1. At home with clients: health visiting know how in action Dr. Alison Bryans Glasgow Caledonian University Funding Body - QNIS

2. Study background Research approach builds on earlier published research into district nursing assessment practice during home visits Sample of health visitors recruited from Greater Glasgow Primary Care NHS Trust Data-gathering from September 2000 - January 2002

3. Practice context Health visiting in UK broad in scope Core service is to families with children under 5 years Dominant focus is prevention Home visits vary considerably in duration and content Potential to address ‘felt needs’ of clients

4. Study aims to explore the knowledge and skills which underlie health visiting practice during home visits to reveal previously tacit or hidden elements of health visiting expertise to relate processes to client issues and needs addressed during visits

5. Study methods 20 minute simulated home visit interview immediately afterwards which focuses on the simulated visit subsequent observation of actual home visits with all participants (after preliminary data analysis)

6. Simulated client profiles Biographical information Reason for visit Family situation and lifestyle General health & medical background Home setting Personal appearance/presentation Speech mannerisms and phrases

8. Study findings content analysis - identified issues and needs discussed during the simulated visits and the main focus of visits process-orientated analysis - examined micro-processes and health visitors’ approaches during the simulated visits

9. Content findings most HVs covered a wide range of the built- in client issues and needs reasonable degree of consistency within cases but also interesting variation in terms of overall focus and balance of visits

10. Examples of content codes Infant feeding issues grandmother’s advice weaning to solids breastfeeding expressing milk mother’s feelings about feeding Psycho- social issues maternal mental health maternal social support mother-father relationship

11. Process findings include characteristics of health visitor activity and client response / activity reflexive-interactive HV approach less reflexive HV approach

12. Reflexive-interactive HV immediately pursues issue raised by client explicitly acknowledges client feelings gives ‘tailored’ context-specific advice explicitly seeks client perspective

13. Client responses to RI approach Client raises issues, asks questions and freely volunteers new information Responds actively and positively to HV suggestions and advice

14. Relating content and process in ‘balanced’ (M&I issues) and more maternally-focused visits ‘felt’ needs and psycho-social issues were more prominent these visits were reflexive-interactive in nature positive client responses were more common in these visits

15. Simulation findings HV approaches Reflexive-interactive Less reflexive Needs & issues Main HV focus M & I or M issues Main HV focus Infant

16. Observational data a health visitor’s approach to actual home visits generally matched her approach to the simulated visit content of observed visits was too varied and diverse to allow comparison with content-focused simulation findings although therapeutic activity and psycho- social focus did ‘match’

17. Case studies These and other aspects of study findings are synthesised and presented in case study form in the report of this study These provide a more holistic and accessible view of the overall findings for educators and practitioners They are selected to be representative of findings

18. Report Bryans A. (2003) At home with clients: a study of health visiting expertise during home visits Queen’s Nursing Institute Scotland / Glasgow Caledonian University