Health Visiting Preparation for Practice

The fourth edition of this seminal text retains its focus on placing the health visitor at the forefront of supporting and working with children, families, individuals and communities. Health Visiting: Preparation for Practice has been fully revised and updated to reflect the changes and developments in health policy, public health priorities, and health visiting.  It considers the public health role of the health visitor, and the important role and responsibilities the health visitor has with safeguarding children to ensure the child has the best possible start in life.

Key features:

• Fully updated throughout, with new content on practice and policy developments
• Takes into account the challenges and changing role of the health visitor, and the need to ensure that their practice is evidenced-based
• Includes an additional chapter on working in a multicultural society with a discussion on some of the challenges faced by health visitors
• Discusses and debates the practice of public health and working with communities
• Examines the role of the health visitor with safeguarding and child protection, as well as working within a multi-professional team
• Features case studies and learning activities 

Health Visiting: Preparation for Practice is essential reading for student health visitors, public health nurses, and those on community placements, as well as other health practitioners working with and in the community.

Karen A. Luker is QNI Professor of Community Nursing in the School of Nursing, Midwifery and Social Work, The University of Manchester, UK.

Gretl A. McHugh is Professor of Applied Health Research in the School of Healthcare, The University of Leeds, UK.

Rosamund M. Bryar is Professor Emeritus Community and Primary Care Nursing, School of Health Sciences, City University London, UK.

List of Contributors ix

Introduction 1
Karen A. Luker, Gretl A. McHugh and Rosamund M. Bryar

Prevention, public health, and health visiting 2

Health visiting: preparation for practice 4

1 Managing Knowledge in Health Visiting 8
Kate Robinson

Introduction 8

Defining health visiting practice 10

What do health visitors do ± and where do they do it? 13

Evidence-based practice 16

The current landscape of EBP 21

Managing knowledge and evidence in practice 26

Case study 1.1: Introducing new technology 26

Case study 1.2: Creating guidelines in primary care 27

Case study 1.3: Protocol-based decision making in nursing 29

Case study 1.4: Knowledge management in primary care 30

Communities of practice 35

Reflective practice 37

Clients: what do they know and how do they know it? 40

Social networking and the media 41

The debate 44

Summary 45

References 46

Activities 50

2 Health Visiting: Context and Public Health Practice 53
Martin Smith

Introduction 53

Public health 56

Defining ‘public’ 56

Defining ‘health’ 57

Defining ‘public health’ 59

Human rights and public health 60

The principles of health visiting 63

The search for health needs 65

The stimulation of an awareness of health needs 65

The influence on policies affecting health 66

The facilitation of health-enhancing activities 67

Summary 68

Health inequalities 69

Summary 76

References 77

Activities 82

3 The Community Dimension 85
Rosamund M. Bryar

Introduction 85

Public health and communities 87

Defining ‘community’ 89

Impact of communities on health 91

The role of health visitors in working with communities 96

Gaining an understanding of the health of your local community 100

Windshield survey 101

Public health walk 101

Health needs assessment 102

Building community capacity 110

Using health promotion models to support community working 113

Summary 116

References 118

Activities 124

4 Approaches to Supporting Families 127
Karen I. Chalmers and Karen A. Whittaker

Introduction 127

Models of intervention in family life 128

Three models relevant to health visiting practice in families with young children 129

Application of the models in practice 132

Policies 133

Evidence for interventions to support families 136

Characteristics of services and programmes to support families with young children 137

Early home visiting programmes 138

First Parent Health Visiting Programme 138

Community Mothers Programme (CMP) 139

Current home visiting programmes 140

Family Nurse Partnership (FNP) Programme 140

Flying Start ± Wales 143

The Triple-P (Positive Parenting Programme) 144

Maternal Early Childhood Sustained Home Visiting (MECSH) 145

Sure Start programmes 146

Summary 148

Working with families 148

Empirical evidence on relationship development 152

Challenges 154

Public health agenda 154

Level of evidence 155

Adhering to the programme criteria 155

High-needs families 156

Practice specialisation 157

Concerns about child safety 157

Adequate resources 157

Summary 158

Note 158

References 158

Activities 167

5 Safeguarding Children: Debates and Dilemmas for Health Visitors 170
Julianne Harlow and Martin Smith

Introduction 170

The key concepts 172

Defining ‘child’ 172

Defining ‘childhood’ 174

Defining ‘safeguarding’ 175

Defining ‘child abuse’ 180

Defining ‘significant harm’ 187

Incidence and prevalence of child abuse 193

Assessment of vulnerable children 197

Assessment of children in need and their families 198

Common Assessment Framework (CAF) 200

Graded Care Profile (GCP) 202

Working together 203

Confidentiality and information sharing 205

Supervision 206

Summary 210

References 211

Activities 217

6 Working with Diverse Communities 220
Sharin Baldwin and Mark R.D. Johnson

Introduction 220

Culture and migration 221

Cultural sensitivity and competence 222

Some useful tips for developing cultural competence 225

Institutional discrimination and organisational cultural competence 225

Understanding different cultural practices 226

Pregnancy 226

Birth customs 228

Confinement following birth 231

Breastfeeding 231

Diet, weaning, and feeding practices 232

Maternal mental health 235

Safeguarding, domestic violence, and abuse 237

Communication 239

Other communities 240

Case studies 241

Case study 6.1: Breastfeeding support project for Somali mothers in

Harrow 241

Case study 6.2: New ways of delivering health visiting services for

Orthodox Jewish community in Hackney 242

Summary 244

References 244

Activities 250

7 Evaluating Practice 252
Karen A. Luker and Gretl A. McHugh

Introduction 252

Sources of evidence for practice 253

Evaluation ± the problem of definition 257

Conceptualising evaluation 259

Example: tackling childhood obesity 261

Evaluation and evaluative research 263

Evaluation of health care 263

Structure, process, and outcome evaluation 266

Structure evaluation 266

Process evaluation 268

Outcome evaluation 270

Summary 272

The care planning process 272

Actual and potential problems 274

Problem solving 275

Additional issues in evaluating the practice of health visiting 275

Summary 280

References 281

Activities for Chapter 7 287

Index 291

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