided by the study can be utilized in maternity and child welfare clinics, in social services and in family work provided by civic organizations to define the early needs of families for support and to develop services.     

The emerging role of the urban-based aboriginal peer support worker: A Western Australian study

PurposeTo explore the self-perceived role of the Aboriginal peer support worker working with families with young children. This study was a component of a larger participatory action research study undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting program.MethodsFocus group interviews were carried out with peer support workers using unstructured and semi-structured interviews within Action Learning Sets. Data were analysed using thematic analysis.ResultsThe overarching theme on the self-perceived role of the Aboriginal peer support worker was Giving Parent Support, with subsidiary themes relating to development and ongoing sustainability of the support.DiscussionThe peer support workers viewed their role as providing parent support through enabling strategies which developed client acceptance and trust, delivered culturally relevant support, advocated for families, developed therapeutic engagement and communication strategies, and created safe home visiting practices. They recognised the importance of linking families with community support such as community child health nurses which was important for improving long term physical and psychosocial health outcomes for children.ConclusionAboriginal Peer Support Workers identified their emerging integral role in the development of this unique culturally acceptable home visitingsupport for Aboriginal parents. Innovative approaches towards client engagement demonstrated their value in developing creative ways of working in partnership with families, community support services and child health nurses across a range of challenging psychosocial environments.     

Seizures in infants and young children: an exploratory study of family experiences and needs for information and support.

An exploratory study of the experiences of parents caring for young children with seizure disorders and their perceived needs for information and support was conducted. A questionnaire and interview protocol was designed to elicit information about the child's seizure history, child and parent health history, medical and support services, child and family demographic information, parent experiences in caring for a young child with seizures, and perceptions about needs for information and support. Interviews were conducted with 31 parents who were recruited from a pediatric neurology clinic at a university hospital. Interviews were audiotaped, transcribed, and analyzed for major themes. The study revealed a broad range of experiences in caring for young children with seizures, and the early onset and severity of seizures often influenced these experiences. Obtaining information that was easily accessible and helped them to better understand their child's diagnosis and treatment was a challenge reported by many parents. In addition, interviews revealed that parents felt a need for support and information from individuals who were knowledgeable about the medical, developmental, emotional, and family issues related to coping with seizures in infants and young children. Recommendations for a comprehensive approach to the management of seizures for infants and young children are proposed, with particular focus on the role of nurses and early intervention professionals in providing information and support to families.     

A theory of maternal engagement with public health nurses and family visitors

BACKGROUND: Home visiting by public health nurses and family visitors is promoted as an important intervention for enhancing parent and child development. Mothers of children at-risk for developmental delays tend to be the most difficult to access and engage, and commonly drop out of home visiting programmes prematurely. PURPOSE: This paper reports a study developing a theory that describes the process by which mothers of children at-risk engage with public health nurses and family visitors in a blended home visiting programme. METHODS: Grounded theory was used to guide the collection, recording, organization and analysis of the data. A purposeful sample of 20 mothers receiving public health nurse and family visitor home visits were recruited from a public health unit in Canada. Data were collected through client record reviews and 29 in-depth interviews that explored participants' experiences, beliefs and expectations about engagement. Data collection and analysis continued until all categories were saturated. FINDINGS: Mothers felt vulnerable and frequently powerless when they allowed the service providers into their home. Mothers with children at-risk engage with public health nurses and family visitors through a basic social process of limiting family vulnerability, which has three phases: (1) overcoming fear; (2) building trust; and (3) seeking mutuality. The personal characteristics, values, experiences and actions of the public health nurse, family visitor and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship. CONCLUSION: Public health nurses working with families at risk need to identify client fears and perceptions related to home visiting, and to explain the role of public health nurses and family visitors to all family members. Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors continually to assess the quality of their relationships with clients.     

Weaving the seamless web of care: an analysis of parents' perceptions of their needs following discharge of their child from hospital

Changes in children's nursing services in the United Kingdom in recent years have focused on the need for adequate and efficient services to be provided in the interests of the child. Early discharge is now the norm and children are often sent home in an earlier recovery stage than adults with comparable conditions. Whilst the contributions of paediatric community nursing services have gone some way to providing specialist nursing care for children and their families in their own homes, the majority of children are discharged home without such support being available. This may place an overwhelming responsibility of caring for a recovering child onto parents. The purpose of the qualitative research reported in this paper was to identify any gaps in nursing services for acutely sick children and their families following discharge, and to suggest ways to improve integration and communication between hospital and primary care to facilitate a 'seamless web of care' for families. Families were surveyed following discharge (n=164) and interviews carried out with those experiencing problems (n=20). General practitioners were also surveyed for their opinion as key contributors of primary care. Findings revealed the isolation felt by parents following discharge, with their need for information about a child's illness and expected recovery, and for reassurance and specific advice through some means of support, which was clearly not being met. The perceived benefit of continuity of care was a common theme, with both parents and professionals acknowledging the importance of closer liaison between hospital and primary health care services. This study is valuable in providing preliminary qualitative information regarding the gaps in children's nursing services and how these can be overcome by using our present resources more imaginatively, in order to ensure the delivery of cost-effective and quality health care services in the best interests of local need.     

