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Are Health Visitors using research in practice ? The Early Years Toolkit Project:

Are Health Visitors using research in practice ? The Early Years Toolkit Project: Using research into practice. Sandra Anto - Awuakye Research Associate City University, London. What is the role of the Health Visitor ?. Health Visitors Qualified Nurses RN (Adult) RN (Child)

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Are Health Visitors using research in practice ? The Early Years Toolkit Project:

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  1. Are Health Visitors using research in practice ? The Early Years Toolkit Project: Using research into practice. Sandra Anto - Awuakye Research Associate City University, London

  2. What is the role of the Health Visitor ? Health Visitors Qualified Nurses RN (Adult) RN (Child) Some have Midwifery background Universal Service Working with families From antenatal stage to School Reception (5 years) Promote Good health and wellbeing: Social/Emotional Physical Environmental Safeguard Children: Protect them from Maltreatment Injury and harm. Early identification & intervention. Working Partnership across Communities Families Individuals

  3. The Early Years Toolkit Project: Tower Hamlets – London’s East End.

  4. The Early Years Toolkit Cycle. 1.Delphi process Health Visiting Teams/Health Professionals Focus groups led discussions Questionnaires – ranking priorities. 4. Toolkit Development Developing resources, training and skills for Health Visiting practice. . 2. Systematic review of literature 3 priority areas identified 3. Data collection used to Benchmark good practice. The results of the literature review used to develop observation tool and interview questions.

  5. What did focus group tell us ?What issues were most important in practice ?

  6. Three priorities areas for practitioners, working with vulnerable families and young children. 1. Infant Stimulation/Speech & Language Development 2. Preventing Obesity. 3.Working with stressed and unsupported families.

  7. How did we observe research evidence in practice ? Step 1 A literature search undertaken identifying 3 priority areas , to seek what is currently ‘ Best Practice.’ Step 2 From reviewing a selection of the literature and analysing results, - the key themesfor ‘Best Practice’ emerged. Step 3 Observational /interview questions were research tools used to ‘Bench mark’ health visiting practice before the implementation of the Toolkit .

  8. 17 practitioners observed across in clinical practice.November 2012 – February 2013 3 Bank and Agency Health Visitors 8 Health Visitors 2 Community Nurses 2 Nutritional Health Advocates 2 Nursery Nurses

  9. Parents perceptions about Health Visitors… Viewsabout Breastfeeding and Infant feeding…. My Mum told me how to make tomatoes... with curry spinach and soft rice.. Other mums, ....the red book.... After today, I would now speak to my HV Mainly family, my Mum told me to eat fish - helps produce breast milk...

  10. Contemporary Evidence on Preventing Obesity. All children’s require a minimum of 60 minutes of moderate physical activity each day . Make it fun !!! Twice per week weight bearing exercise for strengthening bone density (in 10 min bursts) ie Football, walking running (NICE, 2009) Infants who grow rapidly have an increased risk of becoming obese later Baird et al 2005 A c Changing lifestyles reduces obesity through diet /exercise. Both are required to reduce BMI levels Walters et al (2011) Exercise is required to be a compulsory activity of everyday life to control weight. Connelly (2007) Watching TV increases the risk of obesity. Dennison (2004). Reducing sedentary behaviour increases activity reduces weight gain. DeMattia L, Lemont (2005) Tackling obesity from a whole family approach. Extend outside of school context. This is more sustainability. Obesity C4E0 (2011)

  11. Audit tool: Benchmarking research evidence on ‘Weaning’ practices. HV promotes good weaning practices: Home cooked foods with baby rice, pureed fruits, vegetables (6-8 months) as baby’s first tastes. No added sugar, honey or salt in food for infants & children. HV s aware of TH policy on weighing growth monitoring 0-5 years. Audit tool: Benchmarking research evidence on childhood physical activities. HV raises key issue of Sedentary Behaviour: TVs, computer/games, mobile phones. Under 5 years limited (2 hrs) per day Examples of audit tool for observing ‘Prevention of Obesity’ physical activity. HVs encourage parents for children to do 60 mins vigorous /moderate aerobic exercise per day. E.G Running, cycling

  12. An example: Observing good practice. • Observed: HV, Nursery Nurse and HVA in the Children Centre. • Team working • This review was well coordinated with each practitioner working in sync with one another. • Excellent communication throughout between team members indicating who was • responsible for each activity and the timing of events. All working together in unison. • Observing the unique communication style of the HV with non English speaking and • English speaking parents: • Actively listening to what parents said .... • Calm engaging rapport with parents and genuine/authentic style • Consistently adopting ‘strengthening families’ approach: With positive reinforcement • and affirmation to clients but not patronising for example: • Well done Mum ! I can see you are really doing well ! • Encouraged parents to read out loud or sing songs in home language and • action songs and to turn off the TV/Computer and phones to spend time with children. • The quality of the team work, coordination and communication style demonstrated by • this team created a calm, positive environment in which parents felt respected and • reassured but happy to join in.

  13. Preventing Obesity: Challenges delivering evidence in daily practice. . • HV at a GP CHC: Bangladeshi Mother and Father who spoke • limited English with children aged 3 yrs, 2 yrs & 3 months. • Communication via Bengali speaking Health Advocate. • Why was this situation challenging ? • Parents seeking a letter to support housing application. • Both parents spoke limited English. • Two year old child unwell for past week, poor sleeping and • feeding due to nasal congestion. • Child has been coughing, has pain in one ear, but has not seen • GP. • Parents attempting to calm the 2 year old as he was unsettled. • Two year old drinking strong coloured blackcurrant juice from • a bottle. • Parents came to CHC with a box of fried chicken feeding the children.

  14. Preventing Obesity: Challenges delivering research evidence Knowledge. . The environment and atmosphere was chaotic. The HV stated ‘Why is he not drinking from a cup its not good for his teeth?’ Distracted by : The two year old’s ongoing illness and she [HV] was trying to establish if child had seen a GP. HV unable to address: Drinking of blackcurrant juice from a bottle and the risk of dental caries. Furthermore, eating fast foods, the wider family’s diet. HV consumed with: Assessing the 2 year-old’s illness and poor sleeping pattern Coordinating child to see GP Establishing a need for a housing letter. Listening to the interpretation between parents/Health Advocate.

  15. Preventing Obesity: A HV inability to deliver evidence based advice. Scenario Mother and 8 month old baby attend a Child Health Clinic. Mother has an older child aged 5 years at school. Mother sought advice, support and services for her older child who is overweight. No concerns at present with younger infants health and well being.

  16. Conversation between Mother and Health Visitor • Mother reports: • What shall I do about her weight ?’ • Where can I take her ? • At the minute I do Zumba and she will do Zumba with me . I want her to do Wii Fit at home. Mother explains after giving a healthy meal, her daughter cries saying she’s hungry and requesting bread and treats, her face looks so sad I give in. • Opportunities to address the prevention of obesity were missed: • The HV does not explore diet. • The HV does not ask where the 5 year old goes to school or suggest contact with school nurse or GP for growth monitoring and advice. • The HV does not mention any Healthy Eating or physical activity programmes. • The HV fails to respond to the mother’s obvious motivation. • No mention of physical activities or outdoor play. • HV main response: • Distract the child with food with colouring and play.

  17. Are Health Visitors using research in practice ? Answer: Yes, most of the time... Most of the time HV’s use evidence based research when giving advice/support. Sometimes.... difficult circumstances prevent HV’s communicating research based advice. Some HV’s deliver poor evidence based knowledge.

  18. The Early Years Toolkit Project. Thank you for listening. Any Questions ? R.M.Bryar@city.ac.uk

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