Guide Health Promotion in Midwifery 2nd Edition: Principles and practice (Hodder Arnold Publication)

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The chest X-ray : a survival guide Philadelphia, Pa. Clinical respiratory medicine Fourth edition. Philadelphia, Pa. Lecture notes. Gastroenterology and hepatology Second edition. Oxford : Wiley-Blackwell, Cambridge : Cambridge University Press, Neurology and neurosurgery illustrated. Fifth edition Edinburgh : Churchill Livingstone, Radiology 3rd ed. Obstetrics, gynaecology and women's health on the move London : Hodder Arnold, Bereavement care for childbearing women and their families : an interactive workbook London : Routledge, Elk Grove Village, IL.

Anatomy and physiology for midwives. Infections affecting pregnancy and childbirth London : Radcliffe Publishing, The labour ward handbook 2nd ed. London : Royal Society of Medicine Press, Managing childbirth emergencies in the community and low-tech settings. John Lee , author. London : RCPsych Publications, Differential diagnosis in dermatology Fourth edition. London : Radcliffe Publishing, Clinical dermatology Fifth edition. Child development 9th ed. Boston ; London : Pearson, Birth and breastfeeding : rediscovering the needs of women in pregnancy and childbirth Forest Row : Clairview, London : Radcliffe, Reflective practice in nursing 3rd edition.

Los Angeles : Learning Matters, How to do a systematic literature review in nursing : a step-by-step guide Second edition. Maidenhead : Open University Press, Louis, Mo. Adult nursing at a glance Chichester : Wiley Blackwell, The Roy adaptation model Third edition. New Jersey : Pearson, Patient assessment and care planning in nursing 2nd edition. Leadership and management for nurses : core competencies for quality care Third edition. Boston : Pearson, Leadership in nursing practice : changing the landscape of health care Second edition.

Foundations of nursing in the community : community-oriented practice Fourth edition. Health promotion and public health for nursing students Third edition. London : Learning Matters, Medical-surgical nursing care Fourth edition. London, UK : Radcliffe Publishing, Managing long-term conditions and chronic illness in primary care : a guide to good practice Second edition. Paediatric advanced life support : a practical guide for nurses 2nd ed. Oxford : Wiley-Blackwell, c Acute care oncology nursing Second edition.

Prenatal and postnatal care : a woman - centered approach Chichester : Wiley-Blackwell, Ophthalmic Nursing Fifth edition. Louis Mo. The student nurse handbook : a survival guide Third edition. Sudbury, Mass. Research skills for nurses and midwives London : Quay Books, Nursing research : generating and assessing evidence for nursing practice Tenth edition.

Law and professional issues in nursing Fourth edition. London ; Los Angeles : Learning Matters, Development of the toolkit has been led by a six-cycle process of research making use of an action research approach [ 36 ] as follows:. The steering group includes representatives from public health, the safeguarding children's team, health visiting in the two pilot localities in which the work is being undertaken, the children's centres lead and the project manager CD , and the university research team RB, SA-A, JC.

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The steering group reports to the project sponsor in the Trust. An operational group led by the project manager and the university researchers meets at least every fortnight. The overall aim of the project is to develop an EBP toolkit that will inform practice and benchmark safe and effective early years' HV interventions, thereby supporting service development and audit. It was proposed that the toolkit would contain resources to support delivery of EBP by HVs in priority areas. The first step cycle 1 was to identify the most important issues or top priority needs that the HV team should address, to prioritise the development of the resources.

Various methods may be used to identify priorities in practice including reviewing the literature, examining the local joint strategic needs assessment and public health data, and consultation methods. As the long-term aim of this project was to develop resources for HVs to use in their practice, it was important to involve HVs and other service providers who they work with in the identification of priorities. To do this, the project made use of a modified Delphi process to identify priority issues in HV practice in an inner city area.

Delphi is a structured process that uses a series of repeated rounds to gather information from a panel of experts. Each round summarises information presented in the previous round which is then presented again to stakeholders for prioritisation in order to establish group agreement [ 38 ]. Delphi is usually undertaken in 3 rounds conducted by post and agreement among panel members is achieved by providing each member with feedback and averaged information from the previous round [ 39 , 40 ].

The technique was developed in the s as a means to facilitate the engagement of experts as a group to examine complex defence problems in the USA [ 41 ]. Delphi may be used for two main purposes: priority setting or gaining consensus on an issue. Keeney et al. The modified Delphi they describe has a first round involving the expert group in face-to-face interviews or focus groups.

