The concept of vulnerability in relation to child protection: health visitors' perceptions

Interprofessional and intersectoral collaboration in the care of vulnerable pregnant women: An interpretive study

'Vulnerable' is a term often used for pregnant women in need of extended antenatal care, although the term is not well defined. This study focuses on healthcare professionals' interpretations and understanding of vulnerability in pregnancy, including their own role, to understand the practices of interprofessional and intersectoral collaboration in antenatal care for vulnerable pregnant women. Intrepretive Description informed the methodology of the study and the theoretical framework was inspired by Symbolic Interactionism. It was found that definitions of vulnerability in pregnancy are fluid, being based on the healthcare professional's individual assessment of the pregnant woman´s personal resources, personal characteristics and psychological factors, and that these definitions also depend on the healthcare professional's role in relation to the pregnant woman. The different interprofessional teams' identification of what constitutes vulnerability in a pregnant woman was complex and relied on different components. Interprofessional collaboration was influenced by the relationships between professionals and sectors involved in antenatal care for pregnant women and was thereby influenced by the settings and structures in place for interprofessional and intersectoral collaboration. Insight into the healthcare professionals' perspectives of vulnerability in pregnancy can help develop and improve the interprofessional and intersectoral collaboration in antenatal care of vulnerable pregnant women and their unborn babies.

Health visitors’ assessments of parent–child relationships: A focus group study

BACKGROUND

Health visitors (HVs), also known as public health nurses, in the UK provide a universal community-based service to preschool children and their parents. Since they have ongoing supportive contact with almost all mothers and young children they have opportunities to identify problems in the parent-infant relationship: for example during developmental screening, home visits and immunisation clinics. Research into the role of screening for problems in the parent-child relationship in early childhood is sparse and little is known about how such problems are currently identified in the community.

OBJECTIVE

To explore the approaches taken by health visitors (HVs) to identifying problems in the parent-child relationship.

DESIGN

Focus group study.

SETTING

Glasgow, Scotland.

PARTICIPANTS

24 health visitors sampled purposively.

RESULTS

Multiple sources of information were used by health visitors in assessing parent-child relationships. These include use of known risk factors, knowledge of local norms, direct observations of behaviour, reflection on the relationship between the parent and health visitor, as well as more intuitive reactions. In many cases understanding difficulties in parent-child relationships involved piecing together a jigsaw over a considerable time span. Continuity of relationships appeared to be crucial in this task. Home visits were described as the most informative setting in which to develop an understanding of the parent-child relationship. PARTICIPANTS reported a lack of formal training in the assessment of parent-child relationships and were keen to obtain more training.

CONCLUSIONS

Health visitors use complex strategies to integrate information about parent-child relationships. These strategies are acquired in a variety of ways, but receive little emphasis during basic professional training.

Towards an understanding of nursing as a response to human vulnerability

It is not unusual for the adjective 'vulnerable' to be applied to those in receipt of nursing practice without making clear what it is that persons thus described are actually vulnerable to. In this paper I argue that the way nursing has adopted the idea of vulnerability tends to imply that some people are in some way invulnerable. This is conceptually unsustainable and renders the idea of the vulnerable patient (almost) meaningless. The paper explores the meaning of vulnerability both in general terms and in the context of nursing practice. It is argued that to be in receipt of nursing is to become, to a greater or lesser extent, more-than-ordinary vulnerable. Thus all patients are more-than-ordinarily vulnerable and this restricts their potential to flourish. Nurses are well placed to contribute to the flourishing of more-than-ordinarily vulnerable persons and my substantive claim is that this 'protective' function is indeed a legitimate and fundamental part of the role of nurses.

Assessment of parents and young children (Children Act 1989)--a child psychotherapy point of view

The criteria used by professionals in assessing child care cases are not always made explicit, partly because of the ambiguity of the terms 'vulnerability' and 'at risk'. This paper presents a child psychotherapy view of what professionals may look at in terms of the interactions between parent and young child and how these may be understood. 'Reasonable expectations' of child development and parental care are considered. In terms of the child, overall attachment and communication needs and the specific developmental phase in terms child's maturing cognitive and socio-emotional functions are emphasized. In terms of the parent, the capacity to see the baby as separate from their own internal conflicts and to reflect upon the infant's mental state are seen to be pivotal to the infant's psychological well-being. The authors discuss the unconscious re-enactment of malignant patterns from the past through the relationship with the baby, and why parents are sometimes unable to avoid this. Finally, the authors suggest that assessment of the capacity for change in vulnerable parent-infant constellations must take into account the baby's developmental timetable.

