Health visiting in England: The impact of the COVID-19 pandemic.

This focused review of evidence considers the impact of the pandemic in 2020 on families with children under 5 years in England, and the health visiting (HV) service that supports them. . Data were drawn from national surveys of health visitors (HVs) and parents, a freedom of information request of employers, published research, and national data. Framework analysis and triangulation, using the Key Elements of an effective HV service, were used to categorize the key findings. The findings from the review indicate that the impacts of the pandemic were wide-ranging and disproportionately affected the most disadvantaged families, increasing demand for HV support. HVs' ability to respond was compromised due to national policy decisions to partially stop the service and variations in local implementation including the redeployment of HVs, pre-existing workforce capacity issues, and the effectiveness of innovations to identify and support vulnerable families. The pandemic exacerbated factors that can lead to poorer outcomes for families. Key learning from the pandemic response, including the need to prioritize the HV service, must be acted upon to reduce ongoing impacts now and ensure that the service is equipped for future emergencies.

Improving the way healthcare professionals deliver different news to families during pregnancy or at birth: a qualitative study.

AIM: To explore the lived experience of delivering or receiving news about an unborn or newborn child having a condition associated with a learning disability in order to inform the development of a training intervention for healthcare professionals. We refer to this news as different news. BACKGROUND: How healthcare professionals deliver different news to parents affects the way they adjust to the situation, the wellbeing of their child and their ongoing engagement with services. This is the first study that examined the lived experience of delivering and receiving different news, in order to inform the development of training for healthcare professionals using the Theoretical Domains Framework version 2. METHOD: We conducted qualitative interviews with a purposive sample of 9 different parents with the lived experience of receiving different news and 12 healthcare professionals who delivered different news. It was through these descriptions of the lived experience that barriers and facilitators to effectively delivering different news were identified to inform the training programme. Data analysis was guided by Theoretical Domains Framework version 2 to identify these barriers and facilitators as well as the content of a training intervention. FINDINGS: Receiving different news had a significant impact on parents' emotional and mental wellbeing. They remembered how professionals described their child, the quality of care and emotional support they received. The process had a significant impact on the parent-child relationship and the relationship between the family and healthcare professionals.Delivering different news was challenging for some healthcare professionals due to lack of training. Future training informed by parents' experiences should equip professionals to demonstrate empathy, compassion, provide a balanced description of conditions and make referrals for further care and support. This can minimise the negative psychological impact of the news, maximise psychological wellbeing of families and reduce the burden on primary care services.

The feasibility of a multi-professional training to improve how health care professionals deliver different news to families during pregnancy and at birth.

BACKGROUND: In the United Kingdom, pregnant women are offered foetal anomaly screening to assess the chance of their baby being born with eleven different conditions. How health care professionals (HCPs) deliver news about a child having a congenital anomaly affects how it is received and processed by parents. We refer to this news as different news. METHODS: We conducted a mixed methods evaluation of a training intervention to improve how HCPs deliver different news. Twenty-six HCPs self-completed pretraining and posttraining questionnaires on skills, knowledge, and attitudes related to delivering different news. Qualitative interviews were conducted with eight HCPs. Quantitative data were analysed using descriptive statistics, the paired t test to compare the pre and post scores and estimate the difference between pre and post scores, and the 95% confidence interval. Qualitative data were analysed using framework analysis guided by the Theoretical Domains Framework (TDF). RESULTS: The training intervention was both feasible and acceptable. HCPs indicated that it enhanced or consolidated their knowledge and skills, covered topics relevant to their practice, and that they would recommend it to colleagues. Participants particularly valued integration of the voice of parents with lived experience in the training. Significant increase in mean scores were observed in confidence to deliver different news (2.81, 95% CI [2.43, 3.19] to 4.28, 95% CI [4.09, 4.47]; p < .001) and skills to deliver different news (3.00, 95% CI [2.64, 3.36] to 4.36, 95% CI [4.13, 4.59]; p < .001). HCPs reported feeling more confident in their ability to provide sensitive, responsive, balanced care to families. CONCLUSIONS: The significant improvements in confidence and skills reported by HCPs suggest that the training may be effective in equipping HCPs to minimize the distress, anxiety, and depression associated with receiving different news. This represents a key aspect of the prevention of mental ill health across the life course.

Knowledge, attitude and practice among Health Visitors in the United Kingdom toward children's oral health.

OBJECTIVES: The purpose of this study was to determine knowledge, attitude, and practical behavior of health visitors regarding children's oral health in the United Kingdom (UK). METHODS: A web-based self-administered survey with 18 closed and 2 open ended questions was distributed to a convenience sample of approximately 9,000 health visitors who were currently employed in the United Kingdom and a member of the Institute of Health Visiting. RESULTS: A total of 1,088 health visitors completed the survey, resulting in a response rate of 12%. One-third of the health visitors reported that they had not received oral health training previously. Almost all agreed that oral health advice/promotion should be included in their routine health visiting contacts. Previous oral health training/education was associated with an increase in oral health knowledge; confidence in entering a discussion with parents/caregivers and willingness to be involved in dental referral process. CONCLUSIONS: The results of our study support the need for health visitors to receive oral health training in oral health promotion including oral health risk assessment, guidance on evidence based up-to-date prevention measures, increasing the dental attendance prevalence at early stages and awareness of including specific oral health guidelines/fact sheets into their regular practice.

Vaccination in pregnancy: Attitudes of nurses, midwives and health visitors in England.

OBJECTIVE: To examine amongst healthcare professionals in England; knowledge of vaccinations in pregnancy, their perceived roles in these programmes and whether they recommend scheduled vaccines to pregnant women. DESIGN: Cross sectional survey (online questionnaire) Setting: Healthcare workers in contact with pregnant women in England. PARTICIPANTS: The survey analysis included 3441 healthcare workers who had been surveyed during May to August 2015. The participants were midwives, practice nurses and health visitors, working in England who were members of the Royal College of Midwives, Royal College of Nursing and the Institute of Health Visiting. RESULTS: We found that knowledge of vaccination in pregnancy was high in all professional groups. Seventy three percent of all respondents would recommend the influenza vaccine and 74% would recommend the pertussis vaccine to pregnant women. They were more likely to recommend vaccination in pregnancy if they would personally have the influenza and pertussis vaccines themselves and/or if they had the influenza vaccine as a healthcare worker. Practice nurses were significantly more likely to recommend the pertussis and influenza vaccines to pregnant women than midwives and health visitors. Health professionals who had received immunisation training were more confident in giving advice to pregnant women. CONCLUSION: Immunisation training is essential if healthcare workers are to be informed and confident in effectively delivering the maternal immunisation programme and thus improving uptake of vaccines in pregnancy. These findings are important in tailoring educational programmes and addressing the training needs of different healthcare professional groups.

What leadership skills will community nurses need to improve outcomes in the new NHS?

Nurse leadership in the community will be more important than ever if the health service is to improve the health of the population. This article looks at the essential leadership skills nursingprofessionals working in primary care will need if they are to fulfil government healthcare plans to improve health and wellbeing.

Health visiting: a profession in transition.

Health visiting will celebrate its 150th birthday in 2012. This paper reviews circumstances leading to the highly disturbing reduction in health visitor numbers in England over the past four years and the scale of the reductions. It highlights the considerable impact of these reductions on services for children and families. Finally it discusses what must be done to re-energise health visiting and what actions are expected to result from the "Action on Health Visiting" programme led by the Department of Health.