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In the case of the present study, the aim was to identify priorities to be addressed through the EBP toolkit. A modified Delphi approach was used in which the first round comprised focus groups, the second individual responses but in a group setting and the third was conducted via email. The aim of the first cycle was to identify, explore, prioritise, and gain stakeholders' consensus about the priority health needs that HVs will address through the EBP toolkit, making use of a three-round Delphi approach.

Purposeful samples of people from health visiting and the stakeholder groups who work with the same population of families with children under 5 years were invited by KP to participate in the three rounds. Information was sent to potential participants outlining the aims of the project and detailing what was required from them. Health visitors in the two localities, of four, in which the project was to be piloted were invited to attend.

The two localities reflect the widespread nature of deprivation in the borough and the ethnic mix of the population. The participants were service representatives from across the borough; their invitation and involvement in the process were to ensure that participants were people who had the commitment to the process and shared a level of expertise. For example, participants were diverse, ranging from an HV team member to manager in a children's centre see Table 1. The project was initially planned to run for one year which meant that a very tight timetable for the Delphi process was followed resulting in a short period for recruitment of participants for the Delphi process from the start of the project in mid-May to the focus group in early June.

This resulted in recruitment of only one parent but 21 parents have been involved in later stages of the project. Participants were asked to agree to participate in all three rounds of the Delphi, and at the beginning of Round 1 they were asked to sign participation consent form.

The participants were invited to attend a one-day event in June held in a Trust venue during which the aim was to generate discussion and collect qualitative data about the priority areas. Refreshments and lunch were provided during the day. The day started with a presentation on the project, and then participants were formed into five focus groups each led by a facilitator.

Each focus group had 4—6 participants, an appropriate sample size for a focus group [ 42 ]. The focus groups included people from the same professional groups or services; for example, children centre and outreach workers remained in one group, and allied health professional teams stakeholders and health visiting teams had their own groups. The parent who attended joined the group of children centre and outreach workers as she agreed this group was most acceptable to her. The role of the facilitators was to develop and generate group discussion surrounding their work with health visiting services and families with young children under five years.

Participants were also asked about their perception of health visiting services, how they work with the services, and their thoughts on what are the greatest needs seen in families and children in the services they provide for nonhealth visiting groups. Each facilitator was provided with a guidance document appropriate to the particular group they were facilitating see Table 2 for one example of the guidance to facilitators.

Facilitation guidance for stakeholder focus group.

Introduction: we have some questions that we have prepared to help you think through what people in Tower Hamlets need and what services HVs should offer. However, we don't want these to limit you in anyway. Please feel free to discuss things that you think are relevant. Note to facilitators: key questions are in the left-hand column and should be written on your flip charts in advance of the discussion. The discussions in the focus groups were taped and notes made on flip charts summarising the discussions, and prioritising the identified needs.

The key points from the discussions were fed back verbally to all the participants at the end of each discussion period through the day. The tapes were transcribed and the flip chart notes were typed up by the research team following the event. Content analysis was used to identify the topics which the participants had identified as the priority areas of health visiting practice to be addressed through the toolkit [ 43 ].

A questionnaire was developed listing each of the priority topics with a range of comments illustrating the rationale for the topic as described by the participants. The participants from Round 1 were invited to attend a second half day in June , two weeks after the first session. Following a brief update on the project, each participant was asked to read each topic and comments from Round 1 and to rank each topic as a priority from 0 not important to 10 very important. The numerical rating system aimed to test the extent to which the group agreed or formed a consensus around the most important areas to be addressed in the toolkit.

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Participants were also given the opportunity to add a brief rationale for their decisions if they wished. The topics and individual participants' scores were entered onto a spread sheet, and mean scores for each topic were calculated. This generated an initial list of prioritised topics. A questionnaire, individualised for each participant, was constructed covering all the priority topics and sent to participants via email in July In this questionnaire, the participants' individual score for each priority area was shown alongside the mean score from the group for that topic.

Comments explaining the rationale for the topic, from the individual participant and other participants, were also included. The participants were asked to confirm their previous score for the topic or to change it in light of the mean score and the comments. In the third round, the participants were thus given the opportunity to reprioritise the priority topics.

The results from the three rounds are presented below in the order in which they occurred. The majority of the 25 participants took part in the three stages of this study, with 23 responses from 25 participants in Rounds 2 and 3. One participant was not present at Round 2 but undertook the online questionnaire at Round 3. Another participant completed the Round 2 questionnaire but not the one in Round 3.