The function of home visits in maternal and child welfare as evaluated by service providers and users

This study looks at how public health nurses and clients of maternal and child welfare clinics evaluate the function and meaning of home visits Another concern is with the options available to the service user The data were collected during November and December 1992 from a total of 203 health centres across Finland, responses were obtained from 263 public health nurses and 323 clients The results are presented in the form of frequencies, percentages and cross tabulations According to the results, the clients felt that the most important function of home visits was to have a competent professional examination of the newborn They also attached much importance to the information function, i e learning about the growth and care of small children The public health nurses, on the other hand, felt that the most important function of home visits was to support and encourage parents and to ensure the continuity of care The advantages of meeting in the client's home environment were equally stressed by both sides By contrast, clients and public health nurses had very different views on the options available to the client Almost all nurses said that the client can freely choose between home visits and visiting the clinic, however, only about half the clients felt they could choose the service they best preferred     

Supporting the case for ‘progressive universalism’ in health visiting: Scottish mothers and health visitors’ perspectives on targeting and rationing health visiting services,with a focus on the Lothian Child Concern Model

Aims and objectives. To explore parents and professionals’ experience of family assessment in health visiting (public health nursing), with a focus on the Lothian Child Concern Model. Background. Health visitors currently assess families as requiring core, additional or intensive support, and offer support at a corresponding level. The majority of families are assessed as core and receive no pro‐active support beyond the early days. Previous assessment tools, consisting of checklists, have been criticised as being ineffective in identifying a range of health needs and unacceptable to parents and health visitors. The Lothian Child Concern Model was developed and introduced in the study area to promote a partnership approach with parents and assess strengths as well as difficulties in parents’ capacity to care for their child. Methods. Qualitative methods were used. Ten mothers and 12 health visitors took part in individual semi‐structured interviews. Results. Most mothers were aware of the assessment process but some felt that they were not involved in the decision‐making process. Explaining the assessment process to parents is problematic and not all health visitors do so. The assessment process was stressful for some mothers. Health visitors find the model useful for structuring and documenting the assessment process. Many believe that most families benefit from some support, using public health approaches. Health visitors said that families are often assessed as core because there are insufficient resources to support all those who meet the criteria of the additional category and that managers assess caseloads in terms of families with child protection concerns. Conclusions. The study findings significant the concept of ‘progressive universalism’ that provides a continuum that intensity of support to families, depending on need. Mothers would like better partnership working with health visitors. Relevance to clinical practice. The study endorses proposed policy changes to re‐establish the public health role of health visitors and to lower the threshold for families to qualify for support.     

Children of parents with a mental illness visiting psychiatric facilities: perceptions of staff

Children of parents with mental illness have been identified as a hidden population within mental health services, despite many clients being parents. In Australia, children of parents with a mental illness have been the focus of initiatives aimed at promoting their health and well-being and developing family-focused services. However, there has been little focus on children visiting acute inpatient mental health facilities. The aim of this study was to understand the experiences of children, their parents and carers, and staff when children visit, to better inform service planning. A qualitative exploratory research framework was used, and data were gathered through interviews. This paper presents the findings from the perspective of staff. Findings indicated that staff experienced being in a dilemma about children visiting and there were barriers to implementing family-friendly services. While staff mostly agreed in principle that children's visiting was beneficial, there was a lack of local policy and guidelines, and ad hoc arrangements existed. In addition, staff were unsure of their role with children, felt ill-equipped to talk to children about mental illness; and lacked knowledge of age-appropriate resources. Models of inpatient care need to be developed with a family focus that acknowledges the parental roles of clients and supports children visiting.     

Australian parents’ experiences with universal child and family health services

BackgroundAustralian governments provide free services to promote maternal and child health, and to support parenting for families with children up to age five. Services are principally provided by dedicated child and family health nurses, but also by general practitioners, practice nurses, pharmacy nurses and midwives.AimThis study aimed to examine the experiences of families with young children across Australia in accessing and receiving health care for well children, parenting support and advice from a range of providers.MethodsThe study used quantitative and qualitative data from an online survey of 719 parents and carers with children aged up to five years.FindingsOn quantitative scales, most respondents rated healthcare providers favourably for accessibility, credibility and their approach to families. However, qualitative responses revealed widely varying reactions to child and family health provision. Parents described both positive and negative experiences, highlighting elements of practice that are critical to consumer engagement.DiscussionParents require health care and support that are accessible, consistent, affordable, encouraging, trustworthy, evidence-based and non-judgemental. Parents feel more confidence in the information and care provided by health professionals who are well-informed, resourceful and who respect their knowledge and beliefs.ConclusionThe findings demonstrate ways in which child and family health providers can engage and effectively support families with young children.     