Deconstructing the role of the public health nurse in child protection

This paper argues that children who have been deemed to be 'at-risk' need specialist intervention and that the Irish public health nurse (PHN) cannot provide this intervention. It is further argued that a failure to acknowledge and act on this is placing children at further risk and it is suggested that the mismatch between actual and perceived (or expected) roles leads to practices which undermine rather than support child protection. The PHN's remit in protecting children is situated within the following contexts: the variety of client groups with whom the PHN works, overall provision of child health services in the community, her education and training, and primary, secondary and tertiary protection of children. Two recent reports on enquiries into the failure of the services to protect children living with their families are used to explore the discontinuity. Existing evidence on how personnel involved (directly and indirectly) in community care services perceive or understand the PHN's role in child protection is described in the context of what the PHN's role actually is. The evidence suggests that the PHN fulfils a range of prescribed roles but that there is a perception or expectation among other service providers that she is also fulfilling additional roles. The paper concludes by suggesting some possible solutions to this discontinuity with a view to improving child protection services.

Parental education as viewed by nurses. An interview study

This interview study of nurses in three health centres in Växjö municipality in Sweden sought to find out how they perceived their work with parental education. The aim was to study the possibilities of and any obstacles to achieving the goals of good parenthood training on equal terms for all people. The results showed areas where further development is needed. It appears to be difficult to achieve the goals. Parents' needs for educational measures differed depending on social, cultural, and gender differences. Young single mothers rarely took part in the parents' groups. They belonged to a minority whose needs and problems differed from those of the majority of parents. Also immigrant parents rarely participated in parents' groups. According to the nurses, this may have been due to cultural differences in child care and difficulties with the Swedish language. To give fathers more scope and opportunity to take part, it was suggested that special fathers' groups should be set up. To sum up, families with specific needs should be given more individual education and guidance by nurses. This study, confined to one geographical area, has only shed light on a few nurses' perceptions of parental education, so the findings merely serve to indicate a trend. More general knowledge would require further research-oriented trial projects with the focus on the parents' perspective.

Relationships between infant temperament, demographic variables, and family dynamics of childrearing families

Relationships between infant temperament, demographic variables, and family dynamics of child-rearing families were investigated in this study. The revised Infant Temperament Questionnaire (RITQ), the Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were sent to 118 families who had participated in the first stage of the study as child-bearing families. About 8 months after childbirth 96 mothers and 95 fathers completed the questionnaires. The characteristics of infant temperament and demographic variables related to the variance of dimensions of family dynamics. Characteristics of the temperamentally easy baby related to more positive family dynamics perceived by child-rearing parents. Fathers rearing their first child reported that their families functioned better than fathers with their second infant. In child health clinics families rearing their second child should also be supported, especially families with arrhythmic and negative mood infants.

Successive surveys of an expert panel: research in decision-making with health visitors

A United Kingdom expert panel was consulted to develop a self-completion instrument for research on decision making in health visiting practice. The use of a Delphi-type technique demonstrated how a stand-alone postal survey was an insufficient measure for health visitors, requiring a supplementary follow-up method to study types of casework. A review of literature raised questions about the significance of intuitive thinking and reasoning in health visitor practice, in relation to measuring professional service and individual performance.

Establishing the validity and reliability of clinical practice guidelines used to identify families requiring increased health visitor support

One of health visitors' main roles is that of case finding and actively searching for health needs. This paper describes part of the findings of a study evaluating the clinical practice guidelines issued to health visitors to assist them in identifying families requiring increased health visitor support. A postal questionnaire was distributed to all Community Trust Chief Nurses in England (179), employing health visiting staff. The aim of the questionnaire was to assess the extent to which clinical guidelines are used throughout the country to identify families requiring extra health visiting support and to examine their validity and reliability. The survey results confirm the widespread existence of clinical guidelines in England to assist health visitors in identifying vulnerable families requiring extra support. The study provides evidence that the guidelines are largely subjective and invalid in nature. Questions are raised about the relationship between clinical guidelines and professional judgements.

Helping the vulnerable or condoning control within the family: where is nursing?

The World Health Organization urges nurses to heed the health needs of the vulnerable groups 'to permit all citizens to lead socially and economically productive lives'. The characteristics of vulnerable adults and children are linked to relationship problems (Browne et al. 1988) within the family. Because of the diverse nature of families, it is not surprising that there is some ambiguity and complexity to the concept of vulnerability. This paper explores vulnerability within families through the explanations for domestic violence and child abuse; and concludes with the implications for nursing practice.