Twenty-five people attended the Delphi event representing health visiting teams and a wide range of stakeholders. Group discussion took place in several sessions over the day, each lasting for up to 2 hours, with the objective that at the end of the day each member would feel that their own priorities were properly represented on the list of priorities.

Discussions were vibrant, interactive, and revealing and covering a wide range of issues from how health visiting services are perceived to how allied health professionals and children centres endeavour to work with families more closely. This discussion provided an opportunity to learn about how another service like CAMHS complements the work being achieved in health visiting such as early intervention strategies for maternal mental health.

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These issues were raised as potential barriers to building sustainable relationships between health visiting and children's centre staff; however, both groups recognised the value of working together to achieve positive outcomes for families. Each group identified major social issues such as poor housing, unemployment, social isolation, and difficult family circumstances linked to fragmented family relationships, difficult marriages, and problems with extended family as impacting the work of HVs.

These concerns were recurrent themes in daily work with families; participants asked if an issue such as housing was worth identifying on their priority list as HVs have limited capacity to influence these kinds of social issues. It was agreed that all issues however great or small would be identified by the groups to ensure a true representation of their views about the priorities. The discussions generated a large volume of data and some of which is illustrated in Table 3.

Round 1 led to the generation of 27 priority topics see Table 4. The purpose of Rounds 2 and 3 was to generate the priority ordering of the health needs. Priority needs for Health Visiting as identified by participants in Rounds 2 and 3 of the Delphi process. The questionnaire completed at the second meeting by individuals asked participants to give a priority score for each of the 27 topic areas from 1 to The following provides an example of a questionnaire entry, on the topic of play, including representative statements from the discussions in Round 1 illustrating the topic. We need some form of play sessions which could be done in conjunction with children's centre.

We wish that we could do more play activities as most people live in high-rise flats and the children are living indoors. Children's behaviour is really poor in hospital; they are stuck in a flat with lack of stimulation. When the toy library went, that created a real gap. The numerical rating system aimed to test the extent to which the group agreed or formed a consensus around the most important areas to be addressed in the project.

A list of the 27 topics in priority order was generated by entering the results from the questionnaires into a spread sheet. A mean score for each topic was generated from the 23 responses in Round 2 the same procedure was followed in Round 3 giving the list of topics in priority order. Participants were also asked to add any additional comments to justify their scores. Table 5 illustrates some of these comments in relation to three topics. Individualised questionnaires for each of the 25 participants were constructed for Round 3.

These included additional comments made by the group and the individual during Round 2. First-Time Mothers. First-time mothers need more support. Round 1 Focus Group. Depends on support networks around them. Some first time mothers will have support of family, friends and neighbours. I see a lot of first-time mothers who are very socially isolated and do not have family support. They present with problems frequently. This is a problem that crosses both cultures and social class boundaries. Your Personal Comment. The response rate was high with 23 of the 25 questionnaires returned.

There was little change in the mean scores across the 27 topics suggesting a strong consensus among the stakeholders about the priorities. The order of the prioritised health needs remained the same as that in Round 2. The priority order is shown in Table 4. The topics identified through the Delphi process cover a wide spectrum of health and social needs indicative of the level of deprivation in the area and pressures on families with children. The steering group discussed the list of topics and came to the conclusion that it would be impractical to address all of them at the same time given the time scale of the project at that stage one year later extended to two years and the resources available.

Consideration of the list of ranked topics showed that a number were closely associated, for example, topics 1 and 3, infant stimulation and speech and language. Discussion in the steering group also identified topics which were the focus of local initiatives and development, for example, topic 2 domestic violence, and it was agreed that this work should be incorporated into the toolkit in due course. It was agreed that a number of the topics could be amalgamated into three priority areas to be addressed in the next stages of the toolkit development:.

The use of the modified Delphi technique allowed a participative and inclusive approach that encouraged all the stakeholders to influence the selection of priority needs. It promoted consideration of the three elements of EBP utilisation outlined by Eraut [ 2 ] and led to identification of 27 priority topics from a variety of stakeholders' perspectives that included consideration of their context of practice and experiences of service delivery. The process was also successful in engaging people through the three stages of the consultation process as 23 participants completed all three stages.

The prioritised list of topics is the list identified and then ranked by a group of HVs and other practitioners working with families in an area of high deprivation in east London. The highest ranked topic, infant stimulation and speech and language reflects the local concerns but also national policy concerned with the importance of the early foundation years [ 7 , 12 , 22 ].

