My name is Claire
I work as a flying start health visitor in Pembrokeshire for 2 years and have 30+ years’ experience as a health visitor and practice teacher.
playgroup
8am Starting work
First thing in the morning I go to the health visiting office, check my emails, network with colleagues and collect any resources for the day. I may make appointments and return telephone calls, depending on how much time I have and when my visits are due to start. Today is an early start, my first visit is at 9am.
Home visiting families is a unique opportunity to see families in their own environment, health visitors are a guest in their home and work in partnership with parents. I
It is important that the health visitor develops a therapeutic relationship with the family in order to develop trust in the health visitor and accept information, advice and support to assist them to make positive health choices.
9am - Home visit
6-month-old baby with Cow’s Milk Protein Allergy
First visit of the morning to a refugee family, they have a nursery age child and a 6-month-old baby. They moved into my area when the baby was about 8 weeks.
The mother speaks reasonable English which is supported by the husband’s help to clarify some discussion and using google translate. The baby has been diagnosed as having Cow’s milk protein allergy and reflux and is being followed up by the hospital paediatrician.
The objective of today’s home visits to discuss the outcome of the baby’s hospital review, weigh the baby if needed, review symptoms, complete the 6 month review and discuss weaning, home safety and dentition. In addition, there is review of family physical and mental health and general health promotion
At our first introductory contact I found baby was failing to gain weight and on the declining in the centile chart, he also was experiencing rash, loose stools and some vomiting, as a result he was referred to the General Practitioner, who referred him to the hospital Paediatrician who diagnosed him as having Cow’s milk protein allergy (CMP) and reflux (GORD), and prescribed Omeprazole and specialist Neocate formula Since then I have visited him at home regularly to monitor his weight and symptoms. There has been a change treatment options during this period, because the symptoms remained, however his weight has stopped falling and is now stable.
Mother has told me today, at last weeks appointment the paediatrician said he is pleased the baby’s growth is now stable, albeit his weight is just below the 0.4 centile which is just below the normal range (https://www.rcpch.ac.uk/resources/growth-charts) in addition his mother says his symptoms have improved. Observing him he was happy, lively, responsive and content is parents’ care.
My review of his development today found everything to be as expected. (From Birth to five Years -Mary Sheridan) Weaning was discussed at length, the mother was reluctant to start because she was worried it will increase the baby’s symptoms but following advice about milk free weaning and to introduce iron and other nutrients into the diet which is necessary at 6 months, and are not available in formula. With the encouragement of her husband, she agreed. Tooth brushing, suitable cups, dental registration, and home safety advice were also given. In addition, I also discussed the Book start pack which encourages reading to babies and library registration.
In relation to family health mother has epilepsy, but she says she is taking her medication and there have been no fits. She says she feels well and has no concerns. This household are non-smoking and have no lifestyle issues.
Other issue discussed are referral to the local baby bank for clothes for the baby and also mother gave me a bag of clothes he had grown out of to pass on to other families via the baby bank.
The plan on completion of the home visit is to review the baby’s weight and weaning progress in a few weeks and the parents are invited to contact hv before if needed. Following my home visit, I make my way to the local mother and baby/toddler group
10am local mother and baby/toddler group
The mother and toddler group was set up by the health visiting service following the lock down of COVID 19, in response to local need.
Parents were feeling isolated, and a significant number of children were presenting with slow speech and communication issues The group is delivered by the nursery nurses, it consists of a session for mothers and babies under one and this is followed by a toddler group. Both groups have an element of singing and story time.
There are craft sessions at the group for the mothers with babies and for the toddlers. There is a healthy snack to promote healthy and social eating.
Everyone is welcome to attend the group, mums, dads, carers and grandparents. and there is no charge to attend. This is important because some of the mothers suffer mental health issues which affect their confidence and willingness to go out alone and the are is one of deprivation, so there is no barrier to people attending.
My role as the health visitor is to support the nursery nurses with the group and be available to parents in sessions to answer their questions and queries.
We also work closely with other groups who use the centre, we signpost and encourage parents to attend other sessions in the community centre, for example there is family support session and a low-cost community café.
The trustees of the Community Centre have kindly funded the healthy snacks for the group, and we are looking forward to working closely with all agencies for summer and summer activities.
12.30 Home visit to a New Baby and family (Healthy Child Programme)
Next visit of the day is to follow up to a tiny baby who is now 4 weeks old, she has two siblings aged 2 years and 4years. The objective of today’ home visit is to assess the growth and feeding of the new baby, enquire about maternal physical and emotional health and address any general concerns the parents may have
The mother and baby have been discharged by the midwifery service. Health visitors work closely with midwives, we meet every two months in person or by Microsoft teams, sharing information and discussing antenatal cases. This information helps the health visitors prioritize their work with pregnant women and help support them before the babies are born.
Midwives also transfer written information is to the health visitor about any health/social concerns which may occur during the pregnancy and Discharge summaries are also sent by the midwife to the health visitor when the mother and baby are discharged.
Today is my third visit to the family since the birth, the baby was born small for the date due and was less than 2.5kg, but over the weeks she has been taking her formula feeds well and her growth has been increasing, and stable on the 0.4th centile. (https://www.rcpch.ac.uk/resources/growth-charts) The parents were concerned about a napkin rash, but in discussion I found they were using appropriate treatment and the rash was improving, so I reassured them and advised them to continue.
During our home contacts there have a few minor health issues with baby oral thrush, snuffles, and nappy rash. Advice has been given and acted on by the parents and the symptoms have resolved or improved. It is fortunate that health visitors are Nurse prescribers, so these minor ailments can be managed in a timely fashion.
During the visit I also enquired about the health of the mother who has recovered from a complicated birth. She had an emergency caesarean section because the umbilical cord prolapsed. She reports today feeling well but tired at times, but everything is fine because she has the support her partner and family. It is the health visitor’s role to assess and support at maternal health and emotional wellbeing. We use tools for example Whooley questions. (whooley questions - Search (bing.com)) Edinburgh postnatal depression scale (edinburghscale.pdf (ucsf.edu) ) and the GAD anxiety assessment ( https://www.mdcalc.com/calc/1727/gad7-general-anxiety-disorder7) This mother’s emotional health is stable and even though she had an unexpected traumatic birth she is recovering well and she will arrange to see the GP to organize her postnatal check and update her cervical smear when due.
My plan is to complete another home visit next week to review the baby’s weight and feeding and the parents are invited to contact HV before if needed.
13.30 Home visit
Family with safeguarding Issues
My next visit is to a vulnerable young mother who has three children, the family moved into my area 6 weeks ago and were subject to safeguarding concerns (https://safeguarding.wales) These current concerns are due to drug misuse, domestic abuse, issues with home conditions mental health and lifestyle issues (which included unknown adults attending the home). The objective of today’s home visit is to assess the growth and development of the toddler, to address issues identified eg fussy eating to gain the confidence and trust of the mother and establish a good working relationship and to assess the conditions in the home.
At an initial child protection conference all the children’s names added to the Child Protection register under the category of neglect. The purpose of today’s visit is to review the youngest child who is 19 months old and to offer the mother any support she needs.
This is my second attempt to complete my visit, I tried yesterday but there was no one home. I left a note and telephoned the mother who said she had forgotten the appointment and confirmed today’s appointment was convenient.
When I arrived at the visit, the young mother was welcoming, she told me the two younger children were unwell, one was in bed and the toddler who I had come to visit was asleep in the buggy. She says she had taken the toddler to hospital, and he had been diagnosed as having a virus and the doctors recommended the symptoms are treated with paracetamol, which she told me she has been doing.
At today’s home visit my plan was to weight and measure the toddler and discuss his fussy eating in detail, vitamins had been provided at the last home visit. The toddler also has slow speech development, which is being supported by one of the flying start nursery nurses visiting the family in the home to encourage play activities to develop speech and the toddler has a one-day placement at a flying start nursery. Today, the mother has informed me the number of words he is speaking has improved, however his eating remains the same.
As the toddler has just settled to sleep, it is not appropriate to wake the toddler today, I have arranged another home visit for next week to complete his measurements and asked mother to complete a diet diary when he has recovered from the virus.
I also discussed the conference and child protection plan with the mother. At our last home visit, prior to the conference she was very anxious and upset about some of the things she had read in the conference reports. At that visit I reassured the mother about the purpose of the conference and the positive support she would receive should the children’s names be placed on the Child protection register.
Today the mother spoke positively about the case conference and the plan, she say she intends to attend the Dyfed drug and Alcohol Services with her edge of care worker. ( https://barod.cymru/where-to-get-help/west-wales-services/ddas-dyfed...) to seek support to reduce and ultimately stop using cannabis.
The mother told me she has no contact with her ex-partner (the toddler’s father) and the police has told him he is not allowed to contact her. The father is having contact with the toddler at his parent’s home and the contact was supervised because of the domestic abuse and the father’s unstable drug issues.
The home conditions today are good, I observed a quiet clean, tidy calm home with no visitors present and the mother acknowledged have time together without lots of friends present is important for the children.
The ongoing health visitor plan for this family is to visit next week to review the toddler and offer general support, mother is also invited to contact the hv as needed. Also, I intend to liaise with the family social worker who has ask me to feed back about the health of the children and to liaise with the nursery nurse to check progress with her session. In addition, I will be attending a multiagency core group meeting with parents and other professional next week to discuss the progress in relation to the child protection plan.
Finally, my days visits are finished, it is still early, and my working day is not over yet. I drive back to the flying start centre reflecting on the day’s visits. Health visiting is an exciting, responsible role, every day is different. Health Visitors are constantly using our communication, health promotion and assessment skills. Health Visitors are non judgmental, empathic and supportive.
Once I arrive back at the office it is time to write my records, make any referrals to other services, and liaise with other professional if needed. Health Visitors are currently using a computer record system (WCCIS). https://dhcw.nhs.wales/systems-and-services/in-the-community/digital...
Record keeping is an import part of the health visitor role to ensure continuity of care for clients, it is used for communication, to support the planning and evaluation of care and provide an accurate account of the care given to other organisations e.g. courts children’s services etc. Keep records of all evidence and decisions - The Nursing and Midwifery Council (nmc.org.uk).
The future of health visiting is ever changing, the role is often changing to adapt to changes in society, the health and lifestyle of the population and government priorities.
The health visiting service is used to adapting to change and COVID 19 was an excellent example of this. The service continued to be delivered to families throughout the pandemic and the mode of delivery, for example face to face, telephone, by screen or a combination of all three were utilized depending on advice from government and the safest direction for staff and clients.