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.

Keeping the focus on children: the challenges of safeguarding children affected by domestic abuse.

Safeguarding children affected by domestic abuse is a key responsibility for all professionals working with children and families, but can be difficult to achieve in practice. Despite a policy emphasis on early intervention and child-centred work, limited attention has been paid to how professionals in universal and additional support services address this important area of work. This paper reports findings from qualitative research undertaken in one local authority area in the north of England during 2011 which examines the challenges facing professionals in safeguarding children affected by domestic abuse. Six mixed professional focus groups were held, attended by a total of 23 participants. Discussion focused upon participants' awareness of domestic abuse, how they assessed and met children and young peoples' needs, and their views about service provision and safeguarding processes. Data were transcribed and thematic analysis undertaken. The themes presented in this paper--embodied recognition, someone else's job, service gaps, skills deficits, and focusing upon children and young people--illustrate the scope and limitations of professionals' work with children and young people affected by domestic abuse. Areas for practice improvement are discussed.

Inter-professional electronic documents and child health: a study of persisting non-electronic communication in the use of electronic documents.

Information and communication technologies are widely used in health and social care settings to replace previous means of record keeping, assessment and communication. Commentary on the strengths and weaknesses of such systems abound, thus it is useful to examine how they are used in practice. This article draws on findings from two separate studies, conducted between 2005 and 2007, which examined how child health and welfare professionals use electronic documents in Finland and England. Known respectively as Miranda and CAF, these systems are different in terms of structure and function but in their everyday use common features are identified, notably the continued use of and reliance on non-electronic means of communication. Based on interviews with professionals, three forms of non-electronic communication are described: alternative records, phone calls and letters, which facilitate the sharing of the electronic record. Finally, the electronic documents are further analysed as potential boundary objects which aim to create common understanding between sites and professionals.

'A Juggling Act': an analysis of the impact of providing clinical placements for pre-registration students on the organisation of community nursing and health visiting work.

Modernising policies for the NHS have aimed to strengthen the nursing workforce through enhancing professional roles and increasing the numbers of pre-registration students. The current emphasis upon community based health care has led to an increase in the quantity and complexity of the workload for community nurses and health visitors, whilst at the same time educational developments have led to additional responsibilities supporting nursing students on community placements. These issues are explored in this paper which reports findings from a qualitative study in a large city based Primary Care Trust (PCT). The findings demonstrate that the provision of clinical placements for nursing students leads community nurses and health visitors to juggle the demands of their workload with meeting the needs of nursing students and clients. This requires a (re)-organisation of their work, often impacting on the wider team. Additionally the nature of community nursing/health visiting work, shaped by time, space, resources and location, constrains opportunities for clinical learning. If government policies are to be implemented successfully, community nursing and health visiting staff require appropriate support to enable them to fulfil their educational and clinical roles.

Too frightened to care? Accounts by district nurses working with clients who misuse substances.

Drug misusers have complex health and social care needs, and experience considerable difficulties in accessing the assessment, care and treatment that they require. Despite the development of specialist services in many parts of the UK, substance misuse is often marginalised within mainstream general healthcare, and many practitioners are unprepared for the challenges of working with this client group. The present paper reports findings from a qualitative study that aimed to explore district nurses' understandings and practices in relation to discrimination and inequalities issues. The research took place during 2003 in two city-based primary care trusts in the North of England. Semistructured interviews were undertaken with 18 'G' grade district nurses. The authors present findings that highlight some of the challenges and tensions district nurses encounter when providing care to clients who misuse substances. The discourses of 'prejudice' and 'risk' were intertwined throughout the data, and served to shape service provision for clients who misuse substances. This was reflected in the district nurses' accounts of their own practice and that of other services, suggesting that these clients receive suboptimal care. The discourse of 'risk' was also used by district nurses to construct themselves as 'vulnerable', and this helped to explain some of their own practices of care provision. Many participants acknowledged their limited knowledge and experience of working with this client group. There is an urgent need for district nurses and other health professionals to develop their practice with these clients, who may present as both vulnerable and dangerous, in order to ensure that care is provided equitably and safely.

The (un)-certainties of district nurses in the context of cultural diversity.

AIM: This paper is a report of part of a study exploring district nurses' understanding and practices in relation to discrimination and inequalities issues. BACKGROUND: Clients from minority ethnic groups continue to experience inequalities in health status and care provision. District nurses work with a wide range of clients, yet research has demonstrated inequities in service provision to clients from minority ethnic groups due to organizational, professional and personal constraints. METHODS: A qualitative methodology was used to explore district nurses' understanding of discrimination and equalities issues in the context of their work. Semi-structured interviews were undertaken during 2003 with 18 district nurses employed in two primary care organizations in England providing healthcare services to a large and culturally diverse population. FINDINGS: District nurses' accounts were marked by uncertainty, suggesting that many lacked confidence when discussing issues of ethnicity and cultural difference. There were marked differences in the extent to which they appeared to recognize or engage with clients' experiences of discrimination or inequalities, or to recognize inequitable service provision to clients from minority ethnic groups. Key issues were a lack of provision of district nursing services to some clients, and failures to meet clients' language and communication needs, and although reflecting organizational constraints, such continuing inequities were largely unquestioned. CONCLUSION: There is a need for further educational and practice developments to enable district nurses to provide more equitable care to clients from culturally diverse communities, ensuring that the key professional discourse of individual care and advocacy are fully realized in their work with all clients.