A quarter of year 6 children in Tower Hamlets are classified as obese, above the average for England [ 44 ], and therefore the ranking of prevention of obesity as the second highest priority reflects local needs. There are many challenges to families in the borough including high levels of poverty, unemployment, deprivation, and environmental challenges including congested housing and high traffic flows [ 3 , 44 ]. Many national reports have identified the pressures on families facing such challenges and thus the identification of stressed and unsupported families as the third priority reflects the high need in the area but is also in accordance with national findings and policy [ 9 , 10 , 12 ].

This list provides clear guidance for the next stages of development of the toolkit for health visitors in this area. It would be interesting to explore in other areas, with similar or different levels of deprivation, if the same or a different list of priority topics would be generated. The next stages of the project involve examining the literature for evidence of best practice in the three amalgamated topic areas, collection of data on the use of this evidence in practice through observation of HV-client interaction, interviews with parents and HVs, and examination of electronic records.

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This will be followed by development and implementation of the EARLY toolkit and evaluation of its use in supporting HVs in their practice with families with children under five years. The authors wish to thank The Burdett Trust for Nursing for their financial support, without which this project would not have been possible.

National Center for Biotechnology Information , U. Journal List Nurs Res Pract v.

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Nurs Res Pract. Published online Sep 9. Author information Article notes Copyright and License information Disclaimer. Received Mar 29; Accepted Jul This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Families with children living in areas of high deprivation face multiple health and social challenges, and this high level of need has impacts on the work of health practitioners working in such areas.

Introduction Development of methods to enable practitioners to use evidence in practice has had increasing focus within the evidence-based health care movement and in all areas of the NHS, with the aim of delivering high-quality care [ 1 ]. Health Visiting Health visitors are qualified nurses or midwives who undertake an additional qualification at either BSc or MSc levels to register with the NMC as specialist community public health nurses HV. Evidence-Based Practice As Nursing and Midwifery Council registered nurses, HVs are required to ensure that they provide safe, effective, and evidence-based care [ 24 ].

He describes three dimensions which interact to inform practice as follows: the first is concerned with the analysis of needs in practice including assessment, planning, and implementation; the second is concerned with the context of practice, for example, cultural aspects, deprivation; the third is concerned with how the professionals think which is affected by their experience and the time available. Development of the toolkit has been led by a six-cycle process of research making use of an action research approach [ 36 ] as follows: 1st cycle is identification of priority needs and development of consensus among stakeholders about the top priority health needs to be addressed through the EARLY toolkit by HVs in Tower Hamlets.

Analysis of Needs in Practice The overall aim of the project is to develop an EBP toolkit that will inform practice and benchmark safe and effective early years' HV interventions, thereby supporting service development and audit. Modified Delphi Delphi is a structured process that uses a series of repeated rounds to gather information from a panel of experts. Method The aim of the first cycle was to identify, explore, prioritise, and gain stakeholders' consensus about the priority health needs that HVs will address through the EBP toolkit, making use of a three-round Delphi approach.

Participants Purposeful samples of people from health visiting and the stakeholder groups who work with the same population of families with children under 5 years were invited by KP to participate in the three rounds. Table 1 Delphi participants representing stakeholder groups. Open in a separate window. Round 1 The participants were invited to attend a one-day event in June held in a Trust venue during which the aim was to generate discussion and collect qualitative data about the priority areas.

Table 2 Facilitation guidance for stakeholder focus group. Key questions Triggers if required What types of needs to you see or know about in your area? What gaps do you notice in current health and social service provision for families with young children? What gaps do you notice in public health provision for the local community?


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Tell us about local health and social needs in Tower Hamlets. What families have the greatest needs? And why? What communities have the greatest needs? What services are offered and are they well received? What services are poorly resourced? What could be done about these? How does your service interface with health visiting? What things do families report that HVs do for them? What things do HVs do well? What things could be improved?

Is there a difference between your personal experience of HV compared to your professional experience? What are your experiences of working with skill mix teams?


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  6. How could they meet these? Therapeutic interventions? What are the most important things for HVs to do? Round 2 A questionnaire was developed listing each of the priority topics with a range of comments illustrating the rationale for the topic as described by the participants. Round 3 A questionnaire, individualised for each participant, was constructed covering all the priority topics and sent to participants via email in July Results and Discussion The results from the three rounds are presented below in the order in which they occurred.

    Round 1 Twenty-five people attended the Delphi event representing health visiting teams and a wide range of stakeholders. Table 3 Examples of focus group statements related to the priority health needs.