A life enriching togetherness--meanings of informal support when being a parent of a child with disability

The majority of children affected by disability are cared for at home by their parents. It is well documented in research literature that the parents are in need of professional support. In the striving to improve the professional caring, it is also important to deepen our understanding about the meaning of informal support from the perspective of parents' life world. The aim of this study was to illuminate the meanings of lived experience of informal support, when being a parent of a child affected by disability. Thirteen parents, eight mothers and five fathers within eight families, participated in narrative interviews, which were analysed by using a phenomenological-hermeneutic method. The meanings resulted in three themes: 'being gratified by experiences of the child as having a natural place in relation with others', 'being provided a room for sorrow and joy' and 'being enabled to live an eased and spontaneous daily life'. These themes emanated from the experiences of other persons' being and doing in relation to the parents, the child affected by disability and the siblings. According to our interpretation, informal support means a life enriching togetherness, the core of which is natural human caring. The findings also showed that parents highly valued professional support concerning informal supporters.     

Health visiting assessment--unpacking critical attributes in health visitor needs assessment practice: a case study

BACKGROUND: Assessment of family health need is a central feature of health visiting practice in which a range of skills, knowledge and judgements are used. These assessments are pivotal in uncovering need, safeguarding children and in determining levels of health intervention to be offered to children and their families by the health visiting service in the UK. OBJECTIVES: The central focus of this paper is to outline the critical attributes of the basic principles that underpin health visiting assessment practice that emerged as part of a case study enquiry. DESIGN: A case study design informed by a constructivist methodology was used to examine health visitors' professional judgements and use of formal guidelines in identifying health needs and prioritising families requiring extra health visiting support. SETTINGS: The main study was conducted in three community Trust case sites in England, UK, with pilot work being undertaken in a fourth site. METHODS AND PARTICIPANTS: Fifteen health visitors participated in the main study and data were collected during 56 observed home visits to families receiving extra health visiting support. Separate in-depth interviews were conducted with the health visitors, pre- and post-home contacts, while 53 client interviews also took place. RESULTS/CONCLUSIONS: The analysis suggests that there are certain fundamental elements associated with the majority of health visitor assessments and these have been termed assessment principles. These characteristics are integral to, and provide the basis upon which health visitors' assessments are conducted and professional judgement is formed. They reflect the basic principles of health visiting assessment practice, which exist despite the constraints and realities of the practice context and can be differentiated from the activity centred methods of assessment processes.     

Intercountry adoption and nursing care

AIMS AND OBJECTIVES: This paper is based on a Norwegian study that addressed the importance of nurses understanding adoptive families' particular needs. The study aimed to provide a diverse picture of adoptive families' challenges and resources. It addressed adoptive families' experiences with welfare professions, particularly public health nurse services, and explored their need for support before and after adoption. This paper focuses particularly on challenges confronting 'transracial' families. PARTICIPANTS AND METHOD: The qualitative research interview was used as the methodological approach. Nine couples of adoptive parents, four adoptive mothers, three public health nurses and four adult adoptees were interviewed. The analysis process was an ad hoc generation of meaning, and the data were systematically reviewed and categorized through an intuitive analysis style. RESULTS: The study indicates that adoptive families manage their 'most common' challenges on their own, but the informants also spoke about a need for professional support and assistance in many cases. Recurring themes in the study were challenges linked to 'attachment difficulties', 'external categorization', 'grief' and 'the meaning of biological heritage and roots'. Findings indicate that there is a substantial demand for increased knowledge of adoptive families' special needs, not least in the public health nurse services; there is also limited knowledge within other welfare professions. Nurses particularly need to strengthen their understanding on how external categorization affects transracial adoptive families. CONCLUSIONS: The study recommendations call for improved follow-up after adoptions. This can be met by establishing a special programme for adoptive families at maternity and child health centres. In addition, public health nurses can support adoptees in their teenage years through individual consultations.     