Research governance and postgraduate nurse education: the tensions and some solutions.

In this paper Lorraine Ellis and Sue Peckover discuss the implications of the current NHS Research Governance Framework for the supervision of Masters level students undertaking empirical research as part of their programme of study. The paper highlights some of the inherent tensions resulting from the introduction of research governance, and offers some solutions.

Health visitors' understandings of domestic violence.

BACKGROUND: Feminist work has made visible the extent and nature of domestic violence and the problems women face in having their experiences recognized by health and welfare professionals. Research has demonstrated that many health care professionals, including nurses, midwives and health visitors have little working knowledge about this issue. This impacts on their ability to recognize and respond to domestic violence within their practice. AIM: This paper is based upon a study of British health visitors, which explored their practice in relation to domestic violence. Drawing upon empirical data from interviews with health visitors, it explores their understandings of the extent and nature of domestic violence in the context of their work. METHODS: Semi-structured interviews were undertaken with 24 health visitors selected by convenience and purposive sampling. Data collection took place during 1997-1998. The research draws on the theoretical perspectives of feminist poststructuralism. FINDINGS: The findings demonstrate considerable differences between health visitors in their understandings of the extent of domestic violence in their caseloads and their recognition of different types of abuse experienced by women. There were also differences between participants in their willingness to name situations other than physical violence as abusive, as well as the extent to which they recognized domestic violence within different social groups. CONCLUSIONS: A feminist perspective provides critical insight into the professional knowledge base in relation to domestic violence, demonstrating the need for health visitors to develop their understandings further in order to respond appropriately to women and children experiencing domestic violence. This is discussed in the context of ongoing struggles for professional identity within an ever-changing arena of health and welfare provision.

'I could have just done with a little more help': an analysis of women's help-seeking from health visitors in the context of domestic violence.

Domestic violence is a serious issue that adversely affects large numbers of women and children. Despite having an adverse impact upon health and welfare, women experiencing domestic violence face a number of difficulties seeking help about their situation from statutory health and welfare agencies. The present paper is based upon a study of British health visiting in relation to women experiencing domestic violence. Drawing upon interview data from 16 women who experienced domestic violence and were the mothers of small children, this paper explores their accounts of contact with the health visiting service. All of the 16 women who participated in this research described difficulties in seeking help about domestic violence. These included practical concerns such as fears for their own safety, lack of knowledge regarding appropriate sources of support and protection, and concerns about losing custody of their children. Given these concerns, some women concealed their experiences of domestic violence from their health visitors. For those who disclosed the domestic violence to their health visitors, they did not always receive appropriate support or protection. Of particular concern was the absence of information about accessing more specialist services. The research findings suggest that there is considerable scope for practice development in order to ensure that women experiencing domestic violence are able to receive safe and appropriate responses from health visitors.

Teaching research to undergraduate community nursing students: reflections upon curriculum design.

Despite the widespread inclusion of research education within nursing courses, there remain a number of tensions about the purpose, content, and philosophy underpinning such programmes. Of particular concern is the importance of establishing appropriate teaching and learning strategies in order to ensure that research education is enjoyable and effective. These issues are explored within this paper, and provide the background context for this discussion on the redesigning of a research module within an undergraduate programme for post-registration community nursing students. The paper highlights the rationale for undertaking this change, and discusses the educational frameworks, which were used in order to develop the programme. An initial evaluation suggests the redesigned curriculum is a positive development that has enhanced both the teaching and learning of research.

Supporting and policing mothers: an analysis of the disciplinary practices of health visiting.

AIM: This paper draws on the notion of disciplinary power developed by Michel Foucault to discuss whether the professional practices inherent in British health visiting can be understood in terms of support or surveillance. BACKGROUND: The notion of disciplinary power embedded within Foucault's writings has been widely applied to the sociological analysis of health care professions. While a number of studies have focused on nursing practice, there has been little empirical work developing these ideas in the context of British health visiting. METHODS: A qualitative approach using interviews with 24 health visitors and 16 women who had experienced domestic violence was used. For reasons of confidentiality, the women were not matched to the health visitors. Data analysis was continuous with data collection and led to identification of a number of categories. The theoretical framework of feminist poststructuralism underpinned the analysis. FINDINGS: The women who participated in this research described their engagement in a number of disciplinary practices. These included the discursive production of themselves as good mothers, subjects and objects of the health visiting gaze, as well as their practices of resistance to health visiting work. Analysis of the health visitors' interview data provided further evidence concerning the exercise of disciplinary power in their everyday work of providing support and health care to women and children. CONCLUSIONS: The paper highlights tensions within the health visitor's role between welfare and surveillance, as well as differences between lay and professional perspectives.