Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Working in Partnership in the Antenatal Period: What Do Child and Family Health Nurses Do?

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Working in Partnership in the Antenatal Period: What Do Child and Family Health Nurses Do?

Article excerpt

BACKGROUND

There is strong evidence that sustained nurse home visiting can improve child and family outcomes for vulnerable and at-risk children and families (for example, the work of Olds et al. 1997 and reviews by Elkan et al. 2000 and MacLeod & Nelson, 2000). The international evidence on early childhood home visiting, predominantly by nurses, shows that programs with more comprehensive interventions incorporating physiological, psychological and social intervention show greater promise (Davis & Spurr 1998). In addition, meta-analyses indicate that nurse home visiting programs commencing antenatally, with continuity of care provider through the antenatal and postnatal period have greater success (Elkan et al. 2000; MacLeod & Nelson 2000).

This evidence of best practice in sustained nurse home visiting programs would thus suggest that community child and family health nurses, who traditionally have engaged with families post-birth, should implement a comprehensive range of home-based interventions in the antenatal period. Community child and family health nurses are well positioned to undertake this new role, as research has shown that they are accepted by families into their homes and can provide on-going support (Darbyshire & Jackson 2004). There is, however, little empirical work on what child and family health nurses do in this new area of antenatal child and family health nursing practice.

Antenatal care by child and family health nurses is a new practice area where there is currently little guidance. There is evidence that nurses experience challenges in delivering sustained nurse home visiting models of care (Hanks & Smith 1999; Hebbeler & GerlachDownie 2002), and that additional and expanded nursing competencies are needed in the areas of:

(a) enhanced knowledge of child development, social determinants of health, and broader outcomes for individuals and populations;

(b) advanced skills in fine observation, anticipatory guidance, negotiating, modelling and experimentation, holistic case management, and working in interdisciplinary teams; and

(c) attitudinal competency for working 'with' and supporting risk taking.

(Kemp et al. 2005)

The context of working within the client's home influences the practice agenda through exposure to information not available in clinical settings such as clinics or hospitals (Carr 2001). Although there is recognition of the differences and challenges of working in the home environment, dealing with the reality experienced by the family (Hanks & Smith 1990), there is scant literature detailing the interventions that are included in the home visiting model, particularly in the antenatal period. The fact that there is no baby, the traditional focus of child and family health nursing, and that the child and family health nurse is not expected to undertake antenatal midwifery care, means that this emerging area of nursing practice needs to be informed by evidence on what happens and for whom.

Studies of nurse home visiting have focussed on the importance of the development of the nurse-client relationship (Hebbeler & GerlachDownie 2002; McNaughton 2000) and the quality of the staff-parent child interaction (Roggman 2001). The evidence from systematic reviews suggests, however, that whilst relationship building and a social support role are necessary for the success of home visiting, they are not sufficient to change parent behaviour. Rather, the relationship forms the context and conduit for the interventions provided by the nurse (Elkan et al. 2000; MacLeod & Nelson 2000). Information on what interventions actually occur during home visits, however, is not available for most programs (Gomby 1999). Roggman et al. (2001) suggests that the private nature of home visits may be one reason why little is known about the content and processes of home visiting. McNaughton's (2004) review of programs listed 19 different domains of nursing activities drawn from 13 different studies, including 'anticipatory guidance, breastfeeding promotion, counseling, focus on mother's concerns, health information, health services, parenting, problem solving, referral, screening, social support'. …

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