Children visiting parents in inpatient psychiatric facilities: perspectives of parents, carers, and children

A significant number of clients utilizing mental health services will also be parents. Being a child of a parent with mental illness increases health risks for the child, and hospitalization of the parent has been identified as one of the most difficult times for children. However, few proactive measures have been taken to understand or provide for the needs of children visiting psychiatric inpatient facilities. The aim of this exploratory study was to identify the perspectives children, their parents, nominated carers, and clinicians from their experience of children visiting. The study used qualitative data gathered from interviews to develop an understanding of the issues. The purpose of this paper was to present the findings from parents, carers, and children. Children indicated that they wanted to visit and to remain involved with their parent, but that there was little support from staff. Families indicated that children visiting psychiatric inpatient facilities were not well managed, and they received little support about decisions around children visiting. The issue of children visiting psychiatric facilities when they have a parent who is an inpatient appears not to have been addressed in models of inpatient mental health care.     

Finnish families' need for special support as evaluated by public health nurses working in maternity and child welfare clinics

The purpose of this study was to describe public health nurses' views of the everyday problems of families and their needs for special support. Seventy-four nurses filled in a tripartite questionnaire. The needs varied by region and were seen in 4% to 23% of all families expecting a baby or with a child younger than 3 age in the nurses' clientele. Approximately one-third of the families were considered to have a pressing need for support. More than half of families (54%) had difficulties coping with parenthood and family structure, almost one-third (30%) with raising their children and with childcare, and nearly one-third (27%) with their social network. In 20% of the families, the parents experienced problems relating to their relationship as a couple; 20% of the families had problems connected to the children's development, growth, and health; and in 19% of the families, the parents had health problems. Special needs were also caused by the parents' use of alcohol (15%) and by disputes over the children's custody and visiting rights (7%). The information provided by the study can be used in developing clinical services and the family work supporting them.     

Supporting bereaved parents: a phenomenological study of a telephone intervention programme in a paediatric oncology unit

Aims and objectives. This study sought to discover bereaved parents’ perspectives and experiences of a nurse‐led, ward‐based, telephone support programme in a children’s oncology unit. Background. Parental grief is especially intense and long‐lasting, and many parents can experience serious psychological problems. The oncology team learned that some parents felt ‘forgotten’ or ‘abandoned’ following their child’s death and addressed this concern by initiating and subsequently evaluating a telephone bereavement support programme. Design. An interpretive phenomenological investigation of the experiences of six parents who participated in the programme. Methods. Parents shared their experiences and perceptions of the programme in individual interviews. Interpretive phenomenology and thematic analysis guided the interviews’ interpretation to ascertain both the parents’ experiences of the programme and their understandings of everyday clinical terms such as ‘support’ or ‘reassurance’. Results. Parents found the programme supportive, especially valuing ongoing contact with a nurse who ‘knew them’. Telephone contact was preferred to visiting the hospital, which brought back painful memories. Calls were important elements in helping parents create meaning and memory around their deceased child. Conclusions. Regular telephone contact over an agreed period from a familiar member of the child’s treating team can create a more positive and supportive bereavement experience for parents in the year following their child’s death. The specific findings are discussed in the context of the death of a child as a crisis of meaning. Relevance to clinical practice. Clinical nurses are ideally placed to use existing close relationships to extend care and support to bereaved parents. This study shows how nurses can identify service gaps, work with interdisciplinary team colleagues to initiate appropriate actions and participate in the essential evaluation subsequently required.     

Parents’ Experiences of the Provision of Community‐Based Family Support and Therapy Services Utilizing the Strengths Approach and Natural Learning Environments

Background In recent years, community based therapy service providers have explored different service delivery models to optimize child and family outcomes. This qualitative study aimed to explore parents’ experiences of one particular service team that adopted a strengths approach, utilizing natural learning environments. Materials and methods Nine parents undertook in‐depth, semi‐structured interviews that were taped, transcribed, and examined using thematic content analysis. Rigour was ensured through peer and member checking, field journals and an audit trail. Results Several key themes emerged including; families’ initial experiences of the service, their views of their child with a disability, their hopes for the future, and their experiences of receiving intervention from the team. Conclusions Parents were generally positive about the adoption of a strengths approach. ‘Working together’, ‘being positive’ and ‘information exchange’ were the main themes that parents’ attributed to their positive experiences with the service.     

International adoption families: a unique health care journey

The purpose of this study was to identify and describe the health care experiences of families with an internationally adopted child. Content analysis of data from 107 adoptive parents was used to identify themes that characterized health care experiences of the families. Four themes were identified: a) Coming home: Like a lobster thrown into a boiling pot; b) Vigilance: Is my child healthy today? Will my child be healthy tomorrow?; c) Unique health care needs of international adoption families: We are different; and d) Importance of support by health care providers: Do they know or care? Health care providers need to be aware of the unique experiences of the increasing number of international adoption families. The themes identified provide insight into the health care experiences of international adoption families and the crucial role of health care providers in helping international adoption families feel supported on their journey.