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Appendix 3
EXECUTIVE SUMMARY
Family Centred Health Care: The Contribution of Family Health Nurses. An Evaluation of the Family Health Nurse Role, Phase 2
Professor Barbara Parfitt, Dr Flora Cornish, Lesley Whyte & Meaghan Van Hooren Glasgow Caledonian University
According to current WHO Europe and Scottish health policy, the delivery of health care must shift away from an acute, hospital-focused service, and towards a community-based service. Family Health Nursing offers one possible new model for the delivery of community nursing services. Family Health Nurses work to a generalist model, delivering clinical care, promoting families' health, and organising community health initiatives. Family Health Nursing has been piloted in Scotland, since 2001 in remote and rural areas, and in 2005 in an urban area. This small-scale study evaluated the implementation of Family Health Nursing after 6 months in an urban area, and followed up the implementation after 3-4 years in remote and rural areas. The study aimed to understand the impact of the Family Health Nurse role, and the factors that have helped or hindered the implementation of the role.
Key findings
- Family Health Nurses were working to a generalist model, covering clinical care, health promotion, and community health initiatives. Many were working across the generations in a family
- the generalist model enabled the Family Health Nurses to pick up health issues and individuals who otherwise may have 'fallen through the cracks' of more specialist services
- Family Health Nurses were particularly effective in working with families with multiple needs
- both Family Health Nurses and service users had very positive attitudes to the Family Health Nurse role
- while service users and carers were positive about other nursing services, they particularly valued the Family Health Nurses' accessibility and their holistic perspective which included all members of the family
- service users and carers valued the Family Health Nurses as a first point of contact
- building relationships with families required significant time, which was not always easy in a context of large client caseloads
- the Family Health Nurse model may risk creating a relationship of dependency between vulnerable families and the nurse. To foster self-care and empowerment, Family Health Nurses should identify and develop family and community strengths
- professional colleagues' responses were key to successful implementation. While some colleagues felt that the Family Health Nurse role had much to offer and supported it, others resisted the role, feeling that it was a duplication of existing nursing roles
- the twin challenges of Family Health Nurse' time and colleagues' 'buy in' were effectively addressed when teams collaborated to plan a new way of working together based on identification of community need and the expertise of each team member.
Background
Family Health Nursing has been implemented in Scotland in two phases. Phase 1 took place in remote and rural areas, beginning in 2001, and evaluated after one year of practice by a team of researchers from The Robert Gordon University. Phase 2 was undertaken to:
(i.) understand the impact of the Family Health Nurse role in an urban area during the first 6 months of practice from the perspectives of service users, Family Health Nurses and Family Health Nurses' professional colleagues
(ii.) follow up Family Health Nurses' experience of the role after 3-4 years in remote and rural areas
(iii.) understand the factors that have helped or hindered the implementation of the Family Health Nurse role.
Impact of the Family Health Nurse role
The Family Health Nurse role is particularly suited to providing services to families with multiple healthcare needs. The Family Health Nurses' generalist skills enable them to uncover unmet needs and to address a wide range of health issues, including disease treatment and health promotion, and to work with all generations of a family. Service users and carers had a positive attitude to the Family Health Nurse role. In a context where many service users felt that they should not 'bother' the doctor, they greatly appreciated having the Family Health Nurse as a first point of contact who could give the appropriate care or refer service users on to appropriate services. Key to service users' high levels of satisfaction was their feeling that the Family Health Nurses had sufficient time available to develop a holistic perspective on the full range of issues confronting the family.
Implementation of Family Health Nursing
Family Health Nurses' expertise in advanced communication, listening, family dynamics and relationships, creating networks in a community, liaising with the range of services available to service users, risk analysis and family assessment were crucial to their success. The investment of time during the initial stages of building relationships with families and conducting family assessments was essential. The long-term benefits of this approach were perceived as helping families to develop and identify their own coping mechanisms. Time could be created for these activities when teams worked together to consider priorities and allocate work on the basis of each team member's particular skills and expertise. Full implementation of the Family Health Nurse role was hampered in some practices by resistance from professional colleagues, some of whom chose not to make referrals to Family Health Nurses.
Conclusions
The Family Health Nurse model is highly acceptable to service users, and is a role valued by the Family Health Nurses themselves. The generalist model enabled Family Health Nurses to pick up on health issues that would not otherwise have been addressed. Change management is crucial to the role's success, a finding also supported by the WHO multinational study of Family Health Nursing ( WHO Europe 2006). Achieving the full potential of the Family Health Nurse role requires the transformation of the current model of service delivery to embrace a family-focused approach to care that is rooted in the needs of the community. It is anticipated that the findings from this report will contribute to the future policy development of nursing in the community.
Recommendations
(i.) strategic leadership at Community Health Partnership ( CHP) level is required to instigate the required systems change.
(ii.) man power modelling research is required to explore the practical feasibility of the Family Health Nurse model.
(iii.) community nursing education programmes should be reviewed to ensure that all practitioners are familiarised with Family Health Nurse concepts.
Research methods
The research used mainly qualitative methods. Twenty-eight Family Health Nurses (10 urban; 18 remote & rural - 60% response rate) completed a postal questionnaire with open-ended questions asking them about their experiences in the Family Health Nurse role.
Twenty service users and carers in the urban area were interviewed about their experience of the Family Health Nurse. Thirty-one (52% response rate) professional colleagues of urban Family Health Nurses completed questionnaires about their attitudes to the Family Health Nurse